Factor structure and predictors of causal beliefs about seven mental illnesses among the Singapore general population

Yoke Boon Tan^1*Eng Hong Tay¹Shazana Shahwan¹Savita Gunasekaran¹Benedict Wei Zhi Lim¹Bernard Tan¹Wei Jie Ong¹Saleha Shafie¹Edimansyah Abdin¹Porsche Poh²Georg Schomerus³Siow-ann Chong¹Mythily Subramaniam^1,4

• ¹Research Division, Institute of Mental Health, Singapore, Singapore
• ²Silver Ribbon Singapore, Singapore, Singapore
• ³Leipzig University, Leipzig, Lower Saxony, Germany
• ⁴Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

Introduction: Knowledge about the causes of mental illness is a crucial component of mental health literacy. Poor understanding of the etiology of mental illness can lead to stigmatizing behaviors and hinder access to appropriate help. The current cross-sectional study examined the general population's causal beliefs about seven mental illnesses and explored the factor structure of the revised causal beliefs scale.Methods: 4195 respondents were randomly assigned a vignette and were asked questions on their recognition of the mental illness depicted, causal beliefs, and prior experience related to the mental illness (similar problems, had a mental health-related job or family and friends with similar problems). Exploratory and confirmatory factor analyses were used to examine the factor structure of the causal beliefs scale. Multivariable linear regression was used to examine its predictors.Factor analyses revealed a four-factor structure of causal beliefs: physical, psychosocial, personality, and biogenetic. Causal beliefs differed across the vignettes: Compared to schizophrenia, biogenetic beliefs were less likely to be endorsed for all mental illnesses except dementia, while personality beliefs were more likely to be endorsed for depression with suicidality. Compared to respondents who did not recognize the mental illness, those with correct recognition were more likely to endorse biogenetic and psychosocial beliefs, and less likely to endorse physical and personality beliefs.Discussion: Factor structure of the original causal beliefs scale is validated in the Singapore population. Individuals who correctly recognized the mental illness appeared to comprehend its etiology well. However, some misconceptions about the etiology of mental illness persist, particularly with regards to relating obsessive-compulsive disorder to physical factors (e.g., virus) and depression with suicidality to personality flaws. As future awareness campaigns continue to address the gaps in literacy levels, careful promotion of certain causal beliefs is crucial to avoid conveying unintended messages.