STIGMA AND TREATMENT-SEEKING BEHAVIOR AMONG PATIENTS WITH PSYCHIATRIC DISORDERS IN URBAN VS. RURAL POPULATIONS

Abstract

Stigma remains one of the most pervasive barriers to mental health care utilization globally, particularly in low- and middle-income countries where sociocultural norms and healthcare disparities exacerbate the problem. In Pakistan, a country with pronounced urban–rural health inequalities, psychiatric stigma often intersects with cultural beliefs, illiteracy, and structural constraints, leading to delayed or inadequate treatment-seeking behavior.

Objectives:
This study aimed to evaluate and compare the levels of perceived and internalized stigma and their impact on treatment-seeking behavior among patients diagnosed with psychiatric disorders in urban and rural populations of Punjab, Pakistan. The research sought to identify key socio-demographic predictors influencing these patterns and to explore how cultural, educational, and infrastructural differences shape the pathways to care.

Methodology: A comparative cross-sectional design was employed from February 2025 to August 2025, including a total sample of 118 participants. Urban participants were recruited from M. Islam Medical and Dental College Hospital, Gujranwala, and Sheikh Zayed Hospital, Lahore, whereas rural participants were drawn from five government rural health centers located between Lahore and Gujranwala. Data were collected using a structured questionnaire comprising the Internalized Stigma of Mental Illness (ISMI) scale and a validated Treatment-Seeking Behavior Index (TSBI). Socio-demographic characteristics, delay to first professional contact, and first point of care were recorded. Descriptive statistics summarized key characteristics, while inferential analyses including independent t-tests, chi-square tests, and multiple linear regression were applied. A significance level of p < 0.05 was adopted for all analyses.

Results & Findings: The results demonstrated a significantly higher mean stigma score among rural participants (3.02 ± 0.61) compared with urban participants (2.66 ± 0.48), indicating greater internalized and perceived stigma in rural populations (p < 0.001). The mean delay before initiating psychiatric treatment was 8.6 months in rural participants versus 4.3 months in urban participants (p = 0.002). Education and income were inversely associated with stigma scores, suggesting that higher socio-economic status reduces stigma perception and promotes help-seeking. Also 40.7% of rural respondents reported first seeking help from traditional healers, compared to only 11.9% of urban participants. Regression analysis revealed that the stigma subscales of alienation (β = −0.38, p < 0.001) and social withdrawal (β = −0.33, p = 0.004) were the strongest negative predictors of treatment-seeking behavior. No significant gender difference was observed in overall stigma levels (p = 0.27). Correlation analysis showed a strong inverse relationship between stigma and treatment-seeking index (r = −0.62, p < 0.001), confirming that increased stigma substantially reduces the likelihood of professional psychiatric consultation.

Conclusion: This study concludes that stigma profoundly impedes timely and effective psychiatric treatment, disproportionately affecting rural populations in Pakistan. Reducing stigma through community engagement, mental health literacy campaigns, and integration of psychiatric services into primary healthcare can substantially improve help-seeking behaviors. Policymakers must prioritize equitable access to mental health services and develop rural-focused strategies incorporating telepsychiatry, community counseling, and faith leader involvement.