The majority of responds that were neither HCP nor CHP recognized schizophrenia as MI in Goma city. However, a low proportion of respondents recognized anxiety, DD and NDD as MI (Table 2). This trend was similarly reported by Benti et al. (2016) in communities of Gimbi town, Ethiopia, where the proportion of respondents who recognized schizophrenia as MI was 94.9% and the proportion of respondents who recognized anxiety as MI was low. Also, Jingyi et al. (2013) and Wang (2013) mental health literacy studies among residents in Shanghai, anxiety was misclassified by respondents. However, a study done by Reavley et al. (2011) in Australian communities found that the proportion of respondents who recognized schizophrenia and depression were 37.0% versus 96.6% in the current study. Difference in findings could be justified by the fact that MI literacy differs from a culture to another (Amuyunzu-Nyamongo, 2013). Despite the difference, results suggested that residents of Goma city had poor knowledge on DD, anxiety and NDD.
Bizarre behavior was the major symptom of schizophrenia perceived by the majority of respondents. However, major symptoms of DD, anxiety and NDD were reported at low proportions by respondents (Table 3). Likewise, the result of the study reported by Ventevogel et al. (2013) showed that people of Butembo city, located from about 380 Km, were able to describe psychotic disorders as a syndrome of severe behavioral disturbances. The study done by Jingyi et al. (2013) in Shangai reported that 41.0% of most people consider symptoms of anxiety as normal. Also, the study done by(Espinoza, 2016) reported that residents of Butembo, in NKP understood persistent sadness as an adaptive reaction to a situation of distress rather than as a MI. This result suggested that respondents had poor perception of symptoms of anxiety, DD and NDD as MI.
The major causes of MIs in Goma city perceived by the majority of respondents were malevolent spirits and drug abuse (Table 4). Similar perceptions were reported by Benti et al. (2016) in Gimbi Town, western Ethiopia, where majority of the respondents attributed the cause of MIs to supernatural causes like evil spirit, God’s punishment, and witchcraft. Regarding substance abuse, DRC has been reported to be the most producers of Cannabis sativa, plant reported to be associated with psychosis, across African continent (Laudati, 2016). The fact that residents of Goma city attributed MIs to spiritual cause suggested their poor knowledge and perception toward the condition.
Education, religion, occupation and age were not statistically significant in predicting one’s odds of MI perception (Table 5). This means that any resident of Goma city perceived the same causes of MIs regardless of education, religion, occupation and age. This was similar to what was reported in Iraq and India with no significant association found with age regarding the community’s view of MI (Sadik, 2010; Salve, 2013). However, this finding was not in agreement with the studies done in Agaro town (Deribew, 2005) and Nigeria that found out that perception of MIs correlated with educational level (Adewuya, 2008). It has been reported that religion is a significant factor in mental health and it was perceived to have both positive and negative impact on perception of MI (Papaleontiou-Louca, 2021). However, the study was limited to Christian populations in USA that could be socio-culturally different from Goma city population.
In FGD, MIs were perceived by CHP as defined according to American Psychiatric Association (Roehr, 2013) whereas, residents of Goma city that were neither HCP nor CHP perceived MIs according to their socio-cultural background. Schizophrenia, anxiety, depression, neurodevelopmental disorders and mania were reported by FGD as MIs managed at specialized hospitals in Goma city. Focus group discussions reported the existence of the five MIs including schizophrenia, mania, anxiety, DD and NDD as common in Goma city unlike residents that were neither HCP nor CHP of Goma city whom the majority recognized schizophrenia as the commonest MIs in the city but ignored mania, anxiety, DD and NDD as MI in the city. This finding suggested poor knowledge of MI by residents of Goma city.
Male individuals of 18 to 35 years old were reported by FGD to be the most affected by schizophrenia. The gender and age group reported to be the most affected by anxiety were females from 18 to 35 years old. Also, females from 18 to 40 years old were reported to be the most affected by DD. WHO (2017) reported similar result that depression and anxiety disorders are more common among females than males.
To be possessed by bad spirit and bizarre behavior were reported by FGD participants as word used by mental ill patient’s family during medical consultation to name or characterize schizophrenia. Fear; increased heart rate; high blood pressure and poisoning were reported by participants in FGDs as words used by patients to nominate anxiety. Social unrest or trauma, anorexia, loss of interest for enjoyable things and being overwhelmed were reported as names or characteristics of depression. Also, sorcery; gang member or street urchins were reported by participants in FGD as words used in Goma communities to nominate a person with mania. Furthermore, word idiot and stupid was reported by respondents as the name and characteristic of NDD in indigenous residents of Goma city. This finding suggested that Goma city residents had their own terms to perceive and recognize MIs and their symptoms. This could be their traditional diagnostic tool in relation to use of herbal medicine. There is need however to harmonize and obtain evidence based diagnosis of MIs in the city. Somewhere, residents of Goma city did not recognize those symptoms as MIs. Similar findings were reported by Spinosa (2016) as reported before, in Butambo culture aforementioned symptoms of depression and anxiety are rather an expression of someone not doing well and being overwhelmed by the tasks of life. Also, this finding suggested poor perception of MIs in the city.
Participants in FGD reported prayer among common methods for management of MIs in Goma city. The finding regarding prayer suggested the positive role of religion in management of MIs in the city which have been reported by others authors in previous studies (Tepper, 2001).
Traditional medicine was cited by all participants in focus groups as the most preferred of mode treatment of MIs in Goma city. Indeed, it has been reported that more than 80.0% of population of African countries relies on TM for the care of various ailments including MIs (Abbo, 2019). WHO has acknowledged the contributions of TM to prevention and management of various ailments in developing countries (Abdullahi, 2011). In current study, all FGD participants suggested collaboration between CM and TM in future for management of MIs. Also, among common MPs reported by ETHP to treat MIs in Goma city, A. hypogea has been reported with sedative activity affects suggesting its use against MIs. However, little is known on MPs including E. abyssinica, M. parassidiaca, C. gynandra and C. sumatrensis suggesting the exploration of their psychopharmacological activities in further studies.
As study limitation: To reduce the complexity of the questionnaire, case vignette based standardized questionnaire which explains cases like schizophrenia, major depressive disorder, epilepsy, and generalized anxiety disorder was not used in data collection. Further studies are needed to access knowledge and perception of Goma city population toward MIs.