ABSTRACT | PDF

RESEARCH

Stigma: knowledge of college going students about mental illness and reaction towards the persons with mental illness

Sudeshna Basu Mukherjee, Kamlesh Kumar Sahu¹, Soma Sahu²

Associate Professor and Head, Department of Sociology, University of Calcutta, Kolkata, India

¹PhD Scholar, Department of Sociology, University of Calcutta, and Assistant Professor in Psychiatric Social Work, Department of Psychiatric Social Work, Institute of Psychiatry (IPGME&R, SSKM Hospital), Kolkata, India

²Lecturer, Department of Psychology, Bangabasi College, Kolkata, India

 

 

Abstract

The community attitude towards the person with mental illness has major influence on the acceptance of the person with mental illness (PWMI) and their social integration. Attitude may be at least partly determined by knowledge about mental illness and reaction towards PWMI. The goal of the study was to assess the knowledge of the college going students about mental illness and reaction towards PWMI. The study sampled 100 students using purposive sampling technique from different under graduate colleges in Kolkata, India. This was a cross-sectional descriptive study. Tools used in the study were (a) Star vignette (updated version) containing factors about the person described, viz. paranoid schizophrenia, and (b) Semi-structured interview schedule. The schedule includes: Demographic characteristics, attribution/ causes of mental illness, reactions towards PWMI, agencies most likely to help PWMI, personal experience, and origin/source of information. Results revealed that students had knowledge in some areas of mental illness, but in some areas they had deficiency. They had shown positive attitude towards PWMI, but the social distances increased with the level of intimacy required in the relationship. Personal experience (or contact) with PWMI had positive impact on knowledge about mental illness and attitude (reactions) towards PWMI.

 

Mukherjee SB, Sahu KK, Sahu S. Stigma: knowledge of college going students about mental illness and reaction towards the persons with mental illness. Dysphrenia. 2014;5:106-13.

Keywords: Community integration. Stereotyping. Prejudice. Discrimination. Societies.

Correspondence: withkamlesh@gmail.com

Received on 2 April 2014. Accepted on 14 April 2014.

 

 

Social stigma is a social process or related adverse experience characterised by shame, blame, secrecy, isolation, social exclusion, rejection, devaluation,stereotype that result in adverse social judgement and discrimination about a person or group.[1-2] It is the severe disapproval or discontent with a person on the ground of characteristics that distinguish them from other members of a society. Stigma is the situation of the individual which disqualify them from full social acceptance.[3] However, one can understand stigma that refers to any attribute, trait, or disorder that makes an individual as being unacceptably different from the normal people with whom he or she routinely interacts in the community.[4] Not only mental illness, persons living with other chronic illnesses like human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) are also exposed to stigma.[5]

“Public stigma is the reaction that the general population has towards people with mental illness which includes:

·   Stereotype - Negative belief about a group (e.g. dangerousness, incompetence, moral character weakness)

·   Prejudice - Agreement with belief and/or negative emotional reaction (e.g. anger, fear)

·   Discrimination - Behaviour response to prejudice (e.g. avoidance, withhold employment and housing opportunities, withhold help).”[6]

Lack of knowledge seems to be associated with negative attitudes in the community.[7] The general public has its own definitions, or stereotypes of mental illness and, moreover, has certain attitudes toward those they recognise as persons with mental illness.[8] Stigma is seen as a construct consisting of lack of knowledge, negative attitudes, and avoiding behaviour towards a certain group of people.[9] Perceived public stigma is extent to which an individual believes that the public stereotype and discriminate against a stigmatised group.[10] In a study, Golberstein et al.[10] found that male students, older students, students of lower socioeconomic status, and students with current mental health problems reported higher levels of perceived public stigma than students who were not so categorised.

Table 1: Socio-demographic characteristics of the respondents (N=100)
Variables	Mean±SD/%
Age (in years)	19.20±10.54
Gender
Male	54
Female	46
Marital status
Unmarried	95
Married	5
Education (in years)	7.201±4.42
Religion
Hindu	89
Muslim	6
Christian	5
Category
General	68
OBC	21
SC	9
ST	2
Residence area
Rural	20
Urban	80
Time spend outside home (in hours)	5.84 ± 1.51
Socioeconomic status
Low	27 (25.5%)
Middle	46 (35.3%)
High	27 (39.2%)
Type of family
Nuclear	79
Joint	21
Size of family	6.58±2.85
SD=standard deviation, OBC=other backward class, SC=scheduled caste, ST=scheduled tribe

Every section of society, particularly the young generation and college going students, has its unique way of perception about mental Illness. College has remained the best place to develop a comprehensive mental health programme, because the attitude and values of college-going students influence the society most.[11] In India, more than 13 million youths, representing seven per cent of the population aged 15-24, are pursuing a college education.[12] They can make a significant difference in community attitudes (whether stigmatising or not) towards the persons with mental illness (PWMI), and on the acceptance of PWMI and their social integration.

Table 2a: Knowledge of mental illness
Knowledge area or responses	Per cent
Can be successfully treated outside the hospital
Most likely	17
Likely	40
Uncertain	23
Unlikely	14
Very unlikely	6
Need prescribed drugs
Most likely	30
Likely	30
Uncertain	30
Unlikely	2
Very unlikely	8
Can work in regular job
Most likely	9
Likely	31
Uncertain	22
Unlikely	14
Very unlikely	24
Can get married
Most likely	8
Likely	12
Uncertain	14
Unlikely	29
Very unlikely	37
Can lead a normal life
Most likely	16
Likely	24
Uncertain	23
Unlikely	21
Very unlikely	16

Methods and materials: The aim of the study was to assess the knowledge of the college going students about mental illness and reaction towards PWMI. The study sampled 100 students using purposive sampling technique from different undergraduate colleges in and around Kolkata, India between January to March 2014. The study was a cross-sectional descriptive vignette study. Tools used in the study were: (a) Star vignette,[13] updated version used by Hall et al.,[14] containing factors about the person described, viz. paranoid schizophrenia; and (b) Semi-structured interview schedule. The schedule includes: Demographic characteristics, attribution/causes of mental illness, reactions towards PWMI, person/agencies most likely to help PWMI, personal experience, and origin/source of information. Items of the schedule were taken from various studies conducted to assess similar domains.[7,14-16]

Results: Results are summarised in seven tables

Table 2b: Knowledge of mental illness
Knowledge of vignette	Per cent
Has a mental illness	44
Don’t has a mental illness	56
Know the name	21
Don’t know the name	79
Knowledge of name of mental illness
Yes	30
No	70
Able to name of mental illnesses (N=30)
Schizophrenia	6
Depression	10
‘Pagol’	10
Others	4
Person with mental illness can be identifying by:
Things they do	70
Things they say	41
The way they look	18
Have heard or read anything about mental illness
Yes	64
No	36
Source of information about mental illness
Movie	32
TV	21
Any other (specify)	18
Radio	7
Magazine (specify)	7
Don’t know	6
Other news paper (specify)	3
Local news paper in English	3
Local language news paper	3
National news paper, Course curriculum,   Brochure/pamphlets / Poster, Outdoor billboards, Advertising on bus, Internet	0

Table 3: Rank ordered attribution/cause for mental illness
Attribution/cause	Per cent
Brain damage through injury or birth	24
Substance abuse	20
Stress (unspecified)	11
Influence of social environment	7
Stress at home	7
Possessed by spirits	5
Bereavement	3
Childhood experiences	3
Financial worries	3
Insecurity	3
Effect of the moon	3
Faulty nutritional habits	3
Depression-unhappiness	2
Inherited from parents	2
Difficulties in intimate relationship	2
Specific precipitating factor	2
Stress (at work), Stress (at home), Age, Faulty biological functionin, Jealousy, Specific precipitating factors, No cause it just happened, None of the above	0
Total	100

Discussion

Socio-demographic characteristics(Table 1)

The mean age of the respondents was 19.20±10.54 years; they were almost equal in number of men (56%) and women (44%). Large majority of them were unmarried (95%), Hindu (89%), from urban area (80%), and living in nuclear families (79%). More than half (68%) were belonged to general category followed by other backward class (OBC) 21%, scheduled caste (SC) nine per cent, and scheduled tribe (ST) two per cent. Forty six per cent were from middle socioeconomic status, followed by 27% each from high and low socioeconomic status. Mean size of their families were 6.58±2.85 persons. The mean of time spend outside home by them were 5.84±1.51 hours. These socio-demographic characteristics are understandable in undergraduate college student population in a metropolitan city of the country.

Knowledge of mental illness(Tables 2a and 2b)

Among five knowledge items, majority (60%) students responded that PWMI need prescribed drugs, and little more than half (57%) responded that they can be successfully treated outside the hospital. This is a very positive response by the students. Less than half (40%) students responded that they can work in regular job and can lead a normal life. Only 20% students responded that they can get married.

Table 4: Agencies/people most likely to help the persons with mental illness
Agencies/people most likely to help the persons with mental illness	Per cent
Psychiatrist	70
Hospital doctor	7
Clinical psychologist	7
General practitioner	6
Faith healer	3
Don’t know	3
Nurse	2
Voluntary worker	2
Rehabilitation professional, Friend, Neighbour, Political leader, The police, Religious leader None of these	0

On asking about the vignette, more than half (56%) students responded that ‘don’t has a mental illness’. It means they don’t have knowledge that which kind of sign and symptoms in PWMI can have. In a study, vignettes representing mentally ill people were presented to about 2000 randomly selected residents in Bromsgrove, and Hallet al.[14] found that overall identification of vignette subjects as mentally ill was surprisingly low, which is consistent with the present study. On the contrary, present study finding is not consistent with a study by Kermode et al.[17] where most participants recognised that the people in the vignettes were experiencing a mental health problem. ‘Depression’ was the most common label for the problems explained in the depression vignette, and ‘a mind/brain problem’ was the most common label in the case of the psychosis vignette.  In the present study, less than half (44%) said they (person described in vignette) had a mental illness, but only 21% were knowing the name of the mental illness of a person described in vignette, and large majority (79%) of the students were unaware about the same. Furthermore, 70% did not know the name of any mental illness; only ten per cent knew the name of depression, six per cent schizophrenia, and four per cent other mental illnesses; ten per cent students named ‘pagol’ (means crazy in the regional language). Again, large majority (70%) of the students could identify the person to have mental illness by the things they do which is similar with an earlier study by Crisp et al.,[18] where British adults felt that PWMI are different from the way we do things. Other ways by which students could identify the person to have mental illness were things they say (48%) and the way they look (18%). Majority (64%) of students had heard or read something about mental illness: Movie was the main source of information (32%), television (TV) was the second (21%). Radio or magazines (seven per cent) were another source, but other sources offered as an option were opted by very less number of students. Hottentot[19] cites in a study that 70% public gathers information about persons with mental illness and mental illness from TV. Electronic media remains the main source of information where generally negative stereotyping and stigmatised image of mental illness and PWMI is common.[20-27]

Attribution for mental illness (Table 3)

If we see the rank order of attribution for mental illness by students, brain injury (24%), substance abuse (20%), and unspecified stress (11%) emerged as main causes. Other options were opted by very less students (less than ten per cent). In another study by Bella et al.,[28] students viewed mental illness primarily as a disorder of the brain and were aware of its multi-factorial causation. Some deficits in knowledge were identified, and cultural and supernatural themes were evident in 164 students aged ten to 18 years from rural and urban schools in Southwest Nigeria.

Table 5: Reaction towards the persons with mental illness
	Per cent
	Most Likely	Likely	Uncertain	Unlikely	Very Unlikely
Speak to them if youpassed them in the street	52	25	18	3	2
Work with them	11	6	59	24	0
Have them as fellow member of a club or a organisation to which you belong	52	25	18	3	2
Allow your young children to speak to them	11	6	59	24	0
Live next door to them	14	14	57	15	0
Go to a festival at their home	15	0	42	43	0
Invite them to your home	12	3	62	23	0
Share a house with them	22	17	50	8	3
Have a close relationship with them	27	14	43	13	1
Marry them	3	0	41	53	3

Agencies/people most likely to help the persons with mental illness (Table 4)

Large majority (70%) students responded that psychiatrist was most likely to help PWMI. Other agencies or people were opted by very less number of students. So, it shows that students are aware of who can treat PWMI, but surprisingly they have no idea about other mental health professionals, i.e., psychologist or psychiatric social worker.

Table 6: Correlation between knowledge of mental illness and reaction towards the persons with mental illness
Items	R1	R2	R3	R4	R5	R6	R7	R8	R9	R10
K1	.060	-.199*	-.245*	-.007	-.052	-.138	-.037	-.239*	-.091	-.317**
K2	-.444**	-.292**	-.241*	-.446**	-.323**	-.462**	-.496**	-.384**	-.127	-.253*
K3	-.024	-.171	-.141	.032	-.303**	.045	.139	.088	.051	-.027
K4	-.180	-.218*	-.272**	-.106	-.109	-.106	.033	-.031	-.070	-.019
K5	.221*	-.152	.028	.199*	.149	.019	.134	.006	-.039	-.331**
* p < .05, ** p < .01 level two tail K1- Can be successfully treated outside the hospital, K2- Need prescribed drugs, K3- Can work in regular job, K4- Can get married, K5- Can lead a normal life, R1- Speak to them, R2- Work with them, R3- Have them as fellow member, R4- Allow your young children to speak to them, R5- Live next door to them, R6- Go to a festival at their home, R7- Invite them to your home, R8- Share a house with them, R9- Have a close relationship with them, R10- Marry with them

Personal experience of mental illness

More than half (52%) students had not had any experience at all of mental illness, 17% of them had a friend, and same percentage of students had an acquaintance that had mental illness. Only nine per cent were having a distance relative and five per cent a family member with mental illness.

 

In Pearson’s correlation test, personal experience of mental illness was negatively correlated with knowledge items: Can be successfully treated outside the hospital (r=-.284, p<.01), need prescribed drugs (r=-.205, p<.05) and can lead a normal life (r=-.230, p<.05). Personal experience of mental illness was positively correlated with reaction to PWMI items: Have them as fellow member (r=.269, p<.01), leave next door to them (r=.267, p<.01), go to a festival at their home (r=.289, p<.01), and invite them to their home (r=.288, p<.01). It means those who had less personal experience (or contact) with PWMI had less knowledge about mental illness and more negative attitudes (reactions) towards PWMI. Having a direct contact with persons who are stigmatised is an effective method of decreasing fear, increasing tolerance, and changing negative attitudes.[29] Being acquainted with someone with mental illness has also been shown to positively influence attitudes.[30] In a study by Alexander and Link,[31] it was shown that participants with more overall contact with the PWMI, “regardless of type”, viewed the PWMI as less dangerous and “reported less desired social distance”. In another study, Chung et al.[32] found that greater social distance was associated with no previous contact with PWMI in the university students. Vibha et al.[33] found that psychiatric ward attendants had more positive attitudes than the general attendants towards psychiatric illnesses.

Reaction towards the persons with mental illness (Table 5)

Large majority (77%) of students were ready to speak with PWMI while passing them in the street, which is contradictory to an earlier study by Crisp et al.,[18] where British adults perceived it hard to talk with PWMI. Forty one per cent were willing to invite them at their home, 39% were willing to go to a festival at their home, and 28% were willing to have them as fellow member of a club or an organisation to which they belong, but only 17% would like to work with them, 15% would allow their young children to speak to them, 12% would like to live next door to them, eight per cent would like to have a close relationship with them, and three per cent would like to share a house with them or marry them. Overall findings of the present study is consistent with a study by Adewuya and Makanjuola,[34] where they found that the social distances increased with the level of intimacy required in the relationship among Nigerian university students.

Correlation between knowledge of mental illness and reaction towards the persons with mental illness (Table 6)

Significant correlations (at p<.05 and p<.01 level) were found between the different items of knowledge about mental illness and reaction towards PWMI using Pearson’s correlation test: Can be successfully treated outside the hospital was negatively correlated with work with them (r=-.199), have them as fellow member (r=-.245), share a house with them (r=-.239), and marry with them (r=-.317). Need prescribed drugs was negatively correlated with all reaction items except have a close relationship with them. This finding is somewhat similar to a study by Stone and Merlo,[35]  which found that less stigmatised attitudes toward mental illness were correlated with both increased beliefs about the treatability of mental illness in students of University of Florida. Can get married was negatively correlated with live next door to them (r=-.303). Can get married was negatively correlated with work with them (r=-.218) and have them as fellow member (r=-.272). Can lead a normal life was positively correlated with speak to them (r=.221) and allow your young children to speak to them (r=.199), but was negatively correlated with marry with them (r=-.331). It means who had less knowledge of mental illness had shown more negative attitudes (i.e., reactions). Exceptionally, students having less knowledge about mental illness were also willing to talk with PWMI and they would like to allow their young children to speak to PWMI. Kermode et al.[36] found in a community based vignette study that false beliefs and negative attitudes were still evident, and social distance was consistently greater for the person depicted in the psychosis vignette compared to the depression vignette which is somewhat similar with the present study finding.

Vijayalakshmi et al.[37] found that rural Indians had stigmatising attitudes towards PWMI. But, the same population foavour community based rehabilitation services to PWMI.[37] Kumar et al.[38] felt that awareness about mental illness was growing, even in general population. People are becoming more receptive towards PWMI.[38] In spite of disparities in information and knowledge about mental illness, there is no difference in the areas of stigma and treatment between key informants of PWMI and general population.[38]

Limitations

Small sample size, viz. 100 participants, is definitely not good enough to make conclusive remarks with regard to ‘knowledge about mental illness and reaction towards PWMI’. The same study can be replicated with a larger sample size and by including larger geographical areas. Considering the above limitations, findings of the present study should be generalised cautiously. Another limitation of the study is lack of analysis of socio-demographic association with knowledge about mental illness and reaction towards PWMI.

Conclusion

Results reveal that students had knowledge in some areas of mental illness like PWMI need prescribed drugs, they can be successfully treated outside the hospital, and psychiatrist can help PWMI, but in some areas, they had deficiency. They had shown positive attitude towards PWMI, but the social distances increased with the level of intimacy required in the relationship. Personal experience (or contact) with PWMI had positive impact on knowledge about mental illness and attitudes (reactions) towards PWMI. Those students who had less knowledge about mental illness had more negative attitude (reactions) towards PWMI. Students having more personal experience or exposed to PWMI had more knowledge about mental illness. So, education may need to be tailored to address the determinants of stigma in the country. It can be possible through formal or informal curriculum for public, particularly for the young generation and college going students. College campus might be the best place to sensitise them about mental health issues, because the knowledge and attitude of college-going students might influence the society most, which will have positive influence in stigma alleviation.

Source of support: Nil. Declaration of interest: None.

References

1. Sahu KK, Pillai RR, Hazra S, Verma AN. Stigma experienced by primary care givers of persons with epilepsy. National Journal of Professional Social Work. 2010;10(1& 2):17-33.

2. Byrne P. Stigma of mental illness and ways of diminishing it. Adv Psychiatr Treat. 2000;6:65-72.

3. Weiss MG, Ramakrishna J, Somma D. Health-related stigma: rethinking concepts and interventions. Psychol Health Med. 2006;11:277-87.

4. Goffman E. Stigma: notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice Hall; 1963.

5. Das B, Sarma J. Dealing with HIV/AIDS related stigma, stress, and coping. Dysphrenia. 2014;5:12-8.

6. Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry. 2002;1:16-20.

7. Wolff G, Pathare S, Craig T, Leff J. Community knowledge of mental illness and reaction to mentally ill people. Br J Psychiatry. 1996;168:191-8.

8. Eker D. Attitudes toward mental illness: recognition, desired social distance, expected burden and negative influence on mental health among Turkish freshmen. Soc Psychiatry Psychiatr Epidemiol. 1989;24:146-50.

9. Markström U, Gyllensten AL, Bejerholm U, Björkman T, Brunt D, Hansson L, et al. Attitudes towards mental illness among health care students at Swedish universities--a follow-up study after completed clinical placement. Nurse Educ Today. 2009;29:660-5.

10. Golberstein E, Eisenberg D, Gollust SE. Perceived stigma and mental health care seeking. Psychiatr Serv. 2008;59:392-9.

11. Mahto RK, Verma PK, Verma AN, Singh AR, Chaudhury S, Shantna K. Students’ perception about mental illness. Ind Psychiatry J. 2009;18:92-6.

12. Office of the Registrar General and Census Commissioner, India (RGI). Population Attending Educational Institution by Age, Sex and Type of Educational Institution, Table C-10. New Delhi: Office of the Registrar General and Census Commissioner; 2001.

13. Star S. The public’s ideas about mental illness (monograph). Chicago: National Opinion Research Center; 1955.

14. Hall P, Brockington IF, Levings J, Murphy C. A comparison of responses to the mentally ill in two communities. Br J Psychiatry. 1993;162:99-108.

15. Thara R, Srinivasan TN. How stigmatising is schizophrenia in India? Int J Soc Psychiatry. 2000;46:135-41.

16. Verghese A, Beig A. Public attitudes towards mental illness: The Vellore Study. Indian J Psychiatry. 1974;16:8-18.

17. Kermode M, Bowen K, Arole S, Joag K, Jorm AF. Community beliefs about treatments and outcomes of mental disorders: a mental health literacy survey in a rural area of Maharashtra, India. Public Health. 2009;123:476-83.

18. Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ. Stigmatisation of people with mental illnesses. Br J Psychiatry. 2000;177:4-7.

19. Hottentot EI. Print media portrayal of mental Illness: an Alberta study. Draft. Edmonton: Alberta Mental Health Board Consumer Advisory Council; 2000.

20. Signorielli N. The stigma of mental illness on television. J Broadcast Electron Media. 1989;33:325-31.

21. Wahl OF, Roth R. Television images of mental illness: results of a metropolitan Washington media watch. J Broadcast Electron Media. 1982;26:599-605.

22. Schneider KG. Stereotypes of mental illness as portrayed through Hollywood movies. Duke University; 2003.

23. Diefenbach DL. The portrayal of mental illness on prime-time television. J Community Psychol. 1997;25:289-302.

24. Olstead R. Contesting the text: Canadian media depictions of the conflation of mental illness and criminality. Sociol Health Illn. 2002;24:621-43.

25. Rose D. Television, madness and community care. J Community Appl Soc Psychol. 1998;8:213-28.

26. Wahl O. Media madness: public images of mental illness. New Jersey: Rutgers University Press; 1995.

27. Wilson C, Nairn R, Coverdale J, Panapa A. Mental illness depictions in prime-time drama: identifying the discursive resources. Aust N Z J Psychiatry. 1999;33:232-9.

28. Bella T, Omigbodun O, Dogra N, Adeniyi Y. Perceptions of mental illness among Nigerian adolescents: an exploratory analysis. Int J Cult Ment Health. 2012;5:127-36.

29. Allport GW. The nature of prejudice. Reading, MA: Addison-Wesley; 1954.

30. Song LY, Chang LY, Shih CY, Lin CY, Yang MJ. Community attitudes towards the mentally ill: the results of a national survey of the Taiwanese population. Int J Soc Psychiatry. 2005;51:162-76.

31. Alexander LA, Link BG. The impact of contact on stigmatizing attitudes toward people with mental illness. J Ment Health. 2003;12:271-89.

32. Chung KF, Chen EY, Liu CS. University students’ attitudes towards mental patients and psychiatric treatment. Int J Soc Psychiatry. 2001;47:63-72.

33. Vibha P, Saddichha S, Kumar R. Attitudes of ward attendants towards mental illness: comparisons and predictors. Int J Soc Psychiatry. 2008;54:469-78.

34. Adewuya AO, Makanjuola RO. Social distance towards people with mental illness amongst Nigerian university students. Soc Psychiatry Psychiatr Epidemiol. 2005;40:865-8.

35. Stone AM, Merlo LJ.  Attitudes of college students toward mental illness stigma and the misuse of psychiatric medications. J Clin Psychiatry. 2011;72:134-9.

36. Kermode M, Bowen K, Arole S, Pathare S, Jorm AF. Attitudes to people with mental disorders: a mental health literacy survey in a rural area of Maharashtra, India. Soc Psychiatry Psychiatr Epidemiol. 2009;44:1087-96.

37. Vijayalakshmi P, Ramachandra, Nagarajaiah, Reddemma K, Math SB. Attitude and response of a rural population regarding person with mental illness. Dysphrenia. 2013;4:42-8.

38. Kumar D, Kumar P, Singh AR, Bhandari SS. Knowledge and attitude towards mental illness of key informants and general population: a comparative study. Dysphrenia. 2012;3:57-64.

 

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