Ethiopia (Internalized stigma among patients with schizophrenia in Ethiopia: a cross-sectional facility-based study)
Determine correlates of internalized stigma among outpatients with schizophrenia in Ethiopia
Quantitative (cross-sectional) survey
Data were collected from 212 outpatients aged over 18, who were mostly single (71.2%), unemployed (70.3%), and male (65.1%)
Outpatients with schizophrenia were recruited and assessed using an Amharic version of the Internalized Stigma of Mental Illness (ISMI) Scale
Nearly all participants (97.4%) expressed agreement with at least one stigma item contained in the ISMI. They reported high internalized stigma. Persons who discontinued their treatment reported that they had done so because of perceived stigma, perceived discrimination, alienation, and stereotype endorsement, leading to social withdrawal. Caregiver stigmata (formal and informal) were also common. There was evidence of an association between a history of suicide attempts and high internalized stigma score
Ghana (The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients’ views)
To examine attitudes of patients and the public towards mentally illness in Ghana
Quantitative (cross-sectional) study
A convenience sample of 403 participants aged over 18 (210 men, mean age years) from urban regions in Accra, Cape Coast, and Pantang answered the Perceived Stigma and Discrimination Scale. 105 patients (75 were men, mean age years).
Researcher-administered interviews were carried out using the Community Attitude towards the Mentally Ill (CAMI) Scale. Perceived stigma was measured with the Perceived Devaluation and Discrimination (PDD) Scale
Patients reported high levels of stigma with secrecy. Perceived discrimination and devaluation Perceived stigma was high. The public regarded PWMI as inferior. The public will not accept them as close friends and will not hire them due to perceptions that they were unintelligent and not trustworthy. Their opinions were also not taken seriously by the community. The participants used concealment to cope
Ethiopia (Perceived stigma and associated factors among people with epilepsy at Gondar University Hospital, Northwest Ethiopia: A cross-sectional institution-based study)
To assess the prevalence of perceived stigma and associated factors among people with epilepsy attending the outpatient department in Ethiopia
Quantitative (cross-sectional) study
408 outpatients with epilepsy. The participants were selected using a systematic random sampling technique. All were aged more than 18 years
Face-to-face interviews were done using semistructured questionnaire. Perceived stigma was measured using the modified Family Interview Schedule (FIS). Beck Depression Inventory (BDI-II) was used to assess depression. The Perceived Stress Scale was used to measure the perception of stress
Overall, the prevalence of perceived stigma was found to be 71.6%. Marital status (single (, CI: 0.25, 0.90), widowed (, CI: 0.15, 0.90)), duration of illness (2-5 years (, CI: 1.98, 9.62), 6-10 years (, CI: 1.90, 9.64), ≥11 years (, CI: 1.84, 10.00)), and seizure frequency (1-11 per year (, CI: 2.21, 3.56), ≥1 per month (, CI: 3.42, 10.32)) were all associated with perceived stigma
Ethiopia (Perceived Stigma and Associated Factors among People with Schizophrenia in Addis Ababa.
Assess associated factors of perceived stigma among people with schizophrenia
Quantitative (cross-sectional) study
Sample was select by systematic sampling techniques. 411 outpatients, aged 18 and above, had schizophrenia and were studied using an Amharic version of the Perceived Devaluation and Discrimination (PDD) Scale
Perceived stigma was measured using the Perceived Devaluation and Discrimination (PDD) Scale
The prevalence of perceived stigma was found to be 83.5%. Education status (not able to read and write) (, 95% CI: 1.118, 6.227), difficulties of adherence to antipsychotic drug (, 95% CI: 2.309, 8.732), and duration of illness less than one year (, 95% CI: 2.238, 5.422) were highly associated with perceived stigma Employment status and residence also mediated perceptions of stigma
13 European countries (Self-stigma, empowerment, and perceived discrimination among people with bipolar disorder or depression in 13 European countries: The GAMIAN–Europe study
Describes the levels of self-stigma, stigma, resistance, empowerment, and perceived discrimination reporting by people diagnosed with bipolar disorder or depression in 13 European countries
Quantitative (cross-sectional) survey
1182 people with bipolar disorder or depression from 13 countries (Belgium, Croatia, Estonia, Finland, Greece, Italy, Lithuania, Macedonia, Malta, Poland, Romania, Spain, Sweden)
Participants completed a mail surveys measuring self-stigma, stigma, resistance, empowerment, and perceived discrimination. The measures included the Internalized Stigma of Mental Illness (ISMI) for self-stigma, the Boston University Empowerment Scale (BUES) for empowerment, and the Perceived Devaluation and Discrimination (PDD) Scale for perceived discrimination
Self-stigma was prevalent. However, there was moderate or high stigma resistance, 63% moderate or high empowerment, and 71.6% moderate or high perceived discrimination. Participants had the lowest scores for the stereotype endorsement subscale. Alienation was the most frequently endorsed subscale (39.3%), followed by social withdrawal (28.7%) and discrimination experience (22.7%). Empowerment, social contact, university education, and employment were all significantly associated with lower self-stigma scores
Europe (Self-stigma, empowerment, and perceived discrimination among people with schizophrenia in 14 European countries: The GAMIAN-Europe study
Describes the level of self-stigma, stigma, resistance, empowerment, and perceived discrimination reported by mental health service users with a diagnosis of schizophrenia or other psychotic disorder across 14 European countries
Quantitative (cross-sectional) study
1229 people with schizophrenia in 14 European countries (Bulgaria, Croatia, Czech Republic, Estonia, Greece, Lithuania, Macedonia, Poland, Romania, Russia, Slovenia, Spain, Turkey, Ukraine site A)
Participants completed a mail survey measuring self-stigma, stigma resistance, empowerment, and perceived discrimination levels. The measures included ISMI for self-stigma, Boston University Empowerment Scale (BUES) for empowerment, and PDD for perceived discrimination
Self-stigma was predominant Participants had the lowest scores for the stereotype endorsement subscale. Alienation was the most frequently endorsed subscale (39.3%), followed by social withdrawal (28.7%) and discrimination experience (22.7%). Empowerment, social contact, university education, and employment were all significantly associated with lower self-stigma scores
35 countries (Discrimination in the workplace, reported by people with major depressive disorder: a cross-sectional study in 35 countries
Assess if (1) people with MDD anticipate and experience discrimination when trying to find or keep paid employment
Quantitative (cross-sectional) study
Participants purposively sampled () were over 18 years. Diagnosis of MDD in the past 12 months from 35 countries. Twenty-five patients were recruited from each site. About half of the participants were married or cohabiting. Two-thirds were women
Participants were interviewed face to face using the Discrimination and Stigma Scale (DISC-12). Internalized stigma was measured with the Internalized Stigma of Mental Illness (ISMI) Scale to assess the subjective experience of stigma
About 63% of participants had anticipated and experienced discrimination in the work setting. Almost 60% of respondents had stopped themselves from applying for work, education, or training because of anticipated discrimination. Participants in countries with a very high HDI reported significantly more anticipated ( (),) and more experienced ( (),) discrimination than participants in countries with moderate/low HDI
Ghana (Stigmatization and Discrimination Experiences of Persons with Mental Illness: Insights from a Qualitative Study in Southern Ghana)
Find out how PWMIs are stigmatized and discriminated against by family members, public (friends and neighbors), employers, and work colleagues
Qualitative study (phenomenology)
Purposive sampling of 10 persons with mental illness aged 18 years, eight PWMI had never married. Two were divorced. The PWMIs were unemployed. Majority of the respondents were Christians and belonged to different ethnic groups
In-depth interviews using unstructured open-ended questions
Findings showed that stigmatization and discrimination during interaction with own family members, association with friends and community members, and contact with employers and work colleagues were common. Social distance and withdrawal from the affected family member were common. Some PWMIs were ignored or neglected by their fathers on grounds that the illness was coming from the mother’s lineage. They no more share common space such as the same bed or eating together. Close friends and partners deserted them; some neighbors ridiculed them. Some participants became unemployed due to the inability to find or keep their jobs despite being competent. Employers described them as incapable to work
2014 UK (experienced discrimination among people with schizophrenia, bipolar disorder, and major depressive disorder: A cross-sectional study)
Establish associations of anticipated and experienced discrimination among people with schizophrenia and comparators (bipolar and major depressive disorders)
Quantitative (cross-sectional) study
202 individuals with mental illness aged over 18 were studied. 55% were female and 54% were White, while 62% were unemployed. All had some form of education. About 63% of the participants were single Diagnosis from notes indicated bipolar disorder (20.3%), depression (32.2%), and schizophrenia spectrum (47.5%)
Researchers used instruments that include Discrimination and Stigma Scale (DISC), Questionnaire on Anticipated Discrimination (QUAD), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF), Beck Hopelessness Scale (BHS), Internalized Stigma of Mental Illness (ISMI) Scale, and Multigroup Ethnic Identity (MEIM) Scale
93% of the sample anticipated discrimination and 87.6% of participants had experienced discrimination in at least one area of life in the previous year (employment, friends, dating, neighborhood, housing, transport, family, education, benefits, religion, and physical health). There was a significant association between the anticipation and the experience of discrimination. Higher levels of experienced discrimination were reported by those of mixed ethnicity and those with higher levels of education. Women anticipated more discrimination than men. Neither diagnosis nor levels of functioning were associated with the extent of discrimination. Clinical symptoms of anxiety, depression, and suspiciousness were associated with more experienced and anticipated discrimination. Females anticipated more discrimination in housing (mean difference ,), education (,), family (,), employment (,), and physical healthcare (,) than males
2013 Iran (Internalized stigma of mental illness in Tehran, Iran
To investigate experiences of internalized stigma in mentally ill persons in Tehran, Iran, using the Internalized Stigma of Mental Illness (ISMI) Scale
Quantitative (cross-sectional) study
About 138 outpatients with affective and schizophrenia spectrum disorders. 60% were males and the majority had high school diploma. Mean age of the participants was 30 years. About 79% were unemployed. More females (55%) were married
The Internalized Stigma of Mental Illness (ISMI) Questionnaire was used to measure internalized stigma
About 56% of participants agreed with the statement “having a mental illness has spoiled my life.” Few agreed with the statement “stereotypes about the mentally ill apply to me” (38%) and “mentally ill people tend to be violent” (38%) and “mentally ill people should not get married” (33%). Some also experienced discrimination; for example, 53% agreed with the statement “people discriminate against me because I have a mental illness.” Others (46%) also withdrew by avoiding social situations to protect their family or friends from embarrassment. A few (30%) agreed that they could have “a good fulfilling life” and “be able to live my life the way I want to”
Spain (Mental Illness Stigma. A Comparative Cross-sectional Study of Social Stigma, Internalized Stigma and Self-esteem)
To investigate relationships between social stigma, internalized stigma, and self-esteem
Quantitative (cross-sectional) study
Convenient sampling of 255 persons with severe mental illness. (136 males, 119 females). Majority were single (156), married (61), divorced (34), and widowed (4). Most were employed (74), unemployed (71), or disabled (97). Most finished either elementary studies (73), high school (121), or university (53). About 125 had psychosis, bipolar (11), personality disorder (30), depression (32), and anxiety (57)
Rosenberg Self-Esteem (RSE) Scale to measure self-esteem, Attribution Questionnaire-9 (AQ-9) to measure social stigma, and Internalized Stigma of Mental Illness (ISMI) to measure internalized stigma
Internalized stigma and discrimination were very high among persons with severe mental illness. Persons with severe mental illness were also found to demonstrate more stigma resistance. Overall, most participants reported low self-esteem
Ghana (Individual factors that influence experiences and perceptions of stigma and discrimination towards people with mental illness in Ghana)
To examine perceptions of stigma and discrimination and self-stigma in individuals diagnosed with mental illness
Qualitative study
Purposive sampling of 12 participants (9 males, 3 females). Majority were single (8/12), unemployed (8/12), lived with family members or friends (10/12), and endorsed a Christian faith (10/12). The duration of treatment ranged from 8 months to 18 years (mean treatment years). Their ages ranged between 18 and 50 (mean ). All participants had some form of education
A single investigator interviewed all participants one on one in English
Negative perceptions about stigma and experiences of discrimination were prevalent. Some lost their jobs, close friends, and partners after discharge from hospital. Their opinions were discounted, and decisions were made for them. Some felt isolated and described themselves as “not being human anymore.” Self-stigma was also common. Family members and coworkers discriminated against them. Most participants considered or were told that the problem was spiritual and reflected Christian and traditional thinking around spirituality. Some also attributed their illness to God’s punishment for previous poor behavior. Many sought support from Christian churches. Those with a traditional view of being cursed or being invaded by evil spirits paid community healers to rid them of the curse or evil spirits. Eventually, all sought hospital care, either on the advice of a close relation or the church. They also attributed social and biological causation to their illness. Some coped by quitting their jobs and concealing their illness, while some moved multiple times to avoid persons who knew about their illness. Others engaged in social withdrawal and self-isolation. Some also prayed
Sweden (Perceived and anticipated discrimination in people with mental illness— An interview study)
To investigate perceived discrimination in a sample of users in contact with mental health services in Sweden
Quantitative (cross-sectional) study
156 outpatients were involved. Two-thirds of whom were female. About 55% were living alone, while nearly 74% were unemployed. The two major diagnostic subgroups were anxiety/depression (46.3%) and psychosis (38.5%). The mean number of years since first contact with psychiatric services was 15. Mean number of hospitalizations was five, and around one-third of the participants had been involuntarily hospitalized
Telephone interviews were conducted with 156 outpatients, asking for perceived and anticipated discrimination during the last 2 years. Background characteristics were also collected. The instrument used for the interviews was DISC-12
Perceived discrimination was common. Family and caregiver stigma and discrimination were prevalent, including avoidance by people who knew about the mental illness. Most of those anticipating discrimination regarding job or education seeking or starting a close relationship had no experience of discrimination in these areas. Previous hospitalizations were associated with discrimination and age with anticipated discrimination. Areas with the least perceived discrimination included religious practice, starting a family, and using public transport. Most participants coped by concealing their illness from others. They also stopped themselves from having close personal relationships and from applying for work or education
21 countries: Bulgaria, Italy, Hungary, Lithuania, Poland, Romania, UK, Slovakia, India, Slovenia, Cyprus, Finland, France, Germany, Greece, Malaysia, Spain, Netherlands, Norway, Portugal, Switzerland)
To investigate whether people with schizophrenia experience discrimination when using healthcare services
Quantitative (cross-sectional) study
About 777 participants with schizophrenia (62% male and 38% female) from inpatient and outpatient home care and day care
Face-to-face researcher interviews. Data collection related to healthcare, disrespect of mental health staff, personal privacy, safety, and security, starting a family, pregnancy, and childbirth. Discrimination was measured by the Discrimination and Stigma Scale (DISC)
Participants experienced discrimination when treated for physical health problems and at mental health hospitals. They were discriminated against in several life domains related to friendship, treatment by family, keeping a job, travel visas, welfare benefits, and pension and opening a bank account, voting in elections, religious practices, social life, treatment by the police, arranging payment for medical care, and dental treatment. Even home care service patients also felt discriminated against when wanting to start a family. Perceived disrespect was also high
Hong Kong (Predictors and outcomes of experienced and anticipated discrimination in patients treated for depression: A 2-year longitudinal study
Investigate predictors of experienced and anticipated discrimination, as well as the impacts of discrimination, on treatment outcomes in patients with depressive disorders receiving pharmacological interventions
Quantitative (longitudinal) study
230 patients with depressive disorders
The Hamilton Rating Scale for Depression, Hospital Anxiety and Depression Scale, Clinical Global Impression Scale-Severity, Social and Occupational Functioning Assessment Scale (SOFAS), EuroQol-5 Dimension (EQ-5D) Questionnaire, and Sheehan Disability Scale were administered to assess various depression outcomes. Baseline personality was evaluated using the Big Five Inventory-10
A history of depression predicted experienced discrimination. Higher levels of education predicted a higher level of anticipated discrimination. A nonmarried status predicted a greater level of anticipated discrimination. Anticipated discrimination was high in those with worse functional impairment. Patients who reported higher levels of experienced discrimination exhibited worse outcomes. Anticipated discrimination score, the male gender, educational level, current nonmarried status, being employed, a previous suicide attempt, the PSS score, HADS-A score, and SDS score were positively associated, whereas age, having religion, a monthly income >2,000 USD, the CDRS score, EQ-5D utility index score, and BFI-K-10 extraversion and agreeableness scores were negatively associated. On multivariable analysis, the years of education, nonmarried status, and disability score at baseline were independently associated with higher-level anticipated discrimination
China (Stigma and discrimination experienced by people with schizophrenia living in the community in Guangzhou, China)
To investigate experienced stigma and discrimination and their associated factors in people with schizophrenia who live in the community in Guangzhou, China
Quantitative (cross-sectional) study
A total of 384 people aged between 18 and 50 with schizophrenia were randomly recruited from four districts of Guangzhou
Participants completed self-reported questionnaires: Internalized Stigma of Mental Illness (ISMI) Scale, Self-Esteem Scale (SES), Discrimination and Stigma Scale (DISC-12), Brief Psychiatric Rating Scale (BPRS), PANSS negative scale, Global Assessment of Functioning (GAF), and Schizophrenia Quality of Life Scale (SQLS)
People with schizophrenia often experience stigma and discrimination in the Chinese population. The public perceived them as dangerous. Participants were avoided or shu by the public Participants concealed their illness. Most of the participants were also unemployed and unmarried
USA (Beliefs about causes, symptoms, and stigma associated with severe mental illness among ‘highly acculturated’ Chinese American patients
To examine mental health beliefs among highly acculturated Chinese American patients with severe mental illness and serves to fill the gap in the literature of Chinese American mental health
Qualitative study
About 29 persons aged 20-75 years. Twenty-six participants had high school education. Twenty-two were diagnosed with schizophrenia, schizoaffective disorder, and psychosis not otherwise specified (NOS). Six people were diagnosed with bipolar disorder type I and one person with major depressive disorder recurrent type. They received health services on an average of 13.9 years
Semistructured interviews were conducted based on Kleinman’s explanatory model
Causes of mental illness include biological factors, head trauma, and personal loss. About 15 persons believed mental illness is hereditary, from neurotransmitter deficiencies or brain abnormalities, while seven and six participants believed family loss and past negative interpersonal experiences and drug use, respectively caused the illness. Four participants also referred to head trauma as the causative factor. Three participants also cited sexual abuse and psychological trauma. Additionally, two participants believed that their mental illness was caused by improper diet. Public stigma was also common; some neighbors blamed them and described them as a disgrace to their families. However, some participants did not feel ashamed of their illness, and that they were going to go public about their illness to be role models to many who were hiding their illness. Few participants spoke about traditional Chinese medicine when asked about treatment options
China (Experienced stigma and self-stigma in Chinese patients with schizophrenia)
To investigate experienced stigma and self-stigma in patients with schizophrenia in mainland China. Methods
Quantitative (cross-sectional) study
Nonprobabilistic sampling method was used to recruit 95 outpatients. About 61% were male. Participants’ mean age was 26.27 years. About 64% were employed. About 68% were single, married (27%), and divorced (4%). About 68% completed high school. Duration (years) of mental illness, . Family history of mental disorder (20.0%) (76.8%) Hospitalizations below (72.6%) and (27.4%)
Ninety-five patients with schizophrenia completed Chinese versions of two self-report questionnaires: the Internalized Stigma of Mental Illness (ISMI) Scale and the Modified Consumer Experiences. of Stigma Questionnaire (MCESQ). They also completed two other self-report questionnaires: the Social Support Rating Scale (SSRS) and the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. A senior psychiatrist also assessed patients using the Scale for Assessment of Positive Symptoms (SAPS) and the Scale for Assessment of Negative Symptoms (SANS)
On the ISMI, the percentage of participants who rated themselves above the midpoint of 2.5 (i.e., high level of self-stigma) was 44.2% () for alienation, 14.7% () for stereotype endorsement, 25.3% () for perceived discrimination, 32.6% () for social withdrawal, and 20.0% (). On the Stigma Questionnaire (MCESQ), the percentage of participants who rated themselves above the midpoint of 3.0 was 24.2% () for stigma. Socioeconomic factors were related to the severity of psychiatric stigma. Some described themselves as looking strange and their lives as “spoiled,” while others concealed their illness from family, friends, and the public
Canada (The Impact of Stigma of Mental Illness in a Canadian Community: A Survey of Patients Experiences
Examined how willing patients are to share details of their mental illness and to determine if individual characteristics have a role on stigma
Quantitative (cross-sectional) study
41 persons agreed to participate. About 56% were male. About 51% completed a college diploma. Participants were diagnosed with schizophrenia, bipolar depression, and substance abuse. Twelve inpatients had been hospitalized first time, while 29 had one or more hospitalizations. Average length of illness was 19.5 years ()
Face-to-face interviews assessed opinions on the Experiences with the Stigma of Mental Illness—Consumer Version
Those who attended outpatient sessions, previously hospitalized, or younger suffered more stigma impact. Health professionals were rude and stigmatized them. This impacted recovery negatively because they lost trust in the professionals. Stigma also negatively influenced their health seeking. Participants feared or lost trust in community members. They could not ask for help from them; they felt safer staying away from the public due to the shame their illness brought unto them
Nigeria (Pattern of experienced and anticipated discrimination among people with depression in Nigeria: a cross-sectional study.
The study evaluated the impact of stigma and discrimination among. Individuals with major depression in Nigeria
Quantitative (cross-sectional) study
Person with major depression aged over 18. The mean age of the participants was 35.5 years
Face-to-face interviews were conducted with 103 participants using a sociodemographic questionnaire, the Discrimination and Stigma Scale, the Internalized Stigma of Mental Illness Scale, the Boston University Self-Empowerment Scale, and the Rosenberg Self Esteem Scale
Participants were unfairly treated in dating or intimate relationships, while concealment of mental illness was the most common for anticipated discrimination. Younger people (less than 40 years) with higher level of education had a high risk for experienced discrimination. Some also faced unfair treatment at work and therefore withdrew from their job. About 51% coped by making friends with people who did not use mental health services, while 36% used personal capabilities in coping with stigma. The greatest advantage was being positively treated by family (62.1%), followed by positive treatment in religious activities (23.3%). More than half of the respondents concealed their diagnosis from others. Self-esteem and self-efficacy were low. Patients with tertiary education compared with those with secondary or lower level of education showed experienced stigma
USA (From Discrimination to Internalized Mental Illness Stigma: The Mediating Roles of Anticipated Discrimination and Anticipated Stigma)
Explored how experiences of discrimination relate to greater anticipation of discrimination, devaluation, and internalized stigma
Quantitative (cross-sectional) study
Participants were 105 adults with mental illness
Using laptops, 105 adults with mental illness self-reported their experiences of discrimination based on their mental illness. The instruments used include the lifetime discrimination scale used in the National Midlife in the United States (MIDUS) and the Berger et al. [36] stigma scale
Experienced discrimination was common and resulted in increased anticipated discrimination, social stigma, and greater internalized stigma. The most common types of discrimination reported were not getting hired for a job (26%), getting hassled by the police (23%), getting fired from a job (16%), and getting poorer medical treatment/services (13%). The degree to which participants anticipated some discriminatory experiences was not influenced by having experienced that event. Participants also reported not getting promoted for a job. They experienced discrimination from healthcare providers as well
Uganda (Beliefs, stigma and discrimination associated with mental health problems in Uganda: Implications for theory and practice)
To understand beliefs, stigma, and discrimination associated with mental health in Uganda from the perspectives of different stakeholders
Qualitative study
Purposive sampling of 40 participants, i.e., mental health activists (with lived experience) (they did not describe the sample in detail)
Key informant interviews in English and two focus groups discussions, each with 12 mental health activists in a language they could understand
The public describe every mental health issue as “madness.” The public still hold unto traditional cultural explanations for mental illness, such as being possessed by evil spirits, as a punishment or curse. The best way to treat mental illness was to seek traditional treatment or faith cures. They also believed in social and biological causes of mental illness. While the participants stigmatized themselves, family and community members discriminated against them. Participants were also discriminated against by health professionals, employers, and colleagues in the workplace. Negative media reportage was common on TV, radio, and newspapers
USA (A Stress-Coping Model of Mental Illness Stigma: I. Predictors of Cognitive Stress Appraisal)
Tested whether the level of perceived public stigma and personal factors such as rejection sensitivity, perceived legitimacy of discrimination, and in-group perceptions predict the cognitive appraisal of stigma as a stressor
Quantitative (cross-sectional) study
85 outpatients with schizophrenia, schizoaffective, or affective disorders participated in the study. Participants’ average age was about 45 years (,), and 68% were male. More than half (58%) were African American and a third (34%) Caucasian, while a few reported Hispanic or Latino (5%) and mixed or other ethnicities (4%). On average, participants with mental illness were first diagnosed about 15 years ago (,) and had been hospitalized in psychiatric institutions about nine times (,)
Cognitive appraisal of sexism was used to measure cognitive appraisal of stigma-related stress. The Perceived Devaluation and Discrimination Questionnaire measured the perceived levels of stigma against PWMI. The Adult Rejection Sensitivity Questionnaire measured rejection sensitivity. The Social Cue Recognition Test measured social cognitive deficits that affect stigma perception
Stress appraisal did not differ between diagnostic subgroups but was positively correlated with rejection sensitivity. Higher levels of perceived societal stigma and holding the group of people with mental illness in low regard (low group value) independently predicted high stigma stress appraisal. High group value was related to more perceived resources to cope with stigma. More rejection sensitivity was also associated with higher perceived stigma, stress, and lower perceived coping resources. Group identification and entitativity were positively related to both perceived harm and perceived coping resources. The findings support the model that public and personal factors predict stigma stress appraisal among people with mental illness, independent of diagnosis and clinical symptoms
Thailand (Illness perspectives of Thais diagnosed with schizophrenia
Explored the perceptions of 18 people diagnosed with schizophrenia from 1–10 years to uncover how they perceived themselves and their illness.
A qualitative, descriptive study that employed in-depth interviews and observations
18 outpatients with schizophrenia were purposively selected. All were over 18 years (24-57 years, years). Eight participants were single, six were married, and four were divorced. All were Buddhists. Seven were unemployed, three were employed in government services, and eight were in private employment
Data were collected using in-depth interviews and observations
Participants felt their symptoms including physical, behavioral, cognitive, and emotional aspects were abnormal, chronic, and required continuous medication and treatment. They believed supernatural powers, bad karma from the past, or biological factors caused their symptoms. They blamed themselves for their illness, describing themselves as sinners and living a bad life, that is why they got sick from karma. Participants felt discriminated by society. They were isolated leading to a feeling of shame. They felt disrespected and distrusted and lost their self-confidence. Participants coped through encouraging themselves, seeking social support from relatives, and following “dharma” or Buddhist morality teachings, practicing mindfulness or positive concentration, meditation (detachment), and praying
India (Origin and Impact of Stigma and Discrimination in Schizophrenia - Patients’ Perception: Mumbai Study)
Assessed the perceptions of patients with schizophrenia regarding the stigma and discrimination they face in their lives
Quantitative (cross-sectional) study
Convenience sample of 100 patients (74 males) with schizophrenia, who were attending outpatient psychoeducation in a hospital in Mumbai, India, was surveyed. Their mean age was 39.2 years (; range 22-58). All participants had a minimum of grade 12 education. They were living with families and belonged to the middle class
Opinions on various aspects of stigma were obtained using a semistructured interview guide developed by a national working group in India by the World Psychiatric Association steering committee
About 69% of the respondents experienced stigma in their personal lives. A lack of knowledge, the nature of the illness, and behavioral symptoms were the main causes of stigma and discrimination. Common effects of stigma were low self-esteem and discrimination in family and work settings. Providing care and treatment was identified as the most common method of combating stigma. The availability of effective treatment was thought to be the most important method of reducing stigma. The prevailing social stigma from family members, coworkers, and health professionals resulted in low self-esteem of participants. Participants also reported problems coping with their marriage and not receiving proposals for marriage due to their illness
Five Asian countries: China, Korea, Malaysia, Singapore, and Thailand (Perception of Stigma and Its Associated Factors Among Patients with Major Depressive Disorder: A Multicenter Survey from an Asian Population)
To examine the level of perceived stigma and its associated factors in MDD patients in five Asian countries, including China, Korea, Malaysia, Singapore, and Thailand
Quantitative (cross-sectional) study
A total of 547 outpatients with MDD were enrolled from mainland China (114 cases), Taiwan (99 cases), Singapore (40 cases), Korea (101 cases), Thailand (103 cases), and Malaysia (90 cases)
Researchers used the Explanatory Model Interview Catalogue (EMIC) to assess stigma and the Montgomery–Asberg Depression Rating Scale (MADRS), Symptoms Checklist 90-Revised (SCL-90-R), Fatigue Severity Scale (FSS), Sheehan Disability Scale (SDS), 36-Item Short-Form Health Survey (SF-36), and Multidimensional Scale of Perceived Social Support (MSPSS) to assess their symptoms, clinical features, functional impairment, health status, and social support
The stigma scores of patients under 55 years old were significantly higher than those equal to or greater than 55 years old (). The stigma scores exhibited a significant negative correlation with age and MSPSS scores of family, friends, and others
Ghana (mental health-related stigma and discrimination in Ghana: experiences of patients and their caregivers
To provide evidence on the types of mental health, stigma and discrimination, and challenges, coping, and support strategies used by patients
Quantitative (cross-sectional exploratory) study
Two hundred and seventy-seven patients were selected through simple random sampling and interviewed. About 55% were above 35years. Nearly 62% of the patients were females and 65% were unmarried. Close to 45% were educated, while 93% were Christian
Two research assistants conducted face-to-face interviews using a structured questionnaire with (patients)
More females were stigmatized than males at the work/employment and educational levels. Various forms of stigma were observed at the economic, psychological, and social levels, while for discrimination, it was only observed at the economic and social levels. Caregivers were also stigmatized and discriminated. The coping strategies adopted by the patients and their caregivers were also economic, psychological, and social in nature. The main reported cause of mental disorder was biological (45%), while 32% reported spiritual causes and curses. The preferred treatment of mental disorders was biomedical (79%) and faith based (18%)
Global (Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey)
To describe the nature, direction, and severity of anticipated and experienced discrimination reported by people with schizophrenia in 27 countries
Quantitative study
732 outpatients with schizophrenia
Face-to-face interviews with 732 participants with schizophrenia
Rates of experienced discrimination were high and consistent across countries. Negative discrimination was experienced by 344 (47%) of 729 participants in making or keeping friends, by 315 (43%) of 728 in family members, by 209 (29%) of 724 in the finding job, by 215 (29%) of 730 in keeping a job, and by 196 (27%) of 724 in intimate or sexual relationships. Positive experienced discrimination was rare. Anticipated discrimination affected 469 (64%) in applying for work, training, or education and 402 (55%) looking for a close relationship; 526 (72%) felt the need to conceal their diagnosis. Over a third of participants anticipated discrimination for job seeking and close personal relationships when no discrimination was experienced. Rates of both anticipated and experienced discrimination were high across countries among PWMI
United States (The influence of structural stigma on mental illness: State level structural stigma and attitudes towards treatment seeking and quality of life)
The influence of structural stigma on mental illness in relation to attitudes towards treatment seeking and quality of life
Quantitative (structural equation modelling)
787 adults with mental illness, aged 18 years or older. Majority of the sample was female (511 (64.86%)), employed (412 (52.33%)), White 554 ((70.39%)), and married or cohabitating with a partner (466 (59.15%))
Participants completed the scales and questionnaires: Satisfaction with Life Scale (SWLS), Attitudes toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-S), Perceived Devaluation and Discrimination Scale (PDD), Community Attitudes towards the Mentally Ill (CAMI), and ISMI
Higher levels of structural stigma were associated with lower quality of life (,). Higher levels of structural stigma were significantly associated with more negative attitudes regarding treating the mentally ill in communities (,). Higher levels of experienced stigma negatively influence attitudes towards treatment seeking. Higher levels of self- stigma negatively influenced attitudes toward seeking treatment. Individuals with higher levels of public stigma also had higher levels of experienced stigma (,)
Australia (Stigma and discrimination experienced by people living with severe and persistent mental illness in assertive community treatment settings)
Describe perceived experiences of stigma and discrimination among PWMI in assertive community treatment (ACT team) settings in New South Wales, Australia
Quantitative (cross-sectional) study
Fifty clients with schizophrenia or schizoaffective disorder aged 18 and above participated. Majority of participants were male (72%) with a median age of 52 years (), a primary diagnosis of schizophrenia (86%), or schizoaffective disorder (14%)
The Discrimination and Stigma Scale (DISC) was used to explore and measure negative, anticipated, and positive discrimination levels. Face-to-face interviews were conducted
Participants experienced negative discrimination and unfair treatment including being avoided or shunned by neighbors and family. Participants were denied employment and even volunteering, once they disclosed their illness. These experiences impacted self-esteem and perception of self-stigma of participants. Participants also experienced discrimination from healthcare professionals when seeking physical healthcare, including lack of respect and perceived as less intelligent irrespective of education level. Some also anticipated discrimination in relationships that was not linked to experienced discrimination. Participants overcame stigma through music, meditation, writing, avoidance, and acceptance of one’s illness
