Skip to main content Accessibility help
×
Home

Stigma and discrimination related to mental illness in low- and middle-income countries

  • M. Semrau (a1), S. Evans-Lacko (a1), M. Koschorke (a1), L. Ashenafi (a1) and G. Thornicroft (a1)...

Abstract

Aims.

This paper aims to provide an overview of evidence from low- and middle-income countries (LAMICs) worldwide to address: the nature of stigma and discrimination, relevant context-specific factors, global patterns of these phenomena and their measurement and quantitative and qualitative evidence of interventions intended to reduce their occurrence and impact. The background to this study is that the large majority of studies concerned with identifying effective interventions to reduce stigma and discrimination originate in high-income countries (HICs). This paper therefore presents such evidence from, and relevant to, LAMICs.

Methods.

Conceptual overview of the relevant peer-reviewed and grey literature on stigma and discrimination related to mental illness in LAMICs are available in English, Spanish, French and Russian.

Results.

Few intervention studies were identified related to stigma re-education in LAMICs. None of these addressed behaviour change/discrimination, and there were no long-term follow-up studies. There is therefore insufficient evidence at present to know which overall types of intervention may be effective and feasible and in LAMICs, how best to target key groups such as healthcare staff, and how far they may need to be locally customised to be acceptable for large-scale use in these settings. In particular, forms of social contacts, which have been shown to be the most effective intervention to reduce stigma among adults in HICs, have not yet been assessed sufficiently to know whether these methods are also effective in LAMICs.

Conclusion.

Generating information about effective interventions to reduce stigma and discrimination in LAMICs is now an important mental health priority worldwide.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Stigma and discrimination related to mental illness in low- and middle-income countries
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Stigma and discrimination related to mental illness in low- and middle-income countries
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Stigma and discrimination related to mental illness in low- and middle-income countries
      Available formats
      ×

Copyright

Corresponding author

* Address for correspondence: G. Thornicroft, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK (Email: graham.thornicroft@kcl.ac.uk)

References

Hide All
Alonso, J, Buron, A, Bruffaert, R, He, Y, Posada-Villa, J, Lepine, JP, Angermeyer, MC, Levinson, D, De, GG, Tachimori, H, Mneimneh, ZN, Medina-Mora, ME, Ormel, J, Scott, KM, Gureje, O, Haro, JM, Gluzman, S, Lee, S, Vilagut, G, Kessler, RC, Von, KM (2008). Association of perceived stigma and mood and anxiety disorders: results from the World Mental Health Surveys. Acta Psychiatrica Scandinavica 118, 305314.
Alonso, J, Buron, A, Rojas-Farreras, S, De, GR, Haro, JM, De, GG, Bruffaerts, R, Kovess, V, Matschinger, H, Vilagut, G (2009). Perceived stigma among individuals with common mental disorders. Journal of Affective Disorders 118, 180186.
Askenasy, A (1974). Attitudes Towards Mental Patients: A Study Across Cultures. Mouton: Hague.
Barke, A, Nyarko, S, Klecha, D (2011). The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients’ views. Social Psychiatry & Psychiatric Epidemiology 46, 11911202.
Bayar, MR, Poyraz, BC, Aksoy-Poyraz, C, Arikan, MK (2009). Reducing mental illness stigma in mental health professionals using a web-based approach. Israel Journal of Psychiatry & Related Sciences 46, 226230.
Botha, UA, Koen, L, Niehaus, DJ (2006). Perceptions of a South African schizophrenia population with regards to community attitudes towards their illness. Social Psychiatry and Psychiatric Epidemiology 41, 619623.
Chung, KF, Wong, MC (2004). Experiences of stigma among Chinese mental health patients in Hong Kong. Psychiatric Bulletin 28, 451454.
Cohen, J, Struening, EL (1962). Opinions about mental illness in the personnel of two large mental hospitals. Journal of Abnormal Social Psychology 64, 349360.
Cooper, J, Sartorius, N (1977). Cultural and temporal variations in schizophrenia: a speculation on the importance of industrialization. British Journal of Psychiatry 130, 5055.
Corrigan, PW, Morris, SB, Michaels, PJ, Rafacz, JD, Rüsch, N (2012). Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatric Services 63, 963973.
Da Silva Cais, CF, Da Silveir, IU, Stefanello, S, Botega, NJ (2011). Suicide prevention training for professionals in the public health network in a large Brazilian city. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research 15, 384389.
Drew, N, Funk, M, Tang, S, Lamichhane, J, Chavez, E, Katontoka, S, Pathare, S, Lewis, O, Gostin, L, Saraceno, B (2011). Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis. Lancet 378, 16641675.
El-Islam, EF (1979). A better outlook for schizophrenics living in extended families. British Journal of Psychiatry 135, 343347.
Evans-Lacko, S, Knapp, M, Mccrone, P, Thornicroft, G, Mojtabai, R (2013). The mental health consequences of the recession: economic hardship and employment of people with mental health problems in 27 European countries. PLoS ONE 8, e69792.
Evans-Lacko, SCE, Fiorillo, A, Knapp, M, Luciano, M, Park, A, Brunn, M, Byford, S, Chevreul, K, Forsman, AK, Gulacsi, L, Haro, JM, Kennelly, B, Knappe, S, Lai, T, Lasalvia, A, Miret, M, O'sullivan, C, Obradors-Tarragó, C, Rüsch, N, Sartorius, N, Švab, V, Van Weeghel, J, Van Audenhove, C, Wahlbeck, K, Zlati, A, Also on Behalf of the Roamer Consortium, Mcdaid, D*, Thornicroft, G (2014). The state of the art in European research on reducing social exclusion and stigma related to mental health: a systematic mapping of the literature. European Psychiatry 29, 381389.
Goffmann, E (1963). Stigma: Notes on the Management of Spoiled Identity.Prentice-Hall: Englewood Cliffs, NJ.
Griffiths, KM, Carron-Arthur, B, Parsons, A, Reid, R (2014). Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry: Official Journal of the World Psychiatric Association 13, 161175.
Harrison, G, Hopper, K, Craig, T, Laska, E, Siegel, C, Wanderling, J, Dube, KC, Ganev, K, Giel, R, An Der, HW, Holmberg, SK, Janca, A, Lee, PW, Leon, CA, Malhotr, S, Marsella, AJ, Nakane, Y, Sartorius, N, Shen, Y, Skoda, C, Thara, R, Tsirkin, SJ, Varma, VK, Walsh, D, Wiersma, D (2001). Recovery from psychotic illness: a 15- and 25-year international follow-up study. British Journal of Psychiatry 178, 506517.
Henderson, C, Noblett, J, Parke, H, Clement, S, Caffrey, A, Gale-Grant, O, Schulze, B, Druss, B, Thornicroft, G (2014a). Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry 1, 467482.
Henderson, RC, Corker, E, Hamilton, S, Williams, P, Pinfold, V, Rose, D, Webber, M, Evans-Lacko, S, Thornicroft, G (2014b). Viewpoint survey of mental health service users’ experiences of discrimination in England 2008–2012. Social Psychiatry and Psychiatric Epidemiology 49, 15991608.
Hopper, K, Harrison, G, Janca, A, Sartorius, N (2007). Recovery from Schizophrenia: An International Perspective. Oxford University Press: Oxford.
Jablensky, A, Sartorius, N, Ernberg, G, Anker, M, Korten, A, Cooper, JE, Day, R, Bertelse, A (1992). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine Monograph Supplement 20, 197.
Kakuma, R, Kleintje, S, Lund, C, Drew, N, Green, A, Flisher, A (2010). Mental health stigma: what is being done to raise awareness and reduce stigma in South Africa? African Journal of Psychiatry 13, 116124.
Khairy, N, Hamdi, E, Sidrak, A, Sabry, N, Nasreldin, M, Khoweiled, A, Loza, N (2012). Impact of the first national campaign against the stigma of mental illness. Egyptian Journal of Psychiatry 33, 3539.
Knaak, S, Modgill, G, Patten, SB (2014). Key ingredients of anti-stigma programs for health care providers: a data synthesis of evaluative studies. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 59, S19S26.
Koschorke, M, Padmavati, R, Kumar, S, Cohen, A, Weiss, HA, Chatterjee, S, Pereira, J, Naik, S, John, S, Dabholkar, H, Balaji, M, Chavan, A, Varghese, M, Thara, R, Thornicroft, G, Patel, V (2014). Experiences of stigma and discrimination of people with schizophrenia in India. Social Science & Medicine 123C, 149159.
Lasalvia, A, Zoppei, S, Van Bortel, T, Bonetto, C, Cristofalo, D, Wahlbeck, K, Bacle, SV, Van Audenhove, C, Van Weeghel, J, Reneses, B, Germanavicius, A, Economou, M, Lanfredi, M, Ando, S, Sartorius, N, Lopez-Ibor, JJ, Thornicroft, G, Grp A. I. S. (2013). Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet 381, 5562.
Lauber, C, Rossler, W (2007). Stigma towards people with mental illness in developing countries in Asia. International Review of Psychiatry 19, 157178.
Lee, S, Chiu, MY, Tsang, A, Chui, H, Kleinman, A (2006). Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong. Social Science and Medicine 62, 16851696.
Lee, S, Lee, MTY, Chiu, MYL, Kleinman, A (2005). Experience of social stigma by people with schizophrenia in Hong Kong. British Journal of Psychiatry 186, 153157.
Link, BG, Yang, LH, Phelan, JC, Collins, PY (2004). Measuring mental illness stigma. Schizophrenia Bulletin 30, 511541.
Littlewood, R (1998). Cultural variation in the stigmatisation of mental illness. Lancet 352, 10561057.
Livingston, JD, Boyd, JE (2010). Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Social Science & Medicine 71, 21502161.
Lund, C, De Silva, M, Plagerson, S, Cooper, S, Chisholm, D, Das, J, Knapp, M, Patel, V (2011). Poverty and mental disorders: breaking the cycle in low-income and middle-income countries. Lancet 378, 15021514.
Murthy, RS (2002). Stigma is universal but experiences are local. World Psychiatry 1, 28.
Murthy, RS (2005). Stigma of mental illness in the third World. In Perspectives on the Stigma of Mental Illness (ed. Okasha, A and Stefanis, CN). Cairo: World Psychiatric Association, p. 28.
Phillips, MR, Pearson, V, Li, F, Xu, M, Yang, L (2002). Stigma and expressed emotion: a study of people with schizophrenia and their family members in China. British Journal of Psychiatry 181, 488493.
Ritsher, JB, Otilingam, PG, Grajales, M (2003). Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research 121, 3149.
Ritsher, JB, Phelan, JC (2004). Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Research 129, 257265.
Rong, Y, Glozier, N, Luscombe, GM, Davenport, TA, Huang, Y, Hickie, IB (2011). Improving knowledge and attitudes towards depression: a controlled trial among Chinese medical students. BMC Psychiatry 11, 36.
Rose, D, Willis, R, Brohan, E, Sartorius, N, Villares, C, Wahlbeck, K, Thornicroft, G (2011). Reported stigma and discrimination by people with a diagnosis of schizophrenia. Epidemiology and Psychiatric Sciences 20, 193204.
Rosen, A (2003). What developed countries can learn from developing countries in challenging psychiatric stigma. Australasian Psychiatry 11, S89S95.
Sartorius, N, Schulze, H (2005). Reducing the Stigma of Mental Illness: A Report from a Global Association. Cambridge University Press: Cambridge.
Sorsdahl, KR, Kakuma, R, Wilson, Z, Stein, DJ (2012). The internalized stigma experienced by members of a mental health advocacy group in South Africa. International Journal of Social Psychiatry 58, 5561.
Switaj, P, Wciorka, J, Smolarska-Switaj, J, Grygiel, P (2009). Extent and predictors of stigma experienced by patients with schizophrenia. European Psychiatry 24, 513520.
Taylor, SM, Dear, MJ (1981). Scaling community attitudes toward the mentally ill. Schizophrenia Bulletin 7, 225240.
Thara, R, Kamath, S, Kumar, S (2003). Women with schizophrenia and broken marriages--doubly disadvantaged? Part II: family perspective. International Journal of Social Psychiatry 49, 233240.
Thara, R, Srinivasan, TN (2000). How stigmatising is schizophrenia in India?. International Journal of Social Psychiatry 46, 135141.
Thornicroft, G (2006). Shunned: Discrimination Against People with Mental Illness. Oxford University Press: Oxford.
Thornicroft, G, Brohan, E, Rose, D, Sartorius, N, Leese, M, Group, IS (2009). Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 373, 408415.
Thornicroft, G, Mehta, N, Clement, S, Evans-Lacko, S, Doherty, M, Rose, D, Koschorke, M, Shidhaye, R, O'Reilly, C, Henderson, C (2015). Evidence for effective interventions to reduce mental health related stigma and discrimination: narrative review. Lancet. In Press.
Thornicroft, G, Rose, D, Kassam, A (2007). Stigma: ignorance, prejudice or discrimination. British Journal of Psychiatry 190, 192193.
Ucok, A, Brohan, E, Rose, D, Sartorius, N, Leese, M, Yoon, CK, Plooy, A, Ertekin, BA, Mile, R, Thornicroft, G (2012). Anticipated discrimination among people with schizophrenia. Acta Psychiatrica Scandinavica 125, 7783.
United Nations (2006). Convention on the Rights of Persons with Disabilities. United Nations: New York.
Villares, CC, Sartorius, N (2003). Challenging the stigma of schizophrenia. Revista brasileira de psiquiatria 25, 12.
Wasserman, C, Hoven, CW, Wasserman, D, Carli, V, Sarchiapone, M, Al-Halabi, S, Apter, A, Balazs, J, Bobe, J, Cosman, D, Farkas, L, Feldman, D, Fischer, G, Graber, N, Haring, C, Herta, DC, Iosue, M, Kahn, JP, Keeley, H, Klug, K, Mccarthy, J, Tubiana-Potiez, A, Varnik, A, Varnik, P, Ziberna, J, Postuvan, V (2012). Suicide prevention for youth--a mental health awareness program: lessons learned from the Saving and Empowering Young Lives in Europe (SEYLE) intervention study. BMC Public Health 12, 776.
Waxler, NE (1979). Is outcome for schizophrenia better in nonindustrial societies? The case of Sri Lanka. Journal of Nervous and Mental Disease 167, 144158.
Weiss, MG, Jadhav, S, Raguram, R, Vounatsou, P, Littlewood, R (2001). Psychiatric stigma across cultures: local validation in Bangalore and London. Anthropology & Medicine 8, 7187.
WHO (1979). Schizophrenia: An International Follow-up Study. John Wiley and Sons: Chichester, UK.
Yang, L, Kleinman, A, Link, BG, Phelan, J, Lee, S, Good, B (2007). Culture and stigma: adding moral experience to stigma theory. Social Science & Medicine 64, 15241535.
Yang, LH, Thornicroft, G, Alvarado, R, Vega, E, Link, BG (2014). Recent advances in cross-cultural measurement in psychiatric epidemiology: utilizing ‘what matters most’ to identify culture-specific aspects of stigma. International Journal of Epidemiology 43, 494510.
Yang, LH, Valencia, E, Alvarado, R, Link, B, Huynh, N, Nguyen, K, Morita, K, Saavedra, M, Wong, C, Galea, S, Susser, E (2013). A theoretical and empirical framework for constructing culture-specific stigma instruments for Chile. Cadernos Saúde Coletiva 21, 7179.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed