Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries

Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK.
Psychological Medicine (Impact Factor: 5.94). 11/2011; 42(8):1741-52. DOI: 10.1017/S0033291711002558
Source: PubMed


Little is known about how the views of the public are related to self-stigma among people with mental health problems. Despite increasing activity aimed at reducing mental illness stigma, there is little evidence to guide and inform specific anti-stigma campaign development and messages to be used in mass campaigns. A better understanding of the association between public knowledge, attitudes and behaviours and the internalization of stigma among people with mental health problems is needed.
This study links two large, international datasets to explore the association between public stigma in 14 European countries (Eurobarometer survey) and individual reports of self-stigma, perceived discrimination and empowerment among persons with mental illness (n=1835) residing in those countries [the Global Alliance of Mental Illness Advocacy Networks (GAMIAN) study].
Individuals with mental illness living in countries with less stigmatizing attitudes, higher rates of help-seeking and treatment utilization and better perceived access to information had lower rates of self-stigma and perceived discrimination and those living in countries where the public felt more comfortable talking to people with mental illness had less self-stigma and felt more empowered.
Targeting the general public through mass anti-stigma interventions may lead to a virtuous cycle by disrupting the negative feedback engendered by public stigma, thereby reducing self-stigma among people with mental health problems. A combined approach involving knowledge, attitudes and behaviour is needed; mass interventions that facilitate disclosure and positive social contact may be the most effective. Improving availability of information about mental health issues and facilitating access to care and help-seeking also show promise with regard to stigma.

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Available from: Sara Evans-Lacko, Mar 08, 2014
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    • "A second barrier to recognition, disclosure of distress and accessing mental health care is stigma and embarrassment. Stigma around mental illness has two aspects; public stigma refers to negative prejudicial attitudes and discrimination towards individuals with mental illness endorsed by the general population, while self-stigma describes an individuals' internalisation of these negative attitudes and beliefs (Corrigan & Rao, 2012; Evans-Lacko et al., 2012). Both public and selfstigma have a broad range of negative ramifications for those with mental illness, notably social exclusion and reduced treatment-seeking (Conner et al., 2010; Evans-Lacko et al., 2012; Patel et al., 2010). "
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    Journal of Adolescence 08/2014; 37(7):1143-1151. DOI:10.1016/j.adolescence.2014.08.001 · 2.05 Impact Factor
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    • "Experience of mental health problems early in life can be associated with a trajectory of exclusion and disadvantage, for example, through reduced participation in higher education, exclusion from civil society (including functions such as democratic participation), increased risk of contact with criminal justice systems, victimization , less access to physical healthcare, poverty and homelessness and reduced life expectancy [16] [21] [26] [35] [42] [47]. Stigma and exclusion of these kinds can directly reduce well-being and can also have significant consequences in terms of lower participation in healthcare, higher rates of mortality, higher levels of self-stigma, lower levels of empowerment and higher rates of unemployment [14] [40] [43]. Employment rates for people with mental health problems, for instance, are lower than those of the overall population and lower than those for people with physical health problems [25] [38]. "
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    ABSTRACT: Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.
    European Psychiatry 08/2014; in press(6). DOI:10.1016/j.eurpsy.2014.02.007 · 3.44 Impact Factor
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    • "We did not examine the role of individual risk factors for suicidal behaviour nor individual reactions to stigma. Previous studies combining individual-level data on stigma experience and country levels of stigma have, however, shown that aggregate stigma levels have a negative impact on individual experiences of mental illness (Mojtabai, 2010; Evans-Lacko et al. 2012, 2013). "
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    ABSTRACT: Aims: There is substantial diversity in national suicide rates, which has mainly been related to socio-economic factors, as well as cultural factors. Stigma is a cultural phenomenon, determining the level of social acceptance or rejection of persons with mental illness in a society. In this study, we explore whether national suicide rates are related to the degree of mental illness stigma in that country. Methods: We combine the data on country-level social acceptance (Eurobarometer) with the data on suicide rates and socio-economic indicators (Eurostat) for 25 European countries. Results: In a linear regression model controlling for socio-economic indicators, the social acceptance of someone with a significant mental health problem in 2010 was negatively correlated with age standardised national suicide rates in the same year (β -0.46, p = 0.014). This association also held true when combining national suicide rates with death rates due to events of undetermined intent. Conclusions: Stigma towards persons with mental health problems may contribute to differences in suicide rates in a country. We hypothesise possible mechanisms explaining this link, including stigma as a stressor and social isolation as a consequence of stigma.
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