Stigma towards People with Mental Illness in Developing Countries in Asia

Psychiatric University Hospital, Zurich, Switzerland.
International Review of Psychiatry (Impact Factor: 1.8). 05/2007; 19(2):157-78. DOI: 10.1080/09540260701278903
Source: PubMed


There is a wide range of literature on stigmatization and discrimination of people with mental illness. Most studies, however, derive from Western countries. This review aims at summarizing results from developing countries in Asia published between 1996-2006.
Medline search focusing on English-speaking literature.
Comparable to Western countries, there is a widespread tendency to stigmatize and discriminate people with mental illness in Asia. People with mental illness are considered as dangerous and aggressive which in turn increases the social distance. The role of supernatural, religious and magical approaches to mental illness is prevailing. The pathway to care is often shaped by scepticism towards mental health services and the treatments offered. Stigma experienced from family members is pervasive. Moreover, social disapproval and devaluation of families with mentally ill individuals are an important concern. This holds true particularly with regards to marriage, marital separation and divorce. Psychic symptoms, unlike somatic symptoms, are construed as socially disadvantageous. Thus, somatisation of psychiatric disorders is widespread in Asia. The most urgent problem of mental health care in Asia is the lack of personal and financial resources. Thus, mental health professionals are mostly located in urban areas. This increases the barriers to seek help and contributes to the stigmatization of the mentally ill. The attitude of mental health professionals towards people with mental illness is often stigmatizing.
This review revealed that the stigmatization of people with mental illness is widespread in Asia. The features of stigmatization-beliefs about causes of and attitudes towards mental illness, consequences for help-seeking-have more commonalities than differences to Western countries.

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    • "However, contradicting this, there is now a considerable body of evidence documenting that in many LAMIC settings, experiences of stigma, discrimination and human rights abuses due to mental illness are common and severe (Phillips et al. 2002; Thara et al. 2003; Murthy, 2005; Lee et al. 2005; Botha et al. 2006; Lee et al. 2006; Lauber & Rossler, 2007; Alonso et al. 2009; Barke et al. 2011; Drew et al. 2011; Sorsdahl et al. 2012; Lasalvia et al. 2013). One international study using population-wide data from 16 countries found even higher rates of reported stigma among people with mental disorders in developing (31.2%) than in developed (20%) countries (Alonso et al. 2008). "
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    ABSTRACT: 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. 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. 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. Generating information about effective interventions to reduce stigma and discrimination in LAMICs is now an important mental health priority worldwide.
    Epidemiology and Psychiatric Sciences 05/2015; 24(5):1-14. DOI:10.1017/S2045796015000359 · 3.91 Impact Factor
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    • "Additionally, the patient suffered too much from her psychotic symptoms and found relief in bodily pain. Similar to many other patients, stigma toward mental illness in Iran seems to be the most important reason for the delayed diagnosis [19] [20]. The situation may be more complicated, as in Muslim communities mental illness may be perceived as a punishment from God [21]. "
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    ABSTRACT: There are few reports of severe self-injury to eyes in patients with schizophrenia. We report on a 41-year-old woman, primarily visiting for symptoms of endophthalmitis resulting from self-inflicted needles. Further evaluations established the diagnosis of schizophrenia because of arguing and commenting on auditory hallucinations and negative symptoms including social isolation, decreased self-care, blunt affect, and a monotone voice. The patient had been suffering from auditory hallucinations for several years and found relief in bodily pain caused by needles. The patient received 6 mg of risperidone. Hallucinations were resolved and self-injury behaviour was not repeated.
    03/2015; 2015:960579. DOI:10.1155/2015/960579
    • "He described having no experience of his own or others' mental health difficulties and was not familiar with ideas such as 'PTSD'. Evidence suggests that stigma towards and self-stigma by those with mental health difficulties in Iran is high (Lauber & Rössler, 2007; Ghanean et al. 2011). The consideration of culturally mediated beliefs about emotional expression gives rise to hypothesized prior beliefs and appraisals of the trauma that can be incorporated into reformulation. "
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    ABSTRACT: Self-reflection can aid therapist development, particularly interpersonal skills. It can be achieved through using cognitive-behavioural therapy techniques, for example, formulations of the therapist's cognitions and behaviours have been used to aid self-reflection. As interpersonal skills may be an area that benefits from self-reflection, an approach to formulating the interaction between client and therapist may be beneficial. This study reports the use of simple ‘antecedent-belief-consequence’ (ABC) formulations for the client and therapist to conceptualize their interaction. This description of a treatment failure focuses on cross-cultural work with a survivor of torture, where self-reflection may be particularly indicated to promote cultural competence and address the impact of the content on the therapist. ABC formulations for the client and therapist were completed and through this structured self-reflection, the therapist was able to identify the impact of her own beliefs on the process of therapy. This method identified areas for further development and generated hypotheses for how to continue therapy with this client. Using ABC formulations then may provide a useful and structured way to conduct self-reflection with explicit focus on the interaction between client and therapist.
    The Cognitive Behaviour Therapist 01/2015; 8. DOI:10.1017/S1754470X15000203
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