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
    • "Although our study was unable to address the extent to which shame enhances levels of stigma, the recurrence of psychological symptoms could be hypothesized to cause the recurrence of shame and self-stigma, thus limiting the communication and sharing of any suicidal thoughts that may in turn lead to recurrent attempted suicides. These results further highlight the importance of promoting awareness about suicide as a preventable correlate of mental illness (Serra et al., 2013; Evans-Lacko et al., 2012 ). The development of projects specifically aimed to reduce stigma in the general and clinical populations would be an easily implementable, cost-effective strategy to reduce psychological distress and suicidal behavior. "
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    ABSTRACT: People who suffer from mental illness have high self-stigmatizing attitudes. This study aims to test the effect of psychopathological distress on stigma toward attempted suicide in a population of suicide attempters. Data were collected through an interview and 2 questionnaires (90-item Symptom Checklist; Stigma of Suicide Attempt scale) administered to 67 patients hospitalized after an attempted suicide. Participants with a history of past attempted suicide had higher scores on the Stigma of Suicide Attempt scale (t58.9 = -2.51, p = 0.014). Higher levels of psychological distress were related to greater perceived stigma only in individuals with a history of past attempted suicide (standardized coefficient = 0.37; t = 2.36; p = 0.024; R = 14%; adjusted R = 11.5%). A previous experience of attempted suicide is related to greater self-stigmatizing attitudes toward suicidal behavior. Among those who have previously attempted suicide in particular, psychopathological distress may significantly contribute to increase the perception of stigma.
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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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    ABSTRACT: Evidence suggests that poor mental health literacy is a key barrier to help-seeking for mental health difficulties in adolescence. Educational programs have shown positive effects on literacy, however, the evidence base remains limited and available studies have many methodological limitations. Using cluster Randomised Control Trial (RCT) methodology, the current study examines the impact of 'HeadStrong', a school-based educational intervention, on mental health literacy, stigma, help-seeking, psychological distress and suicidal ideation. A total of 380 students in 22 classes (clusters) from 10 non-government secondary schools was randomised to receive either HeadStrong or Personal Development, Health and Physical Education (PDHPE) classes. Participants were assessed pre- and post-intervention, and at 6-month follow-up. Literacy improved and stigma reduced in both groups at post-intervention and follow-up, relative to baseline. However, these effects were significantly greater in the HeadStrong condition. The study demonstrates the potential of HeadStrong to improve mental health literacy and reduce stigma.
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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.
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