Public stigma |
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Quantitative |
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Delevati & Palazzo1919. Delevati DM, Palazzo LS. Atitudes de empresários do sul do Brasil em relação aos portadores de doenças mentais. J Bras Psiquiatr. 2008;57:240-6.
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536 employers, Brazil |
To learn the attitudes of employers toward people with mental disorders. |
- Questionnaire: sociodemographic information- Attitudes and opinions about mental illness |
Participating employers scored highest in benevolence. Authoritarianism was also a common factor.Employers are generally in favor of social restriction. |
Des Courtis2020. Des Courtis N, Lauber C, Costa CT, Cattapan-Ludewig K. Beliefs about the mentally ill: a comparative study between healthcare professionals in Brazil and in Switzerland. Int Rev Psychiatry. 2008;20:503-9.
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112 mental health professionals, Brazil1, 073 mental health professionals, Switzerland |
1) To assess knowledge about mental health and general attitudes toward people with mental illness in a sample of mental health professionals in Brazil and Switzerland.2) To compare the results between different professional groups. |
- Questionnaire developed by the authors- Semistructured interview- DSM-III-R case vignette |
Mental health professionals in Switzerland, compared with those from Brazil, showed greater social distance and stigmatizing attitudes toward people with mental illness (p < 0.001). Brazilian mental health professionals showed more positive attitudes toward community psychiatry (p < 0.001). |
Gibson66. Gibson RC, Abel WD, White S, Hickling FW. Internalizing stigma associated with mental illness: findings from a general population survey in Jamaica. Rev Panam Salud Publica. 2008;23:26-33.
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1,306 community members, Jamaica |
To determine the degree of internalization of stigma toward mental illness and the assimilation of attitudes, cognitions, and behaviors in people who are at risk of stigmatizing in Jamaica. |
- Semistructured interview- Questionnaire developed by the authors |
People with family members with mental disorders are less likely (57.0%) than others (66.4%) to avoid them. They were also more likely to be friendly (82.6 vs. 72.8%).Moreover, 79-82% of respondents displayed attitudes of compassion, care, love, and concern, compared with 37-43% who showed attitudes of anger, fear, and disgust. |
Ronzani2121. Ronzani TM, Higgins-Biddle J, Furtado EF. Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil. Soc Sci Med. 2009;69:1080-4.
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609 mental health professionals, Brazil |
To investigate the opinions, moral stereotypes, and attributions regarding alcohol and drug dependence in primary centers. |
- Questionnaire developed by the authors assessing stereotypes and attributions- Judgment scale on alcoholism- Questionnaire about mental disorders- Personal difficulty evaluation |
The moral (or stigmatizing) judgments between professional groups showed significant differences (p < 0.01); nursing assistants were the most stigmatizing professionals.Use of tobacco, marijuana/cocaine, and alcohol were most highly judged (p < 0.05), compared with other disorders. |
Fresán2222. Fresán A, Robles-Garcia R, de Benito L, Saracco Alvarez RA, Escamilla R. Desarrollo y propiedades psicométricas de un instrumento breve para evaluar el estigma de agresividad en la esquizofrenia. Actas Esp Psiquiatr. 2010;38:340-4.
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258 community members, Mexico |
To develop an instrument about public conception of aggressiveness in schizophrenia and to determine its reliability and validity. |
- Questionnaire developed by the authors: Public CAQ- Sociodemographic information |
53.9% of participants affirmed that the person described in the vignette (someone with a diagnosis of schizophrenia) was not aggressive or dangerous. Only 23.3% of the sample recommended psychopharmacology as the first line of treatment. Finally, the CAQ had adequate internal consistency (alpha = 0.74). |
Leiderman77. Leiderman EA, Vazquez G, Berizzo C, Bonifacio A, Bruscoli N, Capria JI, et al. Public knowledge, beliefs and attitudes towards patients with schizophrenia: Buenos Aires. Soc Psychiatry Psychiatr Epidemiol. 2011;46:281-90.
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1,254 community members, Argentina |
To assess knowledge, social distance, and perceived social discrimination toward people with schizophrenia. |
- Scale developed by the authors assessing: knowledge about schizophrenia, social distance, perception of social discrimination |
44.4% of the population surveyed believed that people with schizophrenia suffer from “multiple personality,” and 69.9% believe that these individuals show “bizarre or inadequate behavior.” Almost 80% of the population had an elevated perception of social discrimination toward individuals with mental illness. |
Loch88. Loch AA, Hengartner MP, Guarniero FB, Lawson FL, Wang Y, Gattaz WF, et al. Psychiatrists' stigma towards individuals with schizophrenia. Rev Psiquiatr Clin. 2011;38:173-7.
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1,414 psychiatrists, Brazil |
To assess the attitudes of Brazilian psychiatrists toward people with schizophrenia. |
- Questionnaire developed by the authors assessing: stereotypes, social distance, and prejudice; drugs and tolerance of side effects; sociodemographic and professional information concerning the psychiatrists |
Psychiatrists had negative stereotypes and social distance toward people with schizophrenia.Psychiatrists who worked in a university psychiatric hospital exhibited lower levels of social distance that psychiatrists who did not (p = 0.009).Older psychiatrists had positive stereotypes and less prejudice (p = 0.012). |
Peluso2323. Peluso ÉT, Blay SL. Public stigma and schizophrenia in São Paulo city. Rev Bras Psiquiatr. 2011;33:130-6.
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500 community members, Brazil |
To assess public stigma toward people with schizophrenia and possible factors associated with this phenomenon. |
- Vignette (DSM-IV and ICD-10 criteria)- Questions about vignette |
Logistic regression analysis showed that the participants identified the vignette as concerning mental illness (p = 0.02, OR = 1.26). The attribution of “biological reasons” (p = 0.00, OR = 2.26) was associated with increased perceptions of danger. |
Fresán2424. Fresán A, Robles R, Cota M, Berlanga C, Lozano D, Tena A. Actitudes de mujeres estudiantes de psicología hacia las personas con esquizofrenia: relación con la percepción de agresividad y peligrosidad. Salud Ment. 2012;35:215-23.
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110 community members, Mexico |
To evaluate the attitudes of a group of female psychology students toward mental illness to determine their perceptions of risk and aggressiveness of individuals with schizophrenia. |
- OMI-M- CPA |
59.1% of the students felt that the person described in the clinical case vignette could be aggressive in some way.The students who perceived the person described in the vignette as aggressive exhibited higher scores in areas of restriction and higher pessimistic prediction in the total OMI-M score. |
Robles García2525. Robles-Garcia R, Fresan A, Berlanga C, Martinez N. Mental illness recognition and beliefs about adequate treatment of a patient with schizophrenia: association with gender and perception of aggressiveness-dangerousness in a community sample of Mexico City. Int J Soc Psychiatry. 2012;59:811-8.
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1,038 community members, Mexico |
To assess mental illness recognition and beliefs about treatment of schizophrenia, and to determine their relationship with perception of patient aggressiveness/dangerousness. |
- CPA- Questionnaire developed by the authors assessing: perception of patient aggressiveness and dangerousness; mental illness recognition and beliefs about adequate treatment |
54.5% of responders believed that the person described in the vignette would eventually behave aggressively. Specifically, verbal aggression was the most common belief (n=420, 40.5%).Most women could recognize mental illness and suggested psychiatric interventions as the most adequate treatment to control and reduce symptoms. Alternatively, men considered non-psychiatric interventions (such as talking with families or friends) more often. |
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Qualitative |
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Hickling2626. Hickling FW, Robertson-Hickling H, Paisley V. Deinstitutionalization and attitudes toward mental illness in Jamaica: a qualitative study. Rev Panam Salud Publica. 2011;29:169-76.
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159 community members, Jamaica |
To assess whether deinstitutionalization and community mental health care reduce stigma toward mental illness in Jamaica. |
- Focus groups (20, of separate and mixed gender) |
Feelings of avoidance and fear of violent behavior during the period of deinstitutionalization were transformed into feelings of compassion and kindness after the integration of community mental health services into the primary care systems. |
Martin2727. Martin D, Andreoli SB, Pinto RM, Barreira TM. Living conditions of people with psychotic disorders living in slums in Santos, Southeastern Brazil. Rev Saude Publica. 2011;45:693-9.
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Eight community members, Brazil |
Describe living conditions and sociability among people with severe mental disorders living in slums. |
- Ethnographic observations- Semistructured in-depth interviews |
People in the community believed that individuals with mental illness were “angry,” “nervous,” or “mentally weak.”There was great fear about security, i.e., that individuals with impaired control could attack other residents. The community members also expressed some attitudes indicative of compassion. |
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Consumer stigma |
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Quantitative |
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Flores2828. Flores Reynoso S, Medina Dávalos R, Robles García R. Estudio de traducción al espaãol y evaluación psicométrica de una escala para medir el estigma internalizado en pacientes con trastornos mentales graves. Salud Ment. 2011;34:33-339.
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100 consumers, Mexico |
1) To carry out a Spanish adaptation of the ISS.2) To evaluate basic psychometric properties among Mexicans with severe mental disorders. |
- ISS- GAF- CGI |
The Mexican version showed good internal consistency, with alpha coefficients above 0.60 in all subscales. The dimensional assessment of the construct is highly reliable, with a coefficient of 0.87. |
Vázquez2929. Vázquez GH, Kapczinski F, Magalhaes PV, Cordoba R, Lopez Jaramillo C, Rosa AR, et al. Stigma and functioning in patients with bipolar disorder. J Affect Disord. 2011;130:323-7.
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241 consumers, Argentina, Brazil, and Colombia |
To evaluate the association between perceived stigma and functionality in consumers with bipolar disorder in Latin America. |
- FAST- ISE |
Functional impairment was significantly associated with perceived stigma experience: Brazil (r = 0.49, p = 0.001; r = 0.54, p = 0.001).Colombia (r = 0.34, p = 0.002; r = 0.26, p = 0.017).Argentina (p ≤ 0.10) (r = 0.21, p = 0.078; r = 0.18, p = 0.10). |
Mileva3030. Mileva VR, Vazquez GH, Milev R. Effects, experiences, and impact of stigma on patients with bipolar disorder. Neuropsychiatr Dis Treat. 2013;9:31-40.
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392 consumers, Argentina and Canada |
1) To adapt ISE.2) To evaluate basic psychometric properties among Argentines with bipolar disorder. |
- ISE- SES- SIS |
Over 50% of respondents believed that the average person is afraid of those with mental illnesses and that stigma associated with mental illness has affected their quality of life and their self-esteem.SES: coefficient of reliability = 0.78.SIS: Cronbach’s alpha = 0.91. |
Mora-Ríos3131. Mora-Ríos J, Ortega-Ortega M, Natera G, Bautista-Aguilar N. Auto-estigma en personas con diagnóstico de trastorno mental grave y su relación con variables sociodemográficas, clínicas y psicosociales. Acta Psiquiatr Psicol Am Lat. 2013;59:147-58.
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59 consumers (schizophrenia, bipolar disorder, drug abuse and dependence, obsessive/compulsive disorder, among others), Mexico |
To analyze sociodemographic, clinical, and psychosocial variables related to self-stigma in people with mental illness. |
- Sociodemographic and clinical data- EPCP- ISMI |
More than 90% of consumers experienced rejection at least once in their lives. According to respondents, the family was the main source of discrimination, and behaviors such as underestimation or hostile attitudes were frequently reported.Perception of the consequences of mental illness in the workplace explained the variance of alienation (33%), stereotype endorsement (21%), and stigma resistance (23%), all subscales of the ISMI. The consequences of mental illness on family relationships, together with medical diagnosis and time under treatment, explained 49% of variance of the discrimination subscale. |
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Qualitative |
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Jorge & Bezzerra3232. Jorge MSB, Bezerra MLMR. Inclusão e exclusão social do doente mental no trabalho: representações sociais. Texto Contexto Enferm. 2004;13:551-8.
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8 consumers, Brazil |
To understand the social representations of employment for consumers and mental health professionals. |
- Semistructured interview |
Results were organized according to three categories:1) Be excluded from work: life difficulties, bias, disability, and social isolation.2) Harm resulting from the exclusion from work: Marginalization and emotional disintegration.3) Sense of inclusion at work: Need and symbolic value. |
Araújo3333. Araújo TCBC, Moreira V, Cavalcante Junior FS. Sofrimento de Sávio: estigma de ser doente mental em Fortaleza. Fractal Rev Psicol. 2008;20:119-28.
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1 consumer, Brazil |
To understand the stigma experience of a person with a diagnosis of somatoform disorder. |
- Informal conversations- Participant observation- Field notes |
Presence of stigma attached to mental illness in the consumer’s daily life and relationships. Stigma was manifested through discrimination, rejection, difference, and isolation. Stigma led to social isolation due to fear of revealing illness. |
Robillard3434. Robillard C. The gendered experience of stigmatization in severe and persistent mental illness in Lima, Peru. Soc Sci Med. 2010;71:2178-86.
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22 consumers, Peru |
To understand gender keys that produce social stigma of mental illness in the general population. |
- Field notes- Focus group |
Participants’ labels, such as insane, mad, or manic, were associated with violent behavior, bizarre behavior, animal-like behavior, loss of control, and homelessness.Most people had experienced discrimination and/or exclusion. |
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Family stigma |
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Quantitative |
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Lolich3535. Lolich M, Vázquez G, Leiderman EA. Primer episodio psicótico en trastorno bipolar: diferenciación clínica e impacto funcional en una muestra argentina. Vertex. 2010;21:418-27.
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175 consumers, Argentina |
To investigate the clinical characteristics of consumers with bipolar disorder who have manifested psychotic symptoms. |
- Clinical evaluation, YMRS, and HAM-D- Functionality: FAST- Stigma: ISE |
People with BP with psychotic onset had higher work functioning than people with BP without psychotic onset (p = 0.037). For consumers with psychotic onset, a greater perception of stigma in the item of stigmatization due to family illness was identified (p = 0.003). |
Loch3636. Loch AA. Stigma and higher rates of psychiatric re-hospitalization: São Paulo public mental health system. Rev Bras Psiquiatr. 2012;34:185-92.
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169 consumers, 169 relatives, Brazil |
1) To evaluate re-hospitalization rates of people with psychosis and bipolar disorder.2) To study the determinants of readmission. |
- Telephone interview using a questionnaire developed by the author |
Rehospitalization rate after one year was 42.6%. Family members’ agreement with the consumers’ ongoing hospitalization was a predictor associated with readmission. Readmitted persons were often classified as dangerous and unhealthy by their own families. |
Loch3737. Loch AA, Wang YP, Guarniero FB, Lawson FL, Hengartner MP, Rössler W, et al. Patterns of stigma toward schizophrenia among the general population: a latent profile analysis. Int J Soc Psychiatry. 2014;60:595-605.
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1,015 general population individuals, Brazil |
To assess stigma toward schizophrenia in a sample of the Brazilian general population. |
- Vignette (DSM-IV criteria)- Questions about vignette- Likert scale of stereotypes (12 items), social restriction (3 items), perceived prejudice (8 items), and social distance (7 items) |
Four stigma profiles were found: no stigma individuals (n=251); labelers (n=222) scored high on social distance; discriminators, the group with the majority of individuals (n=302), showed high levels of stigmatizing beliefs in all dimensions; and unobtrusive stigma individuals (n=240). |
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Multiple stigma |
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Chuaqui3838. Chuaqui J. El estigma en la esquizofrenia. Cienc Soc Online. 2005;2:45-66.
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250 consumers, 60 relatives, 200 community members, 150 employers, Chile |
To describe stigma toward mental illness in a group of consumers, family members, employers, guardians, and community members. |
- Semistructured interview- Questionnaire developed by the authors |
Consumer stigma: only 13.3% were working in competitive situations and unprotected.Family stigma: 71.6% knew nothing or little about schizophrenia before their family members was diagnosed.Public stigma: 68% of employers think that people with schizophrenia do even simple tasks poorly. |
Uribe Restrepo3939. Uribe Restrepo M, Mora OL, Cortés Rodríguez AC. Voces del estigma Percepción de estigma en pacientes y familias con enfermedad mental. Univ Med. 2007;48:207-20.
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52 consumers, 18 relatives, Colombia |
To describe characteristics of stigma. |
- Focus group- Semistructured interview |
Consumer stigma: consumers described stigma as rejection, ignorance, derogatory language, low self-esteem, lack of autonomy and freedom. These included feelings of social exclusion and of being different.Family stigma: consumers’ siblings commented on their denial, pain, and frustration after learning the diagnosis. |
Wagner4040. Wagner LC, Torres-González F, Geidel AR, King MB. Existential questions in schizophrenia: perception of patients and caregivers. Rev Saude Publica. 2011;45:401-8.
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146 consumers, 80 relatives, Argentina, Brazil, Chile, England, Spain, and Venezuela |
To examine existential questions from people with schizophrenia and their caregivers. |
- Focus groups were used to gather qualitative data |
Consumer stigma: consumers experience a sense of uselessness, feel unproductive, dependent and therefore inferior to others. Gender differences were reported.Family stigma: several families feel embarrassed to have a “special member.” Many families feel like victims of a cruel fate. Abandonment and institutionalization occur specially in Argentina and Venezuela. |
Mora-Ríos4141. Mora-Ríos J, Bautista-Aguilar N, Natera G, Pedersen D. Adaptación cultural de instrumentos de medida sobre estigma y enfermedad mental en la Ciudad de México. Salud Ment. 2013;36:9-18.
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8 health professionals, 15 relatives, 4 community members, 2 consumers, Mexico |
To describe the cultural adaptation and semantic validation of three instruments for measuring stigma and mental illness. |
- ISMI- OMI- DDS- Focus groups- Semistructured interviews |
The instruments included in this research had good levels of understanding, acceptability, relevance, and semantic integrity. After qualitative analysis, the responders suggested several new items for addition to each instrument. Many related to gender issues (“Most people think that a woman is more prone to mental illnesses,” “Women are more likely to develop a mental illness”) or family (“Most of the relatives of a person who is mentally ill are ashamed of him/her,” “Due to my mental illness I’m feeling closer to my family”). |