Global Pattern of Experienced and Anticipated Discrimination against People with Schizophrenia: a Cross-sectional Survey

BACKGROUND Many people with schizophrenia experience stigma caused by other people's knowledge, attitudes, and behaviour; this can lead to impoverishment, social marginalisation, and low quality of life. We aimed to describe the nature, direction, and severity of anticipated and experienced discrimination reported by people with schizophrenia. METHODS We did a cross-sectional survey in 27 countries, in centres affiliated to the INDIGO Research Network, by use of face-to-face interviews with 732 participants with schizophrenia. Discrimination was measured with the newly validated discrimination and stigma scale (DISC), which produces three subscores: positive experienced discrimination; negative experienced discrimination; and anticipated discrimination. FINDINGS Negative discrimination was experienced by 344 (47%) of 729 participants in making or keeping friends, by 315 (43%) of 728 from family members, by 209 (29%) of 724 in finding a job, 215 (29%) of 730 in keeping a job, and by 196 (27%) of 724 in intimate or sexual relationships. Positive experienced discrimination was rare. Anticipated discrimination affected 469 (64%) in applying for work, training, or education and 402 (55%) looking for a close relationship; 526 (72%) felt the need to conceal their diagnosis. Over a third of participants anticipated discrimination for job seeking and close personal relationships when no discrimination was experienced. INTERPRETATION Rates of both anticipated and experienced discrimination are consistently high across countries among people with mental illness. Measures such as disability discrimination laws might, therefore, not be effective without interventions to improve self-esteem of people with mental illness.

[1]  R. Littlewood.  Cultural variation in the stigmatisation of mental illness , 1998, The Lancet.

[2]  A. Jacoby,et al.  Felt versus enacted stigma: a concept revisited. Evidence from a study of people with epilepsy in remission. , 1994, Social science & medicine.

[3]  Jim Bolton Consultant Psychiatrist and Honorary Senior.  Reducing the stigma of mental illness. A report from a Global Programme of the World Psychiatric Association , 2007 .

[4]  A. Korten,et al.  Early manifestations and first-contact incidence of schizophrenia in different cultures: A preliminary report on the initial evaluation phase of the WHO Collaborative Study on Determinants of Outcome of Severe Mental Disorders , 1986, Psychological Medicine.

[5]  L. Siever.  Shunned: Discrimination Against People with Mental Illness , 2007 .

[6]  E. Cumming,et al.  On the stigma of mental illness , 1965, Community Mental Health Journal.

[7]  B. Biesecker,et al.  Living with Marfan syndrome: coping with stigma , 2005, Clinical genetics.

[8]  N. Kadri,et al.  Stigma Impact on Moroccan Families of Patients with Schizophrenia , 2004, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[9]  M. Angermeyer,et al.  Das Stigma psychischer Erkrankung: Konzepte, Formen und Folgen , 2005 .

[10]  G. Scambler.  Stigma and disease: changing paradigms , 1998, The Lancet.

[11]  R L Williams,et al.  A Note on Robust Variance Estimation for Cluster‐Correlated Data , 2000, Biometrics.

[12]  G. Mshana,et al.  Barriers to accessing antiretroviral therapy in Kisesa, Tanzania: a qualitative study of early rural referrals to the national program. , 2006, AIDS patient care and STDs.

[13]  M J Buxton,et al.  Evaluating patient-based outcome measures for use in clinical trials. , 1998, Health technology assessment.

[14]  N. Sartorius,et al.  Reducing the Stigma of Mental Illness: A Report from a Global Association , 2005 .

[15]  S. Blay,et al.  Community perception of mental disorders - a systematic review of Latin American and Caribbean studies. , 2004, Social psychiatry and psychiatric epidemiology.

[16]  P. Vounatsou,et al.  Psychiatric stigma across cultures: Local validation in Bangalore and London , 2001 .

[17]  S. Fiske,et al.  The Handbook of Social Psychology , 1935 .

[18]  A. Carr,et al.  Primary total hip replacement surgery: a systematic review of outcomes and modelling of cost-effectiveness associated with different prostheses. , 1998, Health technology assessment.

[19]  G. Thornicroft.  Most people with mental illness are not treated , 2007, The Lancet.

[20]  Helen Lambert,et al.  Anthropology in health research: from qualitative methods to multidisciplinarity , 2002, BMJ : British Medical Journal.

[21]  N. Rüsch,et al.  [The stigma of mental illness: concepts, forms, and consequences]. , 2005, Psychiatrische Praxis.

[22]  Scott Weich,et al.  The Stigma Scale: development of a standardised measure of the stigma of mental illness , 2007, British Journal of Psychiatry.

[23]  Gerhard Falk,et al.  Stigma: How We Treat Outsiders , 2001 .

[24]  Bruce G. Link,et al.  A modified labeling theory approach to mental disorders : an empirical assessment , 1989 .

[25]  Phil Thomas.  Users' Voices: The Perspective of Mental Health Service Users on Community and Hospital Care: By Diana Rose , 2002 .

[26]  A. Alem,et al.  How are mental disorders seen and where is help sought in a rural Ethiopian community? A key informant study in Butajira, Ethiopia , 1999, Acta psychiatrica Scandinavica. Supplementum.

[27]  A. Ryder,et al.  A Cross-National Study of the Stigmatization of Severe Psychiatric Illness: Historical Review, Methodological Considerations and Development of the Questionnaire , 2007, Transcultural psychiatry.

[28]  J. Ritsher,et al.  Internalized stigma predicts erosion of morale among psychiatric outpatients , 2004, Psychiatry Research.

[29]  S. Blay,et al.  Community perception of mental disorders , 2004, Social Psychiatry and Psychiatric Epidemiology.

[30]  R. Thara,et al.  Women with Schizophrenia and Broken Marriages - Doubly Disadvantaged? Part I: Patient Perspective , 2003, The International journal of social psychiatry.

[31]  Bruce G. Link,et al.  Measuring mental illness stigma. , 2004, Schizophrenia bulletin.

[32]  J. Graham,et al.  Cross-National Study of Attitudes Towards Seeking Professional Help: Jordan, United Arab Emirates (UAE) and Arabs in Israel , 2004, The International journal of social psychiatry.

[33]  P. Corrigan,et al.  Structural levels of mental illness stigma and discrimination. , 2004, Schizophrenia bulletin.