Skip to main content

Table 3 Research on mental health and stigma in LMICs, 2008–2017

From: A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries

Study (First author, year [ref.]) Location Sampling characteristics Sample size Study design Type of stigma assessed Description of stigma association (strength, significance) Significant mediators/moderators
Adewuya, 2009 [94] Nigeria Facility-based sample; any disorder 342 Cross-sectional Internalized (ISMI) Poor medication adherence for high relative to low stigma None
Assefa, 2012 [93] Ethiopia Facility-based sample; schizophrenia 212 Cross-sectional Internalized (ISMI) Discontinuation of psychotropic medication for high relative to low stigma
Psychotic symptoms for high relative to low stigma
Suicide attempt for those with high relative to low stigma
None
Bifftu, 2014, 2014 [95, 187] Ethiopia Facility-based sample; schizophrenia 411 Cross-sectional Perceived (PDD), resistance (ISMI-SR) Poor antipsychotic medication adherence for high perceived relative to low perceived stigma and for high relative to low stigma resistance Duration of illness less than 1 year for high relative to low perceived stigma (NS for stigma resistance)
Poor follow-up care NS for perceived stigma or stigma resistance
None
Cai, 2017 [188] China Facility-based sample; schizophrenia 172 Cross-sectional Internalized (ISMI) Stigma not associated with quality of life None
Dardas, 2017 [106] Jordan School-based; depression 2349 Cross-sectional Personal and perceived (DSS) Stigma associated with care seeking Mod: Significant interaction between stigma and depression for willingness to seek help
Devi Thakoor, 2016 [189] China, Mauritius Facility-based sample; SMI 300 Cross-sectional Internalized (ISMI) Duration of psychosis of greater than 3 months relative to less than 3 months was associated only with the following ISMI items: increased perceived break up due to illness and increased perceived disinheritance due to illness by family (China); decreased patient awareness of illness and decreased family awareness of illness (Mauritius) None
Elkington, 2010 [92] Brazil Facility-based sample; SMI 98 Cross-sectional Internalized, experienced discrimination, perceived (SPISEW) Significantly higher mean personal experiences of stigma score for individuals in the mild to moderate vs. moderate to marked illness severity group
Perceived attractiveness and relationship discrimination stigma scales were NS HIV risk and protective behaviors associated with relationship discrimination for sexual activity, unprotected sex, and fewer partners; perceived attractiveness – all NS; personal experiences – all NS
None
Fawzi, 2016 [91] Egypt Facility-based sample; depression 196 Cohort Internalized (ISMI) Treatment acceptance: patients refusing treatment had a higher stigma score than those who accepted treatment
Diabetes: increase in ISMI score was associated with change in fasting plasma glucose and standardized 8-week percentage change in HbA1c levels in multiple regression analyses
None
Fresan, 2017 [190] Mexico Facility-based sample; schizophrenia 217 Cross-sectional Perceived and experienced discrimination (KSS) Length of hospitalization increase of 1 week associated with KSS score Duration of untreated psychosis was NS None
Grover, 2017 [99] India Facility-based sample; SMI 1403 Cross-sectional Internalized (ISMI) Shorter duration of illness was significantly correlated with higher overall internalized stigma among patients with schizophrenia, but the SE and DE subscales were NS; overall stigma and all subscales were NS among patients with recurrent depressive disorder
Shorter duration of treatment was significantly correlated with higher overall internalized stigma among patients with schizophrenia, but the SE and SR subscales were NS
Among patients with recurring depression, higher overall internalized stigma was significantly correlated, but the SE, DE, and SR subscales were NS Lesser symptom severity among patients with schizophrenia, as measured by the PANSS-P, was significantly correlated with overall stigma and only the SR subscale was NS; however, the PANSS-N and PANSS general psychopathology scales were NS with overall stigma
For patients with depression as measured by the HDRS, overall stigma was significantly correlated, but not the SE, SW, or SR subscales
Greater participation restriction was significantly correlated with overall stigma score and all subscales among patients with schizophrenia; for patients with depression, overall stigma score was significant, but the A and SE subscales were NS
None
Koschorke, 2014 [101] India Schizophrenia 282 Cross-sectional Anticipated and experienced discrimination (DISC) Symptom severity, as measured by total PANSS score, was NS in association with discrimination; however, belonging in a higher PANSS-N quartile was associated with reduced odds of experiencing negative discrimination, while belonging in a higher PANSS-P quartile was associated with increased odds of experiencing negative discrimination None
Kulesza, 2014 [102] India Facility-based sample; majority exhibited depression 60 Cross-sectional Anticipated and perceived (EMIC-SS) Symptom severity for depression was positively correlated with stigma None
Lahariya, 2010 [97] India Facility-based sample; SMI 295 Cross-sectional One question on fear of stigma related to care seeking Delay in care seeking: 73% of patients had delayed seeking care at least in part due to a fear of stigma None
Li, 2017 [88] China Facility-based sample; schizophrenia 384 Cross-sectional Internalized (ISMI) Psychiatric symptoms: Stigma significantly increased with an increase in general symptoms measured via the BPRS in multiple regression analyses; PANSS-N NS
Functioning: Stigma score significantly decreased with an increase in GAF in multiple regression analyses
Quality of life: Stigma score significantly increased b = 0.01 (0.01–0.02) with an increase in SQLS score in multiple regression analyses
None
Loch, 2012 [191] Brazil Facility-based sample; mostly SMI 169 Cohort Question on dangerousness stereotyping Re-hospitalization: Individuals who were readmitted over the year were significantly more likely to be stereotyped as dangerous by family members that those who were not readmitted None
Lu, 2012 [192] China Facility-based sample; schizophrenia 92 Cross-sectional Internalized (ISMI); experienced discrimination (MCESQ) Insight: MCESQ and ISMI total score was NS in multiple regression with insight as the outcome None
Lv, 2013 [100] China Facility-based sample; schizophrenia 95 Cross-sectional Internalized (ISMI) Symptom severity: Positive and negative symptoms of psychosis both NS
Greater duration of illness was associated with a change in stigma score; greater number of hospitalizations was NS; greater quality of life was associated with a change in stigma score
None
Mosanya, 2014 [98] Nigeria Facility-based sample; schizophrenia 256 Cross-sectional Internalized (ISMI) Medication side effects, comorbid medical problem, duration of illness, and number of episodes all NS
Increase in BPRS score increased the odds of having high vs. low stigma Individual in the high stigma group had significantly lower mean quality of life as measured by all WHOQOL-Brief subscales (physical, psychological, social, and environment) as well as the overall quality of life and general health
None
Rayan, 2017 [103] Jordan Facility-based sample; depression 160 Cross-sectional Perceived (PDD) Pain was NS
An increase in number of relapses was associated with a significant change in stigma score
Symptom severity of depression was associated with a significant change in stigma score
None
Rayan, 2017 [104] Jordan Facility-based sample; schizophrenia 161 Cross-sectional Perceived (PDD) In a multivariate regression, increase in stigma was associated with a significant reduction in quality of life
Symptom severity for depression was significantly correlated with stigma
None
Roberts, 2017 [96] Ukraine Community-based time-location sampling; depression, anxiety or PTSD 2203 Cross-sectional One question on stigma related to care seeking Out of the 703 people with a mental health problem, only 180 (25.6%) had sought care from any medical source (including pharmacists, or NGO counselling center); of the 520 who did not seek care, 41 attributed this to stigma or embarrassment (8%) None
Sharaf, 2012 [107] Egypt Facility-based sample; schizophrenia 200 Cross-sectional Internalized (ISMI) In multivariate regression, increase in stigma was associated with increase in suicide risk
Insight was correlated positively with stigma
Mod: Insight was measured but not a significant moderator of stigma–suicide relationship
Shi-Jie, 2017 [90] China Facility-based sample; depression 158 Cross-sectional Anticipated and perceived (EMIC) The depression subscale of the SCL-90 was associated with a significant increase in stigma in multivariate regression
MADRS, somatization, and the SCL-90 total and anxiety subscale score were all NS; fatigue was associated with a significant increase in stigma in multivariate regression; disability NS in multivariate regression; duration of illness NS in multivariate regression
None
Singh, 2016 [89] India Facility-based sample; schizophrenia 100 Cross-sectional Internalized (ISMI); anticipated and perceived (EMIC) Functioning was significantly associated with decrease in all ISMI subscales in regression analyses except ISMI-A and ISMI-SR
Increase in GAF score was associated with reduced odds of having high vs. low overall ISMI score
Functioning was negatively correlated with EMIC score
Duration of illness was NS in regression analyses, except an increase in duration was associated with increased odds of having high vs. low ISMI-SR score; treatment duration was NS
Symptom severity was NS in regression analyses, except an increase in the general PANSS subscale was associated with increased odds of having high vs. low ISMI-A score
None
Vidojevic, 2015 [193] Serbia Facility-based sample; depression 52 Cross-sectional Anticipated and experienced discrimination (DISC) Hospitalization history was associated with higher discrimination and lower ability to overcome stigma None
Wang, 2017 [194] China Facility-based sample; schizophrenia 146 Cross-sectional Perceived and internalized (LSS) Quality of life positively correlated with perceived stigma and a coping orientation of withdrawal, but NS with secrecy, educating challenging and distancing coping strategies; positively correlated with both stigma-related feelings subscales (misunderstood and different/ashamed)
Medication adherence negatively correlated with perceived discrimination and a coping orientation of secrecy, but NS with withdrawal, educating, challenging, and distancing; negatively correlated with feeling different/ashamed but feeling misunderstood NS
None
Xu, 2013 [105] China Facility-based sample; schizophrenia 133 Cross-sectional Self-blame (CSQ-SB) Symptom severity for depression was predicted by self-blame None
  1. BPRS Brief Psychiatric Rating Scale, CSQ-SB Self-Blame subscale of the Coping Style Questionnaire, DISC Discrimination and Stigma Scale, DSS Depression Stigma Scale, EMIC-SS Explanatory Model Interview Catalogue Stigma Scale, GAF General Assessment of Functioning, HDRS Hamilton Depression Rating Scale, ISMI Internalized Stigma of Mental Illness Scale (-SR Stigma Resistance subscale, -A Alienation subscale), KSS King’s Stigma Scale, LSS Link’s Stigma Scale, SE ‘stereotype endorsement’, SR stigma resistance, DE discrimination experience, SW social withdrawal, MADRS Montgomery and Asberg Depression Rating Scale, MCESQ Modified Consumer Experiences of Stigma Questionnaire, Mod moderator, NS not significant, PANSS Positive and Negative Syndrome Scale (-N negative, -P positive), PDD Perceived Devaluation and Discrimination Scale, SCL-90 Symptom Checklist-90, SMI serious mental illness, SPISEW Stigma of Psychiatric Illness and Sexuality among Women, SQLS Schizophrenia Quality of Life Scale, WHOQOL World Health Organization Quality-of-Life Scale