Demographic and clinical features related to perceived discrimination in schizophrenia

Comparing discrimination among people with schizophrenia, affective and anxiety disorders. A multilevel study in five European countries

BACKGROUND

Most research on mental illness stigma has involved people with psychosis; less information is available for people with affective and anxiety disorders. We aimed to compare experienced and anticipated discrimination among people with schizophrenia, and affective and anxiety disorders.

METHODS

People with schizophrenia (n=773), affective (n=1010) and anxiety disorders (n=372) were recruited during psychiatric admission across 5 EU countries. The Discrimination and Stigma Scale (DISC-12) was used. Multivariate mixed effect logistic regression models with a random effect for hospital and country were performed to explore patient characteristics associated with experienced and anticipated discrimination.

RESULTS

With anxiety disorders, there were more reports of experiences of discrimination in social life (35%), intimate relationships (23.5%), and physical healthcare (19%); in schizophrenia, in relations with neighbours (23.6%) and mental health staff (21.7%); and in affective disorders, in parental role (22.8%). In multivariate analyses, anxiety was associated with increased likelihood of experiencing discrimination in police interactions (OR=1.675; p=0.038) and physical healthcare (OR=1.816; p=0.003), and reduced likelihood when starting a family (OR=0.474; p=0.01) as compared with schizophrenia. Affective (OR=1.367; p=0.004) and anxiety disorders (OR=1.354; p=0.034) were associated with increased likelihood of concealing a diagnosis compared with schizophrenia.

LIMITATIONS

As patients with affective and anxiety disorders were recruited from hospital inpatient units, their experiences may not be representative of all people with these disorders.

CONCLUSIONS

In a sample of people receiving inpatient treatment, experienced and anticipated discrimination are perceived, at least in some life domains, as more of a burden for people with affective and anxiety disorders than those with schizophrenia.

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

BACKGROUND

Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions.

METHODS

We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations.

RESULTS

Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes.

CONCLUSIONS

Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.