Psychiatric stigma across cultures: Local validation in Bangalore and London

Abstract

Public responses to depression have a powerful effect on patients' personal experience of illness, the course and outcome of the illness, and their ability to obtain gainful employment. Mental illness-related stigma reduction has become a priority, and to be effective, it requires innovative and effective public mental health interventions based on a clear understanding of what stigma means. Based on Goffman's formulation as spoiled identity, local concepts of stigma were validated and compared in clinical cultural epidemiological studies of depression in Bangalore, India, and London, England, using the EMIC, an instrument for studying illness-related experience, its meaning, and related behaviour. Similar indicators were validated in both centres, and the internal consistency examined to identify those that contributed to a locally coherent concept and scale for stigma. Qualitative meaning of specific features of stigma at each site were clarified from patients' prose narrative accounts. Concerns about marriage figured prominently as a feature of illness experience in both centres, but it was consistent with other indicators of stigma only in Bangalore, not in London. Although stigma is a significant issue across societies, particular manifestations may vary, and the cultural validity of indicators should be examined locally. Analysis of cultural context in the narrative accounts of illness indicates the variation and complexity in the relationship between various aspects of illness experience and stigma. This report describes an approach following from the application of cultural epidemiological methods for identifying and measuring locally valid features of stigma in a scale for baseline and followup assessment to monitor stigma reduction programmes, cultural study, and cross-cultural comparisons.

Stigma Impact on Moroccan Families of Patients with Schizophrenia

“…We found the same results in Western as we found in non-Western countries, including some Arab and Islamic countries (6)(7)(8)(9). These families deal with the patient's illness alone, and there is no protection system against the stigma (8).…”

Black Shadow of Stigma: Lived Experiences of Patients with Psychiatric Disorders on the Consequences of Stigma

“…Women are particularly vulnerable to this aspect of social stigma. In addition, matrimonial matters (ie, the ability to marry, the marriage of a family, and the complications of the disease on the current marriage) were anticipated aspects by stigma, which is in line with African studies that have been conducted using the same approach (20).…”

Padrão global de discriminação experimentada e antecipada contra pessoas com esquizofrenia: estudo transversal

“…O que fomos capazes de mostrar é que os escores de discriminação experimentada variam de acordo com o país, mas os escores de discriminação antecipada não. No entanto, os efeitos do estigma e da discriminação foram identificáveis ao longo de um amplo campo de domínios do dia-a-dia em todos os países estudados (Littlewood et al, 2007;Weiss et al, 2001). A análise regressiva múltipla fornece evidência inicial para os fatores associados com altos níveis de incidentes de discriminação experimentada negativa: aumento dos anos desde o primeiro contato com os serviços de saúde mental e ter recebido tratamento compulsório.…”

“…O estigma produz alterações nos sentimentos, posições e comportamento na pessoa afetada (baixa autoestima, pouco cuidado consigo mesmo e retraimento social) e nos familiares (Thornicroft, 2006;Weiss et al 2001). A pesquisa sobre o estigma e a doença mental tem apresentado diversas limitações: pouca conexão com a prática clínica ou com a política de saúde (por exemplo, em relação à procura de auxílio e acesso à saúde); em geral, tem sido descritiva, compreendendo o estudo de atitudes públicas ou o retrato da doença mental e violência feitos pela mídia.…”