Stigma and discrimination related to mental illness in low- and middle-income countries

Semrau, Maya; Evans‐Lacko, Sara; Koschorke, Mirja; Ashenafi, L; Thornicroft, Graham

doi:10.1017/s2045796015000359

Cited by 158 publications

(138 citation statements)

References 55 publications

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“…Overall, stigma against help-seeking was low and reflects trends obtained from other research from LMIC (Semrau et al 2015). A third of the population had a neighbour or family member with mental illness and that may have acted as an interpersonal contact resulting in reduced stigma.…”

Section: Discussionsupporting

confidence: 84%

“…Mental health attitudes has been found to improve following anti-stigma and mental health awareness campaigns, but not knowledge, even in high-income countries, and no conclusive data are available for behaviour change. Data from LMIC are almost negligible and what little exists is inconclusive about the effectiveness of the interventions or the overall outcomes (Semrau et al 2015). …”

Section: Discussionmentioning

confidence: 99%

“…This is reflected in estimates that only 15–25% people suffering from mental disorders receive any kind of treatment in LMIC (WHO World Mental Health Survey Consortium, 2004). In spite of that, little data exist about suitable interventions in LMIC that address stigma (Semrau et al 2015). …”

Section: Introductionmentioning

confidence: 99%

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Evaluation of an anti-stigma campaign related to common mental disorders in rural India: a mixed methods approach

et al. 2016

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BackgroundStigma related to mental health is a major barrier to help-seeking resulting in a large treatment gap in low- and middle-income countries (LMIC). This study assessed changes in knowledge, attitude and behaviour, and stigma related to help-seeking among participants exposed to an anti-stigma campaign.MethodThe campaign, using multi-media interventions, was part of the SMART Mental Health Project, conducted for 3 months, across 42 villages in rural Andhra Pradesh, in South India. Mixed-methods evaluation was conducted in two villages using a pre-post design.ResultsA total of 1576 and 2100 participants were interviewed, at pre- and post-intervention phases of the campaign. Knowledge was not increased. Attitudes and behaviours improved significantly (p < 0.01). Stigma related to help-seeking reduced significantly (p < 0.05). Social contact and drama were the most beneficial interventions identified during qualitative interviews.ConclusionThe results showed that the campaign was beneficial and led to improvement of attitude and behaviours related to mental health and reduction in stigma related to help-seeking. Social contact was the most effective intervention. The study had implications for future research in LMIC.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Evaluation of an anti-stigma campaign related to common mental disorders in rural India: a mixed methods approach

et al. 2016

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“…During the intervention period people’s attitudes and behaviors appeared to improve but not their scores on knowledge, and this is similar to other studies [17]. Stigma related to help–seeking was low and is similar to earlier research from LMIC [43]. …”

Section: Discussionsupporting

confidence: 88%

Increasing use of mental health services in remote areas using mobile technology: a pre–post evaluation of the SMART Mental Health project in rural India

Maulik

Kallakuri

Devarapalli

et al. 2017

Journal of Global Health

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BackgroundAbout 25% of the Indian population experience common mental disorders (CMD) but only 15–25% of them receive any mental health care. Stigma, lack of adequate mental health professionals and mental health services account for this treatment gap, which is worse in rural areas. Our project evaluated task shifting and mobile–technology based electronic decision support systems to enhance the ability of primary care health workers to provide evidence–based mental health care for stress, depression, and suicidal risk in 30 remote villages in the state of Andhra Pradesh, India.MethodsThe Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health project between May 2014 and April 2016 trained lay village health workers (Accredited Social Health Activists – ASHAs) and primary care doctors to screen, diagnose and manage individuals with common mental disorders using an electronic decision support system. An anti–stigma campaign using multi–media approaches was conducted across the villages at the outset of the project. A pre–post evaluation using mixed methods assessed the change in mental health service utilization by screen positive individuals. This paper reports on the quantitative aspects of that evaluation.ResultsTraining was imparted to 21 ASHAs and 2 primary care doctors. 5007 of 5167 eligible individuals were screened, and 238 were identified as being positive for common mental disorders and referred to the primary care doctors for further management. Out of them, 2 (0.8%) had previously utilized mental health services. During the intervention period, 30 (12.6%) visited the primary care doctor for further diagnosis and treatment, as advised. There was a significant reduction in the depression and anxiety scores between start and end of the intervention among those who had screened positive at the beginning. Stigma and mental health awareness in the broader community improved during the project.ConclusionsThe intervention led to individuals being screened for common mental disorders by village health workers and increase in mental health service use by those referred to the primary care doctor. The model was deemed feasible and acceptable. The effectiveness of the intervention needs to be demonstrated using more robust randomized controlled trials, while addressing the issues identified that will facilitate scale up.

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“…A recent review observed a treatment gap of more than 90% for CMDs in India and China, two relatively well-resourced middle-income countries (Chisholm et al 2016, Patel et al 2016b). There are many reasons for the poor coverage of psychological treatment including a reliance on a limited number of specialists to provide or supervise treatments, as well as to train therapists (Kohrt et al 2015); the use of highly specific disorder-based treatment packages (England et al 2015, Kazdin 2016, Murray et al 2014, Weisz et al 2012); and the stigma of seeking help for CMDs and other mental illnesses (Semrau et al 2015). …”

Section: Introductionmentioning

confidence: 99%

Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries

Singla

Kohrt

Murray

et al. 2017

Annu. Rev. Clin. Psychol.

656

509

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Common mental disorders, including depression, anxiety, and posttraumatic stress, are leading causes of disability worldwide. Treatment for these disorders is limited in low- and middle-income countries. This systematic review synthesizes the implementation processes and examines the effectiveness of psychological treatments for common mental disorders in adults delivered by nonspecialist providers in low- and middle-income countries. In total, 27 trials met the eligibility criteria; most treatments targeted depression or posttraumatic stress. Treatments were commonly delivered by community health workers or peers in primary care or community settings; they usually were delivered with fewer than 10 sessions over 2–3 months in an individual, face-to-face format. Treatments included common elements, such as nonspecific engagement and specific domains of behavioral, interpersonal, emotional, and cognitive elements. The pooled effect size was 0.49 (95% confidence interval = 0.36–0.62), favoring intervention conditions. Our review demonstrates that psychological treatments—comprising a parsimonious set of common elements and delivered by a low-cost, widely available human resource—have moderate to strong effects in reducing the burden of common mental disorders.

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Stigma and discrimination related to mental illness in low- and middle-income countries

Abstract: Generating information about effective interventions to reduce stigma and discrimination in LAMICs is now an important mental health priority worldwide.

Cited by 158 publications

References 55 publications

Evaluation of an anti-stigma campaign related to common mental disorders in rural India: a mixed methods approach

Evaluation of an anti-stigma campaign related to common mental disorders in rural India: a mixed methods approach

Increasing use of mental health services in remote areas using mobile technology: a pre–post evaluation of the SMART Mental Health project in rural India

Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries

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