Systematic Review of Cultural Aspects of Stigma and Mental Illness among Racial and Ethnic Minority Groups in the United States: Implications for Interventions

Abstract

Stigma is integral to understanding mental health disparities among racial and ethnic minority groups in the United States. We conducted a systematic review to identify empirical studies on cultural aspects of mental illness stigma (public, structural, affiliative, self) among three racial and ethnic minority groups (Asian Americans, Black Americans, Latinx Americans) from 1990 to 2019, yielding 97 articles. In comparison studies (N = 25), racial and ethnic minority groups often expressed greater public and/or self‐stigma than White American groups. In within‐group studies (N = 65; Asian American, n = 21; Black American, n = 18; Latinx American; n = 26), which were primarily qualitative (73%), four major cultural themes emerged: 1) service barriers including access and quality (structural stigma); 2) family experiences including concealment for family’s sake, fear of being a burden, and stigma extending to family (affiliative stigma); 3) lack of knowledge about mental illness and specific cultural beliefs (public stigma); and 4) negative emotional responses and coping (self‐stigma). These findings confirmed stigma has both similar and unique cultural aspects across groups. Despite this, few studies tested stigma reduction interventions (N = 7). These cultural insights can inform contextual change at the health systems and community levels to reduce stigma, and empowerment at the interpersonal and individual levels to resist stigma.

Clergy Perceptions of Mental Illness and Confronting Stigma in Congregations

“…Participants expressed confidence in their abilities to directly communicate such tailored messages. This aligns with Misra and colleagues' (Misra et al 2021) recommendations for reducing stigma in racial and ethnic minority communities, including "moving into community settings, integrating cultural considerations, and targeting stigma directly" (Misra et al 2021).…”

“…Stigma of mental illness is considered a widespread threat to public health and communities in the United States (Parcesepe and Cabassa 2013;Casados 2017), and especially impacts racial and ethnic minority groups (Misra et al 2021). Stigma leads to a number of harmful sequelae, including a tendency for individuals with mental illness to avoid seeking treatment (Corrigan 2004), being secretive about one's mental illness and withdrawing from others (Mayer et al 2021), or only seeking spiritual interventions from clergies rather than from mental health professionals (Peteet 2019).…”

Exploring stigma associated with mental health conditions and alcohol and other drug use among people from migrant and ethnic minority backgrounds: a protocol for a systematic review of qualitative studies

“…Stigma has been identified as a major barrier to accessing support for AOD use and mental health conditions among migrant and ethnic minority communities [ 12 ]. Existing evidence suggests that further research underpinned by theory is needed to understand the intersectional factors that influence AOD use and mental health stigma [ 20 , 21 ]. Use of best fit framework analysis guided by the Health Stigma and Discrimination Framework will enable us to provide insight into the different domains of stigma, identify gaps in the literature and provide recommendations for future research.…”

“…Research has acknowledged that interventions targeting stigma must address multiple levels including social, policy and legal structures thus incorporating theory that acknowledges these structures is important [ 28 ]. Although some reviews have explored cultural factors and mental illness stigma, these have predominantly focused on migrant and ethnic minority groups in the USA [ 20 , 21 ]. Our review expands the knowledge base by examining global literature and drawing on robust theory to synthesise findings.…”

Exploring mental illness in the workplace:the role of HR professionals and processes

“…Cultural beliefs and attitudes about mental illness influence how these individuals are perceived and treated in the workplace (Opare-Henaku & Utsey, 2017). The extant literature suggests that the ways in which individuals manage their mental illness is partially dependent on their ethnicity, and that treatment options are often dictated by cultural, religious, and spiritual beliefs (Misra et al, 2021). Cultural traditions and expectations can also influence the extent to which mental illness is deemed to be stigmatising (Zolezzi et al, 2018;Zhang et al, 2020), which can impact employees' willingness to disclose their mental health condition to others, to seek workplace accommodations, or to receive medical treatment for their disorder.…”