Stigma continues to be a significant barrier to effective care in depression. Stigma have different conceptual components, ie knowledge ( ignorance or misinformation), attitudes (prejudice), and behaviour (discrimination). Discrimination, i.e. rejection of and negative behaviour towards people with mental health problems, can cause low rates of help seeking, lack of access to care, under treatment and social marginalisation . Antonio Lasalvia et al (ASPEN/INDIGO Study Group) investigated the patterns of experienced and anticipated discrimination and their relations with socio- demographic and clinical variables in people with depression.This is the first international study with a large sample investigating experiences of discrimination in depression.
Face to face cross-sectional survey was carried out in 35 countries. Individuals attending specialist mental health services with depression ( outpatients/day patients) were invited to participate. Participants completed the discrimination and stigma scale interview.This tool has 32 questions divided in to 4 sub scales i.e. experienced discrimination, anticipated discrimination , overcome discrimination, and positive treatment.
80% of participants have experienced discrimination in at least one domain (by family members, making or keeping friends,marriage,keeping a job etc).Nearly a third of participants reported that they had been avoided or shunned by other people because of their mental health problems.70% actively wished to conceal their diagnosis. Rates in some life domains (eg, family and social relations) are substantially similar to those in people with schizophrenia , though overall rates is slightly lower.
Participants who experienced most discrimination were those who had at least one lifetime psychiatric hospital admission; had several depressive episodes; had lost a spouse or partner (ie, divorced, separated, or widowed); were in unpaid employment/ were looking for a job/were unemployed; and had greater anticipated discrimination.
Main source of discrimination is family. Family is also the source of most reported support. Employment is the other common source of discrimination. It is important to note that in these two important domains, nearly half the people surveyed reported anticipated discrimination in the absence of experienced discrimination. Those who anticipate discrimination might withdraw from social and occupational activities and give up important life goals (the why-try effect). Experienced discrimination was positively associated with poor social functioning.
Conclusions: Discrimination is a significant barrier to productive social and occupational life. Along with general stigma reduction strategies , interventions should address the issue of discrimination towards themselves by people with depression.
Summary of the article:
Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lasalvia A, Zoppei S, Van Bortel T, Bonetto C, Cristofalo D, Wahlbeck K, Bacle SV, Van Audenhove C, van Weeghel J, Reneses B, Germanavicius A, Economou M, Lanfredi M, Ando S, Sartorius N, Lopez-Ibor JJ, Thornicroft G; ASPEN/INDIGO Study Group.Lancet. 2013 Jan 5;381(9860):55-62.