prevalence, danger elements and protecting elements


Stigma in direction of melancholy continues to be pervasive, regardless of mounting proof that melancholy is a number one reason behind avoidable struggling on this planet, and that efficient intervention methods exist for promotion, prevention, therapy, and help (Herrman, 2022).

Psychological health-related stigma is outlined as a mixture of a lack of understanding, prejudice and discrimination towards these with psychological well being difficulties (Corrigan, 2005). It may well present itself in a number of methods, together with:

  • Perceived stigma (i.e., beliefs concerning the attitudes of others)
  • Enacted stigma (i.e., skilled stigma)
  • Remedy stigma (i.e., adverse attitudes or beliefs about receiving therapy)
  • Self-stigma (one’s personal ideas and beliefs about their very own melancholy; Griffiths, 2008; Fox, 2018).

Experiencing stigma for people with psychological issues has been described as a ‘double jeopardy’, referring to experiencing the affect of the psychological well being dysfunction in addition to the extreme penalties of stigma. Many individuals even describe the stigma they expertise as being worse than the psychological well being situation itself (Thornicroft, 2022).

Worldwide, stigma in direction of folks residing with melancholy has been related to adverse outcomes, together with low ranges of help-seeking, poor therapy adherence and outcomes, low high quality of life, and danger of suicidal ideas and behavior. Whereas information on public attitudes towards melancholy is offered for some high-income nations, proof for widespread discount in public stigma over latest many years is scarce (Hermann, 2022).

This systematic evaluation and meta-analysis by Du et. al. (2023) makes an attempt to handle this hole via a first-time evaluation of information on the worldwide prevalence of self-stigma in melancholy. Not like earlier research, this evaluation examined geographical variations in self-stigma and related danger and protecting elements. Particularly, this evaluation aimed to:

  1. Evaluate and synthesise the proof on the prevalence of melancholy self-stigma throughout totally different continents
  2. Determine danger and protecting elements of melancholy self-stigma
  3. Determine limitations of the present proof.
In the context of depression, self-stigma is associated with reduced help-seeking and treatment adherence, increased depressive symptoms, and increased risk of suicidality, meaning it is important to understand the scope of this issue.

Within the context of melancholy, self-stigma is related to decreased help-seeking and therapy adherence, elevated depressive signs, and elevated danger of suicidality, that means it is very important perceive the scope of this challenge.


The authors performed a search of 4 on-line databases to determine research which:

  • Have been in English
  • Concerned samples of individuals with melancholy
  • Assessed self-stigma or it’s correlates with a validated measure
  • Supplied quantitative information on prevalence and/or correlates of self- stigma.

Subgroup analyses have been carried out to look at the variations in imply values throughout geographic areas just for research that measured melancholy self-stigma utilizing the Internalized Stigma of Psychological Sickness Scale (ISMI). Random results fashions have been employed for information synthesis, on condition that numerous covariates might affect the impact sizes of included research.

Research high quality was assessed utilizing an 11-item scale for cross-sectional research offered by the Company for Healthcare Analysis and High quality (AHRQ). 38 research have been rated as average high quality, and 18 research have been rated as prime quality. No research have been low high quality.


56 research met the inclusion standards. Most included research have been cross-sectional (87.5%), with 39.3% of research together with participant samples with a number of psychological well being diagnoses. 62.5% of research used the ISMI to measure self-stigma and offered imply values of self-stigma.

20 research in contrast ranges of self-stigma throughout totally different diagnoses, with 12 reporting important variations amongst medical subgroups (e.g., six research confirmed larger self-stigma scores in schizophrenia than in melancholy and 6 research confirmed larger self-stigma scores in melancholy than in schizophrenia).

Most included research have been performed in Asia, Europe, and North America. Altogether, the research included 11,549 individuals, with pattern sizes throughout research starting from 14 to 1379. Most research (62.5%) embody feminine outpatient individuals.

Prevalence of melancholy self-stigma

  • General prevalence: The pooled prevalence of (average to excessive) self-stigma for melancholy throughout research was 29%. The pooled prevalence of self-stigma in research with sufferers with melancholy alone was 34%. This was larger than within the sub-group the place the pattern included a number of psychological issues (23%), however this distinction was not statistically important.
  • Demographic elements: Male figuring out (r = 0.06, 95% CI [0.00 to 0.11]) and non-White people (r = 0.10, 95% CI [0.01 to 0.19]) have been positively and modestly related to self-stigma. Having a accomplice or being married (r = -0.22; 95% CI [-0.30 to -0.14]) was negatively related to self-stigma.
  • Regional ranges: The variation of self-stigma throughout geographic areas was marginally non-significant (p = 0.06), with findings that melancholy self-stigma was larger in individuals in Africa, Asia and North America as in comparison with Europe. Outcomes additionally urged that ethnic minorities report larger self-stigma, however socio-cultural elements (e.g., cultural beliefs, psychological well being literacy ranges, entry to medical and well being assets, cultures endorsing collectivism) weren’t persistently or strongly correlated with self-stigma within the research on this evaluation, though they have been cited as potential explanations.

Threat elements and protecting elements

Six danger elements have been positively related to self-stigma:

  • Melancholy symptom severity
  • Sickness period
  • Public stigma
  • Remedy stigma
  • Perceived stigma
  • Enacted stigma

Seven protecting elements have been recognized:

  • Age at onset
  • Remedy perspective
  • High quality of life
  • Social relationships
  • Shallowness
  • Extroversion
  • Social functioning
Du et al. (2023) found that the pooled worldwide prevalence of moderate to high self-stigma in depression was 29%.

Du et al. (2023) discovered that the pooled worldwide prevalence of average to excessive self-stigma in melancholy was 29%.


This evaluation concluded that folks residing with melancholy are at appreciable danger of internalising adverse stereotypes and discrimination related to melancholy. Distinguished danger elements have been recognized, together with melancholy symptom severity and stigma-related elements; however protecting elements have been additionally recognized, similar to high quality of life and shallowness.

Given the small diploma of geographic variation of self-stigma on this research, the authors counsel additional examination of contextual and institutional elements, similar to public well being insurance policies and psychological well being techniques, and for future analysis to discover the underlying mechanisms concerned in these findings about self-stigma.

Protective factors against self-stigma in depression was identified, including quality of life and social relationships. Risk factors were also found, such as symptom severity and illness duration.

Protecting elements towards self-stigma in melancholy was recognized, together with high quality of life and social relationships. Threat elements have been additionally discovered, similar to symptom severity and sickness period.

Strengths and limitations


  • Many earlier research have offered insights concerning the results of stigma, however this evaluation makes a brand new contribution in (i) classifying danger and protecting elements and discerning the character of their relationship with stigma and (ii) stratifying findings by geographic parameters.
  • The evaluation has many methodological strengths similar to adherence to PRISMA tips and pre-registration on PROSPERO. Research have been additionally of excessive or average high quality, thereby bettering the reliability of the findings.
  • Suggestions for the way the findings of this evaluation may be put into observe are one other energy. For instance, the authors counsel increasing schooling and contact-oriented interventions past data enchancment in direction of psychosocial points associated to melancholy.
  • This research additionally highlights attainable instructions for intervention in addition to analysis to look at the relative efficacy of utilizing totally different approaches to addressing the self-stigma of individuals residing with melancholy.


  • Methodological limitations embody the usage of a random results mannequin for meta-analysis. The sort of mannequin sometimes requires a whole lot of information and makes use of extra assumptions as a result of estimation of an extra parameter (the between-study variance). As well as, this mannequin may not get rid of heterogeneity fully, as there could also be different sources of variation not captured by the mannequin. For instance, within the consists of research on this evaluation, measurements of self-stigma and different end result variables have been totally different, and these might have influenced the outcomes and their ranges of heterogeneity.
  • As most research have been cross-sectional, the evaluation solely examines correlational quite than causal relationships. For instance, the findings of this evaluation assist us perceive elements related to stigma, however these don’t counsel what may be inflicting it or why.
  • Components recognized in qualitative research included within the systematic evaluation weren’t captured within the meta-analysis findings.
  • Regional illustration of the findings needs to be interpreted with warning. Most research have been from Asia and Europe. Just a few research from Africa and Australia have been included, whereas no research have been from South America. Relatedly, resulting from language limitations (English research solely) it’s attainable that different related research have been missed within the research search.
While the study adhered to best practice guidelines, caution needs to be taken due to heterogeneity, the use of cross-sectional data, and search strategy restrictions.

Whereas the research adhered to greatest observe tips, warning must be taken resulting from heterogeneity, the usage of cross-sectional information, and search technique restrictions.

Implications for observe

The findings from this research have vital implications for medical and community-based programmes and researchers.

For observe

  • Insights can inform de-stigmatisation practices and interventions for clinicians and policymakers to enhance medical and psychosocial outcomes for folks residing with melancholy. The authors define examples for constructing psychosocial abilities and contact-oriented interventions similar to serving to folks residing with melancholy to foster shallowness, self-efficacy and to construct public consciousness of melancholy and its therapies.
  • Focus elevated efforts to mitigate self-stigma in communities which may be particularly susceptible to the adverse impacts of self-stigma. For instance, specializing in males’s psychological well being and on folks marginalised resulting from ethnicity/race.

For analysis

  • Develop and consider de-stigmatisation interventions incorporating the totally different danger and protecting elements recognized.
  • Study the effectiveness of present interventions geared toward decreasing self-stigma.
  • Study the underlying mechanisms concerned in understanding and addressing self-stigma for melancholy.
  • Study contextual and institutional elements, similar to public well being insurance policies and psychological well being techniques and the way these have an effect on variation of self-stigma throughout geographies.
Going forward, it is important for de-stigmatisation to be consistently incorporated within treatments for depression, with emphasis on addressing identified risk factors and fostering potential protective factors.

Going ahead, it is crucial for de-stigmatisation to be persistently integrated inside therapies for melancholy, with emphasis on addressing recognized danger elements and fostering potential protecting elements.

Assertion of pursuits



Main paper

Du, N., Chong, E. S. Okay., Wei, D., Liu, Z., Mu, Z., Deng, S., & Huang, Y.-T. (2023). Prevalence, danger, and protecting elements of self-stigma for folks residing with melancholy: A scientific evaluation and meta-analysis. Journal of Affective Problems, 332, 327–340.

Different references

Corrigan, P. W., Kerr, A., & Knudsen, L. (2005). The stigma of psychological sickness: Explanatory fashions and strategies for change. Utilized and Preventive Psychology, 11(3), 179–190.

Fox, A. B., Earnshaw, V. A., Taverna, E. C., & Vogt, D. (2018). Conceptualizing and measuring psychological sickness stigma: The Psychological Sickness Stigma Framework and demanding evaluation of measures. Stigma and Well being, 3(4), 348–376.

Griffiths, Okay. M., Christensen, H., & Jorm, A. F. (2008). Predictors of melancholy stigma. BMC Psychiatry, 8(1).

Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., McGorry, P., Reynolds, C. F., Weissman, M. M., Chibanda, D., Dowrick, C., Howard, L. M., Hoven, C. W., Knapp, M., Mayberg, H. S., … Wolpert, M. (2022). Time for united motion on melancholy: A Lancet–World Psychiatric Affiliation Fee. The Lancet, 399(10328), 957–1022.

Thornicroft, G., Sunkel, C., Alikhon Aliev, A., Baker, S., Brohan, E., el Chammay, R., Davies, Okay., Demissie, M., Duncan, J., Fekadu, W., Gronholm, P. C., Guerrero, Z., Gurung, D., Habtamu, Okay., Hanlon, C., Heim, E., Henderson, C., Hijazi, Z., Hoffman, C., … Winkler, P. (2022). The Lancet Fee on ending stigma and discrimination in Psychological Well being. The Lancet, 400(10361), 1438-1480.

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