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Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries

  • S. Evans-Lacko (a1), E. Brohan (a1), R. Mojtabai (a2) and G. Thornicroft (a1)



Little is known about how the views of the public are related to self-stigma among people with mental health problems. Despite increasing activity aimed at reducing mental illness stigma, there is little evidence to guide and inform specific anti-stigma campaign development and messages to be used in mass campaigns. A better understanding of the association between public knowledge, attitudes and behaviours and the internalization of stigma among people with mental health problems is needed.


This study links two large, international datasets to explore the association between public stigma in 14 European countries (Eurobarometer survey) and individual reports of self-stigma, perceived discrimination and empowerment among persons with mental illness (n=1835) residing in those countries [the Global Alliance of Mental Illness Advocacy Networks (GAMIAN) study].


Individuals with mental illness living in countries with less stigmatizing attitudes, higher rates of help-seeking and treatment utilization and better perceived access to information had lower rates of self-stigma and perceived discrimination and those living in countries where the public felt more comfortable talking to people with mental illness had less self-stigma and felt more empowered.


Targeting the general public through mass anti-stigma interventions may lead to a virtuous cycle by disrupting the negative feedback engendered by public stigma, thereby reducing self-stigma among people with mental health problems. A combined approach involving knowledge, attitudes and behaviour is needed; mass interventions that facilitate disclosure and positive social contact may be the most effective. Improving availability of information about mental health issues and facilitating access to care and help-seeking also show promise with regard to stigma.


Corresponding author

*Address for correspondence: Dr S. Evans-Lacko, Health Service and Population Research Department P029, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email:


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Alonso, J, Buron, A, Rojas-Farreras, S, de Graaf, R, Haro, JM, de Girolamo, G, Bruffaerts, R, Kovess, V, Matschinger, H, Vilagut, G; ESEMeD/MHEDEA 2000 Investigators (2009). Perceived stigma among individuals with common mental disorders. Journal of Affective Disorders 118, 180186.
Angermeyer, MC, Matschinger, H (2005). Causal beliefs and attitudes to people with schizophrenia. Trend analysis based on data from two population surveys in Germany. British Journal of Psychiatry 186, 331334.
Blumner, KH, Marcus, SC (2009). Changing perceptions of depression: ten-year trends from the general social survey. Psychiatric Services 60, 306312.
Bond, GR, Drake, RE, Becker, DR (2008). An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal 31, 280290.
Bring Change 2 Mind (2010). ( Accessed 18 June 2011.
Brohan, E, Elgie, R, Sartorius, N, Thornicroft, G (2010 a). Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophrenia Research 122, 232238.
Brohan, E, Gauci, D, Sartorius, N, Thornicroft, G (2011). Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: the GAMIAN-Europe study. Journal of Affective Disorders 129, 5663.
Brohan, E, Slade, M, Clement, S, Thornicroft, G (2010 b). Experiences of mental illness stigma, prejudice and discrimination: a review of measures. BMC Health Services Research 10, 80.
Clement, S, Jarrett, M, Henderson, C, Thornicroft, G (2010). Messages to use in population-level campaigns to reduce mental health-related stigma: consensus development study. Epidemiologia e Psichiatria Sociale 19, 7279.
Conner, KO, Copeland, VC, Grote, NK, Koeske, G, Rosen, D, Reynolds, CF 3rd, Brown, C (2010). Mental health treatment seeking among older adults with depression: the impact of stigma and race. American Journal of Geriatric Psychiatry 18, 531543.
Corrigan, PW, Larson, JE, Rusch, N (2009). Self-stigma and the ‘why try’ effect: impact on life goals and evidence-based practices. World Psychiatry 8, 7581.
Corrigan, PW, River, LP, Lundin, RK, Penn, DL, Uphoff-Wasowski, K, Campion, J, Mathisen, J, Gagnon, C, Bergman, M, Goldstein, H, Kubiak, MA (2001). Three strategies for changing attributions about severe mental illness. Schizophrenia Bulletin 27, 187195.
Corrigan, PW, Watson, AC (2003). Factors that explain how policy makers distribute resources to mental health services. Psychiatric Services 54, 501507.
Corrigan, PW, Watson, AC, Barr, L (2006). The self-stigma of mental illness: implications for self-esteem and self-efficacy. Journal of Social and Clinical Psychology 25, 875884.
Corrigan, PW, Watson, AC, Warpinski, AC, Gracia, G (2004). Stigmatizing attitudes about mental illness and allocation of resources to mental health services. Community Mental Health Journal 40, 297307.
Dunion, L, Gordon, L (2005). Tackling the attitude problem. The achievements to date of Scotland's ‘see me’ anti-stigma campaign. Mental Health Today, 2225.
European Commission (2006). Mental Well-being: Special Eurobarometer 248/Wave 64.4 ( Accessed 18 June 2011.
European Commission (2010). Mental Health: Special Eurobarometer 345/Wave 73.2 ( Accessed 18 June 2011.
Evans-Lacko, SE, Baum, N, Danis, M, Biddle, A, Goold, S (2011). Laypersons' choices and deliberations for mental health coverage. Administration and Policy in Mental Health. Published online: 31 March 2011. doi:10.1007/s10488-011-0341-4.
Glied, SA, Frank, RG (2009). Better but not best: recent trends in the well-being of the mentally ill. Health Affairs 28, 637648.
Henderson, C, Thornicroft, G (2009). Stigma and discrimination in mental illness: time to change. Lancet 373, 19281930.
Jorm, AF, Christensen, H, Griffiths, KM (2006). Changes in depression awareness and attitudes in Australia: the impact of beyondblue: the national depression initiative. Australian and New Zealand Journal of Psychiatry 40, 4246.
Jorm, AF, Korten, AE, Jacomb, PA, Christensen, H, Rodgers, B, Pollitt, P (1997). Public beliefs about causes and risk factors for depression and schizophrenia. Social Psychiatry and Psychiatric Epidemiology 32, 143148.
Kelly, CM, Jorm, AF, Wright, A (2007). Improving mental health literacy as a strategy to facilitate early intervention for mental disorders. Medical Journal of Australia 187, S26S30.
Link, BG (1987). Understanding labeling effects in the area of mental disorders: an assessment of the effect of expectations of rejection. American Journal of Community Psychology 11, 261273.
Link, BG, Struening, EL, Neese-Todd, S, Asmussen, S, Phelan, JC (2001). Stigma as a barrier to recovery: the consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services 52, 16211626.
London, J, Evans-Lacko, SE (2010). Challenging mental health-related stigma through social contact. European Journal of Public Health 20, 130131.
Lysaker, PH, Roe, D, Yanos, PT (2007). Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophrenia Bulletin 33, 192199.
Mental Health Commission of Canada (2009). Opening Minds Campaign ( Accessed 18 June 2011.
Mojtabai, R (2010). Mental illness stigma and willingness to seek mental health care in the European Union. Social Psychiatry and Psychiatric Epidemiology 45, 705712.
NICE (2007). Behaviour Change at Population, Community and Individual Levels. National Institute for Health and Clinical Excellence ( Accessed 18 June 2011.
Page-Gould, E, Mendoza-Denton, R, Tropp, LR (2008). With a little help from my cross-group friend: reducing anxiety in intergroup contexts through cross-group friendship. Journal of Personality and Social Psychology 95, 10801094.
Paolini, S, Hewstone, M, Cairns, E, Voci, A (2004). Effects of direct and indirect cross-group friendships on judgments of Catholics and Protestants in Northern Ireland: the mediating role of an anxiety-reduction mechanism. Personality and Social Psychology Bulletin 30, 770786.
Patel, V, Maj, M, Flisher, AJ, DE Silva, MJ, Koschorke, M, Prince, M (2010). Reducing the treatment gap for mental disorders: a WPA survey. World Psychiatry 9, 169176.
Pescosolido, BA, Martin, JK, Long, JS, Medina, TR, Phelan, JC, Link, BG (2010). ‘A disease like any other’? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American Journal of Psychiatry 167, 13211330.
Pinfold, V, Huxley, P, Thornicroft, G, Farmer, P, Toulmin, H, Graham, T (2003 a). Reducing psychiatric stigma and discrimination: evaluating an educational intervention with the police force in England. Social Psychiatry and Psychiatric Epidemiology 38, 337344.
Pinfold, V, Toulmin, H, Thornicroft, G, Huxley, P, Farmer, P, Graham, T (2003 b). Reducing psychiatric stigma and discrimination: evaluation of educational interventions in UK secondary schools. British Journal of Psychiatry 182, 342346.
Ritsher, JB, Phelan, JC (2004). Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Research 129, 257265.
Rogers, ES, Chamberlin, J, Ellison, ML, Crean, T (1997). A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatric Services 48, 10421047.
Rusch, N, Angermeyer, MC, Corrigan, PW (2005). The stigma of mental illness: concepts, forms, and consequences. Psychiatrische Praxis 32, 221232.
Rusch, N, Corrigan, PW, Wassel, A, Michaels, P, Larson, JE, Olschewski, M, Wilkniss, S, Batia, K (2009). Self-stigma, group identification, perceived legitimacy of discrimination and mental health service use. British Journal of Psychiatry 195, 551552.
Rusch, N, Evans-Lacko, SE, Henderson, C, Flach, C, Thornicroft, G (2011). Knowledge and attitudes as predictors of intentions to seek help for and disclose a mental illness. Psychiatric Services 62, 675678.
Schmid, K, Hewstone, M, Tausch, N, Cairns, E, Hughes, J (2009). Antecedents and consequences of social identity complexity: intergroup contact, distinctiveness threat, and outgroup attitudes. Personality and Social Psychology Bulletin 35, 10851098.
Sharac, J, McCrone, P, Clement, S, Thornicroft, G (2010). The economic impact of mental health stigma and discrimination: a systematic review. Epidemiologia e Psichiatria Sociale 19, 223232.
Sibitz, I, Unger, A, Woppmann, A, Zidek, T, Amering, M (2011). Stigma resistance in patients with schizophrenia. Schizophrenia Bulletin 37, 316323.
Thornicroft, G (2008). Stigma and discrimination limit access to mental health care. Epidemiologia e Psichiatria Sociale 17, 1419.
Vaughan, G, Hansen, C (2004). ‘Like Minds, Like Mine’: a New Zealand project to counter the stigma and discrimination associated with mental illness. Australasian Psychiatry 12, 113117.
West, K, Hewstone, M, Holmes, EA (2010). Rethinking ‘mental health stigma’. European Journal of Public Health 20, 131132.
Zeger, SL, Liang, KY, Albert, PS (1988). Models for longitudinal data: a generalized estimating equation approach. Biometrics 44, 10491060.



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