摘要：Objectives. We used the Stigma in Global Context–Mental Health Study to assess the core sentiments that represent consistent, salient public health intervention targets. Methods. Data from 16 countries employed a nationally representative sampling strategy, international collaboration for instrument development, and case vignettes with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition depression and schizophrenia criteria. We measured knowledge and prejudice with existing questions and scales, and employed exploratory data analysis to examine the public response to 43 items. Results. Across countries, levels of recognition, acceptance of neurobiological attributions, and treatment endorsement were high. However, a core of 5 prejudice items was consistently high, even in countries with low overall stigma levels. The levels were generally lower for depression than schizophrenia, and exclusionary sentiments for more intimate venues and in authority-based roles showed the greatest stigma. Negative responses to schizophrenia and depression were highly correlated across countries. Conclusions. These results challenge researchers to reconfigure measurement strategies and policymakers to reconsider efforts to improve population mental health. Efforts should prioritize inclusion, integration, and competences for the reduction of cultural barriers to recognition, response, and recovery. A resurgence in research, programs, and policy efforts targeting prejudice and discrimination associated with mental illness has dramatically improved scientific understanding of causes, correlates, and change. 1 Conceptual and methodological work has provided a solid framework for guiding research hypotheses, 2–4 cross-disciplinary collaboration has accelerated scientific progress, 5–7 and multifaceted approaches to stigma reduction have recently been put into play. 8,9 Despite different designs, respondent groups, measures, and analytic models, results have shown a remarkable consistency in scientific conclusions (e.g., robust influence of contact on tolerance). 10 Most notably, ironically, public acceptance of modern medical and public health views of mental illness appears to be coupled with a stubborn persistence of negative opinions, attitudes, and intentions. 11–15 As recent path-breaking research has documented, cultures of stigma shape individual-level acceptance and rejection, reported willingness to seek treatment, and feelings of self-worth and efficacy that persons with mental illness hold. 8,16 These findings have motivated renewed efforts to rethink standard approaches to stigma research and to reconsider stigma-reduction efforts aimed at improving population mental health. 7,17,18 Yet, a major impediment to the next generation of effective stigma reduction programs lies in identifying the core public sentiments, or “backbone,” underlying misinformation, prejudice, and discrimination associated with mental illness. Certainly, early psychoanalytic ideas about the “schizophregenic mother,” the moral weakness of those with depression, or the inherent proclivity to violence among persons with mental illness mirror both a lack of scientific knowledge and negative appraisals. Findings have been disproportionately limited to North America and Europe and focused primarily upon schizophrenia. 16,19–22 Antistigma campaigns have primarily targeted educational goals to reduce misinformation and mischaracterization of mental illness. 11 Methodological differences in measurement strategies across studies hamper the development of strategically specific programs and policies. We asked 3 fundamental questions in the service of the next generation of antistigma efforts: (1) Is there a “backbone” of larger cultural beliefs, attitudes, and opinions about mental illness that presents the greatest challenges to individuals, families, and providers? (2) Does a lack of knowledge, an unwillingness to include individuals with mental health problems in civil society, or concerns about treatment stand in the way of recovery? (3) Does the public react similarly or differently to schizophrenia and depression? We analyzed data from the Stigma in Global Context–Mental Health Study (SGC-MHS) to examine public responses to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) 23 scenarios for schizophrenia and depression across 16 countries. Using multiple measures to tap ignorance, rejection, exclusion, and negative affect, we searched for those items that may form the backbone of stigma—a widely held damaging core of cultural attitudes and beliefs about causes, solutions, and inclusion.
