The word ‘stigma’ means a form of disgrace associated with a particular situation or person. Stigma has a significant detrimental effect on access to mental health care. It is wellknown that people with mental illness and their families experience stigma and discrimination. Studying stigma can aid in planning appropriate anti-stigma programs for patients, family members and for the community. A narrative literature review of research publications on stigma experienced by people with severe mental disorders and their caregivers was conducted by searching PubMed, ProQuest and Google Scholar databases. Both original research and review articles were included. A total of 114 papers were included. All papers presented some information regarding the various aspects of stigma and its impact among persons with mental illness and their caregivers. The level of intensity of stigma among mentally ill individuals and their caregivers ranges from moderate to high, and is greatly influenced by various sociodemographic and illness variables. Research literature implies the need for the alleviation of stigma to improve the overall mental health of the community.
WHO|Mental disorders affect one in four people [Internet]. WHO. [cited 2017 Nov 5]. Available from: http://www.who.int/whr/2001/media_centre/press_release/en/.
World Health Organisation. WHO|10 facts on mental health [Internet]. [cited 2017 Oct 10]. Available from: http://www.who.int/features/factfiles/mental_health/mental_health_facts/en/index5.html.
Murthy RS. National mental health survey of India 2015–2016. Indian J Psychiatry 2017;59(1):21–26. DOI: 10.4103/psychiatry.IndianJPsychiatry_102_17.
World Health Organization, Mental health in India [Internet]. SEARO. [cited 2019 Oct 9]. Available from: http://www.searo.who.int/india/topics/mental_health/about_mentalhealth/en/.
Thornicroft G. Most people with mental illness are not treated. Lancet 2007;370(9590):807–808. DOI: 10.1016/S0140-6736(07)61392-0.
Shidhaye R, Kermode M. Stigma and discrimination as a barrier to mental health service utilization in India. Int Health 2013;5(1):6–8. DOI: 10.1093/inthealth/ihs011.
Clement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G. Development and psychometric properties the barriers to access to care evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry 2012;12:36. DOI: 10.1186/1471-244X-12-36.
Sartorius N. Iatrogenic stigma of mental illness. BMJ 2002;324(7352):1470–1471. DOI: 10.1136/bmj.324.7352.1470.
Stigma|Definition of stigma in English by Oxford Dictionaries [Internet]. Oxford Dictionaries|English. [cited 2017 Nov 4]. Available from: https://en.oxforddictionaries.com/definition/stigma.
Goffmann E. Stigma: Notes on the management of spoiled identity. New York: Simon and Schuster; 1963.
Elliott GC, Ziegler HL, Altman BM, Scott DR. Understanding stigma: dimensions of deviance and coping. Deviant Behav 1982;3(3): 275–300. DOI: 10.1080/01639625.1982.9967590.
Mental health: Overcoming the stigma of mental illness [Internet]. Mayo Clinic. [cited 2019 Oct 9]. Available from: https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477.
Brohan E, Clement S, Rose D, Sartorius N, Slade M, Thornicroft G. Development and psychometric evaluation of the Discrimination and Stigma Scale (DISC). Psychiatry Res 2013;208(1):33–40. DOI: 10.1016/j.psychres.2013.03.007.
Singh A, Mattoo S, Grover S. Stigma associated with mental illness: conceptual issues and focus on stigma perceived by the patients with schizophrenia and their caregivers. Indian J Soc Psychiatry Mumbai 2016;32(2):134–142. Available from: https://search.proquest.com/health/docview/1824351149/abstract/FDBD0E95FD234FC0PQ/1.
Grover S, Avasthi A, Singh A, Dan A, Neogi R, Kaur D, et al. Stigma experienced by caregivers of patients with severe mental disorders: a nationwide multicentric study. Int J Soc Psychiatry 2017;63(5):407–417. DOI: 10.1177/0020764017709484.
Steele A, Maruyama N, Galynker I. Psychiatric symptoms in caregivers of patients with bipolar disorder: a review. J Affect Disord 2010;121(1–2): 10–21. DOI: 10.1016/j.jad.2009.04.020.
Girma E, Möller-Leimkühler AM, Dehning S, Mueller N, Tesfaye M, Froeschl G. Self-stigma among caregivers of people with mental illness: toward caregivers’ empowerment. J Multidiscip Healthc 2014;7:37–43. DOI: 10.2147/JMDH.S57259.
Brohan E, Elgie R, Sartorius N, Thornicroft G. Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophr Res 2010;122(1–3):232–238. DOI: 10.1016/j.schres.2010.02.1065.
Vrbova K, Prasko J, Holubova M, Kamaradova D, Ociskova M, Marackova M, et al. Self-stigma and schizophrenia: a cross-sectional study. Neuropsychiatr Dis Treat 2016;12:3011–3020. DOI: 10.2147/NDT.S120298.
Thornicroft G, Rose D, Kassam A, Sartorius N. Stigma: ignorance, prejudice or discrimination? Br J Psychiatry 2007;190(3):192–193. DOI: 10.1192/bjp.bp.106.025791.
Sun Y, Chen G, Wang L, Li N, Srisurapanont M, Hong JP, et al. Perception of Stigma and its associated factors among patients with major depressive disorder: a multicenter survey from an Asian population. Front Psychiatry 2019;10:321. DOI: 10.3389/fpsyt.2019.00321.
Chang C-C, Yen C-F, Jang F-L, Su J-A, Lin C-Y. Comparing affiliate stigma between family caregivers of people with different severe mental illness in Taiwan. J Nerv Ment Dis 2017;205(7):542–549. DOI: 10.1097/NMD.0000000000000671.
Lazowski L, Koller M, Stuart H, Milev R. Stigma and discrimination in people suffering with a mood disorder: a cross-sectional study. Depress Res Treat 2012;2012:724848. DOI: 10.1155/2012/724848.
Hasson-Ohayon I, Levy I, Kravetz S, Vollanski-Narkis A, Roe D. Insight into mental illness, self-stigma, and the family burden of parents of persons with a severe mental illness. Compr Psychiatry 2011;52(1): 75–80. DOI: 10.1016/j.comppsych.2010.04.008.
Grover S, Avasthi A, Singh A, Dan A, Neogi R, Kaur D, et al. Stigma experienced by patients with severe mental disorders: a nationwide multicentric study from India. Psychiatry Res 2017;257:550–558. DOI: 10.1016/j.psychres.2017.08.027.
Guttikonda A, Shajan AM, Hephzibah A, Jones AS, Susanna J, Neethu S, et al. Perceived Stigma regarding mental illnesses among rural adults in Vellore, Tamil Nadu, South India. Indian J Psychol Med 2019;41(2):173–177. DOI: 10.4103/IJPSYM.IJPSYM_297_18.
Venkatesh BT, Andrews T, Mayya SS, Singh MM, Parsekar SS. Perception of stigma toward mental illness in South India. J Fam Med Prim Care 2015;4(3):449–453. DOI: 10.4103/2249-4863.161352.
Link BG. Understanding labeling effects in the area of mental disorders: an assessment of the effects of expectations of rejection. Am Sociol Rev 1987;52(1):96–112. DOI: 10.2307/2095395.
Stuart H. Media portrayal of mental illness and its treatments: what effect does it have on people with mental illness? CNS Drugs 2006;20(2):99–106. DOI: 10.2165/00023210-200620020-00002.
Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry 2002;1(1):16–20.
Thomas M. Charted: India's shocking attitudes towards mental illness [Internet]. Quartz India. [cited 2019 Oct 7]. Available from: https://qz.com/india/1237314/fear-and-apathy-how-indians-look-at-those-suffering-mental-illnesses/.
Lauber C, Rössler W. Stigma towards people with mental illness in developing countries in Asia. Int Rev Psychiatry 2007;19(2):157–178. DOI: 10.1080/09540260701278903.
Prabhu GG, Verma ARN, Maridass AC. Public attitudes toward mental illness: a review. NIMHANS J 1984;2(1):1–14.
Angermeyer MC, Matschinger H. The stereotype of schizophrenia and its impact on discrimination against people with schizophrenia: results from a representative survey in Germany. Schizophr Bull 2004;30(4):1049–1061. DOI: 10.1093/oxfordjournals.schbul. a007120.
Link BG, Mirotznik J, Cullen FT. The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided? J Health Soc Behav 1991;32(3):302–320. DOI: 10.2307/2136810.
Graves RE, Cassisi JE, Penn DL. Psychophysiological evaluation of stigma towards schizophrenia. Schizophr Res 2005;76(2–3):317–327. DOI: 10.1016/j.schres.2005.02.003.
Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007;370(9590):878–889. DOI: 10.1016/S0140-6736(07)61239-2.
Zieger A, Mungee A, Schomerus G, Ta TMT, Dettling M, Angermeyer MC, et al. Perceived stigma of mental illness: a comparison between two metropolitan cities in India. Indian J Psychiatry 2016;58(4): 432–437. DOI: 10.4103/0019-5545.196706.
Barke A, Nyarko S, Klecha D. The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients’ views. Soc Psychiatry Psychiatr Epidemiol 2011;46(11):1191–1202. DOI: 10.1007/s00127-010-0290-3.
Boge K, Zieger A, Mungee A, Tandon A, Fuchs LM, Schomerus G, et al. Perceived stigmatization and discrimination of people with mental illness: a survey-based study of the general population in five metropolitan cities in India. Indian J Psychiatry 2018;60(1):24–31. DOI: 10.4103/psychiatry.IndianJPsychiatry_406_17.
Thesen J. Being a psychiatric patient in the community--reclassified as the stigmatized “other”. Scand J Public Health 2001;29(4):248–255. DOI: 10.1177/14034948010290040901.
Wahl OF. Mental health consumers’ experience of stigma. Schizophr Bull 1999;25(3):467–478. DOI: 10.1093/oxfordjournals.schbul.a033394.
Pellegrini C. Mental illness stigma in health care settings a barrier to care. CMAJ Can Med Assoc J 2014;186(1):E17. DOI: 10.1503/cmaj.109-4668.
Lawrence D, Coghlan R. Health inequalities and the health needs of people with mental illness. New South Wales Public Health Bull 2002;13(7):155. DOI: 10.1071/NB02063.
Struening EL, Perlick DA, Link BG, Hellman F, Herman D, Sirey JA. Stigma as a barrier to recovery: the extent to which caregivers believe most people devalue consumers and their families. Psychiatr Serv 2001;52(12):1633–1638. DOI: 10.1176/appi.ps.52.12.1633.
Shibre T, Negash A, Kullgren G, Kebede D, Alem A, Fekadu A, et al. Perception of stigma among family members of individuals with schizophrenia and major affective disorders in rural Ethiopia. Soc Psychiatry Psychiatr Epidemiol 2001;36(6):299–303. DOI: 10.1007/s001270170048.
Trani J-F, Bakhshi P, Kuhlberg J, Narayanan SS, Venkataraman H, Mishra NN, et al. Mental illness, poverty and stigma in India: a case-control study. BMJ Open 2015;5(2):e006355. DOI: 10.1136/bmjopen-2014-006355.
Zhang Y, Subramaniam M, Lee SP, Abdin E, Sagayadevan V, Jeyagurunathan A, et al. Affiliate stigma and its association with quality of life among caregivers of relatives with mental illness in Singapore. Psychiatry Res 2018;265:55–61. DOI: 10.1016/j.psychres.2018.04.044.
Dalky HF, Qandil AM, Natour AS, Janet MC. Quality of life, stigma and burden perception among family caregivers and patients with psychiatric illnesses in Jordan. Community Ment Health J 2017;53(3):266–274. DOI: 10.1007/s10597-016-0028-0.
Greenwood N, Mezey G, Smith R. Social exclusion in adult informal carers: a systematic narrative review of the experiences of informal carers of people with dementia and mental illness. Maturitas 2018;112:39–45. DOI: 10.1016/j.maturitas.2018.03.011.
Muralidharan A, Lucksted A, Medoff D, Fang LJ, Dixon L. Stigma: a unique source of distress for family members of individuals with mental illness. J Behav Health Serv Res 2016;43(3):484–493. DOI: 10.1007/s11414-014-9437-4.
Jeyagurunathan A, Sagayadevan V, Abdin E, Zhang Y, Chang S, Shafie S, et al. Psychological status and quality of life among primary caregivers of individuals with mental illness: a hospital based study. Health Qual Life Outcomes 2017;15(1):106. DOI: 10.1186/s12955-017-0676-y.
Mukherjee S, Mukhopadhyay DK. Stigma towards mental illness: a hospital-based cross-sectional study among caregivers in West Bengal. Indian J Public Health 2018;62(1):15–20. DOI: 10.4103/ijph.IJPH_88_17.
Neupane D, Dhakal S, Thapa S, Bhandari PM, Mishra SR. Caregivers’ attitude towards people with mental illness and perceived stigma: a cross-sectional study in a tertiary hospital in Nepal. PloS One 2016;11(6):e0158113. DOI: 10.1371/journal.pone.0158113.
Ergetie T, Yohanes Z, Asrat B, Demeke W, Abate A, Tareke M. Perceived stigma among non-professional caregivers of people with severe mental illness, Bahir Dar, northwest Ethiopia. Ann Gen Psychiatry 2018;17:42. DOI: 10.1186/s12991-018-0212-4.
Shi Y, Shao Y, Li H, Wang S, Ying J, Zhang M, et al. Correlates of affiliate stigma among family caregivers of people with mental illness: a systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2019;26(1–2):49–61. DOI: 10.1111/jpm.12505.
Pawar AA, Peters A, Rathod J. Stigma of mental illness: Aa study in the Indian Armed Forces. Med J Armed Forces India 2014;70(4):354–359. DOI: 10.1016/j.mjafi.2013.07.008.
Dadson DA, Annor F, Salifu Yendork J. The burden of care: psychosocial experiences and coping strategies among caregivers of persons with mental illness in Ghana. Issues Ment Health Nurs 2018;39(11):915–923. DOI: 10.1080/01612840.2018.1496208.
Östman M, Kjellin L. Stigma by association: psychological factors in relatives of people with mental illness. Br J Psychiatry 2002;181(6):494–498. DOI: 10.1192/bjp.181.6.494.
Poreddi V, BIrudu R, Thimmaiah R, Math SB. Mental health literacy among caregivers of persons with mental illness: a descriptive survey. J Neurosci Rural Pract 2015;6(3):355–360. DOI: 10.4103/0976-3147.154571.
Tsang HWH, Tam PKC, Chan F, Cheung WM, Chang WM. Sources of burdens on families of individuals with mental illness. Int J Rehabil Res 2003;26(2):123–130. DOI: 10.1097/01.mrr.0000070761.13531.a1.
Chadda RK. Caring for the family caregivers of persons with mental illness. Indian J Psychiatry 2014;56(3):221–227. DOI: 10.4103/0019-5545.140616.
Yanos PT, Lysaker PH, Roe D. Internalized stigma as a barrier to improvement in vocational functioning among people with schizophrenia-spectrum disorders. Psychiatry Res 2010;178(1): 211–213. DOI: 10.1016/j.psychres.2010.01.003.
Singh A, Mattoo SK, Grover S. Stigma and its correlates in patients with schizophrenia attending a general hospital psychiatric unit. Indian J Psychiatry 2016;58(3):291–300. DOI: 10.4103/0019-5545.192024.
Lysaker PH, Davis LW, Warman DM, Strasburger A, Beattie N. Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: associations across 6 months. Psychiatry Res 2007;149(1–3): 89–95. DOI: 10.1016/j.psychres.2006.03.007.
Shrivastava A, Johnston ME, Thakar M, Shrivastava S, Sarkhel G, Sunita I, et al. Impact and origin of stigma and discrimination in schizophrenia: patient perceptions. Stigma Res Action 2011;1(1):67–72. DOI: 10.5463/sra.v1i1.5.
Bifftu BB, Dachew BA. Perceived Stigma and associated factors among people with schizophrenia at Amanuel mental specialized hospital, Addis Ababa, Ethiopia: a cross-sectional institution based study. Psychiatry J 2014;2014:694565. DOI: 10.1155/2014/694565.
Lien Y-J, Chang H-A, Kao Y-C, Tzeng N-S, Lu C-W, Loh C-H. Insight, self-stigma and psychosocial outcomes in Schizophrenia: a structural equation modelling approach. Epidemiol Psychiatr Sci 2018;27(2): 176–185. DOI: 10.1017/S2045796016000950.
Staring ABP, Van der Gaag M, Van den Berge M, Duivenvoorden HJ, Mulder CL. Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum disorders. Schizophr Res 2009;115(2–3): 363–369. DOI: 10.1016/j.schres.2009.06.015.
Mishra DK, Alreja S, Sengar KS, Singh AR. Insight and its relationship with stigma in psychiatric patients. Ind Psychiatry J 2009;18(1):39–42. DOI: 10.4103/0972-6748.57858.
Hasson-Ohayon I, Kravetz S, Roe D, David AS, Weiser M. Insight into psychosis and quality of life. Compr Psychiatry 2006;47(4):265–269. DOI: 10.1016/j.comppsych.2005.08.006.
Cavelti M, Kvrgic S, Beck E-M, Rüsch N, Vauth R. Self-stigma and its relationship with insight, demoralization, and clinical outcome among people with schizophrenia spectrum disorders. Compr Psychiatry 2012;53(5):468–479. DOI: 10.1016/j.comppsych.2011.08.001.
Estroff SE. Self, identity, and subjective experiences of schizophrenia: in search of the subject. Schizophr Bull 1989;15(2):189–196. DOI: 10.1093/schbul/15.2.189.
Latalova K, Ociskova M, Prasko J, Kamaradova D, Jelenova D, Sedlackova Z. Self-stigmatization in patients with bipolar disorder. Neuro Endocrinol Lett 2013;34(4):265–272.
Pal A, Sharan P, Chadda RK. Internalized stigma and its impact in Indian outpatients with bipolar disorder. Psychiatry Res 2017;258: 158–165. DOI: 10.1016/j.psychres.2017.09.087.
Ouanes S, Mrizak J, Arouss A, Ben Hammouda A, Rafrafi R, El Hechmi Z. Impact of Stigma on euthymic patients with bipolar disorder type I. Abstr 23rd Eur Congr Psychiatry 2015;30(Suppl 1):562. DOI: 10.1016/S0924-9338(15)30445-4.
Døssing M, Nilsson KK, Svejstrup SR, Sørensen VV, Straarup KN, Hansen TB. Low self-compassion in patients with bipolar disorder. Compr Psychiatry 2015;60:53–58. DOI: 10.1016/j.comppsych.2015.03.010.
Bassirnia A, Briggs J, Kopeykina I, Mednick A, Yaseen Z, Galynker I. Relationship between personality traits and perceived internalized stigma in bipolar patients and their treatment partners. Psychiatry Res 2015;230(2):436–440. DOI: 10.1016/j.psychres.2015.09.033.
Hajda M, Prasko J, Latalova K, Hruby R, Ociskova M, Holubova M, et al. Unmet needs of bipolar disorder patients. Neuropsychiatr Dis Treat 2016;12:1561–1570. DOI: 10.2147/NDT.S105728.
Sarısoy G, Kaçar ÖF, Pazvantoğlu O, Korkmaz IZ, Öztürk A, Akkaya D, et al. Internalized stigma and intimate relations in bipolar and schizophrenic patients: a comparative study. Compr Psychiatry 2013;54(6):665–672. DOI: 10.1016/j.comppsych.2013.02.002.
Grover S, Hazari N, Aneja J, Chakrabarti S, Sharma S, Avasthi A. Recovery and its correlates among patients with bipolar disorder: a study from a tertiary care centre in North India. Int J Soc Psychiatry 2016;62(8):726–736. DOI: 10.1177/0020764016676214.
Nilsson KK, Kugathasan P, Straarup KN. Characteristics, correlates and outcomes of perceived stigmatization in bipolar disorder patients. J Affect Disord 2016;194:196–201. DOI: 10.1016/j.jad.2016.01.025.
Ogilvie AD, Morant N, Goodwin GM. The burden on informal caregivers of people with bipolar disorder. Bipolar Disord 2005;7(Suppl 1):25–32. DOI: 10.1111/j.1399-5618.2005.00191.x.
Bailey RK, Blackmon HL, Stevens FL. Major depressive disorder in the African American population: meeting the challenges of stigma, misdiagnosis, and treatment disparities. J Natl Med Assoc 2009;101(11):1084–1089. DOI: 10.1016/S0027-9684(15)31102-0.
Shi-Jie F, Hong-Mei G, Li W, Bin-Hong W, Yi-Ru F, Gang W, et al. Perceptions of stigma and its correlates among patients with major depressive disorder: a multicenter survey from China. Asia Pac Psychiatry 2017;9(3). DOI: 10.1111/appy.12260.
Raguram R, Weiss MG, Channabasavanna SM, Devins GM. Stigma, depression, and somatization in South India. Am J Psychiatry 1996;153(8):1043–1049. DOI: 10.1176/ajp.153.8.1043.
Chowdhury AN, Sanyal D, Bhattacharya A, Dutta SK, De R, Banerjee S, et al. Prominence of symptoms and level of stigma among depressed patients in Calcutta. J Indian Med Assoc 2001;99(1):20–23.
Dandona R, Kumar GA, Dhaliwal RS, Naghavi M, Vos T, Shukla DK, et al. Gender differentials and state variations in suicide deaths in India: the Global Burden of Disease Study 1990–2016. Lancet Public Health 2018;3(10):e478–e489. DOI: 10.1016/S2468-2667(18)30138-5.
Sewilam AM, Watson AMM, Kassem AM, Clifton S, McDonald MC, Lipski R, et al. Suggested avenues to reduce the stigma of mental illness in the Middle East. Int J Soc Psychiatry 2015;61(2):111–120. DOI: 10.1177/0020764014537234.
Borecki L, Gozdzik-Zelazny A, Pokorski M. Personality and perception of stigma in psychiatric patients with depressive disorders. Eur J Med Res 2010;15(Suppl 2):10–16. DOI: 10.1186/2047-783X-15-S2-10.
Milačić Vidojević I, Dragojević N, Tošković O. Experienced and anticipated discrimination among people with major depressive disorder in Serbia. Int J Soc Psychiatry 2015;61(7):638–644. DOI: 10.1177/0020764014568325.
Holubova M, Prasko J, Ociskova M, Marackova M, Grambal A, Slepecky M. Self-stigma and quality of life in patients with depressive disorder: a cross-sectional study. Neuropsychiatr Dis Treat 2016;12:2677–2687. DOI: 10.2147/NDT.S118593.
Yen C-F, Chen C-C, Lee Y, Tang T-C, Ko C-H, Yen J-Y. Association between quality of life and self-stigma, insight, and adverse effects of medication in patients with depressive disorders. Depress Anxiety 2009;26(11):1033–1039. DOI: 10.1002/da.20413.
Sedlácková Z, Kamarádová D, Prásko J, Látalová K, Ocisková M, Ocisková M, et al. Treatment adherence and self-stigma in patients with depressive disorder in remission - a cross-sectional study. Neuro Endocrinol Lett 2015;36(2):171–177.
Koller R, Haslacher H, Kienesberger K, Schmöger M, Schosser A. Attitudes towards anti-depressive therapy: acceptance vs stigmatization. Neuropsychiatr 2015;29(1):14–22. DOI: 10.1007/s40211-014-0134-6.
Khan N, Kausar R, Khalid A, Farooq A. Gender differences among discrimination & stigma experienced by depressive patients in Pakistan. Pak J Med Sci 2015;31(6):1432–1436. DOI: 10.12669/pjms.316.8454.
Gaudiano BA, Miller IW. Self-stigma and attitudes about treatment in depressed patients in a hospital setting. Int J Soc Psychiatry 2013;59(6):586–591. DOI: 10.1177/0020764012446404.
Shrivastava A, Bureau Y, Rewari N, Johnston M. Clinical risk of stigma and discrimination of mental illnesses: need for objective assessment and quantification. Indian J Psychiatry 2013;55(2):178–182. DOI: 10.4103/0019-5545.111459.
Somasundaram O. Literary destigmatisation of mental illness: a study of the writings of Jayakanthan. Indian J Psychiatry 2013;55(3):295–299. DOI: 10.4103/0019-5545.117154.
Wong EC, Collins RL, Breslau J, Burnam MA, Cefalu M, Roth EA. Differential association of stigma with perceived need and mental health service use. J Nerv Ment Dis 2018;206(6):461–468. DOI: 10.1097/NMD.0000000000000831.
Svensson B, Hansson L. How mental health literacy and experience of mental illness relate to stigmatizing attitudes and social distance towards people with depression or psychosis: a cross-sectional study. Nord J Psychiatry 2016;70(4):309–313. DOI: 10.3109/08039488.2015.1109140.
Alamri Y. Mental illness in Saudi Arabia: stigma and acceptability. Int J Soc Psychiatry 2016;62(3):306–307. DOI: 10.1177/002076401 6628896.
Adewuya AO, Makanjuola ROA. Social distance towards people with mental illness in southwestern Nigeria. Aust N Z J Psychiatry 2008;42(5):389–395. DOI: 10.1080/00048670801961115.
AlAteeq D, AlDaoud A, AlHadi A, AlKhalaf H, Milev R. The experience and impact of stigma in Saudi people with a mood disorder. Ann Gen Psychiatry 2018;17:51. DOI: 10.1186/s12991-018-0221-3.
Mileva VR, Vázquez GH, Milev R. Effects, experiences, and impact of stigma on patients with bipolar disorder. Neuropsychiatr Dis Treat 2013;9:31–40. DOI: 10.2147/NDT.S38560.
Gronholm PC, Henderson C, Deb T, Thornicroft G. Interventions to reduce discrimination and stigma: the state of the art. Soc Psychiatry Psychiatr Epidemiol 2017;52(3):249–258. DOI: 10.1007/s00127-017-1341-9.
Corrigan P. Beat the Stigma: come out of the closet. Psychiatr Serv 2003;54(10):1313. DOI: 10.1176/appi.ps.54.10.1313.
Thornicroft C, Wyllie A, Thornicroft G, Mehta N. Impact of the “Like Minds, Like Mine” anti-stigma and discrimination campaign in New Zealand on anticipated and experienced discrimination. Aust N Z J Psychiatry 2014;48(4):360–370. DOI: 10.1177/0004867413512687.
Rüsch N, Angermeyer MC, Corrigan PW. The stigma of mental illness: concepts, forms, and consequences. Psychiatr Prax 2005;32(5): 221–232. DOI: 10.1055/s-2004-834566.
Cooke M, Peters E, Fannon D, Anilkumar APP, Aasen I, Kuipers E, et al. Insight, distress and coping styles in schizophrenia. Schizophr Res 2007;94(1–3):12–22. DOI: 10.1016/j.schres.2007.04.030.
Hanisch SE, Twomey CD, Szeto ACH, Birner UW, Nowak D, Sabariego C. The effectiveness of interventions targeting the stigma of mental illness at the workplace: a systematic review. BMC Psychiatry 2016;16:1. DOI: 10.1186/s12888-015-0706-4.
Rai S, Gurung D, Kaiser BN, Sikkema KJ, Dhakal M, Bhardwaj A, et al. A service user co-facilitated intervention to reduce mental illness stigma among primary healthcare workers: utilizing perspectives of family members and caregivers. Fam Syst Health 2018;36(2):198–209. DOI: 10.1037/fsh0000338.
Thornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet 2016;387(10023):1123–1132. DOI: 10.1016/S0140-6736(15)00298-6.
Griffiths KM, Carron-Arthur B, Parsons A, Reid R. Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry 2014;13(2):161–175. DOI: 10.1002/wps.20129.
Büchter RB, Messer M. Interventions for reducing self-stigma in people with mental illnesses: a systematic review of randomized controlled trials. Ger Med Sci 2017;15:Doc07. DOI: 10.3205/000248.