title: Embarrassment when illness strikes a close relative: a World Mental Health Survey Consortium Multi-Site Study.
abstract: BACKGROUND
  In this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the afflicted individual but have not assessed family embarrassment in a large-scale study.
  
  
  METHODS
  In 16 sites of the World Mental Health Surveys (WMHS), standardized assessments were completed including items on family embarrassment. Site matching was used to constrain local socially shared determinants of stigma-related feelings, enabling a conditional logistic regression model that estimates the embarrassment close relatives may hold in relation to family members affected by an ADMC, a GMC, or both conditions.
  
  
  RESULTS
  There was a statistically robust association such that subgroups with an ADMC-affected relative were more likely to feel embarrassed compared to subgroups with a relative affected by a GMC (p<0.001), even with covariate adjustments for age and sex.
  
  
  CONCLUSIONS
  . The pattern of evidence from this research is consistent with conceptual models for interventions that target individual- and family-level stigma-related feelings of embarrassment as possible obstacles to effective early intervention and treatment for an ADMC. Macro-level interventions are under way but micro-level interventions may also be required among family members, along with care for each person with an ADMC.
authors.affiliation: Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI 48202, USA. bahmeda1@hfhs.org
authors.forename: B K
authors.initials: BK
authors.lastname: Ahmedani
authors.forename: S P
authors.initials: SP
authors.lastname: Kubiak
authors.forename: R C
authors.initials: RC
authors.lastname: Kessler
authors.forename: R
authors.initials: R
authors.lastname: de Graaf
authors.forename: J
authors.initials: J
authors.lastname: Alonso
authors.forename: R
authors.initials: R
authors.lastname: Bruffaerts
authors.forename: Z
authors.initials: Z
authors.lastname: Zarkov
authors.forename: M C
authors.initials: MC
authors.lastname: Viana
authors.forename: Y Q
authors.initials: YQ
authors.lastname: Huang
authors.forename: C
authors.initials: C
authors.lastname: Hu
authors.forename: J A
authors.initials: JA
authors.lastname: Posada-Villa
authors.forename: J-P
authors.initials: JP
authors.lastname: Lepine
authors.forename: M C
authors.initials: MC
authors.lastname: Angermeyer
authors.forename: G
authors.initials: G
authors.lastname: de Girolamo
authors.forename: A N
authors.initials: AN
authors.lastname: Karam
authors.forename: M E
authors.initials: ME
authors.lastname: Medina-Mora
authors.forename: O
authors.initials: O
authors.lastname: Gureje
authors.forename: F
authors.initials: F
authors.lastname: Ferry
authors.forename: R
authors.initials: R
authors.lastname: Sagar
authors.forename: J C
authors.initials: JC
authors.lastname: Anthony
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D000368:Aged; D000369:Aged, 80 and over; D000569:Americas; D001208:Asia; D005060:Europe; D005195:Family Relations; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D009520:New Zealand; D057545:Social Stigma; D055815:Young Adult