title: Collective levels of stigma and national suicide rates in 25 European countries.
abstract: OBJECTIVE
  There is substantial diversity in national suicide rates, which has mainly been related to socio-economic factors, as well as cultural factors. Stigma is a cultural phenomenon, determining the level of social acceptance or rejection of persons with mental illness in a society. In this study, we explore whether national suicide rates are related to the degree of mental illness stigma in that country.
  
  
  METHODS
  We combine the data on country-level social acceptance (Eurobarometer) with the data on suicide rates and socio-economic indicators (Eurostat) for 25 European countries.
  
  
  RESULTS
  In a linear regression model controlling for socio-economic indicators, the social acceptance of someone with a significant mental health problem in 2010 was negatively correlated with age standardised national suicide rates in the same year (β -0.46, p = 0.014). This association also held true when combining national suicide rates with death rates due to events of undetermined intent.
  
  
  CONCLUSIONS
  Stigma towards persons with mental health problems may contribute to differences in suicide rates in a country. We hypothesise possible mechanisms explaining this link, including stigma as a stressor and social isolation as a consequence of stigma.
authors.affiliation: Department of Psychiatry,Greifswald University,Greifswald,Germany.
authors.forename: G
authors.initials: G
authors.lastname: Schomerus
authors.affiliation: Health Service and Population Research Department,King's College London, Institute of Psychiatry,London,UK.
authors.forename: S
authors.initials: S
authors.lastname: Evans-Lacko
authors.affiliation: Department of Psychiatry II,University of Ulm,Ulm,Germany.
authors.forename: N
authors.initials: N
authors.lastname: Rüsch
authors.affiliation: Department of Mental Health,Johns Hopkins Bloomberg School of Public Health,Baltimore, Maryland,USA.
authors.forename: R
authors.initials: R
authors.lastname: Mojtabai
authors.affiliation: Department of Public Health,University of Cagliari,Cagliari,Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Angermeyer
authors.affiliation: Health Service and Population Research Department,King's College London, Institute of Psychiatry,London,UK.
authors.forename: G
authors.initials: G
authors.lastname: Thornicroft
keywords: suicide