Stigma and discrimination related to mental illness in low- and middle-income countries.
OBJECTIVE
This paper aims to provide an overview of evidence from low- and middle-income countries (LAMICs) worldwide to address: the nature of stigma and discrimination, relevant context-specific factors, global patterns of these phenomena and their measurement and quantitative and qualitative evidence of interventions intended to reduce their occurrence and impact. The background to this study is that the large majority of studies concerned with identifying effective interventions to reduce stigma and discrimination originate in high-income countries (HICs). This paper therefore presents such evidence from, and relevant to, LAMICs.


METHODS
Conceptual overview of the relevant peer-reviewed and grey literature on stigma and discrimination related to mental illness in LAMICs are available in English, Spanish, French and Russian.


RESULTS
Few intervention studies were identified related to stigma re-education in LAMICs. None of these addressed behaviour change/discrimination, and there were no long-term follow-up studies. There is therefore insufficient evidence at present to know which overall types of intervention may be effective and feasible and in LAMICs, how best to target key groups such as healthcare staff, and how far they may need to be locally customised to be acceptable for large-scale use in these settings. In particular, forms of social contacts, which have been shown to be the most effective intervention to reduce stigma among adults in HICs, have not yet been assessed sufficiently to know whether these methods are also effective in LAMICs.


CONCLUSIONS
Generating information about effective interventions to reduce stigma and discrimination in LAMICs is now an important mental health priority worldwide.
Centre for Global Mental Health,Institute of Psychiatry,Psychology and Neuroscience,Kings College London,De Crespigny Park,London SE5 8AF,UK.
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M
Semrau
Centre for Global Mental Health,Institute of Psychiatry,Psychology and Neuroscience,Kings College London,De Crespigny Park,London SE5 8AF,UK.
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S
Evans-Lacko
Centre for Global Mental Health,Institute of Psychiatry,Psychology and Neuroscience,Kings College London,De Crespigny Park,London SE5 8AF,UK.
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M
Koschorke
Centre for Global Mental Health,Institute of Psychiatry,Psychology and Neuroscience,Kings College London,De Crespigny Park,London SE5 8AF,UK.
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L
Ashenafi
Centre for Global Mental Health,Institute of Psychiatry,Psychology and Neuroscience,Kings College London,De Crespigny Park,London SE5 8AF,UK.
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G
Thornicroft
Discrimination; evidence-based psychiatry; health service research; mental illness stigma