title: Cross-national variations in reported discrimination among people treated for major depression worldwide: the ASPEN/INDIGO international study.
abstract: BACKGROUND
  No study has so far explored differences in discrimination reported by people with major depressive disorder (MDD) across countries and cultures.
  
  
  OBJECTIVE
  To (a) compare reported discrimination across different countries, and (b) explore the relative weight of individual and contextual factors in explaining levels of reported discrimination in people with MDD.
  
  
  METHODS
  Cross-sectional multisite international survey (34 countries worldwide) of 1082 people with MDD. Experienced and anticipated discrimination were assessed by the Discrimination and Stigma Scale (DISC). Countries were classified according to their rating on the Human Development Index (HDI). Multilevel negative binomial and Poisson models were used.
  
  
  RESULTS
  People living in 'very high HDI' countries reported higher discrimination than those in 'medium/low HDI' countries. Variation in reported discrimination across countries was only partially explained by individual-level variables. The contribution of country-level variables was significant for anticipated discrimination only.
  
  
  CONCLUSIONS
  Contextual factors play an important role in anticipated discrimination. Country-specific interventions should be implemented to prevent discrimination towards people with MDD.
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK antonio.lasalvia@univr.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lasalvia
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: Tine
authors.initials: T
authors.lastname: Van Bortel
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bonetto
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: Geetha
authors.initials: G
authors.lastname: Jayaram
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: Jaap
authors.initials: J
authors.lastname: van Weeghel
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: Silvia
authors.initials: S
authors.lastname: Zoppei
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: Lee
authors.initials: L
authors.lastname: Knifton
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Quinn
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: Kristian
authors.initials: K
authors.lastname: Wahlbeck
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: Doriana
authors.initials: D
authors.lastname: Cristofalo
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Lanfredi
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: Norman
authors.initials: N
authors.lastname: Sartorius
authors.affiliation: Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
mesh_terms: D000328:Adult; D001208:Asia; D001315:Australia; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000523:psychology*; D005060:Europe; D005260:Female; D006801:Humans; D007391:International Cooperation; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D057566:Self Report; D063508:Social Discrimination; D057545:Social Stigma; D012959:Socioeconomic Factors; D013240:Stereotyping