title: [The Stigma-discrimination Complex Associated With Mental Disorder as a Risk Factor for Suicide].
abstract: BACKGROUND
  The concept stigma-discrimination complex associated with mental disorder (SDCAMD) is proposed to encompass the terms used in the attribution theory: stigma, stereotype, prejudice and discrimination. SDCAMD is one of the most frequent disorders worldwide. Internalized and perceived SDCAMD may explain a number of suicide cases.
  
  
  OBJECTIVE
  To update the factors that may explain the association between SDCAMD and suicide, and postulate possible underlying mechanisms.
  
  
  RESULTS
  Articles were identified in MEDLINE using the descriptors for "stigma", "mental disorders" and "suicide" or "suicide rate". Articles published between January 2000 and June 2014 were included. Reviews and case studies were not considered. The two included studies showed that stigma increased the risk of suicidal behaviors. It was evident that people who meet criteria for mental disorder and reported high self-stigma made a greater number of suicide attempts, and countries with high stigma in the general population have a higher suicide rate. It was considered that the relationship between SDCAMD and suicide is established by a set of interrelated mechanisms. A "direct" mechanism involving perceived stigma and is configured as a barrier to access mental health services, and an "indirect" mechanism involving the self-stigma, which increases the vulnerability to depressive episodes and repeated self-injurious behaviors that ultimately end in suicide.
  
  
  CONCLUSIONS
  The SDCAMD impacts negatively on the quality of life of people who meet criteria for mental disorders, and accounts for a significant number of suicides. One way is related to the perceived stigma that is configured as a barrier to access mental health services and, the second one includes repeated self-injurious behaviors that reduce self-esteem and increases perceived stress. Further research is required to increase the knowledge of this association.
authors.affiliation: Grupo de Investigación del Comportamiento Humano, Investigaciones y Publicaciones, Instituto de Investigación del Comportamiento Humano (Human Behavioral Research Institute), Bogotá, Colombia. Electronic address: campoarias@comportamientohumano.org.
authors.forename: Adalberto
authors.initials: A
authors.lastname: Campo-Arias
authors.affiliation: Grupo de Investigación del Comportamiento Humano, Instituto de Investigación del Comportamiento Humano (Human Behavioral Research Institute), Bogotá, Colombia.
authors.forename: Edwin
authors.initials: E
authors.lastname: Herazo
mesh_terms: D006297:Health Services Accessibility; D006801:Humans; D001523:Mental Disorders / Q000523:psychology*; D008605:Mental Health Services; D011287:Prejudice / Q000523:psychology; D011788:Quality of Life; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000523:psychology; D057545:Social Stigma; D013240:Stereotyping; D013405:Suicide / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology
keywords: Discriminación social; Estigma social; Review; Revisión; Social discrimination; Social stigma; Suicide; Suicidio