title: Discrimination in the workplace, reported by people with major depressive disorder: a cross-sectional study in 35 countries.
abstract: OBJECTIVE
  Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers' attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not).
  
  
  METHODS
  Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data.
  
  
  RESULTS
  Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment.
  
  
  CONCLUSIONS
  Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD.
authors.affiliation: Department of Tranzo, Tilburg University, Tilburg, The Netherlands.
authors.forename: E P M
authors.initials: EP
authors.lastname: Brouwers
authors.affiliation: Department of Tranzo, Tilburg University, Tilburg, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Mathijssen
authors.affiliation: King's College London, Institute of Psychiatry, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Van Bortel
authors.affiliation: Mental Health Foundation, Glasgow, UK.
authors.forename: L
authors.initials: L
authors.lastname: Knifton
authors.affiliation: National Institute for Health and Welfare, Vaasa, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Wahlbeck
authors.affiliation: Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Van Audenhove
authors.affiliation: Ibn Rushd University Psychiatric Centre, Casablanca, Morocco.
authors.forename: N
authors.initials: N
authors.lastname: Kadri
authors.affiliation: Department of Psychiatry, Chi Mei Medical Centre, Tainan, Taiwan.
authors.forename: Ch
authors.initials: Ch
authors.lastname: Chang
authors.affiliation: St John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, India.
authors.forename: B R
authors.initials: BR
authors.lastname: Goud
authors.affiliation: Sistema de Saúde Mãe de Deus, Porto Alegre, Brazil.
authors.forename: D
authors.initials: D
authors.lastname: Ballester
authors.affiliation: Universidade Federal do Ceara, Campus Sobral, Brazil.
authors.forename: L F
authors.initials: LF
authors.lastname: Tófoli
authors.affiliation: Hospital Universitario de Caracas, Caracas, Venezuela.
authors.forename: R
authors.initials: R
authors.lastname: Bello
authors.affiliation: Associacao para o Estudo e Integracao Psicossocial, Lisbon, Portugal.
authors.forename: M F
authors.initials: MF
authors.lastname: Jorge-Monteiro
authors.affiliation: Heinrich-Heine Universitat Dusseldorf, Rheinische Kliniken Dusseldorf, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Zäske
authors.affiliation: Faculty for Special Education and Rehabilitation, Belgrade, Serbia.
authors.forename: I
authors.initials: I
authors.lastname: Milaćić
authors.affiliation: Foundation of Psychiatry Clinic of Medical Faculty of Istanbul, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Uçok
authors.affiliation: Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Bonetto
authors.affiliation: Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lasalvia
authors.affiliation: King's College London, Institute of Psychiatry, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Thornicroft
authors.affiliation: Department of Tranzo, Tilburg University, Tilburg, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Van Weeghel
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011287:Prejudice / Q000706:statistics & numerical data*; D057545:Social Stigma; D014478:Unemployment / Q000706:statistics & numerical data*; D017132:Workplace / Q000706:statistics & numerical data*
keywords: OCCUPATIONAL & INDUSTRIAL MEDICINE; discrimination; human development index; stigma; work