What matters most': stigma towards severe mental disorders in Chile, a theory-driven, qualitative approach.
BACKGROUND
Stigma towards severe mental illness manifests in different ways across cultures and only recently has a theoretical perspective emerged to understand such cultural differences. The 'What Matters Most' framework identifies culturally specific dimensions of stigma by identifying the interactions between cultural norms, roles, and values that impact personhood.


OBJECTIVE
This study explores the cultural underpinnings that create and maintain stigmatizing attitudes towards severe mental illness in Chile.


METHODS
In-depth interviews developed using the 'Scale of Perceived Discrimination and Devaluation', and the 'What Matters Most' framework were conducted with twenty people identified as having a severe mental illness. Interviews were coded and discussed until agreement was reached, then analyzed by an independent reviewer to determine inter-rater reliability.


RESULTS
A key factor shaping stigma among women was the loss of capacity to accomplish family roles (i.e. take care of children).or men, cultural notions of 'Machismo' prevented them from disclosing their psychiatric diagnosis as a means to maintain status and ability to work. A protective factor against stigma for men was their ability to guide and provide for the family, thus fulfilling responsibilities attributable to 'Familismo'. Social appearances could play either a shaping or protecting role,contingent on the social status of the individual.


CONCLUSIONS
In Chilean culture, stigma is rooted in gendered social characteristics and shared familial roles. Interventions should aim to address these norms and incorporate culturally salient protective factors to reduce stigma experienced by individuals with serious mental illness in Chile and other Latin American settings.
School of Public Health, Faculty of Medicine, University of Chile.
Franco
F
Mascayano
Clinical Psychology, Teachers College, Columbia University.
Josefina
J
Toso-Salman
Clinical Psychology, Teachers College, Columbia University.
Bernalyn
B
Ruiz
Clinical Psychology, Teachers College, Columbia University.
Kathleen
K
Warman
School of Psychology, Faculty of Medicine, University of Valparaiso.
Ana
A
Jofre Escalona
School of Public Health, Faculty of Medicine, University of Chile.
Ruben
R
Alvarado Muñoz
Department of Epidemiology, Mailman School of Public Health, Columbia University.
Kathleen Janel
KJ
Sia
Department of Epidemiology, Mailman School of Public Health, Columbia University.
Lawrence Hsin
LH
Yang
D000293:Adolescent; D000328:Adult; D002677:Chile / Q000208:ethnology; D003466:Cultural Characteristics; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology* / Q000523:psychology; D008875:Middle Aged; D036301:Qualitative Research; D012737:Sex Factors; D018434:Sickness Impact Profile; D057545:Social Stigma; D012944:Social Support; D012959:Socioeconomic Factors; D013240:Stereotyping; D055815:Young Adult