Stigma in Global Context-Mental Health Study (SGC-MHS)

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Mental Illness (MI) ranks among the most critical health problems in the global burden of disease, and the stigma associated with it is reported to be at the center of both individual and system problems. In fact, studies such as the World Health Organization's International Study of Schizophrenia (ISOS) have suggested that documented differential outcomes for persons with one of the most serious forms of MI is due in part to the differing cultural norms, attitudes, and behaviors toward persons with MI across societies. Yet, we know relatively little about whether and how the public's reaction to MI varies across countries. 

The conclusion of the ISoS that stigma interferes with recovery from mental illness reignited concern that stigma could be the foremost barrier to mental health treatment and outcomes. While the World Psychiatric Association's "Open the Door" Programme, led by Norman Sartorius, called for research and programs to reduce stigma, there wasn't a comparative study of the cultural climate surrounding mental illness. The Stigma in Global Context-Mental Health Study (SGC-MHS) was designed to fill that gap by mounting a coordinated study of nationally representative populations in 17 countries.

The SGC-MHS, a National Institute of Health-funded program, was designed to answer the International Study of Schizophrenia (ISoS)'s question: Why do individuals in "developing" countries report better outcomes than individuals in "developed" countries? The analysis that surrounded the ISoS led to the conclusion that "stigma" must underlie these findings. Led by Co-Investigators Bernice A. Pescosolido, Jack K. Martin, and J. Scott Long, the SGC-MHS is the first multi-national, methodologically coordinated study of the social, political, and cultural climate surrounding mental illness. Drawing from the International Social Survey Program, the SGC-MHS developed a vignette-designed instrument (providing respondents with vignette "cases" that met DSM-IV criteria for schizophrenia and major depression, as well as a medical case control, asthma) to assess the general public's reaction to mental illness.

Vignettes used and other study information here.

We proposed three specific aims. First, we derived a comprehensive theoretical model of the etiology of the stigma of MI that is informed by an interdisciplinary synthesis of existing research on the causes and correlates of stigmatizing responses to persons with MI. Second, we developed and pre-tested an instrument based on this framework in collaboration with an international set of mental health and survey research experts. Collected data came from face-to-face interviews with a nationally representative sample (n=1,000-1,500) of adults in each country. This provided national and international descriptive profiles of the public's knowledge of, familiarity with, beliefs about, and stigmatizing responses toward MI and persons with MI. Third, we empirically examined hypotheses proposed under the theoretical model, both nationally and cross-nationally. By understanding the public's reaction to different types of serious mental illness, both clinicians and researchers will be in a better position to account for the observed heterogeneity in outcomes of persons with SMI within and across countries. This knowledge can provide the scientific base for public health and treatment system interventions to mitigate the devastating negative effects of stigma on the lives of persons with serious mental illness.

SGC-MHS participating countries are: Argentina, Bangladesh, Belgium, Brazil, Bulgaria, China, Cyprus, Germany, Great Britain, Hungary, Iceland, New Zealand, the Philippines, South Africa, South Korea, Spain, and the United States.