BackgroundStigma and discrimination present an important barrier to finding and keeping work for individuals with a mental health problem. This paper reviews evidence on: 1) employment-related disclosure beliefs and behaviours of people with a mental health problem; 2) factors associated with the disclosure of a mental health problem in the employment setting; 3) whether employers are less likely to hire applicants who disclose a mental health problem; and 4) factors influencing employers' hiring beliefs and behaviours towards job applicants with a mental health problem.MethodsA systematic review was conducted for the period 1990-2010, using eight bibliographic databases. Meta-ethnography was used to provide a thematic understanding of the disclosure beliefs and behaviours of individuals with mental health problem.ResultsThe searches yielded 8,971 items which was systematically reduced to 48 included studies. Sixteen qualitative, one mixed methods and seven quantitative studies were located containing evidence on the disclosure beliefs and behaviours of people with a mental health problem, and the factors associated with these beliefs and behaviours. In the meta-ethnography four super-ordinate themes were generated: 1) expectations and experiences of discrimination; 2) other reasons for non-disclosure; 3) reasons for disclosure; and 4) disclosure dimensions. Two qualitative, one mixed methods and 22 quantitative studies provided data to address the remaining two questions on the employers perspective.ConclusionsBy presenting evidence from the perspective of individuals on both sides of the employment interaction, this review provides integrated perspective on the impact of disclosure of a mental health problem on employment outcomes.
BackgroundMost research on interventions to counter stigma and discrimination has focused on short-term outcomes and has been conducted in high-income settings.AimsTo synthesise what is known globally about effective interventions to reduce mental illness-based stigma and discrimination, in relation first to effectiveness in the medium and long term (minimum 4 weeks), and second to interventions in low- and middle-income countries (LMICs).MethodWe searched six databases from 1980 to 2013 and conducted a multi-language Google search for quantitative studies addressing the research questions. Effect sizes were calculated from eligible studies where possible, and narrative syntheses conducted. Subgroup analysis compared interventions with and without social contact.ResultsEighty studies (n = 422 653) were included in the review. For studies with medium or long-term follow-up (72, of which 21 had calculable effect sizes) median standardised mean differences were 0.54 for knowledge and −0.26 for stigmatising attitudes. Those containing social contact (direct or indirect) were not more effective than those without. The 11 LMIC studies were all from middle-income countries. Effect sizes were rarely calculable for behavioural outcomes or in LMIC studies.ConclusionsThere is modest evidence for the effectiveness of anti-stigma interventions beyond 4 weeks follow-up in terms of increasing knowledge and reducing stigmatising attitudes. Evidence does not support the view that social contact is the more effective type of intervention for improving attitudes in the medium to long term. Methodologically strong research is needed on which to base decisions on investment in stigma-reducing interventions.
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