Beside perceived treatment intensity and diagnostic label, the perception of social disability of mentally ill people accounts for a differentiated stigma. The question arises how anti-stigma-programmes can include the topic of social disability into their messages without risking to strengthen the stigma of mental illness.

BackgroundIn the study, the frequency and nature of asylum seekers’ psychiatric diagnoses in a German admission center were examined. Additional aims were to identify changes in those diagnoses over time and to investigate health care utilization of mentally ill asylum seekers in the community.MethodsThe sample for the study “Psychiatric Examination of Asylum Seekers” in Bavaria consisted of a total of 283 asylum seekers and included 2 subsamples: help-seeking individuals and a randomly selected group. 34 of all asylum seekers were part of an extensive psychiatric follow-up examination (t2) about six months after the first examination (t1). Here, we used psychometric tools and a psychiatric interview by a medical doctor and a psychologist with the help of translators.Results79% of help-seekers and 45% of the random group received at least one psychiatric diagnosis at t1. The most frequent diagnoses were trauma- and stress-related disorders, affective disorders, and insomnia. Men and Muslims were underrepresented in the help-seeking group. In the follow-up subsample, the rate of psychiatric diagnoses went down from 74% at t1 to 38% at t2. In contrast, the number of PTSD cases increased from 4 at t1 to 7 at t2. The severity of PTSD symptoms such as hyperarousal and avoidance also increased. Of the 13 persons in the follow-up-sample diagnosed with depression at t1, only 2 still fit the criteria of the disease at t2. Only 5 subjects had received some sort of psychotherapy or counseling.ConclusionThe prevalence of mental illness in asylum seekers reported here corresponds to the usual range in the literature. It is significantly higher than in European civil society, especially regarding PTSD. At t2, the diagnoses of PTDS had increased within several months without evident additional traumatic events. Asylum seekers’ psychiatric diagnoses soon after arrival should be recorded carefully and examination should be repeated after six months. The psychiatric and psychotherapeutic treatment of asylum seekers is still insufficient. Psychoeducative steps should be taken to relieve the stigma on mental illness, especially among males and Muslims.

ObjectiveWhereas 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).MethodParticipants 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.ResultsOverall, 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.ConclusionsAcross 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.

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The stigma of mental illness affects psychiatry as a medical profession and psychiatrists. The present study aimed to compare the extent and correlation patterns of perceived stigma in psychiatrists and general practitioners. An international multicenter survey was conducted in psychiatrists and general practitioners from twelve countries. Responses were received from N = 1,893 psychiatrists and N = 1,238 general practitioners. Aspects of stigma assessed in the questionnaire included perceived stigma, self-stigma (stereotype agreement), attitudes toward the other profession, and experiences of discrimination. Psychiatrists reported significantly higher perceived stigma and discrimination experiences than general practitioners. Separate multiple regression analyses showed different predictor patterns of perceived stigma in the two groups. Hence, in the psychiatrists group, perceived stigma correlated best with discrimination experiences and self-stigma, while in the general practitioners group it correlated best with self-stigma. About 17% of the psychiatrists perceive stigma as a serious problem, with a higher rate in younger respondents. Against this background, psychiatry as a medical profession should set a high priority on improving the training of young graduates. Despite the number of existing antistigma interventions targeting mental health professionals and medical students, further measures to improve the image of psychiatry and psychiatrists are warranted, in particular improving the training of young graduates with respect to raising awareness of own stigmatizing attitudes and to develop a better profession-related self-assertiveness.

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The stigma of mental illness is a severe burden for people suffering from mental illness both in private and public life, also affecting their relatives, their close social network, and the mental health care system in terms of disciplines, providers, and institutions. Interventions against the stigma of mental illness employ complementary strategies (e.g., protest, education, and contact) and address different target groups (e.g., school children and teachers, journalists, stakeholders). Within this framework, the World Psychiatric Association has adopted an Action Plan with the goal to improve the image of psychiatry and to reduce potential stigmatizing attitudes toward psychiatry and psychiatrists. To evaluate such interventions, a questionnaire has been developed that assesses opinions and attitudes toward psychiatrists and psychiatry in different samples of medical specialists (psychiatrists and general practitioners). The questionnaire comprises scales about perceived stigma in terms of the perception of societal stereotypes, self-stigma in terms of stereotype agreement, perceived stigma in terms of structural discriminations, discrimination experiences, stigma outcomes, and attitudes toward a second medical discipline. It is available in several languages (Arab, English, German, Japanese, Polish, and Spanish) and can easily be adapted for utilization in other medical specialties.

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