Mental health related stigma in Romania: systematic review and narrative synthesis

Abstract

Background Stigma related to mental illness is increasingly and more effectively addressed. Although more research is being conducted, there is relatively little from low and middle-income countries, with former Soviet bloc countries identified as a particular contributor to this evidence gap. Romania struggles with mental health stigma at many levels. The aim of this review was to bring together all relevant data regarding stigma and discrimination related to mental illness as well as actions to address these problems in Romania in order to prioritise further stigma research and identify priority targets for stigma reduction. Methods A systematic literature search was conducted in three online databases and grey literature. After the analysis of full manuscripts, four were excluded based on lack of relevance or incomplete data reporting. Quality assessment was performed for included studies using the Mixed Methods Appraisal Tool (MMAT) and the narrative was synthesized based on the research questions. Results The review included fifteen studies, the majority having a cross-sectional design. Stigma related to mental illness in Romania, has an impact on help-seeking attitudes and behaviours, workplace environment and social relationships of people with mental health problems. Negative stereotypes are maintained and validated by mass media reports. Significant stigma in healthcare and mental care settings has also been observed. Self-stigma was less frequently reported than public stigma. Despite a few stigma reduction actions, no rigorous evaluation of content, delivery and effectiveness has been conducted and no empirical evidence has been published. Conclusions Based on this review, three lines of action are recommended in Romania. Increase research concerning stigma in healthcare and mental care settings and use behavioural outcomes. Develop and deliver evidence-based tailored interventions to reduce stigma in identified priority subgroups of the population and ensure rigorous evaluation and scientific dissemination. Elaborate guidelines for working with community stigma and advocate for structural changes.

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“…First, no control group was used, which diminished the methodological rigour of the study. Psychotherapy and counselling in Romania are still not a popular practice, and stigma and negative stereotypes are associated with them ( Manescu et al, 2023 ), making it difficult to motivate people to participate in such studies. Second, the sampling procedure and small sample size, though sufficient for power analysis, limit the generalisability of the findings.…”

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“…However, other medical professionals frequently discriminate against psychiatric patients by avoiding professional contact with them, disregarding their medical obligations to them. All these facts about the Romanian healthcare system point to a high degree of institutional and societal stigma that has not been effectively addressed by legislative and administrative initiatives [4].…”