Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2010

Open Access 01-12-2010 | Research article

Experiences of mental illness stigma, prejudice and discrimination: a review of measures

Authors: Elaine Brohan, Mike Slade, Sarah Clement, Graham Thornicroft

Published in: BMC Health Services Research | Issue 1/2010

Login to get access

Abstract

Background

There has been a substantial increase in research on mental illness related stigma over the past 10 years, with many measures in use. This study aims to review current practice in the survey measurement of mental illness stigma, prejudice and discrimination experienced by people who have personal experience of mental illness. We will identify measures used, their characteristics and psychometric properties.

Method

A narrative literature review of survey measures of mental illness stigma was conducted. The databases Medline, PsychInfo and the British Nursing Index were searched for the period 1990-2009.

Results

57 studies were included in the review. 14 survey measures of mental illness stigma were identified. Seven of the located measures addressed aspects of perceived stigma, 10 aspects of experienced stigma and 5 aspects of self-stigma. Of the identified studies, 79% used one of the measures of perceived stigma, 46% one of the measures of experienced stigma and 33% one of the measures of self-stigma. All measures presented some information on psychometric properties.

Conclusions

The review was structured by considering perceived, experienced and self stigma as separate but related constructs. It provides a resource to aid researchers in selecting the measure of mental illness stigma which is most appropriate to their purpose.
Appendix
Available only for authorised users
Literature
1.
Goffman E: Stigma: Notes on the Management of Spoiled Identity. 1963, Harmondsworth, Middlesex: Penguin Books
2.
Jones E, Farina A, Hastorf A, Markus H, Milller D, Scott R: Social Stigma: the Psychology of Marked to Relationships. 1984, New York: W.H. Freeman & Co.
3.
Elliott GC, Ziegler HL, Altman BM, Scott DR: Understanding stigma: dimensions of deviance and coping. Deviant Behaviour. 1982, 3: 275-300.CrossRef
4.
Weiss MG, Ramakrishna J, Somma D: Health-related stigma: rethinking concepts and interventions. Psychology, Health & Medicine. 2006, 11: 277-287.CrossRef
5.
Major B, O'Brien LT: The social psychology of stigma. Annual Review of Psychology. 2005, 56: 393-421. 10.1146/annurev.psych.56.091103.070137.CrossRefPubMed
6.
Link BG, Phelan JC: Conceptualizing stigma. Annual Review of Sociology. 2001, 27: 363-385. 10.1146/annurev.soc.27.1.363.CrossRef
7.
Phelan JC, Link BG, Dovidio JF: Stigma and prejudice: one animal or two?. Social Science & Medicine. 2008, 67: 358-367.CrossRef
8.
Corrigan P: On the Stigma of Mental Illness. 2005, Washington, D.C.: American Psychological Association
9.
Thornicroft G, Rose D, Kassam A, Sartorius N: Stigma: ignorance, prejudice or discrimination?. British Journal of Psychiatry. 2007, 190: 192-193. 10.1192/bjp.bp.106.025791.CrossRefPubMed
10.
Sayce L: Stigma, discrimination and social exclusion: what's in a word. Journal of Mental Health. 1998, 7: 331-343. 10.1080/09638239817932.CrossRef
11.
Link BG, Yang LH, Phelan JC, Collins PY: Measuring mental illness stigma. Schizophrenia Bulletin. 2004, 30: 511-541.CrossRefPubMed
12.
Henderson C, Thornicroft G: Stigma and discrimination in mental illness: time to Change. The Lancet. 2009, 373: 1928-1930. 10.1016/S0140-6736(09)61046-1.CrossRef
13.
Knight MTD, Wykes T, Hayward P: Group treatment of perceived stigma and self-esteem in schizophrenia: a waiting list trial of efficacy. Behavioural and Cognitive Psychotherapy. 2006, 34: 305-318. 10.1017/S1352465805002705.CrossRef
14.
Van Brakel WH, Anderson AM, Mutatkar RK, Bakirtzief Z, Nicholls PG, Raju MS, et al: The Participation Scale: measuring a key concept in public health. Disability and Rehabilitation. 2006, 28: 193-203. 10.1080/09638280500192785.CrossRefPubMed
15.
Scrambler G, Hopkins A: Being epileptic: coming to terms with stigma. Sociology of Health and Illness. 1986, 8: 26-43. 10.1111/1467-9566.ep11346455.CrossRef
16.
LeBel T: Perceptions of and responses to stigma. Sociology Compass. 2008, 2: 409-432. 10.1111/j.1751-9020.2007.00081.x.CrossRef
17.
Corrigan PW, Watson AC: The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice. 2002, 9: 35-53. 10.1093/clipsy/9.1.35.
18.
Corrigan PW: The impact of stigma on severe mental illness. Cognitive and Behavioral Practice. 1998, 5: 201-222. 10.1016/S1077-7229(98)80006-0.CrossRef
19.
Caltaux D: Internalized stigma: a barrier to employment for people with mental illness. International journal of therapy and rehabilitation. 2003, 10: 539-543.CrossRef
20.
Zeidner M, Endler NS: Handbook of Coping: Theory, Research, Applications. 1996, New York: John Wiley & Sons
21.
Link BG, Cullen FT, Struening E, Shrout PE, Dohrenwend BP: A modified labeling theory approach to mental disorders: an empirical assessment. American Sociological Review. 1989, 54: 400-423. 10.2307/2095613.CrossRef
22.
Link BG, Struening EL, Neese-Todd S, Asmussen S, Phelan JC: Stigma as a barrier to recovery: the consequences of stigma for the self-esteem of people with mental illness. Psychiatric Services. 2001, 52: 1621-1626. 10.1176/appi.ps.52.12.1621.CrossRefPubMed
23.
Mak WWS, Poon CYM, Pun LYK, Cheung SF: Meta-analysis of stigma and mental health. Social Science & Medicine. 2007, 65: 245-261.CrossRef
24.
Rusch N, Angermeyer MC, Corrigan PW: Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. European Psychiatry. 2005, 20: 529-539. 10.1016/j.eurpsy.2005.04.004.CrossRefPubMed
25.
Link BG: Understanding Labeling Effects in the area of mental disorders: an assessment of the effect of expectations of rejection. American Journal of Community Psychology. 1987, 11: 261-273. 10.1007/BF00893367.CrossRef
26.
Terwee CB, Bot SDM, de Boer MR, Windt van der DAWM, Knol DL, Dekker J, et al: Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology. 2007, 60: 34-42. 10.1016/j.jclinepi.2006.03.012.CrossRefPubMed
27.
Corrigan PW, Watson AC, Barr L: The self-stigma of mental illness: implications for self-esteem and self-efficacy. Journal of Social & Clinical Psychology. 2006, 25: 875-884.CrossRef
28.
Hayward P, Wong G, Bright JA, Lam D: Stigma and self-esteem in manic depression: an exploratory study. Journal of Affective Disorders. 2002, 69: 61-67. 10.1016/S0165-0327(00)00380-3.CrossRefPubMed
29.
Pinel EC: Stigma consciousness: the psychological legacy of social stereotypes. Journal of Personality & Social Psychology. 1999, 76: 114-128.CrossRef
30.
Kanter JWP, Rusch LCM, Brondino MJP: Depression self-stigma: a new measure and preliminary findings. Journal of Nervous & Mental Disease. 2008, 196: 663-670.CrossRef
31.
Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M, for The INDIGO Study Group: Global pattern of anticipated and experienced discrimination against people with schizophrenia. The Lancet. 2009, 373: 408-415. 10.1016/S0140-6736(08)61817-6.CrossRef
32.
Stuart H, Milev R, Koller M: The Inventory of Stigmatizing Experiences: its development and reliability. World Psychiatry. 2005, 4: 33-37.
33.
Ritsher JB, Otilingam PG, Grajales M: Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research. 2003, 121: 31-49. 10.1016/j.psychres.2003.08.008.CrossRefPubMed
34.
35.
Link BG, Struening EL, Rahav M, Phelan JC, Nuttbrock L: On stigma and its consequences: evidence from a longitudinal study of men with dual diagnosis of mental illness and substance abuse. Journal of Health and Social Behavior. 1997, 38: 177-190. 10.2307/2955424.CrossRefPubMed
36.
King M, Dinos S, Shaw J, Watson R, Stevens S, Passetti F, et al: The Stigma Scale: development of a standardised measure of the stigma of mental illness. British Journal of Psychiatry. 2007, 190: 248-254. 10.1192/bjp.bp.106.024638.CrossRefPubMed
37.
Kessler RC, Mickelson KD, Williams DR: The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior. 1999, 40: 208-230. 10.2307/2676349.CrossRefPubMed
38.
Thompson VL, Noel JG, Campbell J: Stigmatization, discrimination, and mental health: the impact of multiple identity status. American Journal of Orthopsychiatry. 2004, 74: 529-544. 10.1037/0002-9432.74.4.529.CrossRefPubMed
39.
Komiya N, Good GE, Sherrod NB: Emotional openness as a predictor of college students' attitudes toward seeking psychological help. Journal of counseling psychology. 2000, 47: 138-143. 10.1037/0022-0167.47.1.138.CrossRef
40.
Vogel DL, Wade NG, Haake S: Measuring self-stigma associated with seeking psychological help. Journal of Counseling Psychology. 2006, 53: 325-337. 10.1037/0022-0167.53.3.325.CrossRef
41.
Craig P, Dieppe P, MacIntyre S, Mitchie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new Medical Research Council guidance. British Medical Journal. 2008, 337: 979-983. 10.1136/bmj.a1655.CrossRef
42.
Teachman BA, Wilson JG, Komarovskaya I: Implicit and explicit stigma of mental illness in diagnosed and healthy samples. Journal of Social & Clinical Psychology. 2006, 25: 75-95.CrossRef
43.
Dinos S, Stevens S, Serfaty M, Weich S, King M: Stigma: the feelings and experiences of 46 people with mental illness. Qualitative study. British Journal of Psychiatry. 2004, 184: 176-181. 10.1192/bjp.184.2.176.CrossRefPubMed
44.
Yanos PT, Rosenfeld S, Horowitz AV: Negative and supportive social interactions and quality of life among persons diagnosed with severe mental illness. Community Mental Health Journal. 2001, 37: 405-419. 10.1023/A:1017528029127.CrossRefPubMed
45.
Chung KF, Wong MC: Experience of stigma among Chinese mental health patients in Hong Kong. Psychiatric Bulletin. 2004, 28: 451-454. 10.1192/pb.28.12.451.CrossRef
46.
Sirey JA, Bruce ML, Alexopoulos GS, Perlick DA, Friedman SJ, Meyers BS: Stigma as a barrier to recovery: perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatric Services. 2001, 52: 1615-1620. 10.1176/appi.ps.52.12.1615.CrossRefPubMed
47.
Bjorkman T, Svensson B, Lundberg B: Experiences of stigma among people with severe mental illness. Reliability, acceptability and construct validity of the Swedish versions of two stigma scales measuring devaluation/discrimination and rejection experiences. Nordic Journal of Psychiatry. 2007, 61: 332-338. 10.1080/08039480701642961.CrossRefPubMed
48.
Ritsher JB, Phelan JC: Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Research. 2004, 129: 257-265. 10.1016/j.psychres.2004.08.003.CrossRefPubMed
49.
Bagley C, King M: Exploration of three stigma scales in 83 users of mental health services: implication for campaigns to reduce stigma. Journal of Mental Health. 2005, 14: 343-355. 10.1080/09638230500195270.CrossRef
50.
Vauth R, Kleim B, Wirtz M, Corrigan P: Self-efficacy and empowerment as outcomes of self-stigmatizing and coping schizophrenia. Psychiatry Research. 2007, 150: 71-80. 10.1016/j.psychres.2006.07.005.CrossRefPubMed
51.
MacInnes DL, Lewis M: The evaluation of a short group programme to reduce self-stigma in people with serious and enduring mental health problems. Journal of Psychiatric & Mental Health Nursing. 2008, 15: 59-65.CrossRef
52.
Hansson L, Bjorkman T: Empowerment in people with a mental illness: Reliability and validity of the Swedish version of an empowerment scale. Scandinavian Journal of Caring Sciences. 2005, 19: 32-38. 10.1111/j.1471-6712.2004.00310.x.CrossRefPubMed
53.
Knight MTD, Wykes T, Hayward P: Group treatment of perceived stigma and self-esteem in schizophrenia: a waiting list trial of efficacy. Behavioural and Cognitive Psychotherapy. 2006, 34: 305-318. 10.1017/S1352465805002705.CrossRef
54.
Perlick DA, Rosenheck RA, Clarkin JF, Sirey JA, Salahi J, Struening EL, et al: Stigma as a barrier to recovery: adverse effects of perceived stigma on social adaptation of persons diagnosed with bipolar affective disorder. Psychiatric Services. 2001, 52: 1627-1632. 10.1176/appi.ps.52.12.1627.CrossRefPubMed
55.
Mueller B, Nordt C, Lauber C, Rueesch P, Meyer PC, Roessler W: Social support modifies perceived stigmatization in the first years of mental illness: a longitudinal approach. Social Science & Medicine. 2006, 62: 39-49.CrossRef
56.
Wright ER, Gronfein WP, Owens TJ: Deinstitutionalization, social rejection, and the self-esteem of former mental patients. Journal of Health and Social Behavior. 2000, 41: 68-90. 10.2307/2676361.CrossRefPubMed
57.
Markowitz FE: The effects of stigma on the psychological well-being and life satisfaction of persons with mental illness. Journal of Health and Social Behavior. 1998, 39: 335-347. 10.2307/2676342.CrossRefPubMed
58.
Kleim B, Vauth R, Adam G, Stieglitz RD, Hayward P, Corrigan P: Perceived stigma predicts low self-efficacy and poor coping in schizophrenia. Journal of Mental Health. 2008, 17: 482-491. 10.1080/09638230701506283.CrossRef
59.
Lundberg B, Hansson L, Wentz E, Bjorkman T: Sociodemographic and clinical factors related to devaluation/discrimination and rejection experiences among users of mental health services. Social Psychiatry and Psychiatric Epidemiology. 2007, 42: 295-300. 10.1007/s00127-007-0160-9.CrossRefPubMed
60.
Link BG, Struening EL, Neese-Todd S, Asmussen S, Phelan JC: On describing and seeking to change the experience of stigma. Psychiatric Rehabilitation Skills. 2002, 6: 201-231.CrossRef
61.
Kahng SK, Mowbray CT: What affects self-esteem of persons with psychiatric disabilities: the role of causal attributions of mental illnesses. Psychiatric Rehabilitation Journal. 2005, 28: 354-361. 10.2975/28.2005.354.360.CrossRefPubMed
62.
Link B, Castille DM, Stuber J: Stigma and coercion in the context of outpatient treatment for people with mental illnesses. Social Science & Medicine. 2008, 67: 409-419.CrossRef
63.
Freidl M, Spitzl SP, Aigner M: How depressive symptoms correlate with stigma perception of mental illness. International Review of Psychiatry. 2008, 20: 510-514. 10.1080/09540260802565422.CrossRefPubMed
64.
Blankertz L: Cognitive components of self esteem for individuals with severe mental illness. American Journal of Orthopsychiatry. 2001, 71: 457-465. 10.1037/0002-9432.71.4.457.CrossRefPubMed
65.
Roeloffs C, Sherbourne C, Unutzer J, Fink A, Tang L, Wells K: Stigma and depression among primary care patients. General Hospital Psychiatry. 2003, 25: 311-315. 10.1016/S0163-8343(03)00066-5.CrossRefPubMed
66.
Rosenfield S: Labeling mental illness: the effects of received services and perceived stigma on life satisfaction. American Sociological Review. 1997, 62: 672-10.2307/2657432.CrossRef
67.
Freidl M, Lang T, Scherer M: How psychiatric patients perceive the public's stereotype of mental illness. Social Psychiatry and Psychiatric Epidemiology. 2003, 38: 269-275. 10.1007/s00127-003-0626-3.CrossRefPubMed
68.
Markowitz FE: Modeling processes in recovery from mental illness: relationships between symptoms, life satisfaction, and self-concept. Journal of Health & Social Behavior. 2001, 42 (1): 64-79.CrossRef
69.
Lysaker PH, Tsai J, Yanos P, Roe D: Associations of multiple domains of self-esteem with four dimensions of stigma in schizophrenia. Schizophrenia Research. 2008, Corrected Proof.
70.
Freidl M, Spitzl SP, Prause W, Zimprich F, Lehner-Baumgartner E, Baumgartner C, et al: The stigma of mental illness: anticipation and attitudes among patients with epileptic, dissociative or somatoform pain disorder. International Review of Psychiatry. 2007, 19: 123-129. 10.1080/09540260701278879.CrossRefPubMed
71.
Graf J, Lauber C, Nordt C, Ruesch P, Meyer PC, Rossler W: Perceived stigmatization of mentally ill people and Its consequences for the quality of life in a Swiss population. The Journal of Nervous and Mental Disease. 2004, 192: 10.1097/01.nmd.0000135493.71192.3a.
72.
Lundberg B, Hansson L, Wentz E, Bjorkman T: Stigma, discrimination, empowerment and social networks: a preliminary investigation of their influence on subjective quality of life in a Swedish sample. International Journal of Social Psychiatry. 2008, 54: 47-55. 10.1177/0020764007082345.CrossRefPubMed
73.
Rusch N, Holzer A, Hermann C, Schramm E, Jacob GA, Bohus M, et al: Self-stigma in women with borderline personality disorder and women with social phobia. Journal of Nervous and Mental Disease. 2006, 194: 766-773. 10.1097/01.nmd.0000239898.48701.dc.CrossRefPubMed
74.
Berge M, Ranney M: Self-esteem and stigma among persons with schizophrenia: implications for mental health. Care Management Journals. 2005, 6: 139-144. 10.1891/cmaj.6.3.139.CrossRefPubMed
75.
Link BG, Mirotznik J, Cullen FT: The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided?. Journal of Health and Social Behavior. 1991, 32: 302-320. 10.2307/2136810.CrossRefPubMed
76.
Rusch N, Lieb K, Bohus M, Corrigan P: Self-stigma, empowerment and perceived legitimacy of discrimination among women with mental illness. Psychiatric Services. 2006, 57: 399-402. 10.1176/appi.ps.57.3.399.CrossRefPubMed
77.
Werner P, Aviv A, Barak Y: Self-stigma, self-esteem and age in persons with schizophrenia. International Psychogeriatrics. 2007, 1-15.
78.
Lysaker PH, Davis LW, Warman DM, Strasburger A, Beattie N: Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: Associations across 6 months. Psychiatry Research. 2007, 149: 89-95. 10.1016/j.psychres.2006.03.007.CrossRefPubMed
79.
Lysaker PH, Buck KD, Taylor AC, Roe D: Associations of metacognition and internalized stigma with quantitative assessments of self-experience in narratives of schizophrenia. Psychiatry Research. 2008, 157: 31-38. 10.1016/j.psychres.2007.04.023.CrossRefPubMed
80.
Lysaker PH, Roe D, Yanos PT: Toward understanding the insight paradox: Internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophrenia Bulletin. 2007, 33: 192-199. 10.1093/schbul/sbl016.CrossRefPubMed
81.
Yanos PT, Roe D, Markus K, Lysaker PH: Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatric Services. 2008, 59: 1437-1442. 10.1176/appi.ps.59.12.1437.CrossRefPubMedPubMedCentral
82.
Watson AC, Corrigan P, Larson JE, Sells M: Self-stigma in people with mental illness. Schizophrenia Bulletin. 2007, 33: 1312-1318. 10.1093/schbul/sbl076.CrossRefPubMedPubMedCentral
83.
Fung KM, Tsang HW, Corrigan PW, Lam CS, Cheung WM: Measuring self-stigma of mental illness in China and its implications for recovery. International Journal of Social Psychiatry. 2007, 53: 408-418. 10.1177/0020764007078342.CrossRefPubMed
84.
Fung KMT, Tsang HWH, Corrigan PW: Self-stigma of people with schizophrenia as predictor of their adherence to psychosocial treatment. Psychiatric Rehabilitation Journal. 2008, 32: 95-104. 10.2975/32.2.2008.95.104.CrossRefPubMed
85.
Tsang HWH, Fung KMT, Corrigan PW: Psychosocial treatment compliance scale for people with psychotic disorders. Australian and New Zealand Journal of Psychiatry. 2006, 40: 561-569.CrossRefPubMed
86.
Dickerson FB, Sommerville J, Origoni AE, Ringel NB, Parente F: Experiences of stigma among outpatients with schizophrenia. Schizophrenia Bulletin. 2002, 28: 143-156.CrossRefPubMed
87.
Charles H, Manoranjitham SD, Jacob KS: Stigma and explanatory models among people with schizophrenia and their relatives in Vellore, South India. International Journal of Social Psychiatry. 2007, 53: 325-332. 10.1177/0020764006074538.CrossRefPubMed
88.
Rusch LCM, Kanter JWP, Manos RCM, Weeks CEM: Depression stigma in a predominantly low income African American sample with elevated depressive symptoms. Journal of Nervous & Mental Disease. 2008, 196: 919-922.
89.
Rosenberg M: Conceiving the Self. 1977, New York: Basic Books
90.
Harvey R: Individual differences in the phenomenological impact of social stigma. The Journal of Social Psychology. 2001, 141: 174-189. 10.1080/00224540109600545.CrossRefPubMed
91.
Landrine H, Klonoff EA: The Schedule of Racist Events: a measure of racial discrimination and a study of its negative physical and mental health consequences. Journal of Black Psychology. 1996, 22: 144-168. 10.1177/00957984960222002.CrossRef
Metadata
Title
Experiences of mental illness stigma, prejudice and discrimination: a review of measures
Authors
Elaine Brohan
Mike Slade
Sarah Clement
Graham Thornicroft
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2010
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-10-80

Other articles of this Issue 1/2010

BMC Health Services Research 1/2010 Go to the issue

Research article

Community health insurance amidst abolition of user fees in Uganda: the view from policy makers and health service managers

Research article

A geographical population analysis of dental trauma in school-children aged 12 and 15 in the city of Curitiba-Brazil

Research article

Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands

Research article

Evaluating quality of obstetric care in low-resource settings: Building on the literature to design tailor-made evaluation instruments - an illustration in Burkina Faso

Research article

Prevalence of chronic diseases and morbidity in primary health care in central Greece: An epidemiological study

Research article

Do coder characteristics influence validity of ICD-10 hospital discharge data?