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Cross-national variations in reported discrimination among people treated for major depression worldwide: the
Antonio Lasalvia1, Tine Van Bortel2, Chiara Bonetto2
1Antonio Lasalvia, Md, PhD, U.O.C. Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy; Tine Van Bortel, PhD, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Chiara Bonetto, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Geetha Jayaram, MD, Johns Hopkins University, Schools of Medicine, Health Policy and Management and Armstrong Institute of Patient Safety, Baltimore, Maryland, USA; Jaap van Weeghel, PhD, Kenniscentrum Phrenos, Utrecht and TRANZO Department, Tilburg University, Tilburg, Netherlands; Silvia Zoppei, PhD, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Lee Knifton, Neil Quinn, Centre for Health Policy, University of Strathclyde, Glasgow, Scotland, UK; Kristian Wahlbeck, MD, PhD, Finnish National Institute for Health and Welfare (THL), Helsinki, Finland; Doriana Cristofalo, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy; Mariangela Lanfredi, PsyD, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Norman Sartorius, MD, MA, DPM, PhD, FRCPsych, Association for the Improvement of Mental Health Programmes, Geneva, Switzerland; Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, King's College, London, UK antonio.lasalvia@univr.it.
Background:
No study has so far explored differences in discrimination reported by people with major depressive disorder (MDD) across countries and cultures.
Aims:
To (a) compare reported discrimination across different countries, and (b) explore the relative weight of individual and contextual factors in explaining levels of reported discrimination in people with MDD.
Method:
Cross-sectional multisite international survey (34 countries worldwide) of 1082 people with MDD. Experienced and anticipated discrimination were assessed by the Discrimination and Stigma Scale (DISC). Countries were classified according to their rating on the Human Development Index (HDI). Multilevel negative binomial and Poisson models were used.
Results:
People living in 'very high HDI' countries reported higher discrimination than those in 'medium/low HDI' countries. Variation in reported discrimination across countries was only partially explained by individual-level variables. The contribution of country-level variables was significant for anticipated discrimination only.
Conclusions:
Contextual factors play an important role in anticipated discrimination. Country-specific interventions should be implemented to prevent discrimination towards people with MDD.
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