Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: A cross-sectional survey

Antonio Lasalvia, Silvia Zoppei, Tine Van Bortel, Chiara Bonetto, Doriana Cristofalo, Kristian Wahlbeck, Simon Vasseur Bacle, Chantal Van Audenhove, Jaap Van Weeghel, Blanca Reneses, Arunas Germanavicius, Marina Economou, Mariangela Lanfredi, Shuntaro Ando, Norman Sartorius, Juan J. Lopez-Ibor, Graham Thornicroft, Samantha Treacy, Elaine Brohan, Diana RoseEsa Aromaa, Johanna Nordmyr, Fredrica Nyqvist, Carolina Herberts, Oliver Lewis, Jasna Russo, Dorottya Karsay, Rea Maglajlic, Isabella Goldie, Knifton Lee, Neil Quinn, Gert Scheerder, Else Tambuyzer, Valentina Hristakeva, Dimitar Germanov, Jean Luc Roelandt, Nicolas Daumerie, Aude Caria, Harald Zaske, Wolfgang Gaebel, Eleni Louki, Lily Peppou, Klio Geroulanou, Judit Harangozo, Julia Sebes, Gabor Csukly, Giuseppe Rossi, Laura Pedrini, Natalja Markovskaja, Vytis Valantinas, Jenny Boumans, Eleonoor Willemsen, Annette Plooy, Teresa Duarte, Fatima Jorge Monteiro, Radu Teodorescu, Iuliana Radu, Elena Pana, Janka Hurova, Dita Leczova, Vesna Svab, Nina Konecnik, Nerea Palomares, Camila Bayon, Alp Ucok, Gulsah Karaday, Nicholas Glozier, Nicole Cockayne, Luís Fernando Tófoli, Maria Suely Alves Costa, Roumen Milev, Teresa Garrah, Liane Tackaberry, Heather Stuart, Branka Aukst Margetic, Petra Folnegovic Grošić, Miro Jakovljević, Barbora Wenigová, Šelepová Pavla, Doaa Nader Radwan, Pradeep Johnson, Ramakrishna Goud, Nandesh, Geeta Jayaram, Yuriko Suzuki, Tsuyoshi Akiyama, Asami Matsunaga, Peter Bernick, James Bowa, Bolanle Ola, Olugbenga Owoeye, Yewande Oshodi, Jibril Abdulmalik, Kok Yoon Chee, Norhayati Ali, Nadia Kadri, Dounia Belghazi, Yassine Anwar, Nashi Khan, Rukhsana Kausar, Ivona Milacic Vidojevic, Athula Sumathipala, Chih Cheng Chang, Fethi Nacef, Uta Ouali, Hayet Ouertani, Rabaa Jomli, Abdelhafidh Ouertani, Khadija Kaaniche, Ricardo Bello, Manuel Ortega, Arturo Melone, María Andreína Marques, Francisco Marco, Arturo Ríos, Ernesto Rodríguez, Arianna Laguado

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Abstract

Background Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination. Methods In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data. Findings 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coeffi cient 0·20 [95% CI 0·09-0·32], p=0·001); at least one lifetime psychiatric hospital admission (0·29 [0·15-0·42], p=0·001); poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01-0·19], p=0·032; unpaid employed 0·34 [0·09-0·60], p=0·007; looking for a job 0·26 [0·09-0·43], p=0·002; and unemployed 0·22 [0·03-0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression; p<0·0001). Anticipated discrimination is not necessarily associated with experienced discrimination because 147 (47%) of 316 participants who anticipated discrimination in fi nding or keeping a job and 160 (45%) of 353 in their intimate relationships had not experienced discrimination. Interpretation Discrimination related to depression acts as a barrier to social participation and successful vocational integration. Non-disclosure of depression is itself a further barrier to seeking help and to receiving eff ective treatment. This fi nding suggests that new and sustained approaches are needed to prevent stigmatisation of people with depression and reduce the eff ects of stigma when it is already established. Funding European Commission, Directorate General for Health and Consumers, Public Health Executive Agency.

Original languageEnglish (US)
Pages (from-to)55-62
Number of pages8
JournalThe Lancet
Volume381
Issue number9860
DOIs
StatePublished - Jan 2013

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ASJC Scopus subject areas

  • Medicine(all)

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Lasalvia, A., Zoppei, S., Van Bortel, T., Bonetto, C., Cristofalo, D., Wahlbeck, K., Bacle, S. V., Van Audenhove, C., Van Weeghel, J., Reneses, B., Germanavicius, A., Economou, M., Lanfredi, M., Ando, S., Sartorius, N., Lopez-Ibor, J. J., Thornicroft, G., Treacy, S., Brohan, E., ... Laguado, A. (2013). Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: A cross-sectional survey. The Lancet, 381(9860), 55-62. https://doi.org/10.1016/S0140-6736(12)61379-8