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Revista de la Facultad de Medicina

Print version ISSN 0120-0011

rev.fac.med. vol.67 no.4 Bogotá Oct./Dec. 2019

https://doi.org/10.15446/revfacmed.v67n4.72529 

Cartas al editor

Stigma-discrimination complex associated with major depressive disorder

Complejo estigma-discriminación relacionado con el trastorno depresivo mayor

Adalberto Campo-Arias1  * 

Edwin Herazo2 

Guillermo Augusto Ceballos-Ospino3 

1 Universidad del Magdalena - Faculty of Health Sciences - Medical Program - Santa Marta - Colombia.

2 Instituto de Investigación del Comportamiento Humano - Director's Office - Bogotá D.C. - Colombia.

3 Universidad del Magdalena - Faculty of Health Sciences - Psychology Program - Santa Marta - Colombia.


Dear Editor:

Throughout history, the stigma-discrimination complex (SDC) has been associated with serious mental disorders such as those on the spectrum of schizophrenia, where symptoms, side effects and impaired social functioning are difficult to conceal. 1 For its part, SDC related to major depressive disorder (MDD) is a growing phenomenon even though its clinical characteristics are easy to hide or are less evident in the social sphere 2,3; in these cases, said association may have more negative effects on people's lives than the disorder itself. 4,5 Consequently, the Depression Stigma Scale (DSS) was designed to quantify the relationship between SDC and MDD (SDC-MDD). This is a Likert scale consisting of two subscales with nine items each. The first addresses the issue of attitude towards people who meet criteria for MDD, i.e. perceived stigma, and the second, the anticipated attitude for MDD, i.e. personal stigma or self-stigma. 6 In order to know the prevalence of SDC-MDD (perceived stigma) among the general population, a review of original research works that used the DSS was carried out between 2005 and 2017. The key words used in the search were "estigma hacia la depresión", "estigma de la depresión", "estigma contra la depresión" and "escala de estigma relacionado con la depresión" (stigma towards depression, stigma of depression, stigma against depression, and depression-related stigma scale). A descriptive analysis of identified research on the perception component was carried out and, given the dimensional nature of the scale, the frequency of response of each item was analyzed without considering the total score due to the lack of a cut-off point to categorize high perceived SDC towards the MDD. 6

Three studies showed the prevalence of SDC-MDD (perceived stigma) with the use of DSS. The first study was Cook & Wang 7, who assessed SDC-MDD in 2 987 adults aged 18-74 years (51% men); the second was Coppens et al.8, which evaluated 4 011 adults aged 18 or over (45.8% male) from four European countries; the third was Subramanian et al.9, who researched SDC-MDD in 607 adults aged 18 to 65 (50.9% male). The three investigations found that between 3.2% and 89.4% (mean 30.7%) of the participants agreed with at least one of the nine items suggestive of perceived stigma (Table 1). 7-9

Table 1 Percentage of agreement for the scale items about stigma related to depression - perceived stigma. 

Source: Own elaboration.

These findings suggest that about one third of the general population has SDC-MDD at different degrees or levels, in other words, they have a negative attitude towards people who meet the MDD criteria. In general, SDC represents a barrier to access to mental health services 4 and reduces the likelihood of seeking help and adherence to treatment plans 10-12, even more so if SDC-MDD is found in health professionals. 13,14

SDC-MDD seems to be frequent, so new research is required to provide more information on the phenomenon and, based on it, take effective actions for its reduction in different contexts and levels. 15,16

Acknowledgements

None stated by the authors.

References

1. Yap MB, Mackinnon A, Reavley N, Jorm AF. The measurement properties of stigmatizing attitudes towards mental disorders: Results from two community surveys. Int J Method Psychiatr Res. 2014;23(1):49-61. http://doi.org/f53x8q. [ Links ]

2. Aromaa E, Tolvanen A, Tuulari J, Wahlbeck K. Predictors of stigmatizing attitudes towards people with mental disorders in a general population in Finland. Nord J Psychiatry. 2011;65(2):125-32. http://doi.org/ddtw9c. [ Links ]

3. Dietrich S, Mergl R, Rummel-Kluge C. Personal and perceived stigmatization of depression: A comparison of data from the general population, participants of a depression congress and job placement officers in Germany. Psychiatry Res. 2014;220(1-2):598-603. http://doi.org/f6q2sg. [ Links ]

4. Simmons LA, Yang NY, Wu Q, Bush HM, Crofford LJ. Public and personal depression stigma in a rural American female sample. Arch Psychiatr Nurs. 2015;29(6):407-12. http://doi.org/f724k9. [ Links ]

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7. Cook TM, Wang J. Descriptive epidemiology of stigma against depression in a general population sample in Alberta. BMC Psychiatry. 2010;10:29. http://doi.org/b5wv85. https://doi.org/10.1186/1471-244X-10-29. [ Links ]

8. Coppens E, Van Audenhove C, Scheerder G, Arensman E, Coffey C, Costa S, et al. Public attitudes toward depression and help-seeking in four European countries baseline survey prior to the OSPI-Europe intervention. J Affect Disord. 2013;150(2):320-9. http://doi.org/f47v8c. [ Links ]

9. Subramaniam M, Abdin E, Picco L, Pang S, Shafie S, Vaingankar JA, et al. Stigma towards people with mental disorders and its components-a perspective from multi-ethnic Singapore. Epidemiol Psychiatr Sci. 2016;26(4):371-82. http://doi.org/gbpmjh. [ Links ]

10. Conner KO, Copeland VC, Grote NK, Koeske G, Rosen D, Reynolds CF, et al. Mental health treatment seeking among older adults with depression: the impact of stigma and race. Am J Geriat Psychiatry. 2010;18(6):531-43. http://doi.org/ftjkfb. [ Links ]

11. Picco L, Abdin E, Pang S, Vaingankar JA, Jeyagurunathan A, Chong SA, et al. Association between recognition and help-seeking preferences and stigma towards people with mental illness. Epidemiol Psychiatr Sci. 2018;27(1):84-93. http://doi.org/gctzmf. [ Links ]

12. Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry. 2010;10:113. http://doi.org/b246pr. [ Links ]

13. Reavley NJ, Mackinnon AJ, Morgan AJ, Jorm AF. Stigmatising attitudes towards people with mental disorders: A comparison of Australian health professionals with the general community. Aust N Z J Psychiatry. 2014;48(5):433-41. http://doi.org/c8qw. [ Links ]

14. Roja-Vistorte AO, Silva-Ribeiro W, Jaen D, Jorge MR, Evans-Lasko S, Mari JJ. Stigmatizing attitudes of primary care professionals towards people with mental disorders: a systematic review. Int J Psychiatr Med. 2018;53(4):317-38. http://doi.org/c8qz. [ Links ]

15. Finkelstein J, Lapshin O. Reducing depression stigma using a web-based program. Int J Med Inform. 2007;76(10):726-34. http://doi.org/cgczkb. [ Links ]

16. Quinn N, Knifton L, Goldie I, Van Bortel T, Dowds J, Lasalvia A, et al. Nature and impact of European anti-stigma depression programmes. Health Prom Int. 2013;29(3):403-13. http://doi.org/f6q6wd. [ Links ]

Conflicts of interest None stated by the authors.

Funding This research was financially supported by Universidad del Magdalena and Instituto de Investigación del Comportamiento Humano.

Received: May 30, 2018; Accepted: August 12, 2018

* Corresponding author: Adalberto Campo-Arias. Programa de Medicina, Facultad de Ciencias de la Salud, Universidad del Magdalena. Carrera 32 No 22-08. Phone: +57 5 4381000, ext.: 1338. Santa Marta. Colombia. Email: acampoa@unimagdalena.edu.co.

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