Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-12-01T07:19:50.144Z Has data issue: false hasContentIssue false
  • English
  • Français

Embarrassment when illness strikes a close relative: a World Mental Health Survey Consortium Multi-Site Study

Published online by Cambridge University Press:  09 January 2013

B. K. Ahmedani ,
S. P. Kubiak ,
R. C. Kessler ,
R. de Graaf ,
J. Alonso ,
R. Bruffaerts ,
Z. Zarkov ,
M. C. Viana ,
Y. Q. Huang  and
C. Hu
...Show all authors
B. K. Ahmedani*
Affiliation:
Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA School of Social Work, Michigan State University, East Lansing, MI, USA
S. P. Kubiak
Affiliation:
School of Social Work, Michigan State University, East Lansing, MI, USA
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
R. de Graaf
Affiliation:
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
J. Alonso
Affiliation:
IMIM-Institut de Recerca Hospital del Mar, Parc de Salut Mar and Pompeu Fabra University (UPF), Barcelona, Spain
R. Bruffaerts
Affiliation:
Universitair Psychiatrisch Centrum, Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium
Z. Zarkov
Affiliation:
Bulgaria National Center for Public Health and Analyses, Sofia, Bulgaria
M. C. Viana
Affiliation:
Department of Social Medicine, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
Y. Q. Huang
Affiliation:
Institute of Mental Health, Peking University, Beijing, PR China
C. Hu
Affiliation:
Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Shenzhen, PR China
J. A. Posada-Villa
Affiliation:
Pontificia Universidad Javeriana, Instituto Columbiano Del Sistema Nervioso – Clinica Montserrat, Bogotá DC, Colombia
J.-P. Lepine
Affiliation:
Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris, France
M. C. Angermeyer
Affiliation:
Center for Public Mental Health, Gösing, Austria
G. de Girolamo
Affiliation:
IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
A. N. Karam
Affiliation:
Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Balamand University Medical School, Beirut, Lebanon
M. E. Medina-Mora
Affiliation:
National Institute of Psychiatry, Mexico City, Mexico
O. Gureje
Affiliation:
WHO Collaborating Centre of Research and Training in Mental Health, Neurosciences, and Substance Abuse and Department of Psychiatry, University of Ibadan, Nigeria
F. Ferry
Affiliation:
School of Psychology, University of Ulster, Londonderry, UK
R. Sagar
Affiliation:
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
J. C. Anthony
Affiliation:
Department of Epidemiology, Michigan State University, East Lansing, MI, USA
*
*Address for correspondence: B. K. Ahmedani, Ph.D., Center for Health Policy and Health Services Research, Henry Ford Health System, One Ford Place, Suite 3A, Detroit, MI 48202, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

In this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the afflicted individual but have not assessed family embarrassment in a large-scale study.

Method

In 16 sites of the World Mental Health Surveys (WMHS), standardized assessments were completed including items on family embarrassment. Site matching was used to constrain local socially shared determinants of stigma-related feelings, enabling a conditional logistic regression model that estimates the embarrassment close relatives may hold in relation to family members affected by an ADMC, a GMC, or both conditions.

Results

There was a statistically robust association such that subgroups with an ADMC-affected relative were more likely to feel embarrassed compared to subgroups with a relative affected by a GMC (p < 0.001), even with covariate adjustments for age and sex.

Conclusions

The pattern of evidence from this research is consistent with conceptual models for interventions that target individual- and family-level stigma-related feelings of embarrassment as possible obstacles to effective early intervention and treatment for an ADMC. Macro-level interventions are under way but micro-level interventions may also be required among family members, along with care for each person with an ADMC.

Keywords

Family embarrassmentpsychiatric conditionsstigmaWorld Mental Health Surveys
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 10 , October 2013 , pp. 2191 - 2202
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adeponle, AB, Thombs, BD, Adelekan, ML, Kirmayer, LJ (2009). Family participation in treatment, post-discharge appointment and medication adherence at a Nigerian psychiatric hospital. British Journal of Psychiatry 194, 86–87.CrossRefGoogle Scholar
Ahmedani, BK (2011). Mental health stigma: society, individuals, and the profession. Journal of Social Work Values and Ethics 8, 41–416.Google ScholarPubMed
Ahmedani, BK, Kubiak, SP, Rios-Bedoya, CF, Mickus, M, Anthony, JC (2011). Willingness to treat drug dependence and depression: comparisons of future health professionals. Substance Abuse and Rehabilitation 2011, 43–51.Google ScholarPubMed
Alonso, J, Buron, A, Bruffaerts, R, He, Y, Posada-Villa, J, Lepine, JP, Angermeyer, MC, Levinson, D, de Girolamo, G, Tachimori, H, Mneimneh, ZN, Medina-Mora, ME, Ormel, J, Scott, KM, Gureje, O, Haro, JM, Gluzman, S, Lee, S, Vilagut, G, Kessler, RC, Von Korff, M; World Mental Health Consortium (2008). Association of perceived stigma and mood and anxiety disorders: results from the World Mental Health Surveys. Acta Psychiatrica Scandinavica 118, 305–314.CrossRefGoogle ScholarPubMed
Alonso, J, Buron, A, Rojas-Farreras, S, de Graaf, R, Haro, JM, de Girolamo, G, Bruffaerts, R, Kovess, V, Matschinger, H, Vilagut, G; ESEMeD/MHEDEA 2000 Investigators (2009). Perceived stigma among individuals with common mental disorders. Journal of Affective Disorders 118, 180–186.CrossRefGoogle ScholarPubMed
Brohan, E, Elgie, R, Sartorius, N, Thornicroft, G (2010). Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophrenia Research 122, 232–238.CrossRefGoogle ScholarPubMed
Brohan, E, Gauci, D, Sartorius, N, Thornicroft, G (2011). Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: the GAMIAN-Europe study. Journal of Affective Disorders 129, 56–63.CrossRefGoogle ScholarPubMed
Brumback, BA, Dailey, AB, Zheng, HW (2012). Adjusting for confounding by neighborhood using a proportional odds model and complex survey data. American Journal of Epidemiology 175, 1133–1141.CrossRefGoogle ScholarPubMed
Buka, SL (2008). Psychiatric epidemiology: reducing the global burden of mental illness. American Journal of Epidemiology 168, 977–979.CrossRefGoogle Scholar
Cao, H, He, N, Jiang, Q, Yang, M, Liu, Z, Gao, M, Ding, P, Chen, L, Detels, R (2010). Stigma against HIV-infected persons among migrant women living in Shanghai, China. AIDS Education and Prevention 22, 445–454.CrossRefGoogle ScholarPubMed
Copello, AG, Velleman, RD, Templeton, LJ (2005). Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review 24, 369–385.CrossRefGoogle ScholarPubMed
Corrigan, P, Markowitz, FE, Watson, A, Rowan, D, Kubiak, MA (2003). An attribution model of public discrimination towards persons with mental illness. Journal of Health and Social Behavior 44, 162–179.CrossRefGoogle ScholarPubMed
Corrigan, PW, River, LP, Lundin, RK, Penn, DL, Uphoff-Wasowski, K, Campion, J, Mathisen, J, Gagnon, C, Bergman, M, Goldstein, H, Kubiak, MA (2001). Three strategies for changing attributions about severe mental illness. Schizophrenia Bulletin 27, 187–195.CrossRefGoogle ScholarPubMed
Corrigan, PW, River, LP, Lundin, RK, Wasowski, KU, Campion, J, Mathisen, J, Goldstein, H, Bergman, M, Gagnon, C, Kubiak, MA (2000). Stigmatizing attributions about mental illness. Journal of Community Psychology 28, 91–102.3.0.CO;2-M>CrossRefGoogle Scholar
Corrigan, PW, Watson, AC, Miller, FE (2006). Blame, shame, and contamination: the impact of mental illness and drug dependence stigma on family members. Journal of Family Psychology 20, 239–246.CrossRefGoogle ScholarPubMed
Crisp, AH, Gelder, MG, Rix, S, Meltzer, HI, Rowlands, OJ (2000). Stigmatisation of people with mental illnesses. British Journal of Psychiatry 177, 4–7.CrossRefGoogle ScholarPubMed
Crocker, J (1999). Social stigma and self-esteem: situational construction of self-worth. Journal of Experimental Social Psychology 35, 89–107.CrossRefGoogle Scholar
Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, Angermeyer, MC, Bernert, S, de Girolamo, G, Morosini, P, Polidori, G, Kikkawa, T, Kawakami, N, Ono, Y, Takeshima, T, Uda, H, Karam, EG, Fayyad, JA, Karam, AN, Mneimneh, ZN, Medina-Mora, ME, Borges, G, Lara, C, de Graaf, R, Ormel, J, Gureje, O, Shen, Y, Huang, Y, Zhang, M, Alonso, J, Haro, JM, Vilagut, G, Bromet, EJ, Gluzman, S, Webb, C, Kessler, RC, Merikangas, KR, Anthony, JC, Von Korff, MR, Wang, PS, Brugha, TS, Aguilar-Gaxiola, S, Lee, S, Heeringa, S, Pennell, BE, Zaslavsky, AM, Ustun, TB, Chatterji, S; WHO World Mental Health Survey Consortium (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association 291, 2581–2590.Google ScholarPubMed
Dietrich, S, Heider, D, Matschinger, H, Angermeyer, MC (2006). Influence of newspaper reporting on adolescents' attitudes toward people with mental illness. Social Psychiatry and Psychiatric Epidemiology 41, 318–322.CrossRefGoogle ScholarPubMed
Dudley, JR (2000). Confronting stigma within the services system. Social Work 45, 449–455.CrossRefGoogle ScholarPubMed
Evans-Lacko, S, Brohan, E, Mojtabai, R, Thornicroft, G (2012). Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychological Medicine 42, 1741–1752.CrossRefGoogle ScholarPubMed
Glynn, SM, Cohen, AN, Dixon, LB, Niv, N (2006). The potential impact of the recovery movement on family interventions for schizophrenia: opportunities and obstacles. Schizophrenia Bulletin 32, 451–463.CrossRefGoogle ScholarPubMed
Goffman, E (1963). Stigma: Notes on the Management of Spoiled Identity. Prentice Hall: Englewood Cliffs, NJ.Google Scholar
Heeringa, SG, West, BT, Berglund, PA (2010). Applied Survey Data Analysis. CRC Press: New York.CrossRefGoogle Scholar
Hinshaw, SP (2005). The stigmatization of mental illness in children and parents: developmental issues, family concerns, and research needs. Journal of Child Psychology and Psychiatry 46, 714–734.CrossRefGoogle ScholarPubMed
Hugo, CJ, Boshoff, DE, Traut, A, Zungu-Dirwayi, N, Stein, DJ (2003). Community attitudes toward and knowledge of mental illness in South Africa. Social Psychiatry and Psychiatric Epidemiology 38, 715–719.CrossRefGoogle ScholarPubMed
Jorm, AF, Barney, LJ, Christensen, H, Highet, NJ, Kelly, CM, Kitchener, BA (2006). Research on mental health literacy: what we know and what we still need to know. Australian and New Zealand Journal of Psychiatry 40, 3–5.CrossRefGoogle ScholarPubMed
Jorm, AF, Oh, E (2009). Desire for social distance from people with mental disorders. Australian and New Zealand Journal of Psychiatry 43, 183–200.CrossRefGoogle ScholarPubMed
Kessler, RC, Ustun, TB (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.CrossRefGoogle ScholarPubMed
Klin, A, Lemish, D (2008). Mental disorders stigma in the media: review of studies on production, content, and influences. Journal of Health Communication 13, 434–449.CrossRefGoogle ScholarPubMed
Lee, S, Lee, MT, Chiu, MY, Kleinman, A (2005). Experience of social stigma by people with schizophrenia in Hong Kong. British Journal of Psychiatry 186, 153–157.CrossRefGoogle ScholarPubMed
Lefley, HP (1989). Family burden and family stigma in major mental illness. American Psychologist 44, 556–560.CrossRefGoogle ScholarPubMed
Link, BG, Phelan, JC (2001). Conceptualizing stigma. Annual Review of Sociology 27, 363–385.CrossRefGoogle Scholar
McSween, JL (2002). The role of group interest, identity, and stigma in determining mental health policy preferences. Journal of Health Politics, Policy and Law 27, 773–800.CrossRefGoogle ScholarPubMed
Ostman, M, Kjellin, L (2002). Stigma by association: psychological factors in relatives of people with mental illness. British Journal of Psychiatry 181, 494–498.CrossRefGoogle ScholarPubMed
Pescosolido, BA, Martin, JK, Long, JS, Medina, TR, Phelan, JC, Link, BG (2010). ‘A disease like any other’? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American Journal of Psychiatry 167, 1321–1330.CrossRefGoogle Scholar
Phelan, JC, Bromet, EJ, Link, BG (1998). Psychiatric illness and family stigma. Schizophrenia Bulletin 24, 115–126.CrossRefGoogle ScholarPubMed
Phelan, JC, Link, BG (1998). The growing belief that people with mental illnesses are violent: the role of the dangerousness criterion for civil commitment. Social Psychiatry and Psychiatric Epidemiology 33 (Suppl. 1), S7–S12.CrossRefGoogle ScholarPubMed
Pinfold, V, Huxley, P, Thornicroft, G, Farmer, P, Toulmin, H, Graham, T (2003). Reducing psychiatric stigma and discrimination – evaluating an educational intervention with the police force in England. Social Psychiatry and Psychiatric Epidemiology 38, 337–344.CrossRefGoogle ScholarPubMed
Robbins, SP, Chatterjee, P, Canda, ER (2005). Contemporary Human Behavior Theory: A Critical Perspective for Social Work. Allyn & Bacon: Needham Heights, MA.Google Scholar
Sartorius, N, Gaebel, W, Cleveland, HR, Stuart, H, Akiyama, T, Arboleda-Flórez, J, Baumann, AE, Gureje, O, Jorge, MR, Kastrup, M, Suzuki, Y, Tasman, A (2010). WPA guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatry 9, 131–144.CrossRefGoogle ScholarPubMed
Sayce, L (2000). From Psychiatric Patient to Citizen: Overcoming Discrimination and Social Exclusion. St Martin's Press, Inc.: New York.CrossRefGoogle Scholar
Shrout, PE, Alegria, M, Canino, G, Guarnaccia, PJ, Vega, WA, Duan, N, Cao, Z (2008). Testing language effects in psychiatric epidemiology surveys with randomized experiments: results from the National Latino and Asian American Study. American Journal of Epidemiology 168, 345–352.CrossRefGoogle ScholarPubMed
Stier, A, Hinshaw, SP (2007). Explicit and implicit stigma against individuals with mental illness. Australian Psychologist 42, 106–117.CrossRefGoogle Scholar
Thornicroft, G, Brohan, E, Kassam, A, Lewis-Holmes, E (2008). Reducing stigma and discrimination: candidate interventions. International Journal of Mental Health Systems 2, 3.CrossRefGoogle ScholarPubMed
U.S. Surgeon General (1999). Mental Health: A Report of the Surgeon General. Center for Mental Health Services, National Institute of Mental Health: Rockville, MD.Google Scholar
Wahl, OF (1999). Mental health consumers' experience of stigma. Schizophrenia Bulletin 25, 467–478.CrossRefGoogle ScholarPubMed
Wang, PS, Berglund, P, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 603–613.CrossRefGoogle ScholarPubMed
Weiss, MG, Ramakrishna, J (2006). Stigma interventions and research for international health. Lancet 367, 536–538.CrossRefGoogle ScholarPubMed
WHO (2001). World Health Report 2001. Mental Health: New Understanding, New Hope. World Health Organization: Geneva, Switzerland.Google Scholar
WHO (2004 a). The World Health Report 2004: Changing History. World Health Organization: Geneva, Switzerland.Google Scholar
WHO (2004 b). The World Mental Health Composite International Diagnostic Interview. World Health Organization: Geneva, Switzerland.Google Scholar