Stigma and discrimination

يَٰٓأَيُّهَا ٱلَّذِينَ ءَامَنُواْ لَا يَسۡخَرۡ قَوۡمࣱ مِّن قَوۡمٍ عَسَىٰٓ أَن يَكُونُواْ خَيۡرࣰ ا مِّنۡهُمۡ وَلَا نِسَآءࣱ مِّن نِّسَآءٍ عَسَىٰٓ أَن يَكُنَّ خَيۡرࣰ ا مِّنۡهُنَّۖ وَلَا تَلۡمِزُوٓاْ أَنفُسَكُمۡ وَلَا تَنَابَزُواْ بِٱلۡأَلۡقَٰبِۖ بِئۡسَ ٱلِٱسۡمُ ٱلۡفُسُوقُ بَعۡدَ ٱلۡإِيمَٰنِۚ وَمَن لَّمۡ يَتُبۡ فَأُوْلَٰٓئِكَ هُمُ ٱلظَّٰلِمُونَ

Believers, no one group of men should jeer at another, who may after all be better than them; no one group of women should jeer at another, who may after all be better than them; do not speak ill of one another; do not use offensive nicknames for one another. How bad it is to be called a mischief-maker after accepting faith! Those who do not repent of this behaviour are evildoers

إِنَّا كَفَيۡنَٰكَ ٱلۡمُسۡتَهۡزِءِينَ

We are enough for you against all those who ridicule your message

وَلَقَدِ ٱسۡتُهۡزِئَ بِرُسُلࣲ مِّن قَبۡلِكَ فَحَاقَ بِٱلَّذِينَ سَخِرُواْ مِنۡهُم مَّا كَانُواْ بِهِۦ يَسۡتَهۡزِءُونَ

Messengers before you [Muhammad] were also ridiculed, but those who mocked them were overwhelmed in the end by the very thing they had mocked

وَقَدۡ نَزَّلَ عَلَيۡكُمۡ فِي ٱلۡكِتَٰبِ أَنۡ إِذَا سَمِعۡتُمۡ ءَايَٰتِ ٱللَّهِ يُكۡفَرُ بِهَا وَيُسۡتَهۡزَأُ بِهَا فَلَا تَقۡعُدُواْ مَعَهُمۡ حَتَّىٰ يَخُوضُواْ فِي حَدِيثٍ غَيۡرِهِۦٓ إِنَّكُمۡ إِذࣰ ا مِّثۡلُهُمۡۗ إِنَّ ٱللَّهَ جَامِعُ ٱلۡمُنَٰفِقِينَ وَٱلۡكَٰفِرِينَ فِي جَهَنَّمَ جَمِيعًا

As He has already revealed to you [believers] in the Scripture, if you hear people denying and ridiculing God’s revelation, do not sit with them unless they start to talk of other things, or else you yourselves will become like them: God will gather all the hypocrites and disbelievers together into Hell

يَٰٓأَيُّهَا ٱلَّذِينَ ءَامَنُواْ لَا تَتَّخِذُواْ ٱلَّذِينَ ٱتَّخَذُواْ دِينَكُمۡ هُزُوࣰ ا وَلَعِبࣰ ا مِّنَ ٱلَّذِينَ أُوتُواْ ٱلۡكِتَٰبَ مِن قَبۡلِكُمۡ وَٱلۡكُفَّارَ أَوۡلِيَآءَۚ وَٱتَّقُواْ ٱللَّهَ إِن كُنتُم مُّؤۡمِنِينَ

You who believe, do not take as allies those who ridicule your religion and make fun of it- whether people who were given the Scripture before you, or disbelievers- and be mindful of God if you are true believers

وَإِذَا نَادَيۡتُمۡ إِلَى ٱلصَّلَوٰةِ ٱتَّخَذُوهَا هُزُوࣰ ا وَلَعِبࣰ اۚ ذَٰلِكَ بِأَنَّهُمۡ قَوۡمࣱ لَّا يَعۡقِلُونَ

When you make the call to prayer, they ridicule it and make fun of it: this is because they are people who do not reason

(O ye who believe! Let not a folk deride a folk who may be better than they (are)�) [49:11]. This was revealed about Thabit ibn Qays ibn Shimas. The latter was hard of hearing and when he came to see the Messenger of Allah, Allah bless him and give him peace, the Companions made room for him in order for him to sit next to the Prophet so that he could hear him. He came one day when people were already seated and started stepping over people, saying: �Make room! Make room!� One man said to him: �You have found a place, so sit down!� Thabit sat down but he was angry. He tried to tease the man. He said: �Who are you?� The man said: �So-and-so�. Thabit exclaimed: �What, the son of so-and-so�, and he mentioned his mother about whom they used to taunt him in the pre-Islamic period. The man lowered his head out of embarrassment. Then, Allah, exalted is He, revealed this verse. (� not let women

O you who believe do not let any people that is any men among you deride yā ayyuhā’lladhīna āmanū lā yaskhar … to the end of the verse was revealed regarding the Banū Tamīm delegation when they derided the poor among the Muslims like ‘Ammār b. Yāsir and Suhayb al-Rūmī; al-sukhriya means ‘scorn’ and ‘disdain’ another people who may be better than they are in God’s sight; nor let any women from among you deride other women who may be better than they are. And do not defame one another do not cast aspersions on others and hence have aspersions cast on you that is let none among you denigrate another; nor insult one another by nicknames do not call another by a nickname which he detests such as ‘O degenerate one!’ or ‘O disbeliever!’. Evil is the name mentioned out of mockery derision and mutual reviling of immorality after faith! al-fusūqu ba‘da’l-īmāni substitutes for al-ismu ‘the name’ to

(O Ye who believe! Choose not for guardians such of those who received the Scripture before you, and of the disbelievers, as make a jest and sport of your religion) [5:57]. Said Ibn �Abbas: �Rifa�ah ibn Zayd and Suwayd ibn al-Harith were among those who displayed their faith in Islam but were hypocrites. Some Muslim men used to show affection to them, and so Allah, exalted is He, revealed this verse�.

(And when ye call to prayer they take it for a jest and sport�) [5:58]. Said al-Kalbi: �When the caller to prayer, appointed by the Messenger of Allah, Allah bless him and give him peace, called to prayer, the Muslims stood up to perform it. Seeing this, the Jews used to comment: 'they stood up, may they never stand up! They prayed, may they never pray! They bowed down, may they never bow down!' They used to say this to mock the Muslims and make fun of them. And so Allah, exalted is He, revealed this verse�. Said al-Suddi: �This was revealed about a man from the helpers of Medina. Whenever he heard the caller to prayer say, 'I bear witness that Muhammad is the Messenger of Allah', he would say: 'May the liar be burnt!' One night, the servant of this man entered his house and brought some fire with him, while this man and his family were sleeping. A spark from this fire caused the whole h

It has been revealed read active nazzala ‘He has revealed’ or passive nuzzila ‘It has been revealed’ to you in the Book in the Qur’ān in sūrat al-An‘ām Q. 668 that an has been softened and its subject omitted in other words read it as annahu ‘When you hear God’s signs the Qur’ān being disbelieved in and mocked do not sit with them that is the disbelievers and the mockers until they engage in some other talk for otherwise you if you were to sit with them would surely be like them’ in sinfulness. God will gather the hypocrites and disbelievers all together into Hell just as they were gathered together in this world in unbelief and mockery.

Verily, those who believe, then disbelieve, then believe (again), and (again) disbelieve, and go on increasing in disbelief; Allah will not forgive them, nor guide them on the (right) way (137)Give to the hypocrites the tidings that there is for them a painful torment (138)Those who take disbelievers for friends instead of believers, do they seek honor with them? Verily, then to Allah belongs all honor (139)And it has already been revealed to you in the Book that when you hear the verses of Allah being denied and mocked at, then sit not with them, until they engage in talk other than that; certainly in that case you would be like them. Surely, Allah will collect the hypocrites and disbelievers all together in Hell (140) Characteristics of the Hypocrites and Their Destination Allah states that whoever embraces the faith, reverts from it, embraces it again, reverts from it and remains on

حَدَّثَنَا إِسْحَاقُ بْنُ إِبْرَاهِيمَ، أَخْبَرَنَا مُعَاذُ بْنُ هِشَامٍ، حَدَّثَنِي أَبِي، عَنْ قَتَادَةَ، عَنْ أَبِي الْمُتَوَكِّلِ النَّاجِيِّ، عَنْ أَبِي سَعِيدٍ الْخُدْرِيِّ ـ رضى الله عنه ـ عَنْ رَسُولِ اللَّهِ صلى الله عليه وسلم قَالَ ‏ "‏ إِذَا خَلَصَ الْمُؤْمِنُونَ مِنَ النَّارِ حُبِسُوا بِقَنْطَرَةٍ بَيْنَ الْجَنَّةِ وَالنَّارِ، فَيَتَقَاصُّونَ مَظَالِمَ كَانَتْ بَيْنَهُمْ فِي الدُّنْيَا، حَتَّى إِذَا نُقُّوا وَهُذِّبُوا أُذِنَ لَهُمْ بِدُخُولِ الْجَنَّةِ، فَوَالَّذِي نَفْسُ مُحَمَّدٍ صلى الله عليه وسلم بِيَدِهِ لأَحَدُهُمْ بِمَسْكَنِهِ فِي الْجَنَّةِ أَدَلُّ بِمَنْزِلِهِ كَانَ فِي الدُّنْيَا ‏"‏‏.‏ وَقَالَ يُونُسُ بْنُ مُحَمَّدٍ حَدَّثَنَا شَيْبَانُ عَنْ قَتَادَةَ حَدَّثَنَا أَبُو الْمُتَوَكِّلِ‏.‏

Narrated Abu Sa`id Al-Khudri:Allah's Messenger (ﷺ) said, "When the believers pass safely over (the bridge across) Hell, they will be stopped at a bridge in between Hell and Paradise where they will retaliate upon each other for the injustices done among them in the world, and when they get purified of all their sins, they will be admitted into Paradise. By Him in Whose Hands the life of Muhammad is everybody will recognize his dwelling in Paradise better than he recognizes his dwelling in this world

حَدَّثَنَا مُوسَى بْنُ إِسْمَاعِيلَ، حَدَّثَنَا هَمَّامٌ، قَالَ أَخْبَرَنِي قَتَادَةُ، عَنْ صَفْوَانَ بْنِ مُحْرِزٍ الْمَازِنِيِّ، قَالَ بَيْنَمَا أَنَا أَمْشِي، مَعَ ابْنِ عُمَرَ ـ رضى الله عنهما ـ آخِذٌ بِيَدِهِ إِذْ عَرَضَ رَجُلٌ، فَقَالَ كَيْفَ سَمِعْتَ رَسُولَ اللَّهِ صلى الله عليه وسلم فِي النَّجْوَى فَقَالَ سَمِعْتُ رَسُولَ اللَّهِ صلى الله عليه وسلم يَقُولُ ‏ "‏ إِنَّ اللَّهَ يُدْنِي الْمُؤْمِنَ فَيَضَعُ عَلَيْهِ كَنَفَهُ، وَيَسْتُرُهُ فَيَقُولُ أَتَعْرِفُ ذَنْبَ كَذَا أَتَعْرِفُ ذَنْبَ كَذَا فَيَقُولُ نَعَمْ أَىْ رَبِّ‏.‏ حَتَّى إِذَا قَرَّرَهُ بِذُنُوبِهِ وَرَأَى فِي نَفْسِهِ أَنَّهُ هَلَكَ قَالَ سَتَرْتُهَا عَلَيْكَ فِي الدُّنْيَا، وَأَنَا أَغْفِرُهَا لَكَ الْيَوْمَ‏.‏ فَيُعْطَى كِتَابَ حَسَنَاتِهِ، وَأَمَّا الْكَافِرُ وَالْمُنَافِقُونَ فَيَقُولُ الأَشْهَادُ هَؤُلاَءِ الَّذِينَ كَذَبُوا عَلَى رَبِّهِمْ، أَلاَ لَعْنَةُ اللَّهِ عَلَى الظَّالِمِينَ ‏"‏‏.‏

Narrated Safwan bin Muhriz Al-Mazini:While I was walking with Ibn `Umar holding his hand, a man came in front of us and asked, "What have you heard from Allah's Messenger (ﷺ) about An-Najwa?" Ibn `Umar said, "I heard Allah's Messenger (ﷺ) saying, 'Allah will bring a believer near Him and shelter him with His Screen and ask him: Did you commit such-and-such sins? He will say: Yes, my Lord. Allah will keep on asking him till he will confess all his sins and will think that he is ruined. Allah will say: 'I did screen your sins in the world and I forgive them for you today', and then he will be given the book of his good deeds. Regarding infidels and hypocrites (their evil acts will be exposed publicly) and the witnesses will say: These are the people who lied against their Lord. Behold! The Curse of Allah is upon the wrongdoers

حَدَّثَنَا قُتَيْبَةُ، حَدَّثَنَا مُحَمَّدُ بْنُ مُوسَى الْمَخْزُومِيُّ الْمَدَنِيُّ، عَنْ سَعِيدِ بْنِ أَبِي سَعِيدٍ الْمَقْبُرِيِّ، عَنْ أَبِي هُرَيْرَةَ، قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ لِلْمُؤْمِنِ عَلَى الْمُؤْمِنِ سِتُّ خِصَالٍ يَعُودُهُ إِذَا مَرِضَ وَيَشْهَدُهُ إِذَا مَاتَ وَيُجِيبُهُ إِذَا دَعَاهُ وَيُسَلِّمُ عَلَيْهِ إِذَا لَقِيَهُ وَيُشَمِّتُهُ إِذَا عَطَسَ وَيَنْصَحُ لَهُ إِذَا غَابَ أَوْ شَهِدَ ‏"‏ ‏.‏ قَالَ هَذَا حَدِيثٌ حَسَنٌ صَحِيحٌ ‏.‏ وَمُحَمَّدُ بْنُ مُوسَى الْمَخْزُومِيُّ الْمَدَنِيُّ ثِقَةٌ رَوَى عَنْهُ عَبْدُ الْعَزِيزِ بْنُ مُحَمَّدٍ وَابْنُ أَبِي فُدَيْكٍ ‏.‏

Narrated Abu Hurairah:that the Messenger of Allah (ﷺ) said: "There are six things due from the believer to another believer: Visiting him when he is ill, attending (his funeral) to him when he dies, accepting his invitation when he invites, giving him Salam when he meets him, replying to him when he sneezes, and wishing him well when he is absent and when he is present

حَدَّثَنَا حُمَيْدُ بْنُ مَسْعَدَةَ، حَدَّثَنَا زِيَادُ بْنُ الرَّبِيعِ، حَدَّثَنَا حَضْرَمِيٌّ، مَوْلَى آلِ الْجَارُودِ عَنْ نَافِعٍ، أَنَّ رَجُلاً، عَطَسَ إِلَى جَنْبِ ابْنِ عُمَرَ فَقَالَ الْحَمْدُ لِلَّهِ وَالسَّلاَمُ عَلَى رَسُولِ اللَّهِ ‏.‏ قَالَ ابْنُ عُمَرَ وَأَنَا أَقُولُ الْحَمْدُ لِلَّهِ وَالسَّلاَمُ عَلَى رَسُولِ اللَّهِ وَلَيْسَ هَكَذَا عَلَّمَنَا رَسُولُ اللَّهِ صلى الله عليه وسلم عَلَّمَنَا أَنْ نَقُولَ الْحَمْدُ لِلَّهِ عَلَى كُلِّ حَالٍ ‏.‏ قَالَ أَبُو عِيسَى هَذَا حَدِيثٌ غَرِيبٌ لاَ نَعْرِفُهُ إِلاَّ مِنْ حَدِيثِ زِيَادِ بْنِ الرَّبِيعِ ‏.‏

Narrated Hadrami, the freed slave of the family of Al-Jarud:from Nafi: "A man sneezed beside Ibn 'Umar and said: 'Al-Hamdulillah Was-Salamu 'Ala Rasulillah. (All praise is due to Allah, and peace upon the Messenger of Allah)'. So Ibn 'Umar said: 'I too say Al-Hamdulillah Was-Salamu 'Ala Rasulillah, but this is not what the Messenger of Allah (ﷺ) taught us. He taught us to say: "Al-Hamdulillah 'Ala Kulli Hal (All praise is due to Allah in every circumstance)

^ يا أيها الذين آمنوا لا يسخر قوم من قوم عسى أن يكونوا خيرا منهم ولا نساء من نسآء عسى أن يكن خيرا منهن ولا تلمزوا أنفسكم ولا تنابزوا بالألقاب بئس الاسم الفسوق بعد الإيمان ومن لم يتب فأولئك هم الظالمون ^ الحجرات وقال تعالى ^ ويل لكل همزة لمزة ^ الهمزة

وهذا محرم مهما كان مؤذيا كما قال تعالى يا أيها الذين آمنوا لا يسخر قوم من قوم عسى أن يكونوا خيرا منهم ولا نساء من نساء عسى أن يكن خيرا منهن ومعنى السخرية الاستهانة والتحقير والتنبيه على العيوب والنقائص على وجه يضحك منه وقد يكون ذلك بالمحاكاة في الفعل والقول وقد يكون بالإشارة والإيماء وإذا كان بحضرة المستهزأ به لم يسم ذلك غيبة وفيه معنى الغيبة قالت عائشة رضي الله عنها حاكيت إنسانا فقال لي النبي صلى الله عليه وسلم والله ما أحب أني حاكيت إنسانا ولي كذا وكذا + حديث عائشة حكيت إنسانا فقال لي النبي صلى الله عليه وسلم ما يسرني أني حاكيت إنسانا ولي كذا وكذا أخرجه أبو داود والترمذي وصححه + وقال ابن عباس في قوله تعالى يا ويلتنا ما لهذا الكتاب لا يغادر صغيرة ولا كبيرة إلا أحصاها إن الصغيرة التبسم بالاستهزاء بالمؤمن والكبيرة القهقهة بذلك وهذا إشارة إلى أن الضحك على الناس من جملة الذنوب والكبائر وعن عبد الله بن زمعة أنه قال سمعت رسول الله صلى الله عليه وسلم وهو يخطب فوعظهم في ضحكهم من الضرطة فقال علا

الثامن السخرية والاستهزاء استحقارا له فإن ذلك قد يجري في الحضور ويجري أيضا في الغيبة ومنشؤه التكبر واستصغار المستهزأ به

الآفة السادسة: السخرية والاستهزاء، ومعنى السخرية: الاحتقار والاستهانة، والتنبيه على العيوب والنقائص على وجه يضحك منه، وقد يكون ذلك بالمحاكاة في الفعل والقول، وقد يكون بالشارة والإيماء، وكله ممنوع منه في الشرع، ورد النهى عنه في الكتاب والسنة.

وأما سوء الظن فهو امتلاء قلبه بالظنون السيئة بالناس حتى يطفح على لسانه وجوارحه فهم معه أبدا في الهمز واللمز والطعن والعيب والبغض ببغضهم ويبغضونه ويلعنهم ويلعنونه ويحذرهم ويحذرون منه فالأول يخالطهم ويحترز منهم والثاني يتجنبهم ويلحقه أذاهم الأول داخل فيهم بالنصيحة والإحسان مع الاحتراز والثاني خارج منهم مع الغش والدغل والبغض

وهذا إنما يحرم في حق من يتأذى به فأما من جعل نفسه مسخرة وربما فرح من أن يسخر به كانت السخرية في حقه من جملة المزاح وقد سبق ما يذم منه وما يمدح وإنما المحرم استصغار يتأذى به المستهزأ به لما فيه من التحقير والتهاون وذلك تارة بأن يضحك على كلامه إذا تخبط فيه ولم ينتظم أو على أفعاله إذا كنت مشوشة كالضحك على خطه وعلى صنعته أو على صورته وخلقته إذا كان قصيرا أو ناقصا لعيب من العيوب فالضحك من جميع ذلك داخل في السخرية المنهى عنها الآفة الثانية عشر إفشاء السر

Mass media interventions for reducing mental health-related stigma.: Background: Mental health-related stigma is widespread and has major adverse effects on the lives of people with mental health problems. Its two major components are discrimination (being treated unfairly) and prejudice (stigmatising attitudes). Anti-stigma initiatives often include mass media interventions, and such interventions can be expensive. It is important to know if mass media interventions are effective. Objectives: To assess the effects of mass media interventions on reducing stigma (

Challenging the public stigma of mental illness: a meta-analysis of outcome studies.: Objective: Public stigma and discrimination have pernicious effects on the lives of people with serious mental illnesses. Given a plethora of research on changing the stigma of mental illness, this article reports on a meta-analysis that examined the effects of antistigma approaches that included protest or social activism, education of the public, and contact with persons with mental illness. Methods: The investigators heeded published guidelines for systematic literature reviews in health care

The different faces of mental illness stigma: Systematic variation of stereotypes, prejudice and discrimination by type of illness.: Mental illness (MI) stigma has been characterized as multi-dimensional including problems of knowledge (stereotypes), attitudes (prejudice) and behavior (discrimination); however, most research practice is predominantly applying unidimensional behavioral measures such as social distance scales. Moreover, specific types of MIs and different forms of discriminatory behaviors are not being differentiated. The Stereotype Content Model predicts that group stereotypes (warmth, competence) are linked w

Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review.: Background: Most research on interventions to counter stigma and discrimination has focused on short-term outcomes and has been conducted in high-income settings. Aims: To synthesise what is known globally about effective interventions to reduce mental illness-based stigma and discrimination, in relation first to effectiveness in the medium and long term (minimum 4 weeks), and second to interventions in low- and middle-income countries (LMICs). Method: We searched six databases from 1980 to 2013

Women's and girls' experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesis.: Background: Attention to women's and girls' menstrual needs is critical for global health and gender equality. The importance of this neglected experience has been elucidated by a growing body of qualitative research, which we systematically reviewed and synthesised. Methods and findings: We undertook systematic searching to identify qualitative studies of women's and girls' experiences of menstruation in low- and middle-income countries (LMICs). Of 6,892 citations screened, 76 studies reported

Continuum beliefs and mental illness stigma: a systematic review and meta-analysis of correlation and intervention studies.: Background: Promulgating a continuum model of mental health and mental illness has been proposed as a way to reduce stigma by decreasing notions of differentness. This systematic review and meta-analysis examines whether continuum beliefs are associated with lower stigma, and whether continuum interventions reduce stigma. Methods: Following a pre-defined protocol (PROSPERO: CRD42019123606), we searched three electronic databases (PubMed, Web of Science, and PsycINFO) yielding 6726 studies. After

Stress and perceived stigma among parents of children with epilepsy.

Purpose: The present study aimed at understanding the stress and perceived stigma among parents of children with epilepsy seeking treatment at a tertiary referral center for neurology in South India. Materials and methods: Parents of sixty children suffering from epilepsy in the age group of 4-15 years were interviewed to explore parental stress and perceived stigma. They were recruited consecutively over a period of 6 months in 2015. Tools administered were Childhood-Illness related Parenting Stress Inventory (Manford in J Neurol 264(8):1811-24, 2017) and the Parent Stigma Scale (Baca et al. in Value Health 13(6):778-786, 2010). Results: The mean age of parents was 37.2 years, and the majority of parents who used to bring their child to the hospital were male (71.7%) and educated up to the secondary/intermediate level (36%) and were from lower socio-economic status. The mean age of chil…

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Are perceived barriers to accessing mental healthcare associated with socioeconomic position among individuals with symptoms of depression? Questionnaire-results from the Lolland-Falster Health Study, a rural Danish population study.

Objective: To evaluate if perceived barriers to accessing mental healthcare (MHC) among individuals with symptoms of depression are associated with their socio-economic position (SEP). Design: Cross-sectional questionnaire-based population survey from the Lolland-Falster Health Study (LOFUS) 2016-17 of 5076 participants. Participants: The study included 372 individuals, with positive scores for depression according to the Major Depression Inventory (MDI), participating in LOFUS . Interventions: A set of five questions on perceived barriers to accessing professional care for mental health problem was posed to individuals with symptoms of depression (MDI score >20). Outcomes: The association between SEP (as measured by educational attainment, employment status and financial strain) and five different types of barriers to accessing MHC were analysed in separate multivariable logistic regres…

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Barriers to diabetic self-care: A qualitative study of patients' and healthcare providers' perspectives.

Aims and objectives: To explore patient and healthcare provider (HCP) perspectives about patients' barriers to the performance of diabetic self-care behaviours in Ghana. Background: Sub-Saharan African urban populations are increasingly affected by type 2 diabetes due to nutrition transition, sedentary lifestyles and ageing. Diabetic self-care is critical to improving clinical outcomes. However, little is known about barriers to diabetic self-care (diet, exercise, medication taking, self-monitoring of blood glucose and foot care) in sub-Saharan Africa. Design: Qualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Methods: Semi-structured interviews were conducted among 23 people living with type 2 diabetes and 14 HCPs recruited from the diabetes clinics of three hospitals in Tamale, Ghana. Interviews were audiotaped and transcrib…

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Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness.

It is unclear to what extent failure to recognize symptoms as potential sign of a mental illness is impeding service use, and how stigmatizing attitudes interfere with this process. In a prospective study, we followed a community sample of 188 currently untreated persons with mental illness (predominantly depression) over 6 months. We examined how lack of knowledge, prejudice and discrimination impacted on self-identification as having a mental illness, perceived need, intention to seek help, and help-seeking, both with respect to primary care (visiting a general practitioner, GP) and specialist care (seeing a mental health professional, MHP). 67% sought professional help within 6 months. Fully saturated path models accounting for baseline depressive symptoms, previous treatment experience, age and gender showed that self-identification predicted need (beta 0.32, p < 0.001), and need pre…

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Out of the silos: identifying cross-cutting features of health-related stigma to advance measurement and intervention.

Background: Many health conditions perceived to be contagious, dangerous or incurable, or resulting in clearly visible signs, share a common attribute - an association with stigma and discrimination. While the etiology of stigma may differ between conditions and, sometimes, cultural settings, the manifestations and psychosocial consequences of stigma and discrimination are remarkably similar. However, the vast majority of studies measuring stigma or addressing stigma through interventions employ a disease-specific approach. Main body: The current paper opposes this siloed approach and advocates a generic concept of 'health-related stigma' in both stigma measurement and stigma interventions. Employing a conceptual model adapted from Weiss, the current paper demonstrates the commonalities among several major stigmatized conditions by examining how several stigma measurement instruments, su…

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Mental health care among blacks in America: Confronting racism and constructing solutions.

Objectives: To describe reasons for unmet need for mental health care among blacks, identify factors associated with causes of unmet need, examine racism as a context of unmet need, and construct ways to improve service use. Data sources: Data from the 2011-2015 National Survey on Drug Use and Health were pooled to create an analytic sample of black adults with unmet mental health need (N = 1237). Qualitative data came from focus groups (N = 30) recruited through purposive sampling. Study design: Using sequential mixed methods, reasons for unmet need were regressed on sociodemographic, economic, and health characteristics of respondents. Findings were further explored in focus groups. Principal findings: Higher education was associated with greater odds of reporting stigma and minimization of symptoms as reasons for unmet need. The fear of discrimination based on race and on mental illne…

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Longitudinal assessment of an anti-stigma campaign related to common mental disorders in rural India.

Background: Stigma related to mental health and lack of trained mental health professionals is a major cause for an increased treatment gap, particularly in rural India. The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health project delivered a complex intervention involving task sharing, an anti-stigma campaign and use of technology-based, decision-support tools to empower primary care workers to identify and manage depression, anxiety, stress and suicide risk. AimsThe aim of this article is to report changes in stigma perceptions over three time points in the rural communities where the anti-stigma campaign was conducted. Method: A multimedia-based anti-stigma campaign was conducted over a 3-month period in the West Godavari district of Andhra Pradesh, India. Following that, the primary care-based mental health service was delivered for 1 year. The anti-stigma c…

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Buffering Internalization of HIV Stigma: Implications for Treatment Adherence and Depression.

Background: One mechanism through which social stigma of HIV affects health outcomes for people living with HIV (PLWH) is through internalization of stigma. However, this transformation of social stigma in the community into internalized stigma may not be of the same magnitude for all PLWH. We examined the moderating effects of 3 personality traits-fear of negative social evaluation, attachment-related anxiety, and dispositional resilience-in transforming perceived stigma in the community into internalized stigma. Furthermore, we investigated downstream effects of these moderated associations on depressive symptoms and antiretroviral treatment (ART) adherence. Setting/methods: In study 1, data from 203 PLWH in the Southeast United States were analyzed controlling for age, sex, education, race, and time on ART. In study 2, data from 453 women in a multisite study were analyzed controlling…

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Determinants of treatment of mental disorders in Lebanon: barriers to treatment and changing patterns of service use.

Aims: To investigate for the first time the determinants and barriers of seeking help for mental disorders in the Arab world based on a national study: Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (L.E.B.A.N.O.N). Methods: A nationally representative (n = 2857) and multistage clustered area probability household sample of adults ≥18 years and older was assessed for lifetime and 12 months mental disorders using the Composite International Diagnostic Interview. In addition, detailed information was obtained on help- seeking behaviour and barriers to treatment. Results: In total, 19.7% of the Lebanese with mental disorders sought any type of treatment: 91% of those who sought treatment did so within the health sector. Severity and perceived severity of disorders predicted seeking help, the highest being for panic disorder. The greatest barrier to seek help was low p…

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"He can send her to her parents": The interaction between marriageability, gender and serious mental illness in rural Ethiopia.

Background: For women in most low- and middle-income countries, the diagnosis with serious mental illness (SMI) leads to stigma and challenges related to starting or maintaining marriages. The purpose of this qualitative study was to explore perspectives on marriage, divorce and family roles of women with SMI in rural Ethiopia. Methods: A qualitative study was conducted in a rural setting of Butajira, South Central Ethiopia. A total of 39 in-depth interviews were carried out with service users (n = 11), caregivers (n = 12), religious leaders (n = 6), health extension workers (n = 4), police officers (n = 2), teachers (n = 2) and government officials (n = 2). Data were analyzed using a thematic approach. Results: Three themes emerged. (1) Marriage and SMI: Chances of getting married for individuals with SMI in general was perceived to be lower: Individuals with SMI experienced various cha…

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Do depression literacy, mental illness beliefs and stigma influence mental health help-seeking attitude? A cross-sectional study of secondary school and university students from B40 households in Malaysia.

Background: Mental illness rates among young people is high, yet the frequency of help-seeking is low, especially among those from lower socioeconomic backgrounds. Understanding factors influencing help-seeking, such as mental illness beliefs, stigma and literacy among B40 individuals is important, but past studies are sparse. Hence, we aimed to examine the factors associated with mental help-seeking attitude among students from the B40 income bracket. Differences in beliefs toward mental illness, stigma and help-seeking attitudes among university and secondary school students were also investigated. Methods: University and secondary school students from low-income households (N = 202) were involved in this cross-sectional study. Participants completed the Depression Literacy Questionnaire (D-Lit), General Help Seeking Questionnaire (GHSQ), Mental Help Seeking Attitudes Scale (MHSAS), Se…

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HIV-related stigma, racial discrimination, and gender discrimination: Pathways to physical and mental health-related quality of life among a national cohort of women living with HIV.

Social inequities compromise health-related quality of life (HR-QoL) among women living with HIV (WLWH). Little is known about health impacts of intersecting stigma based on HIV status, race and gender among WLWH or potential mechanisms to promote HR-QoL. We tested pathways from multiple types of stigma (HIV-related, racial, gender) to physical and mental HR-QoL utilizing baseline survey data from a national cohort of WLWH in Canada (2013-2015). Structural equation modeling was conducted using maximum likelihood estimation methods to test the direct effects of HIV-related stigma, racial discrimination, and gender discrimination on HR-QoL and indirect effects via social support and economic insecurity, adjusting for socio-demographic factors. Among 1425 WLWH (median age: 43years [IQR=35-50]), HIV-related stigma and gender discrimination had significant direct effects on mental HR-QoL. Soc…

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Successful mental health promotion with men: the evidence from 'tacit knowledge'.

There remains significant concern about men's mental health, particularly in terms of personal and societal barriers to help-seeking, negative coping mechanisms and high suicide rates. This article presents findings from a multi-phase study looking at 'what works' in mental health promotion for men. Work here reports the collection and analysis of the tacit knowledge of those working within mental health promotion interventions for men. A 'multiple hub and spoke' approach was used to assist data collection. Thirteen key players, active in the men's mental health field, half from the UK and half beyond, formed an Investigative Network collecting data, mainly through interviews, from wider geographical and professional community contexts where they had networks. The focus of data collection was on 'what works' in mental health promotion for men. Data was analysed using thematic analysis te…

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Health of Transgender Adults in the U.S., 2014-2016.

Introduction: Transgender people experience significant interpersonal and structural discrimination and stigma. However, little is known about the health of transgender people, and even less about the health of specific groups-including male-to-female, female-to-male, and gender-nonconforming transgender populations-despite the variation in social and biological characteristics across groups. Methods: Data are from the 2014-2016 Behavioral Risk Factor Surveillance System, analyzed in 2017. The study population included 2,221 transgender and 523,080 cisgender respondents from 31 states and one territory. The authors estimated the prevalence and adjusted odds of chronic health conditions, health-related quality of life, disabilities, health behaviors, and health utilization among three transgender groups, when compared separately with cisgender males and cisgender females. Results: An esti…

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Structural stigma and the health and wellbeing of Australian LGB populations: Exploiting geographic variation in the results of the 2017 same-sex marriage plebiscite.

Rationale: Lesbian, gay, or bisexual (LGB) people experience poorer life outcomes than heterosexual people, with ongoing debates about the aetiology of these differences. Minority stress theory draws attention to the importance of structural stigma, which concerns hostile social environments for sexual minorities that constrain their opportunity structures. Yet few studies have operationalised structural stigma and tested its influence, with most focusing on the US context; even fewer studies examine the underlying mechanisms. Objective: This study expands the available evidence to Australia, which constitutes an interesting case study due to the implementation in late 2017 of a national postal plebiscite on same-sex marriage legislation. It also adds to knowledge by theorising and testing the mediating role of perceived social support in explaining the association between structural sti…

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Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, and healthcare stress.

Studies show that women with high BMI are less likely than thinner women to seek healthcare. We aimed to determine the mechanisms linking women's weight status to their healthcare avoidance. Women (N = 313) were surveyed from a U.S. health-panel database. We tested a theory-driven model containing multiple stigma and body-related constructs linking BMI to healthcare avoidance. The model had a good fit to the data. Higher BMI was related to greater experienced and internalized weight stigma, which were linked to greater body-related shame. Internalized weight stigma was also related to greater body-related guilt, which was associated with higher body-related shame. Body-related shame was associated with healthcare stress which ultimately contributed to healthcare avoidance. We discuss recommendations for a Weight Inclusive Approach to healthcare and the importance of enhancing education f…

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Sexual orientation disparities in the co-occurrence of substance use and psychological distress: a national population-based study (2008-2015).

Purpose: Although strong evidence documents the elevated prevalence of both substance use and mental health problems among sexual minorities (i.e., gay, lesbian, and bisexuals), relatively less research has examined whether risk of the co-occurrence of these factors is elevated among sexual minorities compared to heterosexuals. The object of this study was to (1) explore sexual orientation-based differences in substance use, psychological distress, and their co-occurrence in a representative sample in Sweden, and (2) examine if greater exposure to stressors, such as discrimination, victimization/threats, and social isolation, could explain these potential disparities and their co-occurrence. Methods: Data come from the cross-sectional Swedish National Public Health Survey, which collected random samples of individuals (16-84 years of age) annually from 2008 to 2015, with an overall respo…

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The gendered experience with respect to health-seeking behaviour in an urban slum of Kolkata, India.

Background: Empirical evidence shows that the relationship between health-seeking behaviour and diverse gender elements, such as gendered social status, social control, ideology, gender process, marital status and procreative status, changes across settings. Given the high relevance of social settings, this paper intends to explore how gender elements interact with health-seeking practices among men and women residing in an Indian urban slum, in consideration of the unique socio-cultural context that characterises India's slums. Methods: The study was conducted in Sahid Smriti Colony, a peri-urban slum of Kolkata, India. The referral technique was used for selecting participants, as people in the study area were not very comfortable in discussing their health issues and health-seeking behaviours. The final sample included 66 participants, 34 men and 32 women. Data was collected through i…

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The impact of self-perceived limitations, stigma and sense of coherence on quality of life in multiple sclerosis patients: results of a cross-sectional study.

Objective: To examine the impact of perceived limitations, stigma and sense of coherence on quality of life in multiple sclerosis patients. Design: Cross-sectional survey. Setting: Department of Neurology, University Medical Center Groningen, the Netherlands. Subjects: Multiple sclerosis patients. Main measures: World Health Organization Quality of Life - abbreviated version, Stigma Scale for Chronic Illness, Sense of Coherence Scale, background and disease-related questions. Results: In total, 185 patients (61% response rate) participated in the study with moderate to severe limitations. Stigma was highly prevalent but low in severity. Patients with a higher sense of coherence experienced a lower level of limitations ( B = -0.063, P < 0.01) and less stigma (enacted stigma B = -0.030, P < 0.01; self-stigma B = -0.037, P < 0.01). Patients with a higher level of limitations experienced mor…

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Judgment hurts: The psychological consequences of experiencing stigma in multiple sclerosis.

Rationale: People living with MS often report feeling stigmatized, but little research has examined the psychological impact of this, which is important considering the high prevalence of depression in this population. Objectives: The aim of this study was to assess, concurrently and prospectively, the association between stigma and depression in people living with MS. Methods: Data were available from 5369 participants enrolled in the semi-annual survey conducted by the North American Research Committee on Multiple Sclerosis (NARCOMS). Participants reported their MS stigma and depression in the spring 2013 update survey (T1) and their depression again one year later (T2). Demographic and health-related covariates were also assessed. Results: People experiencing higher levels of stigma reported more depression symptoms and were more likely to meet the threshold for clinical depression at…

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Mental health literacy, stigma, and help-seeking behaviors among male college students.

Objective: Mental health literacy (MHL) is low in college-aged men potentially resulting in impaired mental wellbeing. This study assessed MHL, psychosocial determinants, and help-seeking behaviors among male university students. Participants: Male undergraduate and graduate students were surveyed in Spring 2017 (n = 1,242) at a large southeastern university in the United States. Methods: Preexisting validated scales for MHL, psychosocial determinants, and help-seeking intention were used in measurement and demographic variables were collected. T-tests and one-way ANOVA were performed to measure differences between groups. Results: Participants showed low scores for all constructs with statistically significant differences between undergraduate and graduate students, as well as between races and major classifications. Undergraduate men had moderate MHL and low intentions to seek professi…

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An exploratory study of stress and coping among Black college men.

Research on coping mechanisms among Black Americans is robust, yet there is a dearth of studies that use qualitative approaches to examine coping specifically among young Black men. The current and historical landscape of race relations in the United States calls for additional concern and exploration of this topic. To fill gaps in this area, this study uncovered the ways Black college men cope with various stressors that impact their mental health. Eleven qualitative interviews were conducted with 18- to 25-year-old Black men enrolled at a college in the Midwest who participated in the Young Black Men, Masculinities, and Mental Health (YBMen) project. Data were analyzed using a rigorous and accelerated data reduction technique that involved transferring transcript data onto spreadsheets, reducing the data, and conducting a rigorous content analysis to generate themes and subthemes. Part…

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Public stigma of prolonged grief disorder: An experimental study.

Prolonged grief disorder (PGD), characterized by severe, persistent and disabling grief, is being considered for inclusion in the International Classification of Diseases' 11 (ICD-11) and a related disorder, Persistent Complex Bereavement Disorder (PCBD), is included for further investigation in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Establishing diagnoses for pathological grief may lead to stigmatization. Additionally, it has been argued that people experiencing severe grief responses after loss of non-family members (i.e., disenfranchised grief) may experience more stigmatizing reactions. Yet, no research to date has investigated this. To fill this gap in knowledge, 379 adults from the general population were randomly allocated to read one of 4 different vignettes of a person with and without a grief disorder diagnosis who had lost a friend or a spouse. Af…

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The impact of social marketing campaigns on reducing mental health stigma: Results from the 2009-2014 Time to Change programme.

Background: In England, during 2009-2014 the 'Time to Change' anti-stigma programme has included a social marketing campaign (SMC) using mass media channels, social media and social contact events but the efficacy of such approach has not been evaluated yet. Methods: The target population included people aged between mid-twenties/mid-forties, from middle-income groups. Participants were recruited through an online market research panel, before and after each burst of the campaign (with a mean number of unique participants per each burst: 956.9±170.2). Participants completed an online questionnaire evaluating knowledge [Mental Health Knowledge Schedule (MAKS)]; attitudes [Community Attitudes toward Mental Illness (CAMI)]; and behaviours [Reported and Intended Behaviour Scale (RIBS)]. Socio-demographic data and level of awareness of the SMC were also collected. Results: A total of 10,526 p…

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Self-stigma and suicidality: a longitudinal study.

Mental illness stigma is a source of distress for persons with mental illness. Self-stigma occurs when negative stereotypes are internalized, leading to low self-esteem, shame and hopelessness. Due to its consequences self-stigma may contribute to suicidality and be a modifiable target for suicide prevention. Based on 222 disability pensioners with mental illness we examined whether self-stigma at baseline is associated with suicidal ideation over a 2-year period, controlling for baseline suicidal ideation, symptoms, age and gender. More self-stigma predicted suicidal ideation at baseline and longitudinally. Interventions on different levels to reduce self-stigma could improve suicide prevention.

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