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Experienced stigma related to common mental illness and alcohol use disorder in rural Uganda: A qualitative study
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Background: Stigma remains a major barrier to mental health care in low- and middle-income countries (LMICs), yet little is known about how stigma operates for common mental illnesses (CMIs) and alcohol use disorder (AUD) in rural Uganda. Methods: We conducted 80 in-depth interviews (IDIs) with individuals and family members affected by CMIs (n=34) or AUD (n=46) in Buyende District, Uganda. Interviews were analyzed inductively using the framework method to identify cross-cutting themes. Results: . Internalized stigma manifested as denial, concealment, shame, and helplessness. AUD participants resisted moral judgment through denial, while those with CMIs internalized stigma through concealment. Communities perpetuated stigma via misinformation, moralization, indifference, and alienation-framing AUD as moral failure and CMIs as irrational or contagious. Families faced emotional exhaustion, economic strain, and religious or moral conflict. AUD households reported sharper public condemnation and financial collapse, while CMI households experienced chronic caregiving stress and hidden grief. Conclusions: Stigma toward people with CMIs and AUD in rural Uganda is pervasive, multilayered, and sustained by moral and structural factors. AUD is publicly moralized, while CMIs are concealed and pathologized. Stigma-reduction strategies should integrate psychoeducation, community and religious engagement, family-centered support, and economic empowerment to disrupt cycles of exclusion and improve care uptake.
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Evidence from Uganda indicates that substance use is strongly moralised within communities, contributing to delayed help-seeking and concealment of illness.
“This aligns with evidence from Uganda, where substance use is strongly moralised within communities, contributing to delayed help‐seeking and concealment of illness [49].”
From Treatment Experiences of Individuals With Co-Occurring Mental Health and Substance Use Disorders and Perspectives of Mental Health Workers in Ashanti Region, Ghana (2026) · cites this paper as [49]
The Discussion describes alcohol use disorder in rural Uganda as highly moralized. The Background says stigma can delay help-seeking, but does not specifically link that delay to moralization of substance use. The Results distinguish denial or minimization among participants with alcohol use disorder from concealment of illness among those with common mental illnesses, so the claim overextends the concealment finding to substance use. (LLM, conf=0.86)
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Metadata
- Authors
- Lee, Y. J., Miller, B., Mbabazi, R., Nakaweesi, S., Atim, C., Ning, S., Kisakye, C., Wagener, T., Tsai, M., Kazungu, R., Ssekalo, I., Ashaba, S., Rosenheck, R., & Tsai, A. C.
- Affiliations
- University of Washington (US)
- University of North Carolina at Charlotte (US)
- Cavendish University Uganda (UG)
- Washington University in St. Louis (US)
- University of California, Los Angeles (US)
- The University of Texas at Dallas (US)
- Mbarara University of Science and Technology (UG)
- Yale University (US)
- Harvard University (US)
- Corresponding author
- Lee, Yang Jae
- Venue
- SSM - Mental Health
- Publisher
- Elsevier BV
- Published
- 2026-06
- Volume
- 9
- Pages
- 100616
- ISSN
- 2666-5603 (ISSN-L)
- PMC
- PMC13099072
- OpenAlex
- W7138995769
- Cited by
- 1
- References
- 32
- Citations by year
- 2026: 1
- FWCI
- 8.07
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- SSM - Mental Health (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Institutes of Health (K24DA061696-01)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- stigma, common mental disorders, alcoholism, self-stigma, moralization, concealment, family caregiving, stigma reduction, rural Uganda, barriers to mental health care, religious conflict, financial stress, moral judgment
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