Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey
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 coefficient 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 finding 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 effective treatment. This finding suggests that new and sustained approaches are needed to prevent stigmatisation of people with depression and reduce the effects of stigma when it is already established.Funding European Commission, Directorate General for Health and Consumers, Public Health Executive Agency.
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Anticipation of discrimination, such as fear of being discredited by police, withdrawing from education, or being avoided by family and friends, accounts for substantial negative effects.
“The anticipation of discrimination, such as the fear of being discredited by police, having to withdraw from educational activities, or being avoided by family, friends, neighbours, also accounts for substantial negative effects.42,79”
From The Lancet Commission on ending stigma and discrimination in mental health (2022) · cites this paper as [79]
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- Authors
- 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.
- Affiliations
- University of Verona (IT)
- Finnish Institute for Health and Welfare (FI)
- Centro de Investigación Biomédica en Red de Salud Mental (ES)
- University Mental Health Research Institute (GR)
- Centro San Giovanni di Dio Fatebenefratelli (IT)
- King's College London (GB)
- Corresponding author
- Lasalvia, Antonio
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2013-01
- Volume
- 381
- Issue
- 9860
- Pages
- 55-62
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2096000431
- Cited by
- 445
- References
- 44
- Citations by year
- 2026: 15 · 2025: 19 · 2024: 24 · 2023: 29 · 2022: 28 · 2021: 20 · 2020: 38 · 2019: 40 · 2018: 36 · 2017: 31 · 2016: 44 · 2015: 33 · 2014: 50 · 2013: 35 · 2012: 1
- FWCI
- 57.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- Research portal (Tilburg University) (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Institutional Research Information System (Università degli Studi di Trento) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Lirias (submittedVersion)
- Faculty of Special Education and Rehabilitation (University of Belgrade) (submittedVersion)
- Funders
- National Institute for Health and Care Research (RP-PG-0606-1053, NF-SI-0611-10053)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- major depressive disorder, experienced discrimination, anticipated discrimination, mental health stigma, diagnosis disclosure, psychiatric hospital admissions, social functioning, employment, unemployment, relationship formation, health care access, cross-national comparison, help-seeking barriers, help-seeking facilitators
- MeSH terms
- Adult, Aged, Major Depressive Disorder, Employment, Female, Humans, Interpersonal Relations, Male, Middle Aged, Prejudice, Socioeconomic Factors, Stereotyping, Safety Management, Young Adult
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