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Cited by 750Mental Health Treatment and AccessMental Health and Patient InvolvementPsychology and Mental Health

The Lancet Commission on ending stigma and discrimination in mental health

Open access
Thornicroft, Graham, Sunkel, Charlene, Alikhon Aliev, Akmal, Baker, Sue, Brohan, Elaine, el Chammay, Rabih, Davies, Kelly, Demissie, Mekdes +36 more·2022·The Lancet
DOI 10.1016/s0140-6736(22)01470-2
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Abstract

Graham Thornicroft*, Charlene Sunkel*, Akmal Alikhon Aliev, Sue Baker, Elaine Brohan, Rabih el Chammay, Kelly Davies, Mekdes Demissie, Joshua Duncan, Wubalem Fekadu, Petra C Gronholm, Zoe Guerrero, Dristy Gurung, Kassahun Habtamu, Charlotte Hanlon, Eva Heim, Claire Henderson, Zeinab Hijazi, Claire Hoffman, Nadine Hosny, Fiona-Xiaofei Huang, Sarah Kline, Brandon A Kohrt, Heidi Lempp, Jie Li, Elisha London, Ning Ma, Winnie W S Mak, Akerke Makhmud, Pallab K Maulik, Maria Milenova, Guadalupe Morales Cano, Uta Ouali, Sarah Parry, Thara Rangaswamy, Nicolas Rüsch, Taha Sabri, Norman Sartorius, Marianne Schulze, Heather Stuart, Tatiana Taylor Salisbury, Norha Vera San Juan, Nicole Votruba, Petr Winkler

Integrity signals

Registry

Crossref · 10.1016/s0140-6736(22)01470-2

Cites

305 of 305 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 348 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In that survey, at least 70% of participants agreed that stigma and discrimination negatively affect most PWLE.

    “stigma and discrimination negatively affect most PWLE”
    Quote in the paperSubstantial claim
  • Findingown data

    An umbrella review of 216 systematic reviews shows that social contact interventions (in person, virtual, or indirect) adapted to different contexts and cultures are the most effective ways to reduce stigmatisation worldwide.

    “Our umbrella review of 216 systematic reviews shows that interventions based on the principle of social contact (whether in person, virtual, or indirect) that have been appropriately adapted to different contexts and cultures are the most effective ways to reduce stigmatisation worldwide”
    • Also stated in: § Abstract · boosted
      “The clearly emerging core finding is that forms of social contact (direct or indirect) between people who do and do not have lived experience of mental health conditions is the most effective evidence-based way to reduce stigmatisation.”
    Quote in the paperSubstantial claim
  • Findingown data

    In that survey, at least 70% of participants agreed that the media could play a crucial part in reducing stigma and discrimination.

    “the media could play a crucial part in reducing stigma and discrimination”
    Quote in the paperNot a substantial claim
  • Findingown data

    The same evaluation found programmes are most effective when target groups are consulted on content and delivery.

    “when target groups are consulted on programme content and delivery”
    Quote in the paperSubstantial claim
  • Findingown data

    In that survey, at least 70% of participants agreed that stigma and discrimination can be worse than the impact of the mental health condition itself.

    “stigma and discrimination can be worse than the impact of the mental health condition itself”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 72
  • May combine two claims. 155
  • The quote only partly states this claim. 2

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    In a global, multilanguage survey of PWLE, 391 people responded from 45 countries and territories.

    “In a global, multilanguage survey of PWLE, 391 people responded from 45 countries and territories.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Stigma stress is associated with increased self-stigma and reduced empowerment and quality of life.

    “It is associated with increased self-stigma and reduced empowerment and quality of life.54”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Rüsch, 2014, Emotional reactions to involuntary psychiatric hospitalization and stigma-related stress among people with mental illness, Eur Arch Psychiatry Clin Neurosci source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Among people who anticipated or experienced high levels of discrimination, psychological distress and shame increase, while empowerment and quality of life decrease.

    “Among people who anticipated or experienced high levels of discrimination, psychological distress and shame were also increased, and empowerment and quality of life were reduced (personal communication, Petr Winkler).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Self-stigma is highest among people with schizophrenia and is on average higher in southeast Asian and Middle Eastern countries than in European and North American countries.

    “In terms of diagnoses, self-stigma was highest among people with schizophrenia and, on average, was higher in southeast Asian and Middle Eastern than in European and North American countries.53”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Dubreucq, 2021, Self-stigma in serious mental illness: a systematic review of frequency, correlates, and consequences, Schizophr Bull source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Findingreasoning

    Key lessons include consulting closely with the identified target groups.

    “consulting closely with the identified target groups”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Self-stigma has particularly negative effects on symptoms and recovery, mediated by reduced self-esteem and increased hopelessness and social isolation.

    “Self-stigma had particularly negative effects on symptoms and recovery, mediated particularly by reduced self-esteem and increased hopelessness and social isolation.53,68,69”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [53] Dubreucq, 2021, Self-stigma in serious mental illness: a systematic review of frequency, correlates, and consequences, Schizophr Bull source

      Not checked in the free run.

    • cites [68] Pellet, 2019, The relationship between self-stigma and depression among people with schizophrenia-spectrum disorders: a longitudinal study, Psychiatry Res source

      Not checked in the free run.

    • cites [69] Fox, 2018, How and when does mental illness stigma impact treatment seeking? Longitudinal examination of relationships between anticipated and internalized stigma, symptom severity, and mental health service use, Psychiatry Res source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Discriminatory legislation exists in many countries, including prohibitions on marriage, violations of property rights, and prohibition from voting in elections.

    “Regarding legal provisions, striking examples of discriminatory legislation exist in many countries, including prohibitions on marriage, 60 violations against property rights, 61 and prohibition from voting in elections. 62”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [60] Bhugra, 2016, Legislative provisions related to marriage and divorce of persons with mental health problems: a global review, Int Rev Psychiatry source

      Not checked in the free run.

    • cites [61] Bhugra, 2016, Right to property, inheritance, and contract and persons with mental illness, Int Rev Psychiatry source

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    • cites [62] Bhugra, 2016, Mental illness and the right to vote: a review of legislation across the world, Int Rev Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In the global survey, almost 300 respondents from 45 countries (mostly low- and middle-income countries) participated.

    “From the almost 300 respondents in 45 countries (mostly low-income and middle-income countries [LMICs])”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Greater perceived public stigma is associated with more self-stigma, more hopelessness, poorer recovery, and reduced quality of life among people with mental health conditions.

    “They also reported more self-stigma, more hopelessness, poorer recovery, and reduced quality of life.17,50”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [17] Sheehan, 2016, Stigma by any other name, Psychiatr Serv source

      Not checked in the free run.

    • cites [50] Mak, 2007, Meta-analysis of stigma and mental health, Soc Sci Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    Key lessons include paying attention to the effects, outcomes, and sustainability of the programme.

    “paying attention to the effects, outcomes, and sustainability of the programme”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Laws with provisions for involuntary admission only for people with mental health conditions are argued to be intrinsically discriminatory.

    “aws with provisions for involuntary admission to only for people with mental health conditions are argued to be intrinsically discriminatory.63”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] Szmukler, 2020, Involuntary detention and treatment: are we edging toward a “paradigm shift”?, Schizophr Bull source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    There is strong evidence that stigma is negatively related to help-seeking, especially among minority ethnic groups, young people with mental health conditions, those living with parents with mental health conditions, military members, and health professionals, but little evidence for people with substance use conditions.

    “There is strong evidence that stigma is negatively related to help-seeking, especially among people in minority ethnic groups, young people with mental health conditions and those who live with parents with mental health conditions, members of the military, and health professionals, 57 although there is little evidence for people with substance use conditions.58”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [57] Clement, 2015, What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies, Psychol Med source

      Not checked in the free run.

    • cites [58] Hammarlund, 2018, Review of the effects of self-stigma and perceived social stigma on the treatment-seeking decisions of individuals with drug- and alcohol-use disorders, Subst Abuse Rehabil source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Public stigma makes people wish to avoid being labelled, and self-stigma, shame, the why-try effect, demoralisation, and giving up life goals deter help-seeking.

    “Public stigma makes people wish to avoid being labelled.Self-stigma, shame, the 'why try' effect, demoralisation, and giving up of life goals also deter individuals from help-seeking.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Stigma is associated with increases in the number of episodes of being unwell, the duration of condition, and psychiatric hospitalisation.

    “Stigma was associated with increases in the number of episodes of being unwell, the duration of condition, and psychiatric hospitalisation.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingreasoning

    Key lessons include carefully creating and adapting programme content based on context and culture.

    “carefully creating and adapting the programme content based on context and culture”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Stigma has an additional adverse impact on adolescents and their relationships with family and peers, and can lead to social exclusion from schools, sports, and other community participation.

    “and stigma has an additional adverse impact on them and their relationships with family and peers, and can lead to social exclusion from schools, sports, and other community participation.84”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] Ferrie, 2020, Psychosocial outcomes of mental illness stigma in children and adolescents: a mixed-methods systematic review, Child Youth Serv Rev source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Barriers to accessing mental health care include lower insurance benefits than for physical conditions, low reimbursement rates to mental health service providers, and restricted insurance coverage, especially in low-income settings.

    “Barriers to accessing mental health care include lower insurance benefits than for physical conditions, low rates of reimbursement by insurers to mental health service providers, and restricted insurance coverage for people with mental health conditions, especially in low-income settings.[71][72][73]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [71] Bishop, 2014, Acceptance of insurance by psychiatrists and the implications for access to mental health care, JAMA Psychiatry source

      Not checked in the free run.

    • cites [72] Ghosh, 2021, Mental health insurance in India: lack of parity, Lancet Psychiatry source

      Not checked in the free run.

    • cites [73] Appelbaum, 2020, Holding insurers accountable for parity in coverage of mental health treatment, Psychiatr Serv source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Identified studies investigated the impact of professional and public initiatives to reduce stigma and discrimination against people with depression in Slovenia and anti-stigma campaigns in several Asian countries.

    “Identified studies investigated the impact of various professional and public initiatives to reduce stigma and discrimination against people with depression in Slovenia, 92 and anti-stigma campaigns in several Asian countries.93”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [92] Valic, 2013, A review of the literature and media reports of patterns of mental health stigma and addressing stigma in Slovenia until 2010, Zdr Varst

      Not checked in the free run.

    • cites [93] Zhang, 2019, An integrative model of internalized stigma and recovery-related outcomes among people diagnosed with schizophrenia in rural China, Soc Psychiatry Psychiatr Epidemiol source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The included reviews were published between 1994 and 2021, with 58 published in 2021 and 30 in 2020.

    “The included reviews were published between 1994 and 2021, with 58 being published in 2021 and 30 in 2020.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    High levels of stigmatisation can lead to neglect or abuse, including shackling, verbal and physical humiliation or ridicule, sexual abuse, and violence, reported from south Asia, Africa, North America, and Europe.

    “High levels of stigmatisation towards people with mental health conditions can lead to acts of neglect or abuse, such as shackling, verbal and physical humiliation or ridicule, sexual abuse, and violence, 9 which has been reported from south Asia, Africa, North America, and Europe.83”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9] Thornicroft, 2007, Stigma: ignorance, prejudice or discrimination?, Br J Psychiatry source

      Not checked in the free run.

    • cites [83] Loganathan, 2011, Living with schizophrenia in India: gender perspectives, Transcult Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    There is some evidence that after the name change more people received a diagnosis than previously, but none indicating positive effects on public attitudes or media reporting.

    “There is some evidence that after the name change more people received a diagnosis than previously, 94 but none indicating positive effects on public attitudes or media reporting.95”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [94] Yamaguchi, 2017, Associations between renaming schizophrenia and stigma-related outcomes: a systematic review, Psychiatry Clin Neurosci source

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    • cites [95] Corrigan, 2018

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  • May combine two claims.

    Findingcitation

    People with mental health conditions often conceal their diagnosis, especially if they want to marry, because they fear a partner may think their children will inherit the condition.

    “Therefore, people with mental health conditions often conceal their diagnosis, especially if they want to marry, as they might fear that their potential partner could think their children will inherit the mental health condition.81”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] Elkington, 2013, Perceived mental illness stigma, intimate relationships and sexual risk behavior in youth with mental illness, J Adolesc Res source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The search yielded 15,323 entries; after removing 7,687 duplicates, 7,636 titles or abstracts were screened; 7,249 irrelevant studies were excluded; 387 full texts were assessed; and 216 reviews were included.

    “The search yielded 15 323 entries.After removing 7687 duplicates, 7636 titles or abstracts were screened.Irrelevant studies (n=7249) were excluded, and 387 full texts were assessed for eligibility.A total of 216 reviews were included.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Several national-level anti-stigma programmes in Asia were effective in reducing experienced and anticipated stigma and facilitated help seeking and engagement with mental health care, although no data were available on whether access to mental health care increased.

    “Several national-level programmes against stigma and discrimination in Asia were effective in reducing experienced and anticipated stigma and facilitated help seeking and engagement with mental health care, although no data were available on whether access to mental health care had increased.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Young people reported fears that their families would not care about their problems or take them seriously, which can invalidate their feelings and decrease willingness to seek support.

    “Young people discussed fears of their families not caring about their problems or not taking them seriously, which can invalidate their feelings and decrease their willingness to seek support.86”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [86] 2021

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  • May combine two claims.

    Findingown data

    Benefits and positive outcomes related to reducing structural stigma through policies were reported, but the quality of the studies was generally low.

    “Benefits and positive outcomes related to reducing structural stigma through policies were reported, but the quality of the studies was generally low.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Of the 216 included reviews, nine addressed structural stigma, 181 interpersonal stigma, and 26 self-stigma.

    “Of those, nine addressed structural stigma, 181 interpersonal stigma, and 26 self-stigma.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Four of the seven reviews focused on high-income countries and three had no geographical limitations.

    “Four focused on HICs [99][100][101][102] and three had no geographical limitations.[103][104][105]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [99] Joshi, 2021, Women-centered drug treatment models for pregnant women with opioid use disorder: a scoping review, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [100] Røsvik, 2020, Interventions to enhance access to and utilization of formal community care services for home dwelling persons with dementia and their informal carers. A scoping review, Aging Ment Health source

      Not checked in the free run.

    • cites [101] Arundell, 2020, Advancing mental health equality: a mapping review of interventions, economic evaluations and barriers and facilitators, Syst Rev source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A review focusing on children and adolescents identified 13 studies on universal school-based interventions and 21 studies to engage at-risk individuals.

    “A review focusing on children and adolescents, 103 identified 13 studies on universal school-based interventions and 21 studies to engage at-risk individuals.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [103] Werlen, 2020, Interventions to improve children's access to mental health care: a systematic review and meta-analysis, Epidemiol Psychiatr Sci source

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  • May combine two claims.

    Findingcitation

    Szeto and Dobson reported on training programmes for managers to support staff during episodes of mental ill health and in providing accommodations or adjustments for return to work, but none of the programmes had undergone evaluation at the time of their review.

    “A review by Szeto and Dobson 107 reported on training programmes for managers to support staff during episodes of mental ill health and in the provision of accommodations or adjustments to support people returning to work.However, at the time of their review none of the programmes included had undergone evaluation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [107] Szeto, 2010, Reducing the stigma of mental disorders at work: a review of current workplace anti-stigma intervention programs, Appl Prev Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Primary outcome data were addressed through education via lectures, texts, or internet-based programmes; interactive elements such as group discussions; or social contact with people with lived experience, directly or indirectly via videos or the internet.

    “Data for the primary outcome were addressed through assessments of the following approaches: education via lectures, texts, or internet-based programmes; interactive elements, such as group discussions; or social contact with PWLE, either directly or indirectly, via videos or the internet.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Formal quality assessment of constituent studies was done in four reviews, and two studies included meta-analyses.

    “Formal quality assessment of constituent studies was done in four reviews.[102][103][104][105] Two studies included meta-analyses.102,104”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [102] Choi, 2018, Intervention models for increasing access to behavioral health services among youth: a systematic review, J Dev Behav Pediatr source

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    • cites [103] Werlen, 2020, Interventions to improve children's access to mental health care: a systematic review and meta-analysis, Epidemiol Psychiatr Sci source

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    • cites [104] Greene, 2016, Interventions to increase retention in mental health services: a systematic review, Psychiatr Serv source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Descriptive studies have reviewed mental health parity with health policies in Commonwealth countries and legislative mechanisms for social participation rights of people with depression in the Asia-Pacific region.

    “Descriptive studies have been done that have, for example, reviewed mental health parity with health policies in Commonwealth countries 96 or legislative mechanisms for social participation rights of people with depression in the Asia-Pacific region.97”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [96] Bhugra, 2018, A review of mental health policies from Commonwealth countries, Int J Soc Psychiatry source

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    • cites [97] Ricci, 2004, A review of the legislative mechanisms available to protect the social participation rights of people with depression in the Asia Pacific region, Australas Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Help-seeking intentions improved in two of nine studies (effect size -0.15 to 0.30), and accessing care improved in one of five studies.

    “At the same time, help-seeking intentions improved in two of nine studies (effect size -0•15 to 0•30) as did accessing care in one of five studies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [103] Werlen, 2020, Interventions to improve children's access to mental health care: a systematic review and meta-analysis, Epidemiol Psychiatr Sci source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Three reviews of ten studies synthesised evidence on interventions aimed at increasing access to work by reducing stigma at the structural level, but only one included a meta-analysis.

    “We found three reviews of ten studies synthesising evidence on interventions aimed at increasing access to work by reducing stigma at the structural level, but only one included an evaluation of data by meta-analysis.106”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [106] Gayed, 2018, Effectiveness of training workplace managers to understand and support the mental health needs of employees: a systematic review and meta-analysis, Occup Environ Med source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Three reports focused on any mental health condition, two on children and adolescents, one on people with dementia or suspected dementia, and one on pregnant women using opioids.

    “Three reports focused on any mental health condition, 102,104,105 two on children and adolescents, 102,105 one on people with dementia or suspected dementia, 101 and one on pregnant women using opioids.99,104”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [102] Choi, 2018, Intervention models for increasing access to behavioral health services among youth: a systematic review, J Dev Behav Pediatr source

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    • cites [104] Greene, 2016, Interventions to increase retention in mental health services: a systematic review, Psychiatr Serv source

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    • cites [105] Xu, 2018, Effectiveness of interventions to promote help-seeking for mental health problems: systematic review and meta-analysis, Psychol Med source

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  • May combine two claims. The quote only partly states this claim.

    Findingcitation

    Arundell and colleagues found that strategies including increasing inclusivity, audio-visual displays, culturally relevant tools, co-creating interventions with communities, training staff to communicate with marginalised communities, and using positive language contributed to improved access to care.

    “They found that employing the following strategies contributed to improved access to care: increasing inclusivity in programmes for individuals with various learning disabilities”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [101] Arundell, 2020, Advancing mental health equality: a mapping review of interventions, economic evaluations and barriers and facilitators, Syst Rev source

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  • May combine two claims.

    Findingown data

    The interventions, most targeting children, adolescents, or youth, aimed to reduce negative attitudes, social distance, or peer victimisation or to enhance social inclusion of peers affected by mental health conditions.

    “The interventions, most of which targeted children, adolescents, or youth, were aimed at reducing negative attitudes, social distance, or peer victimisation or enhancing social inclusion of peers affected by mental health conditions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most studies targeted mental health conditions in general or suicide, while a smaller number exclusively covered autism (n=3), developmental or intellectual disabilities (n=4), addiction (n=1), or schizophrenia (n=1).

    “Most studies targeted mental health conditions in general or suicide.A smaller number of studies exclusively covered autism (n=3), developmental or intellectual disabilities (n=4), or specific conditions, such as addiction (n=1) or schizophrenia (n=1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Xu and colleagues identified 97 original studies on interventions to increase help-seeking behaviours, of which three were in middle-income countries and none in low-income countries.

    “The review identified 97 original studies, of which three were in middle-income countries and none in low-income countries.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [105] Xu, 2018, Effectiveness of interventions to promote help-seeking for mental health problems: systematic review and meta-analysis, Psychol Med source

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  • May combine two claims.

    Findingcitation

    Psychoeducational or cognitive-behavioural strategies to enhance motivation to seek help showed positive short-term effects on attitudes, intentions, and behaviours and positive long-term effects on help-seeking behaviour.

    “Some of these studies applied psychoeducational or cognitive-behavioural strategies to enhance motivation to seek help.The results showed positive short-term effects on attitudes, intentions, and behaviours and positive longterm effects on help-seeking behaviour.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [105] Xu, 2018, Effectiveness of interventions to promote help-seeking for mental health problems: systematic review and meta-analysis, Psychol Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Rosvik and colleagues concluded that addressing lack of awareness about services improved uptake of community-based and social welfare services among people with dementia and their caregivers, but there was a gap in knowledge about which interventions had the greatest impact.

    “Rosvik and colleagues 100 concluded that addressing lack of awareness about services improved the uptake of community-based and social welfare services among people with dementia and their caregivers, but that there was a gap in knowledge about which interventions had the greatest impact.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [100] Røsvik, 2020, Interventions to enhance access to and utilization of formal community care services for home dwelling persons with dementia and their informal carers. A scoping review, Aging Ment Health source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    No studies measured structural stigma in the workplace, and all outcomes were measured at the individual level.

    “However, no studies measured structural stigma in the workplace, and all outcomes were measured at the individual level.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Findingown data

    Altogether seven reviews were identified on approaches to addressing stigma-related barriers to accessing mental health care.

    “Altogether seven reviews were identified.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    All interventions in that review focused on how to respond to employees' mental health needs, and some also covered job stress and workplace promotion of mental health.

    “All the interventions in that review focused on how to respond to employees' mental health needs, and some also covered job stress and workplace promotion of mental health.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [106] Gayed, 2018, Effectiveness of training workplace managers to understand and support the mental health needs of employees: a systematic review and meta-analysis, Occup Environ Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Findingcitation

    Choi and Easterlin concluded that discussions between older adolescents and nurses or counsellors can be effective in increasing access to care, but for younger children it was essential also to educate parents.

    “They concluded that, although there is evidence that discussions between older adolescents and nurses or counsellors can be effective in increasing their access to care, for younger children it was essential also to educate the parents.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [102] Choi, 2018, Intervention models for increasing access to behavioral health services among youth: a systematic review, J Dev Behav Pediatr source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The number of studies included in each systematic review varied from 11 to 128.

    “The number of studies included in each systematic review varied from 11 to 128.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most original studies focused on knowledge and attitudes, despite some promising behavioural results.

    “Even though there are some promising results regarding behavioural outcomes, most original studies focused on knowledge and attitudes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Stigma was directly targeted in 25 studies, and 19 of those showed significant improvements.

    “Stigma was directly targeted in 25 studies, of which 19 showed significant improvements.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [116] Waqas, 2020, Interventions to reduce stigma related to mental illnesses in educational institutes: a systematic review, Psychiatric Quarterly source

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  • May combine two claims.

    Findingcitation

    For teachers, Torok and colleagues found no included studies reporting specific effects on attitudes towards suicide, but one study found parental attitudes improved between first and second assessment (d=0.21), though this was not maintained 2 months later.

    “For teachers, Torok and colleagues 126 found that none of the included studies reported specific effects for measures of attitudes towards suicide, but one study found that parental attitudes improved between the first and the second assessment (d=0•21), although the effect was not maintained 2 months later.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [126] Torok, 2019, Preventing adolescent suicide: a systematic review of the effectiveness and change mechanisms of suicide prevention gatekeeping training programs for teachers and parents, J Adolesc source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Eight systematic reviews with stigma as the primary outcome focused on young people with developmental disabilities, and one concluded that higher-quality original studies were more likely to show efficacy.

    “Eight systematic reviews with stigma as the primary outcome focused on young people with developmental disabilities, such as intellectual disabilities or autism spectrum disorders, and one concluded that the original studies with the highest methodological quality were also more likely to show efficacy.118”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [118] Morris, 2021, Classroom-based peer interventions targeting autism ignorance, prejudice and/or discrimination: a systematic PRISMA review, Int J Incl Educ

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    That review identified 57 studies, eight of which were randomised controlled trials.

    “57 studies were identified (quantitative and qualitative), eight of which were randomised controlled trials.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [117] Gaiha, 2021, Effectiveness of arts interventions to reduce mental-health-related stigma among youth: a systematic review and meta-analysis, BMC Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The overall quality of these studies was quite low, with 35 (80%) at high risk of bias.

    “The overall quality of these studies was quite low, with 35 (80%) showing a high risk of bias.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [116] Waqas, 2020, Interventions to reduce stigma related to mental illnesses in educational institutes: a systematic review, Psychiatric Quarterly source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Universal interventions were effective in changing attitudes, but the effect size was small (d=0.05-0.40) and changes were not sustained.

    “The findings indicated that universal interventions were effective in changing attitudes, although the effect size was small (d=0•05-0•40) and changes were not sustained.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [124] Breet, 2021, Systematic review and narrative synthesis of suicide prevention in high-schools and universities: a research agenda for evidence-based practice, BMC Public Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingreasoning

    Positive attitudes towards mental health conditions and confidence in providing support were identified as important outcomes.

    “Positive attitudes towards mental health conditions and confidence in providing support were identified as important outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Most included trials took place in high-income countries; only six were in middle-income countries (China, Russia, Nigeria, Brazil), and none in low-income countries.

    “Most of the included trials had been conducted in HICs, with only six studies having been done in MICs including China (n=2), Russia (n=2), Nigeria (n=1), and Brazil (n=1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [116] Waqas, 2020, Interventions to reduce stigma related to mental illnesses in educational institutes: a systematic review, Psychiatric Quarterly source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Study quality ranged from low to moderate, with some studies reported as methodologically strong.

    “The study quality ranged from low to moderate, with some studies reported as being methodologically strong.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [117] Gaiha, 2021, Effectiveness of arts interventions to reduce mental-health-related stigma among youth: a systematic review and meta-analysis, BMC Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    An electronic bridging mental health service with personalised feedback and online counselling significantly decreased personal stigma scores with a large effect (d=-1.07) and reduced public stigma among high-risk college students with a medium effect (d=-0.59).

    “An electronic bridging mental health service, which included personalised feedback and online counselling, significantly decreased personal stigma scores with a large effect (d=-1•07) and reduced public stigma among high-risk college students with a medium effect (d=-0•59).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    All 25 of those reviews were published since 2012, and ten were published in 2021.

    “All 25 reviews had been published since 2012, and ten were published in 2021.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Two reviews concluded that findings for intended behaviour were variable and that how far actual behaviour can be predicted from self-reported behavioural intentions was unclear.

    “Two reviews concluded that findings for intended behaviour were variable and concluded how far children's actual behaviour can be predicted from selfreported behavioural intentions was unclear.118,123”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [118] Morris, 2021, Classroom-based peer interventions targeting autism ignorance, prejudice and/or discrimination: a systematic PRISMA review, Int J Incl Educ

      Not checked in the free run.

    • cites [123] Cremin, 2020, Autism awareness interventions for children and adolescents: a scoping review, J Dev Phys Disabil source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Mellor reached a similar conclusion and noted the lack of follow-up data in 17 studies, meaning that sustained effects of anti-stigma interventions could not be assessed.

    “Mellor 115 came to a similar conclusion and noted the lack of follow-up data in 17 studies, meaning that sustained effects of anti-stigma interventions could not be assessed.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [115] Mellor, 2014, School-based interventions targeting stigma of mental illness: systematic review, Psychiatr Bull (2014) source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Most studies on interpersonal stigma among children, adolescents, and youth were done in school settings, but one review identified community interventions aimed at enhancing social inclusion, such as PhotoVoice, dog-walking, peer support, and sports competitions.

    “Most of the studies on interpersonal stigma among children, adolescents, and youth were done in school settings, but one review identified several community interventions aimed at enhancing social inclusion, such as PhotoVoice, dog-walking, peer support, and participation in sports competitions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    For interventions focused specifically on stigma, psychoeducation and interpersonal contact significantly reduced stigma, and this was sustained at 1-month follow-up (d=0.46).

    “For interventions that focused specifically on stigma, results showed that psychoeducation and interpersonal contact significantly reduced stigma, which was sustained at 1-month follow-up (d=0”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [124] Breet, 2021, Systematic review and narrative synthesis of suicide prevention in high-schools and universities: a research agenda for evidence-based practice, BMC Public Health source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Psychoeducation was the most frequently used intervention (25 studies), followed by social contact-based interventions (10 studies).

    “Psychoeducation was used most often (25 studies) followed by social contact-based interventions (ten studies).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [116] Waqas, 2020, Interventions to reduce stigma related to mental illnesses in educational institutes: a systematic review, Psychiatric Quarterly source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    That review found 44 studies, and 36 of them (82%) were published from 2009 onward.

    “They identified 44 studies, of which 36 (82%) had been published since 2009.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [116] Waqas, 2020, Interventions to reduce stigma related to mental illnesses in educational institutes: a systematic review, Psychiatric Quarterly source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Only two randomised controlled trials were considered appropriate for inclusion in Schachter and colleagues' review, and neither reported significant effects.

    “Only two randomised controlled trials were considered appropriate for inclusion and neither reported significant effects.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [114] Schachter, 2008, Effects of school-based interventions on mental health stigmatization: a systematic review, Child Adolesc Psychiatry Ment Health source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Schachter and colleagues' systematic review of school-based interventions on mental health stigmatisation identified 43 original studies, but none was of sufficient quality to produce reliable and valid data.

    “A comprehensive systematic review of school-based interventions on mental health stigmatisation was carried out by Schachter and colleagues.114 They identified 43 original studies, but none was of sufficient quality to produce reliable and valid data.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [114] Schachter, 2008, Effects of school-based interventions on mental health stigmatization: a systematic review, Child Adolesc Psychiatry Ment Health source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Arts interventions were generally effective when multiple art forms were used, although the effects were small.

    “Overall, the results indicated positive effects and a meta-analysis showed that arts interventions are generally effective when using multiple art forms, although the effects were small.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [117] Gaiha, 2021, Effectiveness of arts interventions to reduce mental-health-related stigma among youth: a systematic review and meta-analysis, BMC Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Three of those five studies involved university students and specifically measured attitudes, beliefs, norms, and stigma regarding mental health.

    “Three of these five involved university students and specifically measured attitudes, beliefs, norms, and stigma regarding mental health.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [129] Reis, 2022, The impact of mental health literacy training programs on the mental health literacy of university students: a systematic review, Prev Sci source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Among adolescents, three of four studies measuring stigmatising attitudes found a significant reduction after Mental Health First Aid training, but results were inconsistent at the item level.

    “Among adolescents, three of four studies that measured stigmatising attitudes found a significant reduction after training, but results were inconsistent at the item level.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [128] Ng, 2021, A systematic review of youth and teen mental health first aid: improving adolescent mental health, J Adolesc Health source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In Hartog and colleagues' review of interventions for HIV, mental health conditions, and leprosy in low- and middle-income countries, community education was the most frequently applied stigma reduction strategy, followed by individual empowerment of people with lived experience and social contact within the community.

    “The stigma reduction strategy most often applied was community education, followed by individual empowerment of PWLE and social contact within the community.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [133] Hartog, 2020, Stigma reduction interventions for children and adolescents in low- and middle-income countries: systematic review of intervention strategies, Soc Sci Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A meta-analysis of uncontrolled before-and-after evaluation studies in the Opening Minds programme in Canada found that interventions including social contact through personal testimony were effective and that multiple social contact components improved outcomes for health workers compared with one component.

    “A metaanalysis of uncontrolled before-and-after evaluation studies in the Opening Minds programme in Canada found that interventions including social contact in the form of personal testimony were effective and that including multiple social contact components improved outcomes for health workers compared with interventions that had only one component of social contact”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [152] Knaak, 2014, Key ingredients of anti-stigma programs for health care providers: a data synthesis of evaluative studies, Can J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A gatekeeper training intervention for family and friends of people at risk of suicide led to positive effects on knowledge, self-efficacy, and gatekeeper-related skills, but results for stigma and attitudes were inconsistent.

    “A gatekeeper training intervention for family and friends of people at risk of suicide led to positive effects on knowledge, self-efficacy, and gatekeeper-related skills, but the results for stigma and attitudes were inconsistent.134”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [134] Morton, 2021, Gatekeeper training for friends and family of individuals at risk of suicide: a systematic review, J Community Psychol source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Two reviews of e-interventions for professionals reported improved knowledge and attitudes, more humane treatment of service users, and reductions in the use of coercive methods.

    “Two reviews focused on e-interventions for professionals, and both reported improved knowledge and attitudes, more humane treatment of service users, and reductions in the use of coercive methods.155,156”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [155] Muirhead, 2021, Establishing the effectiveness of technology-enabled dementia education for health and social care practitioners: a systematic review, Syst Rev source

      Not checked in the free run.

    • cites [156] Zubala, 2019, Large-scale online education programmes and their potential to effect change in behaviour and practice of health and social care professionals: a rapid systematic review, Interact Learn Environ source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Of those reviews, 29 addressed mental health conditions generally, ten dementia, seven substance use disorders, five personality disorders, three borderline personality disorder, four suicidality and self-harm, one intellectual disabilities, one neurodevelopmental disorder, one psychosis, and one eating disorders.

    “29 addressed mental health conditions generally, ten exclusively involved people with dementia, seven assessed substance use disorders, five personality disorders, three borderline personality disorder, four suicidality and self-harm, one intellectual disabilities, one neurodevelopmental disorder, one psychosis, and one eating disorders”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Barber, 2019, Microaggressions towards people affected by mental health problems: a scoping review, Epidemiol Psychiatr Sci source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A meta-analysis showed a small to medium effect size for learners' attitudes and a large effect size for clinical skills immediately after simulation interventions, sustained 3 months later.

    “A meta-analysis showed a small to medium effect size for learners' attitudes and a large effect size for clinical skills at immediate follow-up after simulation interventions that was sustained 3 months later.147”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [147] Piot, 2020, Simulation in psychiatry for medical doctors: a systematic review and meta-analysis, Med Educ source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Two other reviews concluded that psychoeducation potentially enables caregivers to cope better with family members' mental health conditions and to reduce stigma.

    “Two other reviews concluded that psychoeducation potentially enables caregivers to cope better with family members' mental health conditions and to reduce stigma.138,139”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [138] Monnapula-Mazabane, 2021, Mental health stigma experiences among caregivers and service users in South Africa: a qualitative investigation, Curr Psychol

      Not checked in the free run.

    • cites [139] Soo, 2018, Randomized controlled trials of psychoeducation modalities in the management of bipolar disorder: a systematic review, J Clin Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Five meta-analyses reported small to medium effect sizes for improved attitudes and medium to large effect sizes for knowledge and clinical skills.

    “Five meta-analyses reported small to medium effect sizes in improved attitudes and medium to large effect sizes in knowledge and clinical skills.[144][145][146][147][148]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [144][145][146][147][148]

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Stigma-related outcomes included changes in knowledge, attitudes, clinical skills, clinical confidence, and self-efficacy.

    “The stigma-related outcomes reported included changes in knowledge, attitudes, and clinical skills as well as clinical confidence and self-efficacy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    All three studies reported some positive impacts of mental health literacy training on these constructs, but the evidence was weak.

    “All three studies reported some positive impacts of mental health literacy training on these constructs, but the evidence was weak.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [129] Reis, 2022, The impact of mental health literacy training programs on the mental health literacy of university students: a systematic review, Prev Sci source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    For youth, six studies measured stigmatising attitudes, four reported significant effects, again with inconsistent results at the item level.

    “For youth, six studies measured stigmatising attitudes, four of which reported significant effects, again with inconsistent results at the item level.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [128] Ng, 2021, A systematic review of youth and teen mental health first aid: improving adolescent mental health, J Adolesc Health source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Riebschleger and colleagues showed that psychoeducation led to decreased mental health stigma and improved family communication about parental mental health conditions.

    “Riebschleger and colleagues 136 showed that psychoeducation led to decreased mental health stigma and improved family communication about parental mental health conditions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [136] Riebschleger, 2017, Mental health literacy content for children of parents with a mental illness: thematic analysis of a literature review, Brain Sci source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Borschmann and colleagues evaluated national anti-stigma campaigns in 21 European countries but found little evidence of a significant reduction in general stigma and showed variations across sub-populations.

    “Borschmann and colleagues 169 evaluated national antistigma campaigns in 21 European countries but found little evidence of a significant reduction in general stigma and showed variations across different sub-populations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [169] Borschmann, 2014, Campaigns to reduce mental illness stigma in Europe: a scoping review, Die Psychiatrie Grundlagen & Perspektiven source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Dumesnil and Verger's review of 43 studies showed that public awareness and information programmes about suicide or depression improved knowledge and, with only two exceptions, attitudes.

    “Their review, which included 43 studies, showed that public awareness and information programmes about suicide or depression improved knowledge and, with only two exceptions, attitudes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [170] Dumesnil, 2009, Public awareness campaigns about depression and suicide: a review, Psychiatr Serv source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    One study found evidence on reduced discrimination, but this was not replicated in two similar larger studies.

    “One found evidence on reduced discrimination, but this finding was not replicated in two similar larger studies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [171] Clement, 2013, Mass media interventions for reducing mental health-related stigma, Cochrane Database Syst Rev

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Findingcitation

    Mascayano and colleagues found that only 20% of studies had addressed cultural adaptation and concluded that more careful cultural adaptation of anti-stigma interventions is required in future.

    “They found that only 20% of studies had addressed cultural adaptation and concluded that a more careful cultural adaptation of anti-stigma interventions is required in future.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [178] Mascayano, 2020, Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries, Transcult Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Cost-effectiveness is a research gap, and more meta-analyses are needed.

    “Costeffectiveness is a research gap 150,164,167 and more metaanalyses are needed.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [150] Brunero, 2012, Mental health education programmes for generalist health professionals: an integrative review, Int J Ment Health Nurs source

      Not checked in the free run.

    • cites [164] Keynejad, 2021, WHO mental health gap action programme (mhGAP) intervention guide: updated systematic review on evidence and impact, Evid Based Ment Health source

      Not checked in the free run.

    • cites [167] Gkioka, 2020, Evaluation and effectiveness of dementia staff training programs in general hospital settings: a narrative synthesis with Holton's three-level model applied, J Alzheimers Dis source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Xu and colleagues could find no strong evidence that using biological attributions for the cause of mental health conditions improved mental health literacy or reduced prejudice.

    “They could find no strong evidence that using biological attributions for the cause of mental health conditions improved mental health literacy or reduced prejudice.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [177] Xu, 2017, Challenging mental health related stigma in China: systematic review and meta-analysis. Interventions among the general public, Psychiatry Res source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    For social contact, effect sizes were d=0.4 for attitudes, d=-0.06 (nonsignificant) for affect, and d=0.19 for behavioural intentions.

    “For social contact, the respective effect sizes were d=0•4, d=-0•06 (nonsignificant), and d=0•19, respectively.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [168] Corrigan, 2012, Challenging the public stigma of mental illness: a meta-analysis of outcome studies, Psychiatr Serv source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Use of mainstream recreational facilities showed that activities fostering social connections increased self-esteem and self-confidence in people with lived experience and gave them a sense of accomplishment.

    “The use of mainstream recreational facilities showed that activities that foster social connections (eg, physical or creative activities, such as theatre, choir, or arts) increased self-esteem and self-confidence in people with PWLE and gave them a sense of accomplishment.176”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [176] Fenton, 2017, The benefits of recreation for the recovery and social inclusion of individuals with mental illness: an integrative review, Leis Sci source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Xu and colleagues showed a small and significant effect on reduction of negative stereotypes and found that interventions including social contact were more effective than those that did not.

    “They showed a small and significant effect on the reduction of negative stereotypes and found that interventions which included social contact were more effective than those that did not.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [177] Xu, 2017, Challenging mental health related stigma in China: systematic review and meta-analysis. Interventions among the general public, Psychiatry Res source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Most studies focused on immediate outcomes, and only a few were considered to have low risk of bias.

    “Most studies focused on immediate outcomes, such as measures of attitudes assessed directly after the intervention, although only a few were considered to have low risk of bias.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [171] Clement, 2013, Mass media interventions for reducing mental health-related stigma, Cochrane Database Syst Rev

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The clearest pattern of evidence emerged for first-person narratives of people with lived experience, which were related to reduced prejudice.

    “The clearest pattern of evidence emerged for first-person narratives of PWLE, which were related to reduced prejudice.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [171] Clement, 2013, Mass media interventions for reducing mental health-related stigma, Cochrane Database Syst Rev

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Improvements were modest and most often only measured in the short term.

    “Improvements were modest and most often only measured in the short term.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [170] Dumesnil, 2009, Public awareness campaigns about depression and suicide: a review, Psychiatr Serv source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Contact and education both improved attitudes and behavioural intentions towards stigma, but contact resulted in significantly greater positive changes among adults.

    “Contact and education both improved attitudes and behavioural intentions towards stigma, but contact resulted in significantly greater positive changes among adults.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [168] Corrigan, 2012, Challenging the public stigma of mental illness: a meta-analysis of outcome studies, Psychiatr Serv source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Rivera and colleagues noted the feasibility of large-scale projects based on partnership between non-profit organisations, churches, community mental health centres, and other organisations.

    “The authors noted the feasibility of largescale projects based on partnership between non-profit organisations, churches, community mental health centres, and other organisations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [172] Rivera, 2021, A narrative review of mental illness stigma reduction interventions among african americans in the United States, J Ment Health Clin Psychol source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A different review of undergraduate nursing students reported that empathy for people who misuse alcohol and drugs improved after exposure to narratives of students' personal experiences and people with lived experience and reflective sessions, but did not improve with simulations.

    “A different review that assessed undergraduate nursing students reported that empathy for people who misuse alcohol and drugs improved after exposure to narratives of students' personal experiences and PWLE and reflective sessions, but did not improve with simulations.158”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [158] Smyth, 2021, Undergraduate nursing student knowledge and attitudes of healthcare consumers with problematic alcohol and other drug use: a scoping review, Int J Ment Health Nurs source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Findingcitation

    Rivera and colleagues highlighted the importance of collaboration between mental health providers and faith-based institutions, as there is much mistrust of the medical sector.

    “They highlighted the importance of collaboration between mental health providers and faith-based institutions, as there is much mistrust of the medical sector.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [172] Rivera, 2021, A narrative review of mental illness stigma reduction interventions among african americans in the United States, J Ment Health Clin Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    The importance of intergenerational social contact was echoed in a scoping review by Gerritzen and colleagues.

    “The importance of intergenerational social contact was echoed in a scoping review by Gerritzen and colleagues. 175”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [175] Gerritzen, 2020, Successful elements of intergenerational dementia programs: a scoping review, J Intergenerational Relationships source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Few such studies were conducted in low- and middle-income countries, but among those that were, China was the most frequently represented.

    “Few such studies were conducted in LMICs, but among those that were, China was the most frequently represented.145,147,[160][161][162][163][164][165]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [145] Lien, 2021, Challenging mental illness stigma in healthcare professionals and students: a systematic review and network meta-analysis, Psychol Health source

      Not checked in the free run.

    • cites [147] Piot, 2020, Simulation in psychiatry for medical doctors: a systematic review and meta-analysis, Med Educ source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    For education, meta-analysis effect sizes were d=0.3 for attitudes, d=0.14 for affect, and d=0.25 for behavioural intentions.

    “For education, the meta-analysis effect sizes were d=0•3 for attitudes, d=0•14 for affect, and d=0•25 for behavioural intentions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [168] Corrigan, 2012, Challenging the public stigma of mental illness: a meta-analysis of outcome studies, Psychiatr Serv source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Social contact was also associated with more social interaction, reduced fear, and reduced experience of discrimination.

    “Social contact was also associated with more social interaction, reduced fear, 98 and reduced experience of discrimination.206”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [98] Zhang, 2019, Overview of stigma against psychiatric illnesses and advancements of anti-stigma activities in six Asian societies, Int J Environ Res Public Health source

      Not checked in the free run.

    • cites [206] Schreiber, 2015, Stigma, American military personnel and mental health care: challenges from Iraq and Afghanistan, J Ment Health source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Most reviews found awareness-raising activities efficacious across multiple formats, but one review reported no difference between the intervention group and the comparison.

    “Most of these reviews found the activities efficacious across multiple formats, [182][183][184][185][186][187][188] but one review reported no difference between the intervention group and the comparison.189”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [182][183][184][185][186][187][188]

      Not checked in the free run.

    • cites [189] Han, 2020, Interventions for attitudes and empathy toward people with dementia and positive aspects of caregiving: a systematic review and meta-analysis, Res Aging source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Although simulated hallucinations increased empathy for people with schizophrenia, evidence for their effectiveness in causing attitude change is inconsistent, with some studies indicating they may worsen rather than improve attitudes and desire for social distance.

    “Although simulated hallucinations increased empathy for people with schizophrenia, the evidence for their effectiveness in causing attitude change is inconsistent, with some studies indicating that they may worsen rather than improve attitudes and desire for social distance.198”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [198] Morgan, 2018, Interventions to reduce stigma towards people with severe mental illness: systematic review and meta-analysis, J Psychiatr Res source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Active interaction with people with lived experience who described their experiences was more effective than passive interaction in reducing stigma and led to greater reductions among health-care professionals than among non-professionals.

    “Active interaction with PWLE who described their experiences was more effective than passive interaction in reducing stigma and led to greater reductions among health-care professionals than among non-professionals.201”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [201] Ren, 2020, Meta-analysis of the effect of mental health literacy intervention in Chinese people, Acta Psychol Sin source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Social contact through theatre or film improved knowledge and attitudes towards people with mental health conditions, addressed misconceptions, and led to some sustainable behavioural changes.

    “Social contact through theatre or film improved knowledge and attitudes towards people with mental health conditions, addressed misconceptions, 178,[194][195][196][197] and led to some sustainable behavioural changes.194,195”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [178] Mascayano, 2020, Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries, Transcult Psychiatry source

      Not checked in the free run.

    • cites [194][195][196][197]

      Not checked in the free run.

    • cites [194] Dalky, 2012, Mental illness stigma reduction interventions: review of intervention trials, West J Nurs Res source

      Not checked in the free run.

    • cites [195] Doley, 2017, Interventions to reduce the stigma of eating disorders: a systematic review and meta-analysis, Int J Eat Disord source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    At the population level, reasonably consistent benefits were seen with social contact interventions for attitude change, and weaker evidence suggested knowledge improvement, although most studies only assessed short-term outcomes.

    “At the population level, reasonably consistent benefits were seen with social contact interventions in relation to attitude change and weaker evidence suggested knowledge improvement, although most studies only assessed short-term outcomes, including in specific target groups.210”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [210] Thornicroft, 2016, Evidence for effective interventions to reduce mental-health-related stigma and discrimination, Lancet source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Video-based contact combined with education was effective in reducing stigma among students and health professionals, and led to a more balanced portrayal of people with mental health problems by media professionals.

    “Video-based contact combined with education was effective in reducing stigma among students in general and among health professionals, 198,199,[209][210][211] and led to a more balanced portrayal of people with mental health problems by media professionals.212”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [198] Morgan, 2018, Interventions to reduce stigma towards people with severe mental illness: systematic review and meta-analysis, J Psychiatr Res source

      Not checked in the free run.

    • cites [199] Morgan, 2021, Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works?, Int J Ment Health Syst source

      Not checked in the free run.

    • cites [209][210][211]

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Gatekeeper training improved knowledge about suicide and suicide prevention and reduced belief in myths immediately after training in various groups, but these effects were not sustained.

    “Gatekeeper training improved knowledge about suicide and suicide prevention and reduced belief in myths about suicide immediately after the training intervention in a range of groups, such as students, teachers, social workers, pharmacists, managers, and carers, but these effects were not sustained.193”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [193] Holmes, 2021, The long-term efficacy of suicide prevention gatekeeper training: a systematic review, Arch Suicide Res source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    One review found that internet-based interventions led to improved literacy and reduced stigma in adults, but stigma among high school students was not affected.

    “However, one review found that although internet-based interventions led to improved literacy and to reduced stigma in adults, stigma among high school students was not affected.191”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [191] Griffiths, 2007, Internet-based mental health programs: a powerful tool in the rural medical kit, Aust J Rural Health source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    One review reported that promoting continuum beliefs about mental health gave mixed results for stigma and even found increased stigma in some studies.

    “One review reported that promoting continuum beliefs about mental health-that is, a continuum between mental health and mental health conditions (rather than a dichotomous approach)-gave mixed results for stigma and even found increased stigma in some studies.216”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [216] Peter, 2021, Continuum beliefs and mental illness stigma: a systematic review and meta-analysis of correlation and intervention studies, Psychol Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Findings were mixed for specific stigma outcomes, with some studies showing reduced stigma toward mental health treatments, beliefs about dangerousness, and social distance, whereas others reported no reduction in stigma towards people who take antidepressants.

    “Findings were mixed for specific stigma outcomes, with some studies showing reduced stigma toward mental health treatments, beliefs about dangerousness, and social distance, whereas others reported no reduction in stigma towards people who take antidepressants.215”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [215] Pérez-Flores, 2021, Effectiveness of mental health literacy and stigma interventions for Latino/a adults in the United States: a systematic review, Stigma Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    There is considerable debate on how far educational interventions lead to behaviour change.

    “There is considerable debate on how far educational interventions lead to behaviour change.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Thirteen reviews assessed interventions related to advocacy, campaigns, and protest, including from seven to 123 original studies.

    “13 reviews assessed interventions related to advocacy, campaigns, and protest, including from seven to 123 original studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Winsper and colleagues suggested that a wide range of recovery-oriented interventions could reduce self-stigma, but found that recovery is rarely measured.

    “The potential for a wide range of recoveryoriented interventions to reduce self-stigma was also made by Winsper and colleagues, 226 but they found that recovery is rarely measured.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [226] Winsper, 2020, How do recovery-oriented interventions contribute to personal mental health recovery? A systematic review and logic model, Clin Psychol Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    A review on self-stigma in people diagnosed with schizophrenia reported that the most methodologically robust study it included showed the largest effect for internalised stigma reduction.

    “A review on selfstigma in relation to people with a diagnosis of schizophrenia, 221 reported that the most methodologically robust study they included showed the largest effect for internalised stigma reduction.225”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [221] Wood, 2016, Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: a systematic narrative synthesis and meta-analysis, Schizophr Res source

      Not checked in the free run.

    • cites [225] Morrison, 2016, Cognitive therapy for internalised stigma in people experiencing psychosis: a pilot randomised controlled trial, Psychiatry Res source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The four reviews assessed between five and 123 studies each; the studies came from high-income and low-income or middle-income countries and concerned severe mental health conditions, suicide, or mental health conditions generally.

    “The number of studies assessed in each review ranged from five to 123, and these studies were conducted in HICs and LMICs, and conditions of interest were severe mental health conditions, 179 suicide, 217 or mental health conditions in general.98,140”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [179] Nguyen, 2019, Informal mental health interventions for people with severe mental illness in low and lower middle-income countries: a systematic review of effectiveness, Int J Soc Psychiatry source

      Not checked in the free run.

    • cites [217] Takada, 2010, Characteristics and effects of suicide prevention programs: comparison between workplace and other settings, Ind Health source

      Not checked in the free run.

    • cites [98] Zhang, 2019, Overview of stigma against psychiatric illnesses and advancements of anti-stigma activities in six Asian societies, Int J Environ Res Public Health source

      Not checked in the free run.

    • cites [140] Adu, 2021, Policies and interventions to reduce familial mental illness stigma: a scoping review of empirical literature, Issues Mental Health Nurs source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In meta-analyses, short-term follow-up showed sustained moderate improvements in self-stigma, but two reviews found that improvements became non-significant over time.

    “In meta-analyses short-term follow-up showed sustained moderate improvements, 218 but two reviews found that the improvements became non-significant over time.221,224”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [218] Rüsch, 2021, Honest, Open, Proud to support disclosure decisions and to decrease stigma's impact among people with mental illness: conceptual review and meta-analysis of program efficacy, Soc Psychiatry Psychiatr Epidemiol source

      Not checked in the free run.

    • cites [221] Wood, 2016, Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: a systematic narrative synthesis and meta-analysis, Schizophr Res source

      Not checked in the free run.

    • cites [224] Büchter, 2017, Interventions for reducing self-stigma in people with mental illnesses: a systematic review of randomized controlled trials, Ger Med Sci

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Ten of the self-stigma reviews assessed interventions specifically designed to address self-stigma, while 16 considered interventions with other primary outcomes but included self-stigma or closely related measures.

    “Ten assessed interventions specifically designed to address self-stigma and 16 considered interventions targeting other primary outcomes but included self-stigma or other closely related measures.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Twenty-six reviews on interventions for self-stigma were included, and all were published between 2012 and 2021.

    “26 reviews were included on interventions for self-stigma and, notably, all were published between 2012 and 2021 (appendix 3 pp 107-108).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Both reviews of self-stigma interventions in low-income and middle-income countries found positive effects of psychoeducation on reduced self-stigma and self-prejudice and improved coping with stigma.

    “Both reviews found positive effects of psychoeducation on reduced self-stigma and selfprejudice, and improved coping with stigma.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [236] Xu, 2017, Challenging mental health related stigma in China: systematic review and meta-analysis. I. Interventions among people with mental illness, Psychiatry Res source

      Not checked in the free run.

    • cites [227] Demissie, 2018, Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review, BJPsych Open source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Aguirre Velasco and colleagues summarised largely school-based interventions for adolescents and found some improvements in help-seeking intentions, stigma related to help-seeking, or both, although study quality was low.

    “Aguirre Velasco and colleagues 230 summarised largely school-based interventions for adolescents, and found some improvements in help-seeking intentions, stigma related to help-seeking, or both, although study quality was low.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [230] Aguirre Velasco, 2020, What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review, BMC Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Reviews questioned whether outcome measures used in self-stigma studies were sufficiently responsive to change and addressed traditional characteristics such as validity and reliability.

    “These reviews questioned whether the outcome measures used in studies were sufficiently responsive to change 224 and addressed traditional characteristics such as validity and reliability.221”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [224] Büchter, 2017, Interventions for reducing self-stigma in people with mental illnesses: a systematic review of randomized controlled trials, Ger Med Sci

      Not checked in the free run.

    • cites [221] Wood, 2016, Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: a systematic narrative synthesis and meta-analysis, Schizophr Res source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Ashton and colleagues found that protest interventions reduced stigma in the short term, but the long-term effects were unclear.

    “Another review by Ashton and colleagues 214 found that protest interventions reduced stigma in the short term, but the long-term effects were unclear.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [214] Ashton, 2018, Key ingredients-target groups, methods and messages, and evaluation-of local-level, public interventions to counter stigma and discrimination: a lived experience informed selective narrative literature review, Community Ment Health J source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Protest interventions might reduce stigma in the short term, but the long-term impact is unclear.

    “Protest interventions might reduce stigma in the short term but the long-term impact is unclear.214”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [214] Ashton, 2018, Key ingredients-target groups, methods and messages, and evaluation-of local-level, public interventions to counter stigma and discrimination: a lived experience informed selective narrative literature review, Community Ment Health J source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In collaborative community-based care via social networking, disclosure about family members' mental health conditions increased and was associated with better knowledge of schizophrenia and greater social inclusion.

    “Disclosure about family members' mental health conditions increased, which was associated with improvements in knowledge of schizophrenia and social inclusion.179”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [179] Nguyen, 2019, Informal mental health interventions for people with severe mental illness in low and lower middle-income countries: a systematic review of effectiveness, Int J Soc Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    Importance was placed on the need for people with lived experience to be involved at every stage of anti-stigma programmes and not just to provide testimonies.

    “placed on the need for PWLE to be involved at every stage of anti-stigma programmes and not just to provide testimonies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Most research on media messaging and stigma has examined traditional media, while evidence about newer media platforms is increasing.

    “Most research has focused on the traditional media, but evidence is growing on the influences of newer media platforms.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Training, feedback, peer support, and remuneration were all emphasised as important.

    “The importance of training, feedback, peer support, and remuneration were all emphasised.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The RESHAPE programme in Nepal, TTC-Global, and other programmes had training packages prepared by people with lived experience for advocacy and social contact interventions and incorporated measures to facilitate peer-to-peer support.

    “The RESHAPE programme in Nepal, TTC-Global, and other programmes had training packages prepared by PWLE for advocacy and social contact interventions and incorporated specific measures to facilitate peer-to-peer support.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Some of the most powerful ways media perpetuate stigma worldwide are using stigmatising language and simplistically or inaccurately linking mental health conditions with violence.

    “Some of the most powerful ways that the media perpetuate stigma worldwide are by using stigmatising language and by simplistically or inaccurately linking mental health conditions with violence.266,267”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [266] Niederkrotenthaler, 2014, Increasing help-seeking and referrals for individuals at risk for suicide by decreasing stigma: the role of mass media, Am J Prev Med source

      Not checked in the free run.

    • cites [267] Brandt Sørensen, 2021, A qualitative analysis of self-harm and suicide in Sri Lankan printed newspapers, Crisis source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    The quantity of mental-health-related content on social media increased markedly in the past decade, producing a mixed picture.

    “The quantity of mental-health-related content on social media has increased markedly in the past decade, leading to a mixed picture.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Terms such as psychosis are often used negatively or as an insult on social media, but factually correct medical information about mental health conditions and sources of help is also present and can increase public knowledge.

    “For example, terms such as psychosis are often used negatively or as an insult but medical information about the mental health conditions, including sources of help, that is often factually correct is also present and can help to increase public knowledge.277”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [277] Alvarez-Mon, 2019, Areas of interest and stigmatic attitudes of the general public in five relevant medical conditions: thematic and quantitative analysis using Twitter, J Med Internet Res source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Negative news reports focused on danger or irresponsible reporting on suicide led to more stigmatising attitudes and reduced willingness to disclose mental health difficulties.

    “Negative reports that focused on danger or which irresponsibly reported on suicide led to more stigmatising attitudes 273,274 and a reduction in willingness to disclose one's own mental health difficulties.199,275”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [273] Corrigan, 2013, The effects of news stories on the stigma of mental illness, J Nerv Ment Dis source

      Not checked in the free run.

    • cites [274] Reavley, 2016, Beliefs about dangerousness of people with mental health problems: the role of media reports and personal exposure to threat or harm, Soc Psychiatry Psychiatr Epidemiol source

      Not checked in the free run.

    • cites [199] Morgan, 2021, Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works?, Int J Ment Health Syst source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    The case studies and lived experience survey emphasised the importance of including members of target groups in programme design and delivery to maximise precise selection of stakeholders.

    “To ensure relevance and relatability, the case studies and PWLE experience survey emphasised the importance of including members of the target groups in the programme design and delivery to maximise precise selection of stakeholders.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The selected case studies are representative of different types of anti-stigma interventions across a wide variety of geographical and cultural locations and with diverse target groups.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The emotional labour of social contact was thought to increase staff turnover in one assessed programme.

    “Nonetheless, the emotional labour of social contact was thought to increase turnover of staff in one of the programmes assessed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Other programmes have included scales more specific to target groups, such as the Mental Illness: Clinicians' Attitudes Scale.

    “Others have included scales more specific to the target groups, such as the Mental Illness: Clinicians' Attitudes Scale.252,253”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [252] Gabbidon, 2013, Mental Illness: Clinicians' Attitudes (MICA) scale-psychometric properties of a version for healthcare students and professionals, Psychiatry Res source

      Not checked in the free run.

    • cites [253] Li, 2014, Levels of stigma among community mental health staff in Guangzhou, China, BMC Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Survey respondents indicated that involvement in anti-stigma programmes could reduce self-stigma and contribute to an individual's recovery journey.

    “Respondents to our survey indicated that involvement in anti-stigma programmes could not only reduce self-stigma but also be an important contribution to an individual's recovery journey.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Most studies of fictional media portrayals measured attitudes, but mental-health-related knowledge was not well assessed and very few measured behaviour changes.

    “Most of these studies measured attitudes but mentalhealth-related knowledge was not well assessed and very few measured changes in behaviour.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In relation to suicide, the media play a major role in influencing stigmatising knowledge and attitudes, and can perpetuate or reduce stigma through irresponsible portrayals or helpful information and campaigns.

    “In relation to suicide, the media play a major role in influencing stigmatising knowledge (ignorance) and attitudes (prejudice), and can perpetuate stigma through irresponsible portrayals of individuals who have self-harmed or died by suicide or reduce stigma through by disseminating helpful information or mobilising campaigns to improve public opinion and attitudes.303,304”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [303] Oquendo, 2020, Barriers for the research, prevention, and treatment of suicidal behavior, Curr Top Behav Neurosci source

      Not checked in the free run.

    • cites [304] Côté, 2021, Suicide-related Twitter content in response to a national mental health awareness campaign and the association between the campaign and suicide rates in Ontario, Can J Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The media can be used as channels for interventions to reduce stigma among the general public, and media messaging is most effective when using social-contact methods.

    “he media can also be used as channels for interventions to reduce stigma among the general public, and media messaging is most effective when using social-contact methods.[290][291][292][293][294]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [290] Yuen, 2021, The effects of immersive virtual reality in reducing public stigma of mental illness in the university population of Hong Kong: randomized controlled trial, J Med Internet Res source

      Not checked in the free run.

    • cites [291] Brown, 2020, The effectiveness of two potential mass media interventions on stigma: video-recorded social contact and audio/visual simulations, Community Ment Health J source

      Not checked in the free run.

    • cites [292] Yamaguchi, 2019, Long-term effects of filmed social contact or internet-based self-study on mental health-related stigma: a 2-year follow-up of a randomised controlled trial, Soc Psychiatry Psychiatr Epidemiol source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Social contact interventions using video content with service users, virtual reality simulation, or social media profiles helped engage and inform the public and reduce stigma.

    “Social contact interventions were applied in several studies using video content with service users, 291,292 virtual reality simulation, or social media profiles, 294 and helped to engage and inform the public and to reduce stigma.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [291] Brown, 2020, The effectiveness of two potential mass media interventions on stigma: video-recorded social contact and audio/visual simulations, Community Ment Health J source

      Not checked in the free run.

    • cites [292] Yamaguchi, 2019, Long-term effects of filmed social contact or internet-based self-study on mental health-related stigma: a 2-year follow-up of a randomised controlled trial, Soc Psychiatry Psychiatr Epidemiol source

      Not checked in the free run.

    • cites [294] Neubaum, 2020, Digital destigmatization: how exposure to networking profiles can reduce social stereotypes, Comput Human Behav source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A multimedia self-stigma reduction campaign was associated with positive recovery beliefs and greater use of mental health care.

    “A multimedia selfstigma reduction campaign showed that campaign exposure was associated with positive recovery beliefs, and greater use of mental health care.282”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [282] Collins, 2019, Social marketing of mental health treatment: California's mental illness stigma reduction campaign, Am J Public Health source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    Poorly considered media reports that portray suicide as normalised or sensationalised can result in a contagion effect and have been associated with the Werther effect, in which suicide attempts may mimic other attempts such as following high-profile celebrity suicides or popular fictional portrayals.

    “Poorly considered media reports that portray suicide in this way can result in a contagion effect and have been associated with the Werther effect, in which suicide attempts may mimic other such attempts, such as following high-profile celebrity suicides or popular fictional portrayals of suicide.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The Netflix series Thirteen Reasons Why powerfully reduced stigma, especially among those with no personal experience relating to suicide, but also led to contagion of suicidality when media guidelines on suicide reporting and portrayal were not followed.

    “The series received both praise and critique, as it powerfully reduced stigma, especially among those with no personal experience relating to suicide but also led to contagion of suicidality when media guidelines on suicide reporting and portrayal were not followed.[307][308][309][310]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [307] Rosa, 2019, Thirteen Reasons Why: the impact of suicide portrayal on adolescents' mental health, J Psychiatr Res source

      Not checked in the free run.

    • cites [308] Mueller, 2019, Why Thirteen Reasons Why may elicit suicidal ideation in some viewers, but help others, Soc Sci Med source

      Not checked in the free run.

    • cites [309] D'Agati, 2021, Thirteen Reasons Why revisited: a monograph for teens, parents, and mental health professionals, J Med Humanit source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    South Korea enacted a suicide prevention law in 2012 and revised media guidelines; a study found these regulatory measures were associated with a substantial reduction in deaths by suicide.

    “To prevent such copycat suicides, the South Korean Government enacted a suicide prevention law in 2012 and revised their media guidelines for suicide reporting.A study found that these regulatory measures were associated with a substantial reduction in deaths by suicide.306”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [306] Chesin, 2020, Knowledge of suicide risk factors, but not suicide ideation severity, is greater among college students who viewed 13 Reasons Why, J Am Coll Health source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Stereotypical negative portrayals of people with mental health conditions increased stigma, whereas positive portrayals improved knowledge and attitudes.

    “Stereotypical (negative) portrayals of people with mental health conditions increased stigma, 297,298 whereas positive portrayals improved knowledge and attitudes.299,300”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [297] Quintero Johnson, 2018, “He acted like a crazy person”: exploring the influence of college students' recall of stereotypic media representations of mental illness, Psychol Pop Media Cult source

      Not checked in the free run.

    • cites [298] Scarf, 2020, Association of viewing the films Joker or Terminator: Dark Fate with prejudice toward individuals with mental illness, JAMA Netw Open source

      Not checked in the free run.

    • cites [299] Stern, 2019, Brief report: does watching the good doctor affect knowledge of and attitudes toward autism?, J Autism Dev Disord source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    71% agreed or strongly agreed that the media is a major factor in making stigma and discrimination worse.

    “The media is a major factor in making stigma and discrimination worse 7 (2%) 41 (11%) 66 (17%) 136 (35%) 140 (36%) 2•93 (1•05) 71%”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    254 (65%) respondents came from upper-middle-income countries and territories.

    “254 (65%) respondents come from upper-middle -income countries and territories.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    46% agreed or strongly agreed that overall stigma and discrimination in their country have been reducing over the last decade.

    “Overall stigma and discrimination in my country have been reducing over the last decade 29 (8%) 66 (17%) 114 (29%) 134 (34%) 46 (12%) 2•26 (1•10) 46%”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    47% agreed or strongly agreed that PWLE must lead anti-stigma efforts.

    “PWLE must lead anti-stigma efforts 18 (5%) 76 (20%) 112 (29%) 128 (33%) 56 (14%) 2•33 (1•09) 47%”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    391 participants responded to the survey from 45 countries and territories.

    “391 participants responded to the survey from 45 countries and territories:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Invitations were extended only to PWLE, yet 69 (18%) did not disclose that they had a mental health condition experience, although respondents could reply that they were mental health activists without such experience.

    “The invitations to participate were extended only to PWLE, yet 69 (18%) did not disclose that they that they had a mental health condition experience, although respondents could reply that they were mental health activists without such experience.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Stigma and discrimination contravene basic human rights.

    “Stigma and discrimination contravene basic human rights and have severe, toxic effects on people with mental health conditions that exacerbate marginalisation and social exclusion, for example by reducing access to mental and physical health care and diminishing educational and employment opportunities”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    PWLE need to be strongly supported to lead or co-lead interventions that use social contact.

    “need to be strongly supported to lead or co-lead interventions that use social contact”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    They include loss of property, inheritance, or rights to vote.

    “loss of property, inheritance, or rights to vote”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    They include social exclusion in relation to education, the workplace, and the community.

    “social exclusion in relation to education, the workplace, and the community”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationnone given

    These barriers to full citizenship and social participation contravene basic human rights that are intended to apply equally to everyone.

    “These pernicious barriers to full citizenship and social participation all share one fundamental characteristic: they contravene basic human rights that are intended to apply equally to all of us (appendix 3 p 16).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Stigma and discrimination have many manifestations, including damage to marital prospects.

    “Stigma and discrimination have many manifestations, ranging from damage to marital prospects; social exclusion in relation to education, the workplace, and the community; loss of property, inheritance, or rights to vote; and poorer health care than for physical conditions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The stigmatisation of people with mental health conditions is very common and is seen worldwide.

    “The stigmatisation of people with mental health conditions is very common and is seen worldwide.12”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Thornicroft, 2006

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The umbrella review was registered with Prospero (CRD42022299682).

    “The umbrella review was registered with Prospero, registration number CRD42022299682.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    One in every seven adolescents aged 10-19 years experiences a mental health condition.

    “This is especially important given that one in every seven adolescents aged 10-19 years experiences a mental health condition, 85”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [85] Salazar de Pablo, 2020, Universal and selective interventions to promote good mental health in young people: systematic review and meta-analysis, Eur Neuropsychopharmacol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Difficulties finding or retaining employment due to unsympathetic employers or co-workers can limit the availability of skilled employees on the labour market and reduce the potential for economic growth.

    “Difficulties in finding or retaining employment due to unsympathetic employers or co-workers can limit the availability of skilled employees on the labour market and reduce the potential for economic growth.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    The weighting of included reviews towards recent years reflects increasing research interest in the topic.

    “This weighting towards recent years reflects increasing research interest in the topic.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    There is potential for vocational workers to collaborate with employers and elicit change at the structural level.

    “Nevertheless, there is the potential for vocational workers to collaborate with employers and elicit change at the structural level.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Waqas and colleagues carried out a systematic review of anti-stigma interventions in educational institutions.

    “Waqas and colleagues 116 conducted a systematic review of anti-stigma interventions in educational institutions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [116] Waqas, 2020, Interventions to reduce stigma related to mental illnesses in educational institutes: a systematic review, Psychiatric Quarterly source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Improving social skills of children with mental health conditions can improve social inclusion, possibly because the children behave in a more socially accepted manner.

    “Improving the social skills of children with mental health conditions can improve social inclusion, although possibly because the children behave in a more socially accepted manner.121,123”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [121] Louw, 2020, Enhancing social inclusion of young adults with intellectual disabilities: a systematic review of original empirical studies, J Appl Res Intellect Disabil source

      Not checked in the free run.

    • cites [123] Cremin, 2020, Autism awareness interventions for children and adolescents: a scoping review, J Dev Phys Disabil source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    There was a limited number of such interventions, so the results must be interpreted with caution.

    “However there was a limited number of such interventions and, therefore, results must be interpreted with caution.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Rivera and colleagues concluded that stigma-reduction programmes among African Americans need to be culturally informed and tailored.

    “In their review of stigma-reduction programmes among African Americans, Rivera and colleagues 172 concluded that such programmes need to be culturally informed and tailored.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [172] Rivera, 2021, A narrative review of mental illness stigma reduction interventions among african americans in the United States, J Ment Health Clin Psychol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Scior concluded that ensuring positive encounters was important, as positive encounters seemed to reduce social distance, whereas negative encounters can have the opposite effect.

    “Nevertheless, the authors concluded that it was important to ensure positive encounters, which seemed to reduce social distance, whereas negative encounters can have the opposite effect.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [173] Scior, 2011, Public awareness, attitudes and beliefs regarding intellectual disability: a systematic review, Res Dev Disabil source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Interventions including communication strategies might facilitate self-confidence in caregivers, leading to improved understanding of the needs of the person with a mental health condition.

    “However, interventions that included communication strategies might facilitate self-confidence in caregivers, leading to improved understanding of the needs of the person with a mental health condition.152,182”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [152] Knaak, 2014, Key ingredients of anti-stigma programs for health care providers: a data synthesis of evaluative studies, Can J Psychiatry source

      Not checked in the free run.

    • cites [182] Bacsu, 2022, Stigma reduction interventions of dementia: a scoping review, Can J Aging source

      Not checked in the free run.

  • May combine two claims.

    Interpretationnone given

    Most self-stigma interventions involve groups, which can create barriers for people unwilling to disclose a mental health condition to others.

    “Most self-stigma interventions involve groups, which can create barriers for people who are not willing to disclose a mental health condition to others.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The findings so far suggest that anti-stigma interventions could be cost-effective at the programme and population levels, although clearer evidence is needed.

    “While clearer evidence is needed, the findings so far suggest that anti-stigma interventions could be costeffective at the programme and population levels.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Integration of anti-stigma interventions into larger governmental priorities, such as the COVID-19 pandemic, might support longevity.

    “Integration of antistigma interventions into larger governmental priorities, such as the COVID-19 pandemic, might also support longevity.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The selected case studies are representative of different types of anti-stigma interventions across a wide variety of geographical and cultural locations and with diverse target groups.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Stigma reduction can be an intended or unintended consequence of policies delivered in the field of mental health.

    “Stigma reduction can also be an intended or unintended consequence of policies delivered in the field of mental health.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The largely unregulated nature of social media creates challenges including credibility and trustworthiness of information and potential risk for stigma.

    “Despite the positive aspects, the largely unregulated nature of these media means that they also present serious challenges, such as credibility and trustworthiness of information 264 and, while not being inherently harmful, might be sources of risk for stigma.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [264] O'Reilly, 2019, Potential of social media in promoting mental health in adolescents, Health Promot Int source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Heavy social media use is linked to lower self-esteem, anxiety, and depression, particularly in young women.

    “For example, there is increasing concern that substantial social media use is associated with low self-esteem, anxiety, and depression, especially among young women.255,256”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [255] Andreassen, 2017, The relationship between addictive use of social media, narcissism, and self-esteem: findings from a large national survey, Addict Behav source

      Not checked in the free run.

    • cites [256] Woods, 2016, #Sleepyteens: social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem, J Adolesc source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Diverse funding, variation of programmes for multiple target groups, crowd-funding activities, and revenue-generating programmes can complement governmental funding and help programmes continue in the long term.

    “Diverse funding, variation of programmes for multiple target groups, crowd-funding activities (such as those employed by Batyr, Australia), and revenuegenerating programmes (eg, as used in Working Minds, Canada) can all complement governmental funding and help programmes to continue in the long-term.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The selected case studies are representative of different types of anti-stigma interventions across a wide variety of geographical and cultural locations and with diverse target groups.

  • May combine two claims.

    Interpretationcitation

    Public stigma may be exacerbated by the structure of mental health services in a country, and deinstitutionalisation can facilitate stigma reduction.

    “For instance, public stigma may be exacerbated by the structure of mental health services in a given country, and deinstitutionalisation can facilitate stigma reduction.241”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [241] Winkler, 2021, Development of public stigma toward people with mental health problems in Czechia 2013–2019, Eur Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A review of Spanish news coverage found that a quarter of analysed news stories contained stigmatising content, often using stereotypes of danger and unpredictability.

    “A review of Spanish news coverage reported that a quarter of the analysed news stories included stigmatising contents, often using stereotypes of danger and unpredictability.268”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [268] Muñoz, 2011, La enfermedad mental en los medios de comunicación: un estudio empírico en prensa escrita, radio y televisión, Clin Salud

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Although mental health care is scarce in low-resource settings, the services that do exist are often institutionalising and may reinforce stigma or exclusion.

    “Although mental health care is scarce in low-resource settings, the services that do exist are often institutionalising and may reinforce stigma or exclusion.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Mental health care is scarce in low-resource settings.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The literature review screened 1826 records, selected 102 for full-text review, and included 24 publications in the final analysis.

    “The search yielded 1826 results.After screening the titles and abstracts and removing duplicates, 102 papers were chosen for full-text review, and of these 24 publications were included in the final analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Using digital communication methods can be very effective and has been suggested as an important component in delivering anti-stigma campaigns.

    “Using digital communication methods can be very effective, and they have been suggested to be important components in delivering anti-stigma campaigns.131”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [131] Ito-Jaeger, 2021, Digital video interventions and mental health literacy among young people: a scoping review, J Ment Health

      Not checked in the free run.

    • Rests on an assumption: The selected case studies are representative of different types of anti-stigma interventions across a wide variety of geographical and cultural locations and with diverse target groups.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Four researchers did the qualitative data analysis.

    “Four researchers (HL, NVSJ, AM, and PCG) did the qualitative data analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Study design and conductreasoning

    Larger sample sizes ensure the survey dataset provides richness and depth of data when viewed in its entirety.

    “Larger sample sizes ensure the survey dataset provides richness and depth of data when viewed in its entirety.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    It is probable that media reporting can increase or reduce structural discrimination through influences on voters and policy makers, but empirical evidence is lacking.

    “Given the evidence of the power of the media to affect public attitudes and policy, it is probable that media reporting can also increase or reduce structural discrimination, through their influences on voters and policy makers, but there is a lack of empirical evidence to support this view at present.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    WHO released updated guidelines for media professionals on suicide prevention in 2017.

    “Regarding media and suicide prevention, in 2017, WHO released updated guidelines for media professionals.283”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [283] 2017

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Media guidelines on suicide reporting may be important for stigma reduction, but they are often incompletely implemented.

    “Overall these data suggest that media guidelines on suicide reporting may be important for stigma reduction, but that they are often incompletely implemented.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    WHO reports that more than 700,000 people die by suicide every year, and suicide is the fourth leading cause of death among young people worldwide.

    “WHO reports that more than 700 000 people die every year due to suicide, and it is the fourth leading cause of death among young people worldwide.302”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [302] 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Ethics approval for the lived experience survey was granted by the Health Faculties Research Ethics Subcommittee at King's College London (RESCM-21/22-25892).

    “Ethics approval for this work was granted by the Health Faculties Research Ethics Subcommittee at King's College London, UK (RESCM-21/22-25892).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The survey questions were developed by Lancet Commissioners, including PWLE, and piloted with PWLE to ensure content, timing, and comprehension were appropriate.

    “The questions used in this survey were specifically developed for this report by the Lancet Commissioners, including PWLE.Before launching the survey, the questions were piloted with PWLE to ensure question content, timing, and comprehension were appropriate.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Papageno effect occurs when media show how people can positively overcome a suicidal crisis and turn towards recovery.

    “Conversely, the Papageno effect occurs when media show how people can positively overcome a suicidal crisis and turn towards recovery.305”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [305] Domaradzki, 2021, The Werther effect, the Papageno effect or no effect? A literature review, Int J Environ Res Public Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisereasoning

    The term committed suicide may suggest suicide is a criminal act even where decriminalised, whereas died by suicide is non-judgemental.

    “The term committed suicide, for example, might suggest that suicide is a criminal act, even where it has been decriminalised whereas died by suicide is non-judgemental.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The survey was available online in Arabic, Chinese, English, French, Russian, and Spanish, reflecting the six official WHO languages.

    “To increase the inclusiveness and reach of the survey, it was made available for completion online in Arabic, Chinese, English, French, Russian, and Spanish, reflecting the six official WHO languages.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    WHO's Comprehensive Action Plan 2013-30 sets out a vision where mental health is valued and protected, mental health conditions are prevented, and affected people can exercise their human rights and obtain quality care and social care without stigmatization or discrimination.

    “WHO's Comprehensive Action Plan 2013-30 clearly states, “The vision of the action plan is a world in which mental health is valued, promoted and protected, mental health conditions are prevented and persons affected by these conditions are able to exercise the full range of human rights and to access high quality, culturally-appropriate health care and social care in a timely way to promote recove”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [315] 2021

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Participants' responses were synthesised through digital text network analysis using InfraNodus and thematic content analysis.

    “Participants' responses to each question were synthesised through a combination of digital text network analysis using InfraNodus (version Pro 2022) and thematic content analysis.314”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [314] Braun, 2006, Using thematic analysis in psychology, Qual Res Psychol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Responses were translated to English using Google Scholar, and selected quotes were crosschecked by native speakers of each language.

    “First, responses to each question were translated to English using Google Scholar, and selected quotes were crosschecked by native speakers of each language.”
    Quote in the paperNot a substantial claim
197 of 197

  • The paper relies on this without support.

    The global survey respondents are representative of people with lived experience of mental health conditions worldwide.

    “In a global, multilanguage survey of PWLE, 391 people responded from 45 countries and territories.”

  • The paper relies on this without support.

    The findings of the umbrella review of 216 systematic reviews are generalisable to all countries and cultures worldwide.

    “Our umbrella review of 216 systematic reviews shows that interventions based on the principle of social contact (whether in person, virtual, or indirect) that have been appropriately adapted to different contexts and cultures are the most effective ways to reduce stigmatisation worldwide”

  • The paper relies on this without support.

    The lessons from the ten large-scale anti-stigma programmes are applicable to other programmes and contexts.

    “Our evaluation of ten large-scale anti-stigma programmes around the world found that they are most effective when they involve people with lived experience of mental health conditions (PWLE) as co-producers in all aspects of development, when target groups are consulted on programme content and delivery, and when programmes are sustained over the long term”

  • The authors state this as an assumption.

    Diagnoses are necessary for communication among health workers, people with lived experience, family members, and policy makers, and for planning and financing treatment and care.

    “Throughout this report, however, we assume that diagnoses are necessary for reasons of communication for health workers, PWLE, family members, and policy makers, and for planning and financing treatments and care.”

  • The paper relies on this without support.

    Culture strongly influences stigma by determining what behaviour is socially acceptable and by shaping beliefs about the causes and treatment of mental health conditions.

    “Culture has a strong influence on stigma because of the role that culture plays in determining what is considered”

  • The paper relies on this without support.

    The selected case studies are representative of different types of anti-stigma interventions across a wide variety of geographical and cultural locations and with diverse target groups.

    “We selected case studies purposively that were representative of different types of anti-stigma interventions in a wide variety of geographical and cultural locations and with diverse target groups (panel 3, table 1).”

  • The paper relies on this without support.

    Mental health care is scarce in low-resource settings.

    “Although mental health care is scarce in low-resource settings, the services that do exist are often institutionalising and may reinforce stigma or exclusion.”

  • The paper relies on this without support.

    The media have great power over citizens and shape perceptions of reality and interpretation of the world.

    “The media wield great power over citizens and influence perceptions of reality and interpretation of the world.”

  • The paper relies on this without support.

    Media messaging affects all elements of stigma, including knowledge, attitudes, and behaviours.

    “Media messaging affects all elements of stigma, including knowledge, attitudes, behaviours.”

  • The paper relies on this without support.

    Media can be beneficial or harmful for stigma.

    “Media can be beneficial (actively reducing stigma) or harmful (perpetuating stereotypes or negative attitudes or behaviours).”

  • The paper relies on this without support.

    For many young people, social media are among their most vital tools for community, self-expression, and challenging stigma.

    “For many young people social media are among their most vital tools for community, self-expression, and for challenging stigma.”

  • The paper relies on this without support.

    Until about 20 years ago, traditional media were the main source of mass information and professional journalists were almost exclusively the disseminators of news and information.

    “Until only about 20 years ago, these media were the main source of mass information and professional journalists were almost exclusively the ones who served as disseminators of news and information.”

  • The paper relies on this without support.

    Several anti-stigma programmes have identified the media as a target group for interventions.

    “For this reason several anti-stigma programmes have identified the media as a target group for interventions.”

  • The paper relies on this without support.

    Adherence to suicide reporting guidelines is especially low in LMICs, where suicides are often sensationalised, stigmatised, and even criminalised in media portrayals.

    “Adherence to suicide reporting guidelines is especially low in LMICs, where suicides are often sensationalised, stigmatised, and even criminalised in their portrayals in the media.”

  • The paper relies on this without support.

    The Hindu newspaper follows suicide reporting guidelines, accompanies every suicide report with helpline contact details, and has been recognised by Sneha for excellence in reporting and prevention of suicides.

    “A notable exception in India is the national newspaper The Hindu, which does follow guidelines.Every report of a suicide is accompanied by helpline contact details for people who need support.The Hindu has been recognised by the support hotline Sneha for its excellence in the reporting and prevention of suicides.”
15 of 15

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Survey summary overstates one agreement rate

    Minor

    The abstract says more than 90% agreed with each listed statement, but table 4 reports exactly 90% agreement for the statement about stigma and discrimination negatively affecting most people with mental health conditions.

  • Survey respondent count differs between summaries

    Minor

    The abstract describes almost 300 survey respondents, but the survey results report 391 respondents from the same 45 countries and territories.

2 of 2

Cites

Flagged first, then by citations

2 of the 307 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Henderson, 2014, Mental health-related stigma in health care and mental health-care settings, Lancet Psychiatry, 1, 467, 10.1016/s2215-0366(14)00023-6 · DOI · Paper page
  2. Valic, 2013, A review of the literature and media reports of patterns of mental health stigma and addressing stigma in Slovenia until 2010, Zdr Varst, 52, 47

Cited by

Sorted by citations

Related

Authors
Thornicroft, G., Sunkel, C., Alikhon Aliev, A., Baker, S., Brohan, E., el Chammay, R., Davies, K., Demissie, M., Duncan, J., Fekadu, W., Gronholm, P. C., Guerrero, Z., Gurung, D., Habtamu, K., Hanlon, C., Heim, E., Henderson, C., Hijazi, Z., Hoffman, C., Hosny, N., Huang, F.-X., Kline, S., Kohrt, B. A., Lempp, H., Li, J., London, E., Ma, N., Mak, W. W. S., Makhmud, A., Maulik, P. K., Milenova, M., Morales Cano, G., Ouali, U., Parry, S., Rangaswamy, T., Rüsch, N., Sabri, T., Sartorius, N., Schulze, M., Stuart, H., Taylor Salisbury, T., Vera San Juan, N., Votruba, N., & Winkler, P.
Affiliations
  • King's College London (GB)
  • Mind (GB)
  • Haramaya University (ET)
  • Bahir Dar University (ET)
  • National Institute of Mental Health (CZ)
  • Addis Ababa University (ET)
  • University of Lausanne (CH)
  • United Nations Children's Fund (US)
  • South London and Maudsley NHS Foundation Trust (GB)
  • George Washington University (US)
  • Guangzhou Medical University (CN)
  • Peking University (CN)
  • Chinese University of Hong Kong (HK)
  • UNSW Sydney (AU)
  • Tunis University (TN)
  • Universität Ulm (DE)
  • Queen's University (CA)
  • University of Oxford (GB)
Corresponding author
Thornicroft, Graham
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2022-10
Volume
400
Issue
10361
Pages
1438-1480
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(22)01470-2
OpenAlex
W4303940215
Semantic Scholar
59590b5243b81e3fa4b20c1c716156e205d7f5a2
Cited by
748
References
307
Citations by year
2026: 190 · 2025: 220 · 2024: 209 · 2023: 121 · 2022: 8
FWCI
20.97
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • IRIS (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion, other-oa)
Funders
Medical Research Council (MR/R023697/1)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
  • Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
Keywords
mental health stigma, discrimination against people with mental illness, stigma reduction, lived experience, people with lived experience, co-production, mental health policy, mental health law, mental health services
MeSH terms
Mental Disorders, Humans, Mental Health, Social Stigma, Social Discrimination

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

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