Abstract
BACKGROUND: Literacy campaigns stand as the most common approach to raising awareness of mental health problems, increasing the use of services, and reducing stigma. However, research suggests that more informed public beliefs may have little effect or even trigger the stigma backlash. We aim to provide a wider, cross-national examination of how stigma varies globally and to examine whether the ability to recognize a mental health problem and see it as "a disease like any other" is the optimal roadmap for stigma reduction. METHODS: Data came from the Stigma in Global Context - Mental Health Study (SGC-MHS), which were collected from non-institutionalized adults 18 years of age or older through face-to-face interviews using vignettes meeting the Diagnostic and Statistical Manual of Mental Disorders, 4(th) edition clinical criteria for schizophrenia and major depression in 17 countries (N = 18,342; response rate 65.9%). Analyses of association between the public's endorsement of problem recognition, disease attributions, and severity on the desire for social distance were conducted using multivariate regression models in the structural equation modeling framework. RESULTS: For both depression and schizophrenia, countries fell into three groups of low, medium and high levels of public stigma. Consistently, Brazil and Germany anchored the lowest levels, Bangladesh and Hungary reported the highest levels, with Great Britain, USA, Belgium falling in midrange. Measures of mental health literacy did not have uniform effects, but, where significant, tended to align with expectations under labelling theory's ideas about rejection rather than attribution theory's claims for mental health literacy. Ironically, the most stable factor associated with lower stigma is the assessment that the situation will improve on its own, in direct contradiction to literacy theories. CONCLUSION: Overall results suggest that anti-stigma efforts should move past a focus on mental health literacy or at least recognize its limitation and potential unintended consequences. Recognizing a situation as a mental illness can change the public's support for mental health services to some extent. The association between seeing the problem resolving on its own and lower stigma levels suggests that newer approaches that focus on connectedness and mental health may hold greater purchase to decrease public stigma and increase recovery.