Determinants of stigma: A comparison of health, mental health, and drug use conditions

Introduction. Psychiatric conditions are among the leading causes of the global burden of disease, but stigma has been cited as a barrier to treatment engagement. The literature discusses several dimensions of stigma including peril, course, origin, stability, aesthetics, controllability, pity, concealability, and disruptiveness. These dimensions are consistent with the most prominent lever of stigma -- social stigma, but stigma can also be internalized (self-stigma) or held among health professionals (health professional stigma). Purpose. The aim of this dissertation is to assess the determinants of stigma, comparing variation by different health, mental health, and drug use conditions. Chapter one discusses theory, epistemology, and literature review, while chapters two and three assess social stigma and self-stigma, respectively. The fourth chapter aims to understand health professional stigma and the fifth chapter provides a more specific discussion, implications, and conclusions for the first four chapters. Methods. Chapters two and three use data from the World Mental Health Surveys (WMHS; n=123,332), and chapter four assesses future social workers and physicians (n=222) on one university campus. Results. Family members held the most social stigma towards their relatives with psychiatric conditions as compared to general physical health conditions, while individuals with mood disorders experienced more self-stigma compared to those with no mood or AOD disorders. Health professionals were least willing to treat individuals with nicotine and alcohol dependence as compared to depression (p<0.05). Discussion & Implications. All three 'levels' of stigma impact the lives of individuals with psychiatric conditions. While more research is needed in these areas, health professionals, including social workers, must consider the implications of stigma in research, education, policy, and practice.