Psychological Medicine

Original Articles

Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries

S. Evans-Lackoa1 c1, E. Brohana1, R. Mojtabaia2 and G. Thornicrofta1

a1 Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK

a2 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA


Background Little is known about how the views of the public are related to self-stigma among people with mental health problems. Despite increasing activity aimed at reducing mental illness stigma, there is little evidence to guide and inform specific anti-stigma campaign development and messages to be used in mass campaigns. A better understanding of the association between public knowledge, attitudes and behaviours and the internalization of stigma among people with mental health problems is needed.

Method This study links two large, international datasets to explore the association between public stigma in 14 European countries (Eurobarometer survey) and individual reports of self-stigma, perceived discrimination and empowerment among persons with mental illness (n=1835) residing in those countries [the Global Alliance of Mental Illness Advocacy Networks (GAMIAN) study].

Results Individuals with mental illness living in countries with less stigmatizing attitudes, higher rates of help-seeking and treatment utilization and better perceived access to information had lower rates of self-stigma and perceived discrimination and those living in countries where the public felt more comfortable talking to people with mental illness had less self-stigma and felt more empowered.

Conclusions Targeting the general public through mass anti-stigma interventions may lead to a virtuous cycle by disrupting the negative feedback engendered by public stigma, thereby reducing self-stigma among people with mental health problems. A combined approach involving knowledge, attitudes and behaviour is needed; mass interventions that facilitate disclosure and positive social contact may be the most effective. Improving availability of information about mental health issues and facilitating access to care and help-seeking also show promise with regard to stigma.

(Received July 26 2011)

(Revised October 11 2011)

(Accepted October 13 2011)

(Online publication November 16 2011)


c1 Address for correspondence: Dr S. Evans-Lacko, Health Service and Population Research Department P029, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email:


† These authors contributed equally to this work.