The Maristán Stigma Scale - A Standardized
The Maristán Stigma Scale - A Standardized
The Maristán Stigma Scale - A Standardized
RESEARCH ARTICLE
Open Access
Abstract
Background: People with schizophrenia face prejudice and discrimination from a number of sources including
professionals and families. The degree of stigma perceived and experienced varies across cultures and communities.
We aimed to develop a cross-cultural measure of the stigma perceived by people with schizophrenia.
Method: Items for the scale were developed from qualitative group interviews with people with schizophrenia
in six countries. The scale was then applied in face-to-face interviews with 164 participants, 103 of which were
repeated after 30 days. Principal Axis Factoring and Promax rotation evaluated the structure of the scale; Horns
parallel combined with bootstrapping determined the number of factors; and intra-class correlation assessed
test-retest reliability.
Results: The final scale has 31 items and four factors: informal social networks, socio-institutional, health professionals
and self-stigma. Cronbachs alpha was 0.84 for the Factor 1; 0.81 for Factor 2; 0.74 for Factor 3, and 0.75 for Factor 4.
Correlation matrix among factors revealed that most were in the moderate range [0.31-0.49], with the strongest
occurring between perception of stigma in the informal network and self-stigma and there was also a weaker
correlation between stigma from health professionals and self-stigma. Test-retest reliability was highest for informal
networks [ICC 0.76 [0.67 -0.83]] and self-stigma [ICC 0.74 [0.64-0.81]]. There were no significant differences in the scoring
due to sex or age. Service users in Argentina had the highest scores in almost all dimensions.
Conclusions: The MARISTAN stigma scale is a reliable measure of the stigma of schizophrenia and related psychoses
across several cultures. A confirmatory factor analysis is needed to assess the stability of its factor structure.
Keywords: Stigma, Questionnaire, Psychometrics, Rating scale schizophrenia
Background
People with schizophrenia and other psychoses face a
range of problems, some arising directly from the illness
and others from the stigma of the disorder. Stigma can best
be understood as the loss of status by, or discrimination of,
a person because of an attribute that others evaluate disapprovingly [1]. Stigma complicates recovery, thereby reducing self-esteem and access to social networks [2,3]. It has
a particularly severe impact on patients quality of life [4].
* Correspondence: ssaldivi@udec.cl
1
Department of Psychiatry and Mental Health, Faculty of Medicine, University
of Concepcion, Concepcion, Chile
Full list of author information is available at the end of the article
2014 Saldivia et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited.
with mental illness. For example, 42% of psychiatrists surveyed recently in Brazil negatively stereotyped people with
schizophrenia, agreed with some restrictions on their civil
liberties (e.g. the right to vote) and scored highly on
attitudes reflecting prejudice and a need to keep a social
distance [15]. Although qualitative studies of interviews
with people with mental illness have shown that stigma
can occur in a variety of forms [16], the main distinction
made by service users is between acts of discrimination
and feelings of stigma. The first concerns actual social rejection, while the second refers to feelings of inferiority
and shame, and fear of provoking negative responses in
others [16].
A further element is self-stigma when the person seems
to accept a negative stereotype and either becomes
ashamed or simply hides some element of their make-up
that they perceive is unacceptable to others. This happens
when the mentally ill person internalizes the stereotypes
and negative social attitudes associated with people with
mental disorders to the extent that they shape his/her
own identity [17,18]. High self-stigma appears to be at the
opposite pole to a sense of personal empowerment and
control [19]. Self-stigma also occurs in family members,
particularly those with full insight into the mental illness
and possibly its gravity [20].
Most instruments used in measuring personal stigma of
mental illness have considered different ways in which
stigma is experienced; some are focused on stigmatisation
of the self [3,21], others are based in the direct experience
of discrimination [13,22], some on the perception of
stigma [23,24], and more recent studies have considered
the anticipated discrimination [5,25]. Most instruments
evaluate both perception and experience of the stigma and
some consider self-stigma [26]. Peoples experience of
stigma is considered mainly in terms of perceived discrimination and stereotypes about the population with mental
illness [26].
Only a few instruments have based the development of
their scale on qualitative data about peoples experiences
and views. Angermeyer et al. [27] developed a scale from
results of focus groups conducted in Germany [27,28]. An
instrument developed by Stuart et al. [12] also started with
a qualitative approach; it has two scales, one of which
assesses the experience of stigma in a number of lifes
domains and the other evaluates its impact [12]. Differences in the response format and number of items make it
difficult to make comparisons with other instruments and
reduce the possibility of exploring the complexity of the
experience. Finally, Thornicroft et al. [5] developed an
instrument starting with a qualitative step but this step
was limited to obtaining the views of people to a number
of items already extracted from the literature. The resulting scale, the DISC is a long and complex instrument that
measures a number of domains. Its main advantage is that
Page 2 of 9
Methods
The method of the overall Maristn study, of which this
is a part, is presented in detail elsewhere [34]. In brief,
the process began with the collection of data from 46
focus groups in six countries in which 303 respondents
participated, including patients with ICD-10 diagnoses
of schizophrenia and other psychotic disorders, informal
and formal carers. All participants in each focus group
were asked to discuss informal care, needs for care and
the stigma experienced by patients with schizophrenia.
The focus groups were undertaken in 2002 in Argentina,
Brazil, Chile, Spain, the United Kingdom and Venezuela.
A tree of categories was constructed from the qualitative
data for stigma and this tree was the basis on which the
items were derived [35]. The questionnaire was first
developed in Spanish and a member of each local team
in Lisbon and London translated the Spanish version
after which both the original and the translation were
reviewed by the research team. Three expert groups
(consisting of 23 people in all), each communicating in
one of three languages [Spanish, Portuguese or English],
then agreed a first version of the instrument. This penultimate version was then sent back to the expert group
members who carried out a final assessment by scoring
the relevance of each statement from 1 (not at all relevant)
up to 5 (highly relevant); the score three, as the median,
was established as the cut-off point and the items that
scored less were considered of little or no relevance [34].
This led to a final draft of the questionnaire, which was
tested in a new sample of patients in Buenos Aires,
Argentina; Porto Alegre, Brazil; Concepcin, Chile; Granada,
Spain; Lisbon, Portugal; and London, England, using the
appropriate versions in Spanish, Portuguese and English.
Page 3 of 9
Instrument
Participants
Procedure
As described, participants took part in individual face-toface interviews in which the questionnaire was delivered
by professionals who had clinical or other experience in
the care of people with severe mental illness. All of the interviewees were invited to answer the questionnaire again
after 30 days in order to estimate temporal stability. Each
investigator kept field notes regarding the application of
the questionnaire, including the degree of comprehension
of each statement, the language terms used, views on the
length of the interviews and any adverse comments about
them.
Data analysis
Page 4 of 9
Results
164 interviews were undertaken, of which 103 repeated
the scale after about 30 days. Socio-demographic characteristics of participants in each country are given in
Table 1. 60.4% of participants were men, 82.2% were single, 54.6% had completed secondary schooling and
54.9% were in receipt of Social Security payments. Mean
age was 39 years (sd 9.8), while mean years of illness was
12.8 (sd 8.8). Patients interviewed in Argentina were
older, had greater involvement in work (27.8%) and included fewer single persons (61.1%). Brazil was the only
country where the proportions of women and patients
with only basic education were the greatest, 72.4% and
55.2% respectively. Patients in the sample from Spain
had a low level of education (45% with basic schooling),
and Argentina and Portugal had the lowest proportion
of patients classified as disabled by Social Security.
Results obtained from Horns Parallel Analysis on
5,000 bootstrap samples revealed that only the first four
eigenvalues of the correlation matrix of the stigma scale
[eigenvalues 7.86, 2.97, 2.07, and 1.85] were greater than
the 95 percentile of the eigenvalues obtained from the
bootstrap samples [values 2.20, 2.03, 1.91 and 1.81]. This
result revealed that there were four main factors in
the scale. For the purposes of comparison, application
of the Kaiser Guttman criterion identified 12 factors, while
the analysis utilizing the scree plot revealed a sharp break
after the second factor.
Given the above, it was decided to extract four factors
followed by a Promax rotation. The analysis of the pattern matrix revealed that six items had coefficients less
than 0.3 on any of the four factors and thus these were
removed and the extraction repeated. The results of the
second analysis showed that one additional item had a
Argentina
Brazil
Chile
Portugal
Spain
U.K.
Total
18 (11.0%)
30 (18.3%)
30 (18.3%)
20 (12.2%)
20 (12.2%)
46 (28.0%)
164 (100.0%)
Male
9 (50.0%)
8 (27.6%)
25 (83.3%)
11 (55.0%)
14 (70.0%)
32 (69.6%)
99 (60.7%)
45.7 (6.4)
36.7 (9.2)
39.6 (10.1)
34.4 (8.3)
38.5 (8.4)
41.2 (10.9)
39.41 (9.8)
Single
11 (61.1%)
25 (86.2%)
25 (83.3%)
16 (80.0%)
17 (85.0%)
40 (87.0%)
134 (82.2%)
Education
None
5 (27.8%)
5 (3.1%)
Elementary
2 (11.1%)
16 (55.2%)
9 (30.0%)
2 (10.0%)
9 (45.0%)
3 (6.5%)
41 (25.2%)
Secondary
10 (55.6%)
11 (37.9%)
17 (56.7%)
14 (70.0%)
7 (35.0%)
30 (65.2%)
89 (54.6%)
Higher
1 (5.6%)
2 (6.9%)
4 (13.3%)
4 (20.0%)
4 (20.0%)
13 (28.3%)
28 (17.2%)
Employment
In work
5 (27.8%)
1 (3.8%)
3 (10.0%)
3 (15.0%)
1 (5.0%)
3 (6.5%)
16 (10.0%)
Unemployed
7 (38.9%)
9 (34.6%)
3 (10.0%)
11 (55.0%)
6 (30.0%)
3 (6.5%)
39 (24.4%)
6 (33.3%)
16 (61.5%)
24 (80.0%)
6 (30.0%)
13 (65.0%)
40 (87.0%)
105 (65.0%)
Years of illness
18.2 (7.2)
15.8 (7.9)
19.3 (11.3)
9.3 (4.1)
18.7 (10.9)
14.1 (10.5)
12.8 (8.8)
Page 5 of 9
Informal
networks
Socioinstitutional
Health
professionals
Selfstigma
0,76
0,10
0,01
0,02
16
0,60
0,02
0,03
0,08
0,59
0,14
0,06
0,03
15
0,57
0,08
0,06
0,18
18
0,57
0,04
0,06
0,01
12
My family is afraid of me
0,56
0,20
0,07
0,02
19
0,56
0,04
0,09
0,00
0,48
0,15
0,13
0,11
0,45
0,11
0,07
0,04
20
0,44
0,11
0,16
0,08
11
0,40
0,02
0,00
0,20
29
Health Problems of people with mental health problems are not taken seriously,
as they tend to be understood as part of the mental illness
0,12
0,66
0,17
0,14
28
The opinion of people with mental health problems is not so well considered
whenever decisions about their treatment (hospital admission) are taken,
unlike in the case of other illnesses
0,05
0,62
0,02
0,13
35
There are not enough services for people with mental health problems
0,09
0,58
0,12
0,05
31
Mental health services have fewer staff than other health services
0,30
0,57
0,13
0,18
26
Medical services try to avoid having to deal with people with mental
health problems
0,10
0,55
0,05
0,02
27
The emergency services dont look after people with mental health
problems in the same way as people with other illnesses.
0,09
0,53
0,01
0,04
33
0,12
0,46
0,06
0,13
14
People use unpleasant words when talking about people with mental
health problems
0,19
0,43
0,14
0,06
34
Mental health law excessively restricts the rights of people with mental
health problems
0,11
0,42
0,08
0,23
30
Mental health facilities are in a worse state than other health service facilities.
0,12
0,41
0,22
0,14
21
The media portray a poor image of people with mental health problems
0,36
0,40
0,09
0,11
32
0,14
0,36
0,25
0,08
23
0,11
0,10
0,84
0,01
22
0,02
0,02
0,76
0,02
24
0,10
0,20
0,53
0,06
25
0,08
0,27
0,33
0,04
0,09
0,20
0,11
0,76
0,03
0,02
0,05
0,67
0,05
0,13
0,11
0,61
0,11
0,22
0,08
0,42
Page 6 of 9
1.00
Socio-institutional
0.42***
0.31***
0.49***
1.00
0.41***
0.32***
1.00
0.18*
Health professionals
Self-stigma
1.00
Discussion
We have developed a reliable instrument to measure the
stigma of severe mental illness across six countries, and
its cross-cultural, bottom-up development provides the
validity needed to compare different dimensions of the
stigma across cultures. It has moderate to high internal
consistency [Cronbachs Alpha 0.89] and moderate testretest reliability [ICC 0.77]. There are four factors in the
scale, namely informal networks, socio-institutional,
health professionals and self-stigma. However, because
of highly variable correlations between them we recommend using the four separate subscale scores rather than
a total score from the sum of all of them. Given that the
self-stigma subscale contains only four items, it could also
be argued that an alternative scale (e.g. Ritsher et al.) [21]
should be used if this were the main focus of a study.
However, it is worth cautioning that test-retest reliability
of this instrument was assessed in only 16 participants.
The questionnaire was applied by interviewers to make
sure the items were understood and to help with any difficulties. Although this increased both time and costs associated with its application, it standardized data collection
in diverse contexts, where the cultural background of the
patients was very different. It now needs to be tested in a
pure self-report format.
Social networks
Table 4 MARISTAN Stigma Scale Factor scores by demography [Mean item score and (sd)]
Informal networks
M (SD)
Total sample
2.9 (1.3)
Socio-institutional
M (SD)
3.7 (1.3)
Health professionals
M (SD)
2.5 (1.5)
Self-stigma
M (SD)
3.7 (1.7)
Gender
Men
2.8 (1.3)
Women
3.0 (1.4)
0.55
3.7 (1.3)
0.06
3.6 (1.3)
2.6 (1.5)
0.28
2.5 (1.6)
3.6 (1.6)
1.34
3.9 (1,9)
Age group
18-29
2.4 (1.1)
2.50
3.5 (1.4)
0.73
2.2 (1.4)
1.93
3.5 (1.4)
30-39
2.8 (1.4)
3.6 (1.4)
2.5 (1.5)
3.4 (1.6)
40-49
3.2 (1.3)
3.9 (1.3)
2.8 (1.6)
3.9 (1.8)
50 and more
3.0 (1.3)
3.6 (1.2)
2.0 (1.3)
4.1 (1.8)
1.43
Country
Argentina
3.9 (1.2)
Brazil
2.6 (1.2)
3.9 (1.5)
2.6 (1.7)
3.5 (1.8)
Chile
3.2 (1.4)
4.0 (1.1)
2.7 (1.5)
4.4 (1.5)
Portugal
2.9 (1.4)
3.6 (1.3)
2.3 (1.2)
3.2 (1.3)
Spain
2.6 (1.1)
3.3 (1.3)
2.6 (1.3)
3.2 (1.7)
UK
2.7 (1.3)
3.3 (1.4)
2.0 (1.5)
3.6 (1.8)
3.10*
4.7 (0.8)
3.36**
3.9 (1.1)
4.28**
4.1 (1.9)
2.08
Unfortunately, formal care givers appear to be an important source of stigma. Two of the factors [socio-institutional and stigma from health professionals] touched
on this source of stigma. Thus it may be important to include both the system and professionals when developing
strategies to reduce stigma. A frequent complaint against
health professionals concerns their attitudes, while perceptions of socio-institutional stigma concern processes of
care and scarcity of resources. The latter requires political
and public health solutions in each country. Stigma arising
from professionals and institutions may be less likely
to be experienced by patients with less than three years of
illness or those who have never been institutionalised.
One modification when applying the Maristn scale to this
group is to use only the subscales informal social
networks and self-stigma, both of which were strongly
correlated with each other and both of which tapped
important, albeit incomplete elements, of perceived stigma
in this group of people.
The relation between stigma and the demand for mental
health care does not appear to be direct. A number of
authors have suggested that perceived stigma may not
affect demand for mental health care in particular populations, but this may vary with the characteristics of the
population affected [46]. Furthermore, people with schizophrenia are in long-term contact with specialized services
and if they perceive stigma arising from such institutions
and from health professionals, specific measures need to
be taken to address it.
Both families and professionals were sources of stigma.
Previous research is contradictory on this issue. There
have been suggestions that close interaction with patients
will reduce stigmatising or negative attitudes [47], however more recent research indicate that those with the
closest contact may be the most discriminating of all [33].
Thus, we need closer study of just how the degree of
intimacy leads to an increase or decrease in stigma.
Types of stigma and scoring
Page 7 of 9
Conclusion
The MARISTAN stigma scale is a reliable measure of
the stigma of schizophrenia and related psychoses across
several cultures. A confirmatory factor analysis is needed
to assess the stability of its factor structure.
Competing interests
The authors declare that they have no competing interests.
Authors contributions
FT-G, MK, SS, MX, EG, JMC, AR-G, BV: Conceived of and designed the study.
MK, HK, RG, AR-G, MX, PG, CA, DAB: Coordinated the collection of data in
each country. SS and MK: wrote the article and PG worked on the draft.
FT-G, EG, BV, JMC, AR-G, MX, PG, CA, DAB: Gave final approval of the version
to be published. RM: undertook the statistical analysis and helped to
interpret the findings. All authors read and approved the final manuscript.
Acknowledgements
We are grateful to all the patients, carers and professionals who took part
and also to Dr Dominic Bishop. We are also grateful for support from the
Pan-American Health Office (PAHO), Camden and Islington NHS Foundation
Trust and University College London (UCL).
Author details
1
Department of Psychiatry and Mental Health, Faculty of Medicine, University
of Concepcion, Concepcion, Chile. 2Department of Pedagogy, University of
Jaen, Jaen, Spain. 3Department of Psychology, Faculty of Social Sciences,
University of Concepcion, Concepcion, Chile. 4Centre of Bio-Medical Research
in Network of Mental Health (CIBERSAM), Section of Psychiatry and Medical
Psychology, University of Granada, Granada, Spain. 5Faculty of Medical
Sciences, University Nova of Lisbon, Lisbon, Portugal. 6Department of
Community Health, University National of Lanus, Buenos Aires, Argentina.
7
University State of Londrina, Londrina, Brazil. 8Division of Psychiatry, Faculty
of Brain Sciences, UCL Medical School, London, UK. 9Camden and Islington
NHS Foundation Trust, London, UK.
Received: 30 July 2013 Accepted: 4 June 2014
Published: 18 June 2014
References
1. Link BG, Phelan J: Conceptualizing stigma. Annu Rev Sociol 2001,
27:363385.
2. Rsch N, Corrigan P, Wassel A, Michaels P, Larson JE: Self-stigma, group
identification, perceived legitimacy of discrimination and mental health
service use. Br J Psychiatry 2009, 195:551552.
3. Karidi MV, Stefanis C, Theleritis C, Tzedaki M, Rabavilas A, Stefanis N:
Perceived social stigma, self-concept, and self-stigmatization of patient
with schizophrenia. Compr Psychiatry 2010, 51:1930.
4. Corrigan PW, Sokol KA, Rsch N: The Impact of Self-Stigma and Mutual
Help Programs on the Quality of Life of People with Serious Mental
Illnesses. Community Mental Health J 2013, 49:16.
5. Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M, INDIGO Study Group:
Global pattern of experienced and anticipated discrimination against
people with schizophrenia: A cross cultural survey. Lancet 2009,
373:408415.
6. Arboleda-Flrez J: Stigma and discrimination: An overview.
World Psychiatry 2005, 4:810.
7. Bauman AE, Rocjter L, Belevsla D, Zske H, Gaebel W, Niklewski G,
Bajraktarov S, Ortakov V, Wahlberg H: Attitudes of the public towards
people with schizophrenia: comparison between Macedonia and
Germany. World Psychiatry 2005, 4:5557.
8. Bhugra D: Severe mental illness across cultures. Acta Psychiat Scand 2006,
113:1723.
9. Link BG, Mirotznik J, Cullen FT: The effectiveness of stigma coping
orientations: can negative consequences of mental illness labelling be
avoided? J Health Soc Behav 1991, 32:302320.
10. Knifton L, Gervais M, Newbigging K, Mirza N, Quinn N, Wilson N,
Hunkins-Hutchison E: Community conversation: addressing mental health
stigma with ethnic minority communities. Soc Psychiatry Psychiatr
Epidemiol 2010, 45:497504.
Page 8 of 9
11. Schomerus G, Schwahn C, Holzinger A, Corrigan PW, Grabe HJ, Carta MG,
Angermeyer MC: Evolution of public attitudes about mental illness: A
systematic review and meta-analysis. Acta Psychiatr Scand 2012,
125:440452.
12. Stuart H, Milev R, Koller M: The inventory of stigmatizing experiences: its
development and reliability. World Psychiatry 2005, 4:3539.
13. Wahl OF: Mental health consumers experience of stigma.
Schizophr Bull 1999, 25:467478.
14. King M, Dinos S, Shaw J, Watson R, Stevens S, Passetti F, Weich S, Serfaty M:
The Stigma Scale: development of a standardised measure of the stigma
of mental illness. Br J Psychiatry 2007, 190:248254.
15. Loch AA, Guarniero FB, Lawson FL, Hengartner MP, Rossler W, Gattaz WF,
Wang YP: Stigma toward schizophrenia: do all psychiatrists behave the
same? Latent profile analysis of a national sample of psychiatrists in
Brazil. BMC Psychiatry 2013, 13:92.
16. Dinos S, Stevens S, Serfaty M, Phil M, Weich S, King M: Stigma: the feelings
and experiences of 46 people with mental illness. Br J Psychiatry 2004,
184:176181.
17. Jenkins JH, Carpenter-Song EA: Awareness of Stigma Among Persons with
Schizophrenia Marking the Contexts of Lived Experience. J Nerv Ment Dis
2009, 197(7):520529.
18. Williams CC: Insight, Stigma, and Post-Diagnosis Identities in
Schizophrenia. Psychiatry 2008, 71(3):246256.
19. Watson A, Corrigan P, Larson J, Sells M: Self-stigma in people with mental
illness. Schizophr Bull 2007, 36:13121318.
20. Hasson-Ohayon I, Levy I, Kravetz S, Vollanski-Narkis A, Roe D: Insight into
mental illness, self-stigma, and the family burden of parents of persons
with a severe mental illness. Comp Psychiatry 2011, 52(1):7580.
21. Ritsher JB, Poorni GO, Grajales M: Internalized stigma of mental illness:
Psychometric properties of a new measure. Psychiatry Res 2003,
121:3149.
22. Lundberg B, Hansson L, Wentz E, Bjorkman T: Sociodemographic and
clinical factors related to devaluation/discrimination and rejection
experiences among users of mental health services. Soc Psychiatry
Psychiatr Epidemiol 2007, 42:295300.
23. Alonso J, Buron A, Rojas-Farrera S, De Graap J, Haro JM, De Girolamo G,
Bruffaerts R, Kovess V, Matschinger H, Vilagut G: Perceived stigma among
individuals with common mental disorders. J Affect Disord 2009,
118:180186.
24. Bagley C, King M: Exploration of three stigma scales in 83 users of mental
health services: Implication for campaigns to reduce stigma. J Men Heal
2005, 14:343355.
25. ok A, Brohan E, Rose D, Sartorius N, Leese M, Yoon CK, Plooy A,
Ertekin BA, Milev R, Thornicroft G: The INDIGO Study Group. Anticipated
discrimination among people with schizophrenia. Acta Psychiatr Scand
2012, 125:7783.
26. Brohan E, Slade M, Clement S, Thornicroft G: Experiences of mental illness
stigma, prejudice and discrimination: a review of measures. BMC Health
Serv Res 2010, 10:80.
27. Angermeyer M, Beck M, Deitriech S, Holzinger A: The stigma of mental
illness: patientsanticipations and experiences. Int J Soc Psychiatry 2004,
50:153162.
28. Schulze B, Angermeyer M: Subjective experiences of stigma. A focus
group study of schizophrenic patients, their relatives and mental health
professionals. Soc Sci Med 2003, 56:299312.
29. Schomerus G, Matschinger H, Kenzin D, Breier P, Angermeyer MC:
Public attitudes towards mental patients: a comparison between
Novosibirsk. Bratislava and German cities. Eur Psychiat 2006,
21:436441.
30. Kurihara T, Kato M, Sakamoto S, Reverges R, Kitamara T: Public attitudes
towards the mental ill: a cross-cultural study between Bali and Tokyo.
Psychiatry Clin Neurosci 2000, 54:547552.
31. Cheon B, Chiao J: Cultural variation in implicit mental illness stigma.
J Cross Cult Psychol 2012, 43:10581062.
32. Lauber C, Rssler W: Stigma towards people with mental illness in
developing countries in Asia. Int Rev Psychiatry 2007, 19(2):157178.
doi:10.1080/09540260701278903.
33. Rose D, Willis R, Brohan E, Sartorius N, Villares C, Wahlbeck K,
Thornicroft G, INDIGO study group: Reported stigma and
discrimination by people with a diagnosis of schizophrenia.
Epidemiol Psychiatr Sci 2011, 20:193204.
Page 9 of 9