American Journal of Public Health publishes special issue on mental health stigma

The articles below will be published online March 14, 2013, at 4 p.m. (EDT) by the American Journal of Public Health ® under "First Look" at, and they are currently scheduled to appear in the May 2013 print issue of the Journal, a special issue devoted to the topic of mental health stigma.

"First Look" articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association,, and is available at

In a historic first, the American Journal of Public Health has devoted an issue to covering stigma and discrimination against people with mental illnesses, a topic that traditionally is under-researched and under-reported.

"Having worked in the mental health field for more than 40 years, I have seen firsthand the detrimental effects that stigma and discrimination can have on a person's recovery from mental illness," said former U.S. First Lady Rosalynn Carter who founded the Carter Center's Mental Health Program in 1991. "With one-quarter of Americans affected by mental illnesses every year, it is fitting that the American Journal of Public Health has devoted this special theme issue to the important role stigma plays in overall public health and in wellness."

The publication includes more than 30 articles by a variety of nationally and internationally renowned experts on the subject. Among the research and commentaries included in the issue are the following:

1) Global public understanding of mental illness high, yet social stigma persist
2) Commentary: Anti-stigma programs needed to supplement laws made to protect persons with mental illness
3) Public stigma can lead to psychological distress among transgender populations, peer support may be the remedy

1)Global public understanding of mental illness high, yet social stigma persist
Many people now recognize, accept and endorse the treatment of mental illness, yet mental health prejudices and stigmas still persist, according to new research from the American Journal of Public Health.
Data were collected from 16 countries, including the U.S. and countries in Europe, Africa and Asia, in which individuals responded to non-labeled vignettes depicting individuals with schizophrenia and depression. The study analyzed public sentiments toward persons with mental illness through participant responses evaluated to understand knowledge and prejudice.
Results indicated that, across the globe, individuals were generally informed about mental health. Many respondents recognized the severity of mental illness, endorsed the use of psychiatry, acknowledged the efficacy of treatment and endorsed mental health professionals. However, many also expressed prejudice including the potential for self-directed violence, unpredictability, or excluding individuals as potential in-laws or teachers.
The study's authors explain, "Our findings reinforce recent conclusions that individuals endorse the 'modern' understandings of the etiology of mental illness, making traditional educational campaigns focusing on mental illness as a 'real' disease a low priority. If the public understands that mental illnesses are medical problems but still reject individuals with mental illness, then educational campaigns directed toward ensuring inclusion become more salient."
The authors charge, "Unless we attack stigma at the cultural level, the prospects for changing the lives of those affected by mental illness is unlikely. A focus on small-scale individual-level efforts, even if successful, will continually confront negative reinforcement from the larger culture."

2)Commentary: Anti-stigma programs needed to supplement laws made to protect persons with mental illness
Existing federal laws strive to improve the rights and opportunities for persons with mental illness, but could be more effective if supplemented with anti-stigma programs, according to a new commentary in the American Journal of Public Health.
Public health experts from Emory University reviewed three anti-discrimination landmark laws that address mental health in terms of health care, education and employment: the Mental Health Parity and Addiction Equity Act of 2008, Education for all Handicapped Children Act of 1975 and Americans With Disabilities Act of 1990.
The experts explain that stigma is comprised of four components: cues, stereotypes, prejudice and discrimination, but discrimination is the only component addressed by existing laws. Despite the laws' legislative advances, the experts found that protections in the laws are not uniform for all subgroups with mental illness. Additionally, the experts charge that existing and future laws can be bolstered with anti-stigma programs that can address the other components of stigma - cues, stereotypes and prejudice - not easily enforced by law.
The experts explain, "Extant federal laws directly address one component of the complex stigma process - discrimination resulting from public stigma - and provide an important foundation to improve disparities in health care, education and employment outcomes for those with mental illness that result from the stigma process."
They further suggest, "As an example, anti-stigma programs that target attitudes and behavioral intentions toward those with mental illness directly address components of public stigma that are beyond the reach of legislation."

3)Public stigma can lead to psychological distress among transgender populations, peer support may be the remedy
Stigma against transgender populations is positively associated with psychological distress, according to new research from the American Journal of Public Health. Receiving peer support from those within the transgender population, however, could moderate this association between stigma and mental health.
Researchers analyzed survey responses from 1,093 male-to-female and female-to-male transgender people and assessed factors, including levels of felt stigma, status of mental health, extent to which they were out as transgender and levels of family and peer support. The study was not first in determining associations between mental health and stigma, but rather, unique in its large and diverse sample of transgender men and women. It further assessed potential factors that might moderate psychological distress within this population.
Results showed particularly high rates of depression, anxiety and somatization among members of the transgender population in which overall psychological distress existed among 40 percent of the sample. Furthermore, when asked about stigma through questions like, "Have you ever been verbally abused or harassed and thought it was because of your transgender identity or gender presentation?" or when rating their agreement with statements like, "Most people have a problem viewing transgender people as equals," enacted and felt stigma were found to be associated with psychological distress. Additionally, peer support within the transgender community was found to moderate the association between stigma and mental health. Other protective factors that could help address psychological distress among transgender persons included family support and identity pride.
The researchers conclude, "Together, these results offer support for the value of transgender individuals connecting with similar others, possibly providing the opportunity to question stigma from the majority culture and reappraise their experiences in a self-affirmative way, which is consistent with what has been postulated and observed among gay and lesbian individuals."


American Public Health Association


  1. Lola Pepe Lola Pepe United States says:

    I am a transgender woman 55 plus who has been diagnosed with a mental illness for over 20 something years. Based on my experience the challenges and barriers have been overwhelming dealing with the extreme stigma in society.  Especially, within my own LGBT community where it is still a taboo to talk about it. Maybe because of our history that has been affiliated with how society used to label us as having. I believe that it is important that peer support is critical but also there has to be proper treatment that goes hand-in-hand in order for those with a mental illness can lead a healthy and productive life.

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