Abstract
BackgroundThere are few national or cross-cultural studies of the stigma associated with mental disorders. Australia and Japan have different systems of psychiatric health care, and distinct differences in cultural values, but enjoy similar standards of living. This study seeks to compare the nature and extent of stigma among the public in the two countries.MethodsA household survey of the public was conducted in each country using similar methodologies. The Australian study comprised a national survey of 3998 adults aged over 18 years. The Japanese survey involved 2000 adults aged 20 to 69 from 25 regional sites distributed across the country. Interviewees reported their personal attitudes (personal stigma, social distance) and perceptions of the attitudes of others (perceived stigma, perceived discrimination) in the community with respect to four case vignettes. These vignettes described a person with: depression; depression with suicidal ideation; early schizophrenia; and chronic schizophrenia.ResultsPersonal stigma and social distance were typically greater among the Japanese than the Australian public whereas the reverse was true with respect to the perception of the attitudes and discriminatory behaviour of others. In both countries, personal stigma was significantly greater than perceived stigma. The public in both countries showed evidence of greater social distance, greater personal stigma and greater perceived stigma for schizophrenia (particularly in its chronic form) than for depression. There was little evidence of a difference in stigma for depression with and without suicide for either country. However, social distance was greater for chronic compared to early schizophrenia for the Australian public.ConclusionStigmatising attitudes were common in both countries, but negative attitudes were greater among the Japanese than the Australian public. The results suggest that there is a need to implement national public awareness interventions tailored to the needs of each country. The current results provide a baseline for future tracking of national stigma levels in each country.
Highlights
There are few national or cross-cultural studies of the stigma associated with mental disorders
Personal stigma Comparison between levels of stigma in Japan and Australia Table 1 presents the results from the personal stigma scale for the Australian and Japanese surveys
Australians were more likely than Japanese participants to state that others in the community would have a stigmatising attitude to the person with depression or schizophrenia. They were more likely to report that a person with depression or schizophrenia would be discriminated against by others in the community. This contrasts with the levels of personal stigma and social distance which we found were higher in Japan than Australia
Summary
There are few national or cross-cultural studies of the stigma associated with mental disorders. This study seeks to compare the nature and extent of stigma among the public in the two countries. Despite the importance of stigma, there have been few systematic national studies of the prevalence and nature of public attitudes to mental illness. One approach to better understanding stigma is to conduct comparative studies across countries that differ in the cultural contexts in which attitudes to mental illness form. A number of crosscultural comparisons of attitudes to mental illness exist (eg, [12,13,14,15,16,17,18]), but with few exceptions (eg, [19]), these studies have involved relatively small, select samples derived from a local area or specific health or educational provider or student samples. Despite the markedly different cultural contexts involved, there is little empirical data contrasting attitudes to mental illness in Asian compared to Western countries
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