Submitted:
06 March 2026
Posted:
06 March 2026
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Abstract
Keywords:
1. Introduction
- Public stigma: Refers to society’s negative attitudes and discriminatory behaviours toward people with mental health problems.
- Self-stigma: Involves the internalization of those attitudes, where individuals adopt society’s negative perception of their own condition.
- Structural stigma: Includes the policies, laws, and institutional practices that perpetuate inequality and restrict rights.
- Associative stigma: Involves prejudice and discrimination toward people connected with someone who is stigmatized, such as relatives or friends.
- Stereotypes (cognitive): Socially held beliefs about mental illness (e.g., danger, weakness, incompetence).
- Prejudice (emotional): Negative emotional reactions toward the stigmatized group.
2. Materials and Methods
2.1. Study Design, Participants, and Setting
2.2. Inclusion and Exclusion Criteria
2.3. Study Variables
2.4. Measurement Instruments
2.5. Ethical Considerations
2.6. Data Analysis
3. Results
| Item | Gender | Age | Place of residence | Marital status | ||||
|---|---|---|---|---|---|---|---|---|
| Value (U) (p-value) |
d (1-β) |
Value (r) (p-value) |
d (1-β) |
Value (K) (p-value) |
d (1-β) |
Value (K) (p-value) |
d (1-β) |
|
| 2 |
19648.5 (0.006)* |
0.160 (0.735) |
- 0.005 (0.915) |
0.398 (0.820) |
2.649 (0.449) |
|||
| 7 | 18287.5 (0.123) |
0.212 (< 0.001)** |
0.460 (1.000) |
8.475 (0.014)* |
0.528 (1.000) |
3.662 (0.3) |
||
| 8 | 18058.5 (0.129) |
0.109 (0.028)* |
0.330 (0.999) |
8.949 (0.011)* |
0.310 (0.999) |
0.323 (0.956) |
||
| 12 | 15532.5 (0.132) |
0.006 (0.898) |
2.314 (0.314) |
2.137 (0.544) |
||||
| 15 | 17048 (0.803) |
0.067 (0.182) |
2.168 (0.338) |
1.626 (0.654) |
||||
| 16 |
18884 (0.02)* |
0.128 (0.515) |
0.060 (0.226) |
3.992 (0.136) |
9.236 (0.026)* |
0.439 (0.999) |
||
| 17 | 17913.5 (0.085) |
0.043 (0.392) |
0.837 (0.658) |
3.596 (0.308) |
||||
| 18 |
18717.5 (0.013)* |
0.132 (0.543) |
0.094 (0.059) |
1.644 (0.440) |
3.913 (0.271) |
|||
| 19 | 18002.5 (0.065) |
0.031 (0.540) |
2.571 (0.277) |
2.972 (0.396) |
||||
| Item | Educational level | Employment status | "Mental disorder" | Close contact | ||||
|---|---|---|---|---|---|---|---|---|
| Value (K) (p-value) |
d (1-β) |
Value (K) (p-value) |
d (1-β) |
Value (U) (p-value) |
d (1-β) |
Value (U) (p-value) |
d (1-β) |
|
| 2 |
32.766 (< 0.001)** |
0.390 (0.999) |
5.980 (0.113) |
4573.5 (< 0.001)** |
0,408 (1.000) |
15020 (< 0.001)** |
0.249 (0.989) |
|
| 7 | 5.212 (0.157) |
17.265 (< 0.001)** |
0.464 (1.000) |
6059 (0.152) |
18413.5 (0.075) |
|||
| 8 |
23.732 (< 0.001)** |
0.335 (0.999) |
6.271 (0.099) |
5644 (0.015)* |
0.275 (0.998) |
19162 (0.209) |
||
| 12 |
19.84 (< 0.001)** |
0.267 (0.971) |
15.439 (0.001)** |
0.530 (1.000) |
8009 (0.05)* |
0.184 (0.856) |
23087 (0.003)* |
0.198 (0.909) |
| 15 |
8.973 (0.03)* |
0.200 (0.764) |
3.380 (0.337) |
6170 (0.239) |
17618 (0.018)* |
0.187 (0.870) |
||
| 16 | 6.940 (0.074) |
6.417 (0.093) |
6171 (0.177) |
16452,5 (< 0.001)** |
0.212 (0.944) |
|||
| 17 |
9.439 (0.024)* |
0.316 (0.997) |
6.402 (0.094) |
6637.5 (0.451) |
18358 (0.006)* |
0.258 (0.993) |
||
| 18 |
14.847 (0.002)* |
0.379 (0.999) |
4.043 (0.257) |
5622 (0.007)* |
0.316 (0.999) |
16863 (< 0.001)** |
0.294 (0.999) |
|
| 19 | 3.003 (0.391) |
1.697 (0.638) |
6195 (0.073) |
19522.5 (0.272) |
||||
4. Discussion
5. Conclusions
- Women show lower levels of stigmatization, reflecting greater willingness for community integration.
- Older age is associated with increased stigma, while younger individuals perceive more risk.
- Married people are more likely to support community participation of people with mental health issues.
- Not having children is associated with less prejudiced attitudes regarding dangerousness and avoidance.
- A higher educational level is linked to reduced stigma and greater support for social inclusion. Additionally, less stigmatizing attitudes are found among those living in rural or semi-rural areas, as well as among economically active individuals.
- Lastly, both the personal experience of having a “mental disorder” and close contact with someone with a mental health condition promote more positive and empathetic perceptions.
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
Public Involvement Statement
Guidelines and Standards Statement
Use of Artificial Intelligence
Abbreviations
| DSM-V-TR | Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision |
| ICD-11 | International Classification of Diseases, 11th Edition |
| CAMI-S | Community Attitudes towards Mental Illness |
| IBM SPSS | International Business Machines Sta |
| SPSS | Statistical Package for the Social Sciences |
| IQR | Interquartile range |
| CEISH | Ethics Committee for Research Involving Human Subjects |
| STROBE | Strengthening the Reporting of Observational Studies in Epidemiology |
References
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR. American Psychiatric Publishing, Ed.; 5.a ed.2022.
- Mora-Tapia, N. Erving Goffman, as a conceptual framework to analyze old age stigma. Dossier. Contributions of the social sciences and feminisms to aging and interventions. Fronteras 2021, 17(2), 79-87. https://www.colibri.udelar.edu.uy/jspui/bitstream/20.500.12008/30792/1/RF_Tapia_2021n17.pdf.
- Link, B. G.; Phelan, J. C. Conceptualizing stigma. Annual Review of Sociology 2001, 27(Volume 27, 2001), 363-385. [CrossRef]
- Andersen, M. M.; Varga, S.; Folker, A. P. On the definition of stigma. Journal of Evaluation in Clinical Practice 2022, 28(5), 847-853. [CrossRef]
- Fábregas, M.; Tafur, A.; Guillén, A.; Bolaños, L.; Méndez, J. L.; Fernández de Sevilla, P. Style guide on mental health for the media: words matter. In the Spanish Mental Health Confederation. 2018. www.comunicalasaludmental.org.
- Pryor, J. B.; Reeder, G. HIV-related stigma. In B. Hall, J. Hall, & C. Cockerell (Eds.), HIV/AIDS in the Post-HAART Era: Manifestations, Treatment and Epidemiology. PMPH-USA, Ltd. 2011; pp 790-806.
- Görzig, A.; Ryan, L. N. The different faces of mental illness stigma: Systematic variation of stereotypes, prejudice and discrimination by type of illness. Scandinavian Journal of Psychology 2022, 63(5), 545. [CrossRef]
- López, M.; Laviana, M.; Fernández, L.; López, A.; Rodríguez, A. M.; Aparicio, A. The struggle against the stigma and discrimination in mental health. A complex strategy based on available data. Journal of the Spanish Association of Neuropsychiatry 2008, 28(1). https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0211-57352008000100004.
- Fox, A. B.; Earnshaw, V. A.; Taverna, E. C.; Vogt, D. Conceptualizing and Measuring Mental Illness Stigma: The Mental Illness Stigma Framework and Critical Review of Measures. Stigma and health 2018, 3(4), 348–376. [CrossRef]
- Chukwuma, O. V.; Ezeani, E. I.; Fatoye, E. O.; Benjamin, J.; Okobi, O. E.; Nwume, C. G.; Egberuare, E. N. A Systematic Review of the Effect of Stigmatization on Psychiatric Illness Outcomes. Cureus 2024, 16(6). [CrossRef]
- Mannarini, S.; Taccini, F.; Sato, I.; Rossi, A. A. Understanding stigma toward schizophrenia. Psychiatry research 2022, 318, 114970. [CrossRef]
- Martínez-Martínez, C.; Esteve-Claramunt, F.; Prieto-Callejero, B.; Ramos-Pichardo, J. D. Stigma towards Mental Disorders among Nursing Students and Professionals: A Bibliometric Analysis. International Journal of Environmental Research and Public Health 2022, 19(3), 1839. [CrossRef]
- Escrig, G.; Ortí, M. J.; Sales, A.; Martínez, N.; Renau, M. Guideline to inclusive and non-sexist language. Vice-Rectorate for Social Responsibility, Inclusive Policies and Equality. Universitat Jaume I. 2024. https://repositori.uji.es/server/api/core/bitstreams/79c1b093-0786-447b-9507-88f224d3a8ad/content.
- Taylor, S. M.; Dear, M. J. Scaling community attitudes toward the mentally ill. Schizophr Bull 1981, 7(2):225-40. [CrossRef]
- Sastre-Rus, M.; Montes-Hidalgo, J.; Lluch-Canut, M. T.; García-Lorenzo, A.; Tomás-Sábado, J. Adaptation and preliminary validation of the Spanish form of the CAMI-S (Community Attitudes towards Mental Illness) scale. Revista de Enfermería y Salud Mental 2018, 10, 5-13. [CrossRef]
- Cohen, J. Statistical Power Analysis for the Behavioral Sciences (2.a ed.). Lawrence Erlbaum Associates.1988.
- Schroeder, S.; Tan, C. M.; Urlacher, B.; Heitkamp, T. The Role of Rural and Urban Geography and Gender in Community Stigma Around Mental Illness. Health Education & Behavior 2020, 48(1), 63-73. [CrossRef]
- Dey, M.; Castro, R. P.; Jorm, A. F.; Marti, L.; Schaub, M. P.; Mackinnon, A. Stigmatizing attitudes of Swiss youth towards peers with mental disorders. PLoS ONE 2020, 15(7), e0235034. [CrossRef]
- Lo, L. L. H.; Suen, Y. N.; Chan, S. K. W.; Sum, M. Y.; Charlton, C.; Hui, C. L. M.; Lee, E. H. M.; Chang, W. C.; Chen, E. Y. H. Sociodemographic correlates of public stigma about mental illness: a population study on Hong Kong’s Chinese population. BMC psychiatry 2021, 21(1). [CrossRef]
- Schomerus, G.; Van der Auwera, S.; Matschinger, H.; Baumeister, S. E.; Angermeyer, M. C. Do attitudes towards persons with mental illness worsen during the course of life? An age-period-cohort analysis. Acta Psychiatrica Scandinavica 2015, 132(5), 357-364. [CrossRef]
- Pescosolido, B. A.; Halpern-Manners, A.; Luo, L.; Perry, B. Trends in Public Stigma of Mental Illness in the US, 1996-2018. JAMA Network Open 2021, 4(12), e2140202. [CrossRef]
- Girma, E.; Tesfaye, M.; Froeschl, G.; Möller-Leimkühler, A. M.; Müller, N.; Dehning, S. Public Stigma against People with Mental Illness in the Gilgel Gibe Field Research Center (GGFRC) in Southwest Ethiopia. PLoS ONE 2013, 8(12), e82116. [CrossRef]
- Alonso, J.; Buron, A.; Rojas-Farreras, S.; De Graaf, R.; Haro, J. M.; De Girolamo, G.; Bruffaerts, R.; Kovess, V.; Matschinger, H.; Vilagut, G.; Angermeyer, M.; Bernert, S.; Brugha, T. S.; Demyttenaere, K.; Gasquet, I.; Katz, S. J.; Kessler, R. C.; Lépine, J. P.; Ormel, J. Perceived stigma among individuals with common mental disorders. Journal of Affective Disorders 2009, 118(1-3), 180-186. [CrossRef]
- Ruiz, J. C.; Fuentes-Durá, I.; López-Gilberte, M.; Dasí, C.; Pardo-García, C.; Fuentes-Durán, M. C.; Pérez-González, F.; Salmeron, L.; Soldevila-Matías, P.; Vila-Francés, J.; Balanza-Martínez, V. (2022). Public stigma profile toward mental disorders across different university degrees in the University of Valencia (Spain). Frontiers in Psychiatry 2022, 13, 951894. [CrossRef]
- Reta, Y.; Tesfaye, M.; Girma, E.; Dehning, S.; Adorjan, K. Public Stigma against People with Mental Illness in Jimma Town, Southwest Ethiopia. PLoS ONE 2016, 11(11), e0163103. [CrossRef]
- Isbell, L. M.; Kang, S.; Barysky, G.; Quinn, G. Stigmatizing attitudes toward Disruptive Mood Dysregulation Disorder (DMDD) in parents vs. non-parents: Effects of medication and genetic etiology. PLoS ONE 2022, 17(9), e0274185. [CrossRef]
- Pescosolido, B. A.; Perry, B. L.; Martin, J. K.; McLeod, J. D.; Jensen, P. S. Stigmatizing attitudes and beliefs about treatment and psychiatric medications for children with mental illness. Psychiatric Services 2007, 58(5), 613-618. [CrossRef]
- Yuan, Q.; Picco, L.; Chang, S.; Abdin, E.; Chua, B. Y.; Ong, S.; Yow, K. L.; Chong, S. A.; Subramaniam, M. Attitudes to mental illness among mental health professionals in Singapore and comparisons with the general population. PloS ONE 2017, 12(11), e0187593. [CrossRef]
- López-López, C.; Freijeiro-Llorca, A.; Arbesú-Fernández, M. E. Evolution of the stigma towards mental health in training health specialists in Asturias. Global Nursing 2023, 22(1), 105-133. [CrossRef]
- Milin, R.; Kutcher, S.; Lewis, S. P.; Walker, S.; Wei, Y.; Ferrill, N.; Armstrong, M. A. Impact of a Mental Health Curriculum on Knowledge and Stigma among High School Students: A Randomized Controlled Trial. Journal of the American Academy of Child and Adolescent Psychiatry 2016, 55(5), 383-391.e1. [CrossRef]
| Item | Gender | Educational level | Employment status | "Mental disorder" | Close contact | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Value (U) (p-value) |
d (1-β) |
Value (K) (p-value) |
d (1-β) |
Value (K) (p-value) |
d (1-β) |
Value (U) (p-value) |
d (1-β) |
Value (U) (p-value) |
d (1-β) |
|
| 1 | 18100.5 (0.12) |
4.649 (0.199) |
0.955 (0.812) |
6277 (0.212) |
19100.5 (0.189) |
|||||
| 3 | 18483 (0.064) |
16.914 (< 0.001)** |
0.319 (0.998) |
1.406 (0.704) |
5560 (0.018)* |
0.172 (0.803) |
18273 (0.042)* |
0.149 (0.661) |
||
| 4 | 15440 (0.154) |
9.983 (0.019)* |
0.274 (0.978) |
5.735 (0.125) |
8928.5 (0.001)* |
0.317 (0.999) |
25093.5 (< 0.001)** |
0.304 (0.999) |
||
| 5 |
14069.5 (0.008)* |
0.158 (0.719) |
13.633 (0.003)* |
0.330 (0.999) |
6.548 (0.088) |
8896.5 (0.003)* |
1.187 (1.000) |
24563.5 (< 0.001)** |
0.222 (0.963) |
|
| 6 | 14989 (0.075) |
16.773 (< 0.001)** |
0.306 (0.995) |
4.147 (0.246) |
8136.5 (0.069) |
24369 (< 0.001)** |
0.196 (0.903) |
|||
| 13 |
13558.5 (0.001)* |
0.170 (0.788) |
24.387 (< 0.001)** |
0.332 (0.999) |
16.179 (0.001)* |
0.409 (0.999) |
8334 (0.029)* |
0.186 (0.867) |
25150.5 (< 0.001)** |
0.300 (0.999) |
| 14 |
19352.5 (0.007)* |
0.179 (0.837) |
17.411 (< 0.001)** |
0.417 (0.999) |
2.697 (0.441) |
5312.5 (0.007)* |
0.195 (0.900) |
17206 (0.003)* |
0.178 (0.829) |
|
| Item | Gender | Age | Children | Educational level | Employment status | "Mental disorder" | Close contact | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Value (U) (p-value) |
d (1-β) |
Value (r) (p-value) |
d (1-β) |
Value (U) (p-value) |
d (1-β) |
Value (K) (p-value) |
d (1-β) |
Value (K) (p-value) |
d (1-β) |
Value (U) (p-value) |
d (1-β) |
Value (U) (p-value) |
d (1-β) |
|
| 9 |
19607 (0.005)* |
0.164 (0.757) |
- 0.013 (0.792) |
22873 (0.026)* |
0.141 (0.605) |
23.186 (< 0.001)** |
0.297 (0.993) |
6.807 (0.078) |
5721.5 (0.057) |
16023.5 (< 0.001)** |
0.214 (0.949) |
|||
| 10 | 15438 (0.095) |
0.072 (0.147) |
18565.5 (0.04)* |
0.129 (0.525) |
28.555 (< 0.001)** |
0.305 (0.995) |
7.031 (0.071) |
7934.5 (0.06) |
22739 (0.007)* |
0.188 (0.874) |
||||
| 11 |
14433.5 (0.018)* |
0.124 (0.487) |
- 0.097 (0.05)* |
0.311 (0.999) |
19447.5 (0.385) |
6.262 (0.1) |
2.201 (0.532) |
8674 (0.007)* |
0.179 (0.836) |
23681.5 (0.002)* |
0.161 (0.739) |
|||
| 20 | 16075.5 (0.337) |
0.090 (0.071) |
18660 (0.034)* |
0.469 (1.000) |
27.667 (< 0.001)** |
0.589 (1.000) |
14.154 (0.003)* |
0.278 (0.982) |
8121 (0.015)* |
0.323 (0.999) |
22695.5 (0.004)* |
0.453 (1.000) |
||
| Variable | Coefficient (β) | Standard Error | p-value |
|---|---|---|---|
| Constant (Total) | 85.001 | 2.518 | < 0.001 |
| Gender (Woman) | 2.523 | 1.205 | 0.037 |
| Educational level (Secondary and University) | 5.061 | 1.604 | 0.002 |
| “Mental disorder” (Yes) | 4.535 | 1.831 | 0.014 |
| Close contact (Yes) | 4.183 | 1.123 | < 0.001 |
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