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Mental health stigma and discrimination in Ethiopia: evidence synthesis to inform stigma reduction interventions

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Eshetu Girma, Bezawit Ketema, Tesfahun Mulatu, Brandon A Kohrt, Syed Shabab Wahid, Eva Heim, Petra C Gronholm, Charlotte Hanlon, Graham Thornicroft

Original languageEnglish
Article number30
Pages (from-to)30
JournalInternational Journal of Mental Health Systems
Volume16
Issue number1
DOIs
Published23 Jun 2022

Bibliographical note

Funding Information: BAK is supported by the U.S. National Institute of Mental Health (R01MH120649). GT is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King’s College London NHS Foundation Trust. CH, AA, and GT are funded through the ASSET research programme, supported by the UK's National Institute of Health Research (NIHR) using Official Development Assistance (ODA) funding (NIHR Global Health Research Unit on Health Systems Strengthening in Sub-Saharan Africa at King's College London (16/136/54)). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care, England. CH also receives support from AMARI as part of the DELTAS Africa Initiative [DEL- [15-01]. GT is also supported by the Guy’s and St Thomas’ Charity for the On Trac project (EFT151101), and by the UK Medical Research Council (UKRI) in relation to the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards. PCG is supported by the UK Medical Research Council in relation to the Indigo Partnership (MR/R023697/1) award. Funding Information: BAK is supported by the U.S. National Institute of Mental Health (R01MH120649). GT is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King’s College London NHS Foundation Trust. CH, AA, and GT are funded through the ASSET research programme, supported by the UK's National Institute of Health Research (NIHR) using Official Development Assistance (ODA) funding (NIHR Global Health Research Unit on Health Systems Strengthening in Sub-Saharan Africa at King's College London (16/136/54)). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care, England. CH also receives support from AMARI as part of the DELTAS Africa Initiative [DEL- [15-01]. GT is also supported by the Guy’s and St Thomas’ Charity for the On Trac project (EFT151101), and by the UK Medical Research Council (UKRI) in relation to the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards. PCG is supported by the UK Medical Research Council in relation to the Indigo Partnership (MR/R023697/1) award. Publisher Copyright: © 2022, The Author(s).

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Abstract

BACKGROUND: People with mental illnesses are at an increased risk of experiencing human rights violations, stigma and discrimination. Even though mental health stigma and discrimination are universal, there appears to be a higher burden in low- and middle-income countries. Anti-stigma interventions need to be grounded in local evidence. The aim of this paper was to synthesize evidence on mental health stigma and discrimination in Ethiopia to inform the development of anti-stigma interventions.

METHODS: This evidence synthesis was conducted as a part of formative work for the International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership research program. Electronic searches were conducted using PubMed for scientific articles, and Google Search and Google Scholar were used for grey literature. Records fulfilling eligibility criteria were selected for the evidence synthesis. The findings were synthesized using a framework designed to capture features of mental health stigma to inform cultural adaptation of anti-stigma interventions.

RESULTS: A total of 37 records (2 grey literature and 35 scientific articles) were included in the evidence synthesis. Some of these records were described more than once depending on themes of the synthesis. The records were synthesized under the themes of explanatory models of stigma (3 records on labels and 4 records on symptoms and causes), perceived and experienced forms of stigma (7 records on public stigma, 6 records on structural stigma, 2 records on courtesy stigma and 4 records on self-stigma), impact of stigma on help-seeking (6 records) and interventions to reduce stigma (12 records). Only two intervention studies assessed stigma reduction- one study showed reduced discrimination due to improved access to effective mental health care, whereas the other study did not find evidence on reduction of discrimination following a community-based rehabilitation intervention in combination with facility-based care.

CONCLUSION: There is widespread stigma and discrimination in Ethiopia which has contributed to under-utilization of available mental health services in the country. This should be addressed with contextually designed and effective stigma reduction interventions that engage stakeholders (service users, service providers, community representatives and service developers and policy makers) so that the United Nations universal health coverage goal for mental health can be achieved in Ethiopia.

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