Skip to main content

Table 1 Synthesized articles

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

Author, Year and Journal

Literature type

Sample size and study participants

Study area

Measurement tool/scale

Extracted themes from the literature

Main finding of the study

Forthal S. et al. (2019). (BMC Psychiatry)

Quantitative cross-sectional study

300 participants with severe mental illness

Community based study in Sodo district, rural South-central Ethiopia

Semi-structured operational CRITeria for research (OPCRIT) interview, discrimination and stigma scale (DISC12), brief psychiatric rating scale—expanded version (BPRS-E), The 36-item World Health Organization disability assessment schedule (WHODAS-2.0) questionnaire, alcohol use disorders identification test (AUDIT) self-reported version, Oslo 3-item social support scale (OSSS-3)

Service users’ perspectives on public stigma against people with mental illness

High level of experienced discrimination and significant difference was found between urban and rural people with schizophrenia

Tesfaw G. et al. (2020). (International journal of mental health systems)

Quantitative cross-sectional study

423 people with schizophrenia

Institution (Amanuel mental specialized hospital) based study at Addis Ababa, Urban central Ethiopia

OSSS-3, positive and negative syndrome scale (PANSS) and perceived devaluation and discrimination (PDD) Scale

Service users’ perspectives on public stigma against people with mental illness

High perceived stigma among people with schizophrenia

Girma E. et al. (2013). (PLoS One)

Quantitative cross-sectional study

845 participants from the community

Community based study at gilgel gibe field research center, rural Southwest Ethiopia

Community attitudes towards the mentally Ill (CAMI) scale,

Public perspectives on public stigma against people with mental illness

Lower stigma was related with better education and perceived explanatory causes (supernatural/psychosocial/biological) of mental illness

Girma E. et al. (2013). (International journal of mental health systems)

Quantitative cross-sectional study

422 people with severe mental illness

Institution (Jimma university specialized hospital) based study at Jimma town, Urban Southwest Ethiopia

Internalized Stigma of Mental Illness (ISMI) Scale

Service users’ perspectives on self-stigma and interventions to reduce stigma against people with mental illness

There was high feeling of inferiority but less alignment with common stereotypes about people with mental illness

Hadera E. et al. (2019). (Psychiatry Journal)

Quantitative cross-sectional study

384 outpatient service users

Institution (Jimma university specialized hospital) based study at Jimma town, Urban Southwest Ethiopia) based study

Perceived devaluation and discrimination (PDD) scale

Service users’ perspectives on public stigma against people with mental illness

Perceived prevailing stigma among outpatient mental health care service users

Reta Y. et al. (2016). (PLoS One)

Quantitative cross-sectional study

820 participants from the community

Community based study at Jimma town, Urban Southwest Ethiopia

Community attitudes toward the mentally Ill (CAMI) scale

Public perspectives on public stigma against people with mental illness

Prevailing negative attitude against people with mental illness

Hailemariam M. et al. (2017). (Int J Equity Health)

Qualitative study

50 In-depth interviews with service users, care givers and service providers in the facility and 2 FGDs (10 per group) with community service providers

Community based study in Sodo district, rural South-central Ethiopia

Interview guide was developed for countries implementing PRIME

Service users’, caregivers’ and service providers’ perspectives on public stigma against people with mental illness

Financial problems and in accessibility of mental health facility and the medication were the main barriers for the engagement to care’

Abayneh Lempp. et al. (2017). (BMC Psychiatry)

Qualitative study

39 interviews with service users, care givers, managers and policy makers/planners/service developers at national and regional level

Community based study at Butajira (rural central part of Ethiopia) and with national representatives

Interview guide was developed for Emerging mental health systems in low- and middle-income countries (Emerald) cross-country study

Service users’, caregivers’ and service providers’ perspectives on public stigma, structural stigma and intervention on stigma

Despite the increasing access of mental health care, there were barriers in relation to stigma and awareness

Hanlon C. et al. (2017). (International journal of mental health systems)

Qualitative study

17 in-depth interviews with national and regional policy makers, service developers and district level health office managers

Community based study in Sodo district, rural South-central Ethiopia

Interview guide was derived from the adapted health system governance (HSG) evaluation framework

Policy makers’ and service developers’ perspectives on structural stigma

There are improved government support and commitment to scale-up mental health care. however, the leadership and coordination among different administrative levels needs to be strengthened in addition to addressing awareness problems

Hailemariam M. et al. (2019). (International Journal of Mental Health Systems)

Quantitative cross-sectional study

369 participants with probable cases of severe mental illness

Community based study in Sodo district, rural South-central Ethiopia

Barriers to access to care evaluation (BACE-3), short explanatory model interview (SEMI), WHO 12 item Disability Assessment Schedule (WHODAS 2.0), Oslo-3 scale, alcohol use disorders identification test (AUDIT), discrimination and stigma scale (DISC-12), Brief physical impairment rating checklist (BPIRC), Washington Group’s disability measure and Work, Family and Well-being (WFW) scales

Service users’ perspectives on structural stigma, interventions to reduce stigma and impact of stigma on help-seeking of people with severe mental illness

Integrating mental health care into primary care highly improves the level of equitable contact coverage

Abayneh S. et al. (2020). (International journal of mental health systems)

Qualitative study, theory of change (ToC) development

31 participants (4 psychiatrists, 3 researchers, 24 stakeholders involved in service planning)

Community and institution-based study at sodo district (rural south-central Ethiopia) and Addis Ababa (urban central Ethiopia) respectively

ToC Maps, workshop and meeting minutes

Service providers’ and service developers’ and administers’ perspectives on structural stigma and interventions to reduce stigma

In order to mobilize and empower service users and caregivers for mental health system improvement, the service user and caregiver program level was the main intervention component identified in the ToC

Girma E. et al. (2014). (Journal of multidisciplinary healthcare)

Quantitative cross-sectional study

422 participants who were caregivers

Institution (Jimma University Specialized hospital) based study at Jimma town, Urban Southwest Ethiopia) based study

Questionnaire adopted from WHO family interview schedule stigma items and other literatures

Care givers’ perspectives on self-stigma due to family members’ mental illness

Even though the care givers’ self-stigma was found to be low, it might have an impact on help seeking behavior of people mental illness

Girma E. et al. (2014). (BMC international health and human rights)

Quantitative cross-sectional study

845 participants from the community

Community based study at gilgel gibe field research center, rural Southwest Ethiopia

Questionnaire adopted from devaluation of consumer families scale and other literatures

Care givers’ perspectives on public stigma due to family members’ mental illness

There was moderate level of perceived public stigma against family members of PWMI and it was negatively correlated with perceived symptoms and explanatory causes (supernatural/psychosocial/biological) of mental illness

Assefa D. et al. (2012). (BMC Psychiatry)

Quantitative cross-sectional study

212 individuals with schizophrenia

Institution (Amanuel Mental Specialized Hospital) based study at Addis Ababa, Urban Central Ethiopia

Internalized stigma of mental illness (ISMI) Scale and diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV)

Service users’ perspectives towards self-stigma among people with schizophrenia

Internalized stigma was indicated to be the prevailing problem among people with schizophrenia as nearly half of them had the problem

Bifftu B. B. et al. (2014). (BMC Psychiatry)

Quantitative cross-sectional study

411 individuals with schizophrenia

Institution (Amanuel mental specialized hospital) based study at Addis Ababa, Urban Central Ethiopia

Internalized stigma of mental illness (ISMI) scale

Service users’ perspectives towards self-stigma among people with schizophrenia

Low stigma resistance was reported by nearly half of the participants with schizophrenia

Zewdu S. et al. (2019). (Substance abuse treatment, prevention, and policy)

Quantitative cross-sectional study

1500 adults from the community

Community based study in Sodo district, rural South-central Ethiopia

Alcohol use disorder identification tool (AUDIT), patient health questionnaire (PHQ-9) for depression, WHO composite international diagnostic interview (CIDI), WHO disability assessment schedule (WHODAS) version 2.0, with 12 items, list of threatening experiences (LTE) questionnaire, 3-item Oslo social support (OSS) questionnaire and internalized stigma of mental illness inventory (ISMI)

Service users’ perspectives towards self-stigma among people with alcohol use disorder

The twelve-month prevalence of alcohol use disorder was 13.9% and most of whom didn’t seek medical help and had high internalized stigma

Asher L. et al. (2017). (Globalization and Health)

Qualitative study (RISE study)

35 participants (5 in-depth interviews and 5 focus group discussions) composed of people with schizophrenia, their caregivers, community leaders and primary and community service providers

Community based study in Sodo district, rural South-central Ethiopia

Used topic guide as part of rehabilitation intervention for people with schizophrenia in Ethiopia (RISE) project

Care givers’ perspectives on the impact of stigma on help-seeking behavior of people with mental illness

Physical restraint of people with schizophrenia was common practice which could restrict them from attending the needed medical care

Fekadu A. et al. (2019). (BMC Psychiatry)

Quantitative cross-sectional study

300 participants with psychosis

Community based study in Butajira, rural central part of Ethiopia

The Butajira treatment gap questionnaire (TGQ), brief psychiatric rating scale- expanded version (BPRS- E), WHO disability assessment schedule (WHODAS 2.0), Oslo 3 social support scale (OSS), Operational Criteria for Research (OPCRIT)

Service users’ perspectives towards the impact of stigma on help-seeking behavior of people with mental illness

Nearly six out of ten participants had current access gap to biomedical care, which could affect their work function and might experience discrimination

Souraya S. et al. (2018). (Globalization and Health)

Qualitative study

18 in depth interviews (people with schizophrenia, caregivers, service providers and officials) and 2 FGDs with community- based rehabilitation workers

Community based study in Sodo district, rural South-central Ethiopia

Used topic guide as part of rehabilitation intervention for people with schizophrenia in Ethiopia (RISE) project

Service users’ and caregivers’ perspectives towards the impact of stigma on help-seeking behavior of people with mental illness

It is not common practice to involve service users and care givers in decision making towards the treatment options

Girma E. and M. Tesfaye (2011). (BMC Psychiatry)

Quantitative cross-sectional study

384 participants with psychosis

Institution (Jimma University Specialized Hospital) based study at Jimma town, Urban Southwest Ethiopia

Questionnaire was developed based on WHO Encounter Form for Pathways to care and good’s pathway model

Service users’ perspectives towards the impact of stigma on help-seeking behavior of people with mental illness

There was significant delay in treatment seeking behavior among people with psychosis

Tsigebrhan R. et al. (2014). (Schizophrenia Research)

Quantitative comparative cross-sectional study

201 participants with severe mental illness

Community based study in Butajira, rural central part of Ethiopia

Questionnaire was prepared based on the macarthur violence interview, modified version of the historical, clinical and risk management (HCR-20) scale and other literatures

Service users’ perspectives towards the impact of stigma on help-seeking behavior of people with mental illness

There significantly higher level of violence and violence victimization among people with severe mental illness which alarms the need improvement in mental health care access

Tirfessa K. et al. (2020). (Tropical medicine & international health)

Quantitative controlled before-after study

239 participants with severe mental illness and 273 participants as control households

Community based study in Sodo district, rural South-central Ethiopia

Household food insecurity access scale (HFIAS), discrimination and stigma scale‐12 (DISC‐12), WHO Disability Assessment Schedule (WHODAS) 2.0 12‐item version, longitudinal interval follow‐up evaluation‐range of impaired functioning tool (LIFE‐RIFT) and 24‐item brief psychiatric rating scale‐expanded version (BPRS‐E)

Service users’ perspectives towards interventions to reduce stigma against people with mental illness

The improvement in access to mental health care led to improvement in the households’ food security of more than half of the households with people with severe mental illness

Habtamu K. et al. (2018). (Social psychiatry and psychiatric epidemiology)

Quantitative cross-sectional study

324 participants with severe mental illness

Community based study at Butajira, rural central part of Ethiopia

WHO Disability Assessment Schedule (WHODAS-2.0), Butajira functioning scale (BFS), brief psychiatric rating scale (BPRS-E), Composite International Diagnostic Interview (CIDI) substance abuse module, Mini International Neuropsychiatric Interview (MINI) Suicidality Scale, Antipsychotic Side effects Checklist (ASC), Life Chart Schedule (LCS), Internalized Stigma of Mental Illness (ISMI) scale

Service users’ perspectives towards interventions to reduce stigma against people with mental illness

Functional impairment was determined by symptom severity, poverty, medication side effects, and internalized stigma among people with severe mental illness

Asher L. et al. (2015). (PloS One)

Qualitative study

Two consecutive workshops with 8 mental health experts and 12 community leaders respectively, 16 in-depth interviews and 5 FGDs with service users (people with schizophrenia), caregivers and service providers

Intervention development work in sodo district, rural South-central Ethiopia

workshop notes, site visits and in-depth consultation, data extraction and interview guide

Service users’, care givers’ and providers’ perspectives towards interventions to reduce stigma against people with mental illness

People with schizophrenia have challenges in maintaining work function, social and family role and experienced stigma which are perceived to be addressed with culturally appropriate, acceptable and feasible community-based rehabilitation intervention

Asher L. et al. (2018). (BMC Psychiatry)

Follow up mixed method (qualitative and quantitative) pilot study

31 individuals (people with schizophrenia, caregivers, community members and service providers)

Community based pilot study at Sodo district, rural South-central Ethiopia

Used topic guide, data extraction form, and measurement scales; Discrimination and Stigma Scale-12 (DISC-12) subscale 1, Alcohol Use Disorders Identification Test (AUDIT), Patient Health Questionnaire-9 (PHQ-9), Involvement Evaluation Questionnaire (IEQ), WHO Disability Assessment Schedule (WHODAS) 2.0 and Clinical Global Impression (CGI)

Service users’, care givers’ and providers’ perspectives towards interventions to reduce stigma against people with mental illness

Community-based rehabilitation intervention was proven to be acceptable and feasible approach which should be used with the existing facility-based care for people with schizophrenia

Hanlon C. et al. (2019). (Epidemiology and psychiatric sciences)

Quantitative interventional cohort study (PRIME study)

245 participants with severe mental illness

Institution based study at Sodo district, rural South-central Ethiopia

Brief Psychiatric Rating Scale, expanded version (BPRS-E), WHO Disability Assessment Schedule (WHODAS), ‘unfair treatment’ subscale of the Discrimination and Stigma Scale-12 (DISC-12), Alcohol Use Disorder Identification Test (AUDIT), locally validated version of the Patient Health Questionnaire (PHQ-9) and three-item oslo social support scale (OSS-3)

Service users’ perspectives towards discrimination and interventions to reduce stigma against people with mental illness

Nearly less than one third of participants had received the minimum required treatment available at district level. The follow up has revealed that those who received the treatment had significant improvement in severe mental illness symptoms, disability measures, depression symptoms, discrimination, restraining, alcohol use disorder and suicidal attempt

Asher L. et al. (2021). (Lancet preprint)

Quantitative study (cluster-randomized controlled trial)

In intervention and control arm, 79 and 87 participants with schizophrenia respectively

Community based study at Sodo district, rural South-central Ethiopia

WHO Disability Assessment Schedule (WHODAS 2·0), Brief Psychiatric Rating Scale-Expanded (BPRSE) score, Clinical Global Impression (CGI), Butajira Functioning Scale score, Chart Schedule, Adapted Client Service Receipt Inventory (CSRI), Discrimination and Stigma Scale-12 (DISC-12), Involvement Evaluation Questionnaire (IEQ) and Patient Health Questionnaire-9 (PHQ-9)

Service users’ perspectives towards interventions to reduce stigma against people with mental illness

After 12 months of community based rehabilitation intervention, disability was effectively reduced. However, it didn’t found evidence on reduction stigma