Predictors of experiences of discrimination and positive treatment in people with mental health problems: findings from an Australian national survey

  • Nicola J. ReavleyEmail author
  • Amy J. Morgan
  • Anthony F. Jorm
Original Paper



The aim of the study was to assess the factors predicting experiences of avoidance, discrimination and positive treatment in people with mental health problems.


In 2014, telephone interviews were carried out with 5220 Australians aged 18+, 1381 of whom reported a mental health problem or scored highly on a symptom screening questionnaire. Questions covered experiences of avoidance, discrimination and positive treatment by friends, spouse, other family, workplace, educational institution and others in the community; as well as disclosure of mental health problems. Avoidance, discrimination and positive treatment scores were calculated by counting the number of domains in which each occurred. Predictors of avoidance, discrimination and positive treatment were modelled with negative binomial regression analyses.


After adjusting for the effects of other predictors in multivariate analyses, symptom severity and a diagnosis of ‘any other disorder’ (most commonly psychotic disorders or eating disorders) predicted experiences of both avoidance and discrimination but not positive treatment. Disclosing a mental health problem in more settings was also associated with higher rates of avoidance and discrimination, but also with positive treatment.


Disclosure of mental health problems to others may increases experiences of discrimination, but may also increase experiences of positive treatment. These findings can help to inform decision making by people with mental health problems about disclosure, particularly in the case of more severe or low-prevalence disorders.


Mental disorders Discrimination Stigma Positive treatment Disclosure 


Compliance with ethical standards


The study was funded by the National Health and Medical Research Council.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Corrigan P (2004) How stigma interferes with mental health care. Am Psychol 59(7):614–625CrossRefPubMedGoogle Scholar
  2. 2.
    Wells JE, Robins LN, Bushnell JA, Jarosz D, Oakley-Browne MA (1994) Perceived barriers to care in St. Louis (USA) and Christchurch (NZ): reasons for not seeking professional help for psychological distress. Soc Psychiatry Psychiatr Epidemiol 29(4):155–164PubMedGoogle Scholar
  3. 3.
    Link BG, Struening EL, Rahav M, Phelan JC, Nuttbrock L (1997) On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. J Health Soc Behav 38(2):177–190CrossRefPubMedGoogle Scholar
  4. 4.
    World Health Organisation (2001) The World Health Report: mental health: new understanding, new hope. World Health Organisation, GenevaGoogle Scholar
  5. 5.
    Thornicroft G, Brohan E, Kassam A, Lewis-Holmes E (2008) Reducing stigma and discrimination: candidate interventions. Int J Ment Health Syst 2(1):3. doi: 10.1186/1752-4458-2-3 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Reavley NJ, Jorm AF (2011) Stigmatizing attitudes towards people with mental disorders: findings from an Australian National Survey of Mental Health Literacy and Stigma. Aust N Z J Psychiatry 48(12):1086–1093CrossRefGoogle Scholar
  7. 7.
    Reavley NJ, Jorm AF (2011) Young people’s stigmatizing attitudes towards people with mental disorders: findings from an Australian national survey. Aust N Z J Psychiatry 45(12):1033–1039. doi: 10.3109/00048674.2011.614216 CrossRefPubMedGoogle Scholar
  8. 8.
    Jorm AF, Oh E (2009) Desire for social distance from people with mental disorders. Aust N Z J Psychiatry 43(3):183–200. doi: 10.1080/00048670802653349 CrossRefPubMedGoogle Scholar
  9. 9.
    Jorm AF, Reavley NJ, Ross AN (2012) Belief in the dangerousness of people with mental disorders: a review. Aust N Z J Psychiatry 46(11):1029–1045. doi: 10.1177/0004867412442406 CrossRefPubMedGoogle Scholar
  10. 10.
    Angermeyer MC, Beck M, Dietrich S, Holzinger A (2004) The stigma of mental illness: patients’ anticipations and experiences. Int J Soc Psychiatry 50(2):153–162CrossRefPubMedGoogle Scholar
  11. 11.
    Lasalvia A, Zoppei S, Van Bortel T, Bonetto C, Cristofalo D, Wahlbeck K, Bacle SV, Van Audenhove C, van Weeghel J, Reneses B, Germanavicius A, Economou M, Lanfredi M, Ando S, Sartorius N, Lopez-Ibor JJ, Thornicroft G (2013) Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet 381(9860):55–62. doi: 10.1016/S0140-6736(12)61379-8 CrossRefPubMedGoogle Scholar
  12. 12.
    Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M (2009) Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 373(9661):408–415. doi: 10.1016/S0140-6736(08)61817-6 CrossRefPubMedGoogle Scholar
  13. 13.
    Wahl OF (1999) Mental health consumers’ experience of stigma. Schizophr Bull 25(3):467–478CrossRefPubMedGoogle Scholar
  14. 14.
    Alonso J, Buron A, Bruffaerts R, He Y, Posada-Villa J, Lepine JP, Angermeyer MC, Levinson D, de Girolamo G, Tachimori H, Mneimneh ZN, Medina-Mora ME, Ormel J, Scott KM, Gureje O, Haro JM, Gluzman S, Lee S, Vilagut G, Kessler RC, Von Korff M, World Mental Health C (2008) Association of perceived stigma and mood and anxiety disorders: results from the World Mental Health Surveys. Acta Psychiatr Scand 118(4):305–314. doi: 10.1111/j.1600-0447.2008.01241.x CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Baldwin ML, Marcus SC (2006) Perceived and measured stigma among workers with serious mental illness. Psychiatr Serv 57(3):388–392. doi: 10.1176/ CrossRefPubMedGoogle Scholar
  16. 16.
    Stuart H, Patten SB, Koller M, Modgill G, Liinamaa T (2014) Stigma in Canada: results from a rapid response survey. Can J Psychiatry 59(10 Suppl 1):S27–S33PubMedPubMedCentralGoogle Scholar
  17. 17.
    Reavley NJ, Jorm AF (2015) Experiences of discrimination and positive treatment in people with mental health problems: findings from an Australian national survey. Aust N Z J Psychiatry 49(10):906–913CrossRefPubMedGoogle Scholar
  18. 18.
    Hamilton S, Corker E, Weeks C, Williams P, Henderson C, Pinfold V, Rose D, Thornicroft G (2016) Factors associated with experienced discrimination among people using mental health services in England. J Ment Health. doi: 10.3109/09638237.2016.1139068 PubMedGoogle Scholar
  19. 19.
    Farrelly S, Clement S, Gabbidon J, Jeffery D, Dockery L, Lassman F, Brohan E, Henderson RC, Williams P, Howard LM, Thornicroft G, group Ms (2014) Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: a cross sectional study. BMC Psychiatry 14:157. doi: 10.1186/1471-244X-14-157 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Cechnicki A, Angermeyer MC, Bielanska A (2011) Anticipated and experienced stigma among people with schizophrenia: its nature and correlates. Soc Psychiatry Psychiatr Epidemiol 46(7):643–650. doi: 10.1007/s00127-010-0230-2 CrossRefPubMedGoogle Scholar
  21. 21.
    Corker EA, Beldie A, Brain C, Jakovljevic M, Jarema M, Karamustafalioglu O, Marksteiner J, Mohr P, Prelipceanu D, Vasilache A, Waern M, Sartorius N, Thornicroft G, Group FS (2015) Experience of stigma and discrimination reported by people experiencing the first episode of schizophrenia and those with a first episode of depression: The FEDORA project. Int J Soc Psychiatry 61(5):438–445. doi: 10.1177/0020764014551941 CrossRefPubMedGoogle Scholar
  22. 22.
    Dickerson FB, Sommerville J, Origoni AE, Ringel NB, Parente F (2002) Experiences of stigma among outpatients with schizophrenia. Schizophr Bull 28(1):143–155CrossRefPubMedGoogle Scholar
  23. 23.
    Alonso J, Buron A, Rojas-Farreras S, de Graaf R, Haro JM, de Girolamo G, Bruffaerts R, Kovess V, Matschinger H, Vilagut G (2009) Perceived stigma among individuals with common mental disorders. J Affect Disord 118(1–3):180–186. doi: 10.1016/j.jad.2009.02.006 CrossRefPubMedGoogle Scholar
  24. 24.
    Bos AE, Kanner D, Muris P, Janssen B, Mayer B (2009) Mental illness stigma and disclosure: consequences of coming out of the closet. Issues Ment Health Nurs 30(8):509–513. doi: 10.1080/01612840802601382 CrossRefPubMedGoogle Scholar
  25. 25.
    Pandya A, Bresee C, Duckworth K, Gay K, Fitzpatrick M (2011) Perceived impact of the disclosure of a schizophrenia diagnosis. Community Ment Health J 47(6):613–621. doi: 10.1007/s10597-010-9341-1 CrossRefPubMedGoogle Scholar
  26. 26.
    Kessler RC, Green JG, Gruber MJ, Sampson NA, Bromet E, Cuitan M, Furukawa TA, Gureje O, Hinkov H, Hu CY, Lara C, Lee S, Mneimneh Z, Myer L, Oakley-Browne M, Posada-Villa J, Sagar R, Viana MC, Zaslavsky AM (2010) Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO World Mental Health (WMH) survey initiative. Int J Methods Psychiatr Res 19(Suppl 1):4–22. doi: 10.1002/mpr.310 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Morgan AJ, Reavley NJ, Jorm AF, Beatson R (2016) Experiences of discrimination and positive treatment from health professionals: a national survey of adults with mental health problems. Aust N Z J Psychiatry 50(8):754–762. doi: 10.1177/0004867416655605 CrossRefPubMedGoogle Scholar
  28. 28.
    Reavley NJ, Morgan AJ, Jorm AF (2016) Discrimination and positive treatment towards people with mental health problems in workplace and education settings: Findings from an Australian national survey. Stigma and Health (in press) Google Scholar
  29. 29.
    Brohan E, Henderson C, Wheat K, Malcolm E, Clement S, Barley EA, Slade M, Thornicroft G (2012) Systematic review of beliefs, behaviours and influencing factors associated with disclosure of a mental health problem in the workplace. BMC Psychiatry 12:11. doi: 10.1186/1471-244X-12-11 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Brohan E, Henderson C, Slade M, Thornicroft G (2014) Development and preliminary evaluation of a decision aid for disclosure of mental illness to employers. Patient Educ Couns 94(2):238–242. doi: 10.1016/j.pec.2013.10.008 CrossRefPubMedGoogle Scholar
  31. 31.
    Angermeyer MC, Matschinger H, Corrigan PW (2004) Familiarity with mental illness and social distance from people with schizophrenia and major depression: testing a model using data from a representative population survey. Schizophr Res 69(2–3):175–182CrossRefPubMedGoogle Scholar
  32. 32.
    Lauber C, Nordt C, Falcato L, Rossler W (2004) Factors influencing social distance toward people with mental illness. Community Ment Health J 40(3):265–274CrossRefPubMedGoogle Scholar
  33. 33.
    Ebneter DS, Latner JD (2013) Stigmatizing attitudes differ across mental health disorders: a comparison of stigma across eating disorders, obesity, and major depressive disorder. J Nerv Ment Dis 201(4):281–285. doi: 10.1097/NMD.0b013e318288e23f CrossRefPubMedGoogle Scholar
  34. 34.
    Roehrig JP, McLean CP (2010) A comparison of stigma toward eating disorders versus depression. Int J Eat Disord 43(7):671–674. doi: 10.1002/eat.20760 CrossRefPubMedGoogle Scholar
  35. 35.
    Clement S, Williams P, Farrelly S, Hatch SL, Schauman O, Jeffery D, Henderson RC, Thornicroft G (2015) Mental health-related discrimination as a predictor of low engagement with mental health services. Psychiatr Serv 66(2):171–176. doi: 10.1176/ CrossRefPubMedGoogle Scholar
  36. 36.
    Curtin R, Presser S, Singer E (2005) Changes in telephone survey non-response over the past quarter century. Public Opin Q 69:87–98CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Centre for Mental Health, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
  2. 2.School of Psychology and Public HealthLa Trobe UniversityBundooraAustralia

Personalised recommendations