Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 11, pp 1391–1410 | Cite as

Geographic distribution and determinants of mental health stigma in central Mozambique

  • Yue ZhangEmail author
  • Orvalho Augusto
  • Kristjana Ásbjörnsdóttir
  • Adam Akullian
  • Vasco Cumbe
  • Deepa Rao
  • Sarah Gimbel
  • Kenneth Sherr
  • Bradley H. Wagenaar
  • with input from the INCOMAS Study Team
Original Paper



This study describes patterns of community-level stigmatizing attitudes towards mental illness (MI) in central Mozambique.


Data for this study come from a representative community household survey of 2933 respondents ≥ 18 years old in Manica and Sofala Provinces, Mozambique. Six MI stigma questions represented primary research outcomes. Bivariate and multivariable analyses examined the relationship between key explanatory factors and each stigma question. Spatial analyses analyzed the smoothed geographic distribution of responses to each question and explored the association between geographic location and MI stigma controlling for individual-level socio-demographic factors.


Stigmatizing attitudes towards MI are prevalent in central Mozambique. Analyses showed that males, people who live in urban places, divorced and widowed individuals, people aged 18–24, people with lower education, people endorsing no religion, and people in lower wealth quintiles tended to have significantly higher levels of stigmatizing attitudes towards MI. Individuals reporting depressive symptoms scored significantly higher on stigmatizing questions, potentially indicating internalized stigma. Geographic location is significantly associated with people’s response to five of the stigma questions even after adjusting for individual-level factors.


Stigmatizing attitudes towards MI are common in central Mozambique and concentrated amongst specific socio-demographic groups. However, geographic analyses suggest that structural factors within communities and across regions may bear a greater influence on MI stigma than individual-level factors alone. Further implementation science should consider focusing on identifying the most significant modifiable structural factors associated with MI stigma in LMICs to inform the development, testing, and optimization of multi-level stigma prevention interventions.


MI stigma Geographic information systems Spatial analysis Determinants of stigma Mozambique 



INCOMAS Study Team includes João Luis Manuel, Leecreesha Hicks, Arlete Mahumane, James Pfeiffer, Stephen Gloyd, Fatima Cuembelo, Miguel Nhumba, Joaquim Lequechane, Alfredo Covele, Manuel Napua, Lucia Vieira, Nelia Manaca, Falume Chale, Alberto Muanido, and Cathy Michel.

Author contributions

BHW and YZ conceived the idea and analyzed the data. YZ wrote the initial draft of the paper under mentorship by BHW. VC, AA, OA, KA, SG, DR, and KS provided creative input on analyses and paper writing. All authors approved the final submitted manuscript.


This study was supported by the African Health Initiative of the Doris Duke Charitable Foundation. BHW was supported by grant number K01MH110599 from the US National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with ethical standards

Ethical approval

This study was approved by the Institutional Review Board of the National Institute of Health in Mozambique.

Conflict of interest

The authors report no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Global HealthUniversity of WashingtonSeattleUSA
  2. 2.Health Alliance InternationalSeattleUSA
  3. 3.Universidade Eduardo MondlaneMaputoMozambique
  4. 4.Institute for Disease ModelingBellevueUSA
  5. 5.Mozambique Ministry of HealthMaputoMozambique
  6. 6.Department of Family and Child NursingUniversity of WashingtonSeattleUSA
  7. 7.Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleUSA
  8. 8.Department of EpidemiologyUniversity of WashingtonSeattleUSA

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