Social Psychiatry and Psychiatric Epidemiology

, Volume 53, Issue 10, pp 1099–1109 | Cite as

Psychiatric diagnosis and other predictors of experienced and anticipated workplace discrimination and concealment of mental illness among mental health service users in England

  • Yusaku Yoshimura
  • Ioannis Bakolis
  • Claire Henderson
Original Paper



This study aims to examine whether psychiatric diagnosis is associated with likelihoods of experienced and anticipated workplace discrimination and the concealment of psychiatric diagnoses.


5924 mental health service users in England were interviewed as part of the Viewpoint survey between 2009 and 2014 using the Discrimination and Stigma Scale. Associations of psychiatric diagnosis with experienced and anticipated work-related discrimination or the concealment of mental illness were examined with the use of logistic regression models.


25.6% of the participants reported experiencing discrimination in at least one work-related domain, contrasting with the 53.7% who anticipated workplace discrimination and the 72.9% who had concealed their mental illness. There was strong evidence that patients with schizophrenia and schizoaffective disorder had a decreased risk of experienced discrimination in keeping a job compared to those with depression, anxiety disorder, bipolar disorder or personality disorder. Furthermore, patients with depression were more likely to report anticipated discrimination in applying for education or training compared to those with schizophrenia and schizoaffective disorder. In addition, patients with depression were more likely to conceal their mental illness compared to those with schizophrenia and schizoaffective disorder and bipolar disorder.


This study suggests that psychiatric diagnosis is a predictor of experienced and anticipated workplace discrimination and the concealment of mental illness and that more support is needed for employees with common mental disorders and their employers to enable better workplace outcomes for this group.


Stigma Discrimination Workplace Mental health service users Disclosure 


Compliance with ethical standards

Conflict of interest

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

Supplementary material

127_2018_1561_MOESM1_ESM.docx (43 kb)
Supplementary material 1 (DOCX 42 KB)


  1. 1.
    Health and Safety Executive (2016) Self-reported work-related ill health and workplace injuries in 2015/16. Accessed 07 Aug 2017
  2. 2.
    Organisation for Economic Cooperation and Development (2014) Mental health and work: United Kingdom. OECD Publishing, Paris. Accessed 05 Aug 2017
  3. 3.
    Caron J, Mercier C, Diaz P, Martin A (2005) Socio-demographic and clinical predictors of quality of life in patients with schizophrenia or schizo-affective disorder. Psychiatry Res 15(3):203–213 137CrossRefGoogle Scholar
  4. 4.
    The Schizophrenia Commission (2012) The abandoned illness: a report by the schizophrenia commission. Accessed 05 Aug 2017
  5. 5.
    Mueser KT, Salyers MP, Mueser PR (2001) A prospective analysis of work in schizophrenia. Schizophr Bull 1(2):281–296 27(CrossRefGoogle Scholar
  6. 6.
    Macias C, DeCarlo LT, Wang Q, Frey J, Barreira P (2001) Work interest as a predictor of competitive employment: policy implications for psychiatric rehabilitation. Adm Policy Mental Health Mental Health Serv Res 28(4):279–297CrossRefGoogle Scholar
  7. 7.
    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 (2013) Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet 11(9860):55–62CrossRefGoogle Scholar
  8. 8.
    Rüsch N, Angermeyer MC, Corrigan PW (2005) Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry 20(8):529–539CrossRefGoogle Scholar
  9. 9.
    Farrelly S, Clement S, Gabbidon J, Jeffery D, Dockery L, Lassman F, Brohan E, Henderson RC, Williams P, Howard LM, Thornicroft G (2014) Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: a cross sectional study. BMC Psychiatry 29(1):157CrossRefGoogle Scholar
  10. 10.
    Brouwers EP, Mathijssen J, Van Bortel T, Knifton L, Wahlbeck K, Van Audenhove C, Kadri N, Chang C, Goud BR, Ballester D, Tófoli LF (2016) Discrimination in the workplace, reported by people with major depressive disorder: a cross-sectional study in 35 countries. BMJ Open 6(2):e009961CrossRefGoogle Scholar
  11. 11.
    Thornicroft G (2006) Shunned: discrimination against people with mental illness. Oxford University Press, OxfordGoogle Scholar
  12. 12.
    Rose D, Willis R, Brohan E, Sartorius N, Villares C, Wahlbeck K, Thornicroft GI (2011) Reported stigma and discrimination by people with a diagnosis of schizophrenia. Epidemiol Psychiatr Sci 20(2):193–204CrossRefGoogle Scholar
  13. 13.
    Üçok A, Brohan E, Rose D, Sartorius N, Leese M, Yoon CK, Plooy A, Ertekin BA, Milev R, Thornicroft G (2012) Anticipated discrimination among people with schizophrenia. Acta Psychiatr Scand 125(1):77–83CrossRefGoogle Scholar
  14. 14.
    Scheid TL. Stigma as a barrier to employment: mental disability and the Americans with disabilities act. Int J Law Psychiatry 28(6):670–90CrossRefGoogle Scholar
  15. 15.
    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(1):11CrossRefGoogle Scholar
  16. 16.
    Thornicroft G (2007) Most people with mental illness are not treated. Lancet 370(9590):807–808CrossRefGoogle Scholar
  17. 17.
    Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rüsch N, Brown JS, Thornicroft G (2015) What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med 45(1):11–27CrossRefGoogle Scholar
  18. 18.
    Walton L (2003) Exploration of the attitudes of employees towards the provision of counselling within a profit-making organisation. Couns Psychother Res 3(1):65–71CrossRefGoogle Scholar
  19. 19.
    Thompson A, Issakidis C, Hunt C (2008) Delay to seek treatment for anxiety and mood disorders in an Australian clinical sample. Behav Change 25(2):71–84CrossRefGoogle Scholar
  20. 20.
    Dell’Osso B, Glick ID, Baldwin DS, Altamura AC (2013) Can long-term outcomes be improved by shortening the duration of untreated illness in psychiatric disorders? A conceptual framework. Psychopathology 46(1):14–21CrossRefGoogle Scholar
  21. 21.
    Boonstra N, Sterk B, Wunderink L, Sytema S, De Haan L, Wiersma D (2012) Association of treatment delay, migration and urbanicity in psychosis. Eur Psychiatry 27(7):500–505CrossRefGoogle Scholar
  22. 22.
    Patrick R (2016) Living with and responding to the’scrounger’narrative in the UK: exploring everyday strategies of acceptance, resistance and deflection. J Poverty Soc Justice 24(3):245–259CrossRefGoogle Scholar
  23. 23.
    Tyler DI (2013) Revolting subjects: social abjection and resistance in neoliberal Britain. Zed Books Ltd, LondonGoogle Scholar
  24. 24.
    Henderson C, Corker E, Lewis-Holmes E, Hamilton S, Flach C, Rose D, Williams P, Pinfold V, Thornicroft G (2012) England’s time to change antistigma campaign: one-year outcomes of service user-rated experiences of discrimination. Psychiatr Serv 63(5):451–457CrossRefGoogle Scholar
  25. 25.
    Henderson C, Thornicroft G (2009) Stigma and discrimination in mental illness: time to change. Lancet 6(9679):1928–1930 373(CrossRefGoogle Scholar
  26. 26.
    Evans-Lacko S, Corker E, Williams P, Henderson C, Thornicroft G (2014) Effect of the time to change anti-stigma campaign on trends in mental-illness-related public stigma among the English population in 2003–13: an analysis of survey data. Lancet Psychiatry 1(2):121–128CrossRefGoogle Scholar
  27. 27.
    Sampogna G, Bakolis I, Evans-Lacko S, Robinson E, Thornicroft G, Henderson C (2017) The impact of social marketing campaigns on reducing mental health stigma: results from the 2009–2014 time to change programme. Eur Psychiatry 40:116–122CrossRefGoogle Scholar
  28. 28.
    Pilgrim D, Rogers AE (2005) Psychiatrists as social engineers: a study of an anti-stigma campaign. Soc Sci Med 61(12):2546–2556CrossRefGoogle Scholar
  29. 29.
    Wheat K, Brohan E, Henderson C, Thornicroft G (2010) Mental illness and the workplace: conceal or reveal? J R Soc Med 103(3):83–86CrossRefGoogle Scholar
  30. 30.
    Lockwood G, Henderson C, Thornicroft G (2012) The equality act 2010 and mental health. Br J Psychiatry 200(3):182–183CrossRefGoogle Scholar
  31. 31.
    Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M, INDIGO Study Group (2009) Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 6(9661):408–415 373(CrossRefGoogle Scholar
  32. 32.
    Lane JD, Wegner DM (1995) The cognitive consequences of secrecy. J Pers Soc Psychol 69(2):237CrossRefGoogle Scholar
  33. 33.
    Pachankis JE (2007) The psychological implications of concealing a stigma: a cognitive–affective-behavioural model. Psychol Bull 133(2):328–345CrossRefGoogle Scholar
  34. 34.
    Social Exclusion Unit (2004) Mental health and social exclusion. Office of the Deputy Prime Minister, London. Accessed 07 Aug 2017
  35. 35.
    Henderson C, Brohan E, Clement S, Williams P, Lassman F, Schauman O, Dockery L, Farrelly S, Murray J, Murphy C, Slade M (2013) Decision aid on disclosure of mental health status to an employer: feasibility and outcomes of a randomised controlled trial. Br J Psychiatry 203(5):350–357CrossRefGoogle Scholar
  36. 36.
    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):238–242CrossRefGoogle Scholar
  37. 37.
    Ellison N, Mason O, Scior K (2013) Bipolar disorder and stigma: a systematic review of the literature. J Affect Disord 151(3):805–820CrossRefGoogle Scholar
  38. 38.
    Yang LH, Anglin DM, Wonpat-Borja AJ, Opler MG, Greenspoon M, Corcoran CM (2013) Public stigma associated with psychosis risk syndrome in a college population: implications for peer intervention. Psychiatr Serv 64(3):284–288CrossRefGoogle Scholar
  39. 39.
    Goulden R, Corker E, Evans-Lacko S, Rose D, Thornicroft G, Henderson C (2011) Newspaper coverage of mental illness in the UK, 1992–2008. BMC Public Health 11(1):796CrossRefGoogle Scholar
  40. 40.
    Clement S, Foster N. Newspaper reporting on schizophrenia: a content analysis of five national newspapers at two time points. Schizophr Res 98(1):178–183CrossRefGoogle Scholar
  41. 41.
    Angermeyer MC, Beck M, Dietrich S, Holzinger A (2004) The stigma of mental illness: patients’ anticipations and experiences. Int J Soc Psychiatry 50(2):153–162CrossRefGoogle Scholar
  42. 42.
    Pyne JM, Kuc EJ, Schroeder PJ, Fortney JC, Edlund M, Sullivan G (2004) Relationship between perceived stigma and depression severity. J Nerv Ment Dis 192(4):278–283CrossRefGoogle Scholar
  43. 43.
    Freidl M, Piralic Spitzl S, Aigner M (2008) How depressive symptoms correlate with stigma perception of mental illness. Int Rev Psychiatry 20(6):510–514CrossRefGoogle Scholar
  44. 44.
    López-Micó C, Reneses B, Gallego L, Sagrario GM, Fernandez R, Huidobro Á, Reyes L, Gómez P (2016) Perceived and anticipating stigma in schizophrenia in relationship with depressive symptoms and functionality degree. Eur Psychiatry 33:S257CrossRefGoogle Scholar
  45. 45.
    Brohan E, Elgie R, Sartorius N, Thornicroft G, GAMIAN-Europe Study Group (2010) Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophr Res 122(1):232–238CrossRefGoogle Scholar
  46. 46.
    Ilic M, Reinecke J, Bohner G, Röttgers HO, Beblo T, Driessen M, Frommberger U, Corrigan PW (2013) Belittled, avoided, ignored, denied: assessing forms and consequences of stigma experiences of people with mental illness. Basic Appl Soc Psychol 35(1):31–40CrossRefGoogle Scholar
  47. 47.
    Perlick DA, Miklowitz DJ, Link BG, Struening E, Kaczynski R, Gonzalez J, Manning LN, Wolff N, Rosenheck RA (2007) Perceived stigma and depression among caregivers of patients with bipolar disorder. Br J Psychiatry 190(6):535–536CrossRefGoogle Scholar
  48. 48.
    Henderson RC, Corker E, Hamilton S, Williams P, Pinfold V, Rose D, Webber M, Evans-Lacko S, Thornicroft G (2014) Viewpoint survey of mental health service users’ experiences of discrimination in England 2008–2012. Soc Psychiatry Psychiatr Epidemiol 49(10):1599–1608CrossRefGoogle Scholar
  49. 49.
    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 Mental Health 25(4):350–358CrossRefGoogle Scholar
  50. 50.
    Corker E, Hamilton S, Robinson E, Cotney J, Pinfold V, Rose D, Thornicroft G, Henderson C (2016) Viewpoint survey of mental health service users’ experiences of discrimination in England 2008–2014. Acta Psychiatr Scand 134(S446):6–13CrossRefGoogle Scholar
  51. 51.
    Glover GR, Robin E, Emami J, Arabscheibani GR (1998) A needs index for mental health care. Soc Psychiatry Psychiatr Epidemiol 33(2):89–96CrossRefGoogle Scholar
  52. 52.
    Williams LM, Patterson JE, Miller RB (2006) Panning for gold: a clinician’s guide to using research. J Marital Fam Ther 32(1):17–32CrossRefGoogle Scholar
  53. 53.
    Brohan E, Clement S, Rose D, Sartorius N, Slade M, Thornicroft G (2013) Development and psychometric evaluation of the Discrimination and Stigma Scale (DISC). Psychiatry Res 208(1):33–40CrossRefGoogle Scholar
  54. 54.
    NHS Information Centre (2013) Mental Health Bulletin: annual report from MHMDS returns—England, 2011–12. Accessed 03 Aug 2017
  55. 55.
    Corrigan PW, Larson JE, Ruesch N (2009) Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry 8(2):75–81CrossRefGoogle Scholar
  56. 56.
    National Collaborating Centre for Mental (2014) National Institute for Health and Clinical Excellence: guidance, psychosis and schizophrenia in adults: treatment and management: updated edition. National Institute for Health and Care Excellence (UK), London. Accessed 08 Aug 2017
  57. 57.
    Becker DR, Drake RE (2003) A working life for people with severe mental illness. Oxford University Press, OxfordGoogle Scholar
  58. 58.
    Drake RE, Bond GR, Becker DR (2012) Individual placement and support: an evidence-based approach to supported employment. Oxford University Press, OxfordCrossRefGoogle Scholar
  59. 59.
    Bevan S, Gulliford J, Steadman K, Taskila T, Thomas R, Moise A (2013) Working with schizophrenia: pathways to employment, recovery & inclusion. The Work Foundation. Accessed 08 Aug 2017
  60. 60.
    Corrigan PW (1998) The impact of stigma on severe mental illness. Cognit Behav Pract 5(2):201–222CrossRefGoogle Scholar
  61. 61.
    Corrigan PW, Watson AC (2002) The paradox of self-stigma and mental illness. Clin Psychol Sci Pract 9(1):35–53CrossRefGoogle Scholar
  62. 62.
    Yanos PT, Roe D, Markus K, Lysaker PH (2008) Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatr Serv 59(12):1437–1442CrossRefGoogle Scholar
  63. 63.
    Grambal A, Prasko J, Kamaradova D, Latalova K, Holubova M, Marackova M, Ociskova M, Slepecky M (2016) Self-stigma in borderline personality disorder–cross-sectional comparison with schizophrenia spectrum disorder, major depressive disorder, and anxiety disorders. Neuropsychiatr Dis Treat 12:2439CrossRefGoogle Scholar
  64. 64.
    Schulze B (2007) Stigma and mental health professionals: a review of the evidence on an intricate relationship. Int Rev Psychiatry 19(2):137–155CrossRefGoogle Scholar
  65. 65.
    Kitson M, Martin R, Tyler P (2011) The geographies of austerity. Camb J Regions Econ Soc 4(3):289–302CrossRefGoogle Scholar
  66. 66.
    Office for national statistics (2017) UK labour market: July 2017. Office for National Statistics, Newport. Accessed 08 Aug 2017
  67. 67.
    Evans-Lacko S, Knapp M, McCrone P, Thornicroft G, Mojtabai R (2013) The mental health consequences of the recession: economic hardship and employment of people with mental health problems in 27 European countries. PloS One 8(7):e69792CrossRefGoogle Scholar
  68. 68.
    Taylor-Robinson D, Whitehead M, Barr B (2014) Great leap backwards. BMJ 349:g7350CrossRefGoogle Scholar
  69. 69.
    Wood L, Byrne R, Morrison AP (2017) An integrative cognitive model of internalized stigma in psychosis. Behav Cognit Psychother 45:1–6CrossRefGoogle Scholar
  70. 70.
    Denenny D, Thompson E, Pitts SC, Dixon LB, Schiffman J (2015) Subthreshold psychotic symptom distress, self-stigma, and peer social support among college students with mental health concerns. Psychiatr Rehabil J 38(2):164–170CrossRefGoogle Scholar
  71. 71.
    Smart L, Wegner DM (2000) The hidden costs of hidden stigma. The social psychology of stigma. Guilford Press, New York, pp 220–242Google Scholar
  72. 72.
    Corrigan PW, Kosyluk KA, Rüsch N (2013) Reducing self-stigma by coming out proud. Am J Public Health 103(5):794–800CrossRefGoogle Scholar
  73. 73.
    Hellström L, Bech P, Hjorthøj C, Nordentoft M, Lindschou J, Eplov LF (2017) Effect on return to work or education of individual placement and support modified for people with mood and anxiety disorders: results of a randomised clinical trial. Occup Environ Med 74(10):717–725CrossRefGoogle Scholar
  74. 74.
    Reme SE, Grasdal AL, Løvvik C, Lie SA, Øverland S (2015) Work-focused cognitive–behavioural therapy and individual job support to increase work participation in common mental disorders: a randomised controlled multicentre trial. Occup Environ Med 72(10):745–752CrossRefGoogle Scholar
  75. 75.
    Anfossi A (2017) The current state of recovery colleges in the UK: final report. 2017. ImROC & Nottinghamshire Healthcare NHS Foundation Trust, NottinghamGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychiatryZikei Hospital/Zikei Institute of PsychiatryOkayamaJapan
  2. 2.Department of PsychiatryKawasaki Medical Graduate SchoolKurashikiJapan
  3. 3.Health Service and Population Research DepartmentKing’s College London, Institute of Psychiatry, Psychology and NeuroscienceLondonUK
  4. 4.Biostatistics and Health Informatics DepartmentKing’s College London, Institute of Psychiatry, Psychology and NeuroscienceLondonUK

Personalised recommendations