Experience of stigma among mental health service users in Hong Kong: Are there changes between 2001 and 2017?

BACKGROUND:: Public expenditure on mental health education has grown exponentially in the past two decades. Does the experience of stigma among people with mental health problems improve over time? Our study aims to compare the levels of perceived stigmatization, rejection experiences and stigma-coping among mental health service users in Hong Kong between 2001 and 2017 using longitudinal and repeated cross-sectional study design.

METHOD:: The baseline survey was completed by 193 psychiatric outpatients in 2001. They were traced for re-assessment in 2017. Another sample of 193 outpatients matched in age, gender and psychiatric diagnosis was recruited in 2017 for cross-sectional comparison. Participants completed a 39-item questionnaire on stigma experiences, Beck Depression Inventory and Disability Assessment Schedule at both time points.

RESULTS:: In total, 109 of 193 participants (56.5%) of the 2001 survey were re-assessed. No significant change in perceived stigmatization, rejection experiences and stigma-coping was found among the 109 participants interviewed in 2001 and 2017. For cross-sectional comparison, significant differences in two perceived stigma items were observed upon Bonferroni correction (chi-square test, p < .005) and remained significant after controlling for confounding factors by regression analysis. Improvements in perceived stigmatization were on marriage and friendship, while viewpoints on trustworthiness, dangerousness, devaluation, avoidance and personal failure remained unchanged, and there was no improvement in rejection experiences and stigma-coping.

CONCLUSION:: Positive attitude changes over time are unlikely to occur if there is no targeted intervention on stigma. Our findings highlight that evidence-based antistigma interventions are urgently needed.