stigma of mental health in the black community

One study, conducted in 2009, found that most Black women didnt have a stigma attached to mental illness. Black Mental Wellness YouTube The Black community isn't any less likely than others to develop mental illness, but Black Americans may lack the resources to get help for their psychological problems. An amendment to this paper has been published and can be accessed via the original article. PubMed 2017;45(2):80-94. doi:10.1002/jmcd.12066. We expected considerable heterogeneity among the studies for various reasons. OE and PC had the idea for the paper. At the time, I did not have the language to express what I was feeling. questionnaires which are constructed by the author for the purpose of the study) as outcome measures. This has an outsize impact on African Americans, who have amongthe lowest rates of health care insuranceof any ethnic group. 1. Part of Related issues were the racial classification and the definition of minority and/or majority statuses in this study. Some communities accept the idea that mental illnesses are health problems that require treatment. PubMed Moreover, our definitions do not capture the changes in ethnicity and minority statuses over time depending on the changing socio-political circumstances [28]. 2013;39:64661. Soc Work. The overall effect size was small but significant g=0.20 (95% CI: 0.12~0.27) indicating that racial minorities had more mental illness stigma about CMDs when compared with the majorities, with very high heterogeneity (I2=91, 95% CI: 89~93). To calculate pooled mean effect sizes, we used the computer programme Comprehensive Meta-Analysis (version 3.3070; CMA). Psychiatry Res. Oxford Textbook of Public Mental Health; 2019. p. 41121. BMJ. 2012;46:64150. Research states that one in four adults and one in ten children will experience mental health problems at some point in their life. Poor communication with health care providers is often an issue. Arch Psychiatr Nurs. When taking into account the study design, there was a high risk of bias in 18 studies (62%) and low risk of bias in 11 studies (38%). Black individuals are less frequently included in research, which means their experiences with symptoms or treatments are less likely to be taken into consideration. For many Black people, all of this is further compounded by the lack of access to mental health services in our communities. PRISMA flow chart of the study selection process. Outcomes were extracted from published reports, and meta-analyses, and meta-regression analyses were conducted in CMA software. Anyone that commits a crime or displays some type of undesired bad behavior would be stigmatized as having a mental illness or along that spectrum, which isnt necessarily true. These numbers don't lie. 2011;13:10138. schizophrenia), 3) Empirical studies without a comparison group (studies which are not comparing different racial groups were excluded), 4) Qualitative studies and 5) Publications focusing on adolescent and children sample. 2009;52(7):695712 https://doi.org/10.1080/01634370902914372. Clinical Associate Professor Ruth White explores the complex social dynamics that create hurdles to mental health care access within black communities, and proposes new approaches to destigmatization. In the African American community, mental health issues are often compounded by the psychological stress of systemic racism. Cuijpers P. Calculating and pooling effect sizes. The Black Church and Mental Health Support - JSTOR Daily 2012;36:197204. He is a professor and chairman of psychiatry at Howard University College of Medicine. The stigmatization of seeking mental health care within many Black communities is one factor. defined as those with high risk of bias scores on three and/or more categories of the risk of bias assessment tool) were excluded, the effect was sustained g=0.20 (95% CI: 0.10~0.25) and the heterogeneity was still very high (I2=88, 95% CI: 84~90) (see figure 3 in Appendix 4 for the forest plot). Eylem, O., de Wit, L., van Straten, A. et al. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Given these reasons, the results of this study must be treated with caution. I was ashamed, and my pride wouldnt let me discuss the matter with my worried co-workers. Mokkarala S, OBrien EK, Siegel JT. https://doi.org/10.1192/bjp.bp.110.082719. Further, some types of mental-illness stigma are under investigated. Culturally competent therapists and psychiatrists could help ease mistrust and provide better care. The results of the analyses are reported in Table 3, and the forest plot is given in Table 4 (see figure 2 in Appendix 3 for the forest plot). Bhui K. Social determinants of mental health. There is also growing number of studies examining the ethnic variations in stigma for CMDs in Western as well as in Non-Western countries. In: Stein D, Bass J, editors. 2008;67:43144. Givens JL, Houston TK, van Voorhees BW, Ford DE, Cooper LA. In one study, the authors recruited participants from their friends and networks of their friends which increased the chances of selection bias and restricted the representativeness of the racial groups in their sample [15]. 2021 Dec;68 (3-4):486-512. doi: 10.1002/ajcp.12516. Brown C, Conner KO, Copeland VC, Grote N, Beach S, Battista D. Depression stigma, race, and treatment seeking behavior and attitudes. Soc Psychiatry Psychiatr Epidemiol. We also conducted Eggers test of the intercept to quantify the bias captured by the funnel plot and to test whether it was significant. Discrepancies between the reviewers selections were resolved through discussions. 2007;43:43958. 's problem. For each comparison between ethnic groups in stigma, the effect size indicating the difference between groups was calculated (Hedges g). First, we run the analyses separately for the studies investigating depression only g=0.22 (95% CI: 0.10~0.34) (I2=94, 95% CI: 93~96) and for the studies investigating various types of CMDs together g=0.18 (95% CI: 0.10~0.28) (I2=86, 95% CI: 81~90). To identify outliers, we looked at whether the 95% CI of the study overlaps with the 95% CI of the pooled effects size and we also looked whether a study considerably differs from the other included studies in the metanalysis [57]. Much of the research has found that the Black community has a high degree of stigma associated with mental illness. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. The adjusted effect size (after imputation of the missing studies) was g=0.27 (95% CI: 0.20~0.33). This may be in part due to the disparities in mental health treatment.. 2002;1:1,1620. geriatric population) (N=4) and 14% recruited participants from clinical populations (N=4). 2007;7:48 https://doi.org/10.1186/1471-244X-7-48. anticipated, internalised) and/or components (e.g. As a result, African American adults are20 percent more likelyto report serious psychological distress than white adults. Two reviewers had personal accounts and selected papers independently in a random order. These barriers include lack of access to care, transportation issues, lack of trust for the providers, and stigmas that are associated with mental illness. A customised data extraction form was generated and included the following characteristics: Method of recruitment into the study (community, clinical samples or other recruitment type), target group (adults in general, older adults, student population or other target group), types of stigma perspectives, types of stigma mechanisms and types of outcome measures used to measure stigmas (self-report instruments, vignettes). The impact of stigma on an individuals life can be understood in terms of three components: 1) Experienced stigma, referring to the day-to-day experiences of stereotypes, prejudice and discrimination from others, 2) anticipated stigma, the expectation to be a target of a stereotype, prejudice or discrimination, and 3) internalised stigma, which is the application of mental illness stigma to oneself such as believing that they are dangerous to others or they are incompetent [11]. https://doi.org/10.1177/1077558709335173. by Rosie Jempson | Dec 6, 2021. Black MENtal Health | Psychology Today Google Scholar. The specific components are: stereotype, prejudice and discrimination); 2) The perspective of the stigmatized (i.e. E-mail: zcheng@uoregon.edu, Stigma for CMDs between ethnic minorities and majorities: Forest plot for all studies. (http://www.consort-statement.org/). 2017;26:37182. Google Scholar. Am J Geriatr Psychiatry. If means and standard deviations were not reported, we used the procedures of the Comprehensive Meta-Analysis software (see below) to calculate the effect size using dichotomous outcomes; and if these were not available either, we used other statistics (such as t-value or p-value) to calculate the effect size. 2011;8:e1001124. This distrust is not without merit: historically, African Americans have beenmisdiagnosed at higher ratesthan white patients, and black communities have beenexploited by the U.S. governmentandmedical communityin the name of medical advancement. https://doi.org/10.1192/bjp.184.5.386. She praises celebrities such as Jay-Z, Kerry Washington, Michelle Obama and Gabrielle Union for speaking openly about their positive experiences with therapy and counseling, hoping that these conversations will help to make mental health awareness and acceptance the cultural norm. Lee S, Juon HS, Martinez G, Hsu CE, Robinson ES, Bawa J, Ma G. Model minority at risk: expressed needs of mental health by Asian American young adults. https://doi.org/10.1186/s12889-020-08964-3, DOI: https://doi.org/10.1186/s12889-020-08964-3. Thousand Oaks: Sage Publications, Inc; 2008. https://doi.org/10.4135/9781412963947.n523. 2016;15:6773. Attitudes (Beliefs) Toward Mental Illness, Coping, and Stigma. Accessed 31 May 2018. Many experts and doctors also tested to see what had caused J.S. Often, educational campaigns do not provide evidence for the effectiveness of anti-stigma campaigns in increasing help-seeking for CMDs [69]. BMC Health Serv Res. 2016. https://doi.org/10.1080/13548506.2015.1090615. Stigma for common mental disorders in racial minorities and majorities a systematic review and meta-analysis, https://doi.org/10.1186/s12889-020-08964-3, https://doi.org/10.1016/b978-0-12-814932-4.00008-2, https://doi.org/10.1007/s00127-014-0999-5, https://doi.org/10.1080/01634370902914372, https://doi.org/10.1080/13674676.2010.497810, https://doi.org/10.1186/s12888-017-1549-y, https://doi.org/10.1186/s12889-016-2815-5, https://doi.org/10.1007/s10903-011-9463-8, https://doi.org/10.1080/13548506.2015.1090615, https://doi.org/10.1080/01488376.2013.816410, https://doi.org/10.1016/j.psychres.08.008, https://ideas.repec.org/c/boc/bocode/s449201.html, https://doi.org/10.4135/9781412963947.n523, https://doi.org/10.1192/bjp.bp.110.082719, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Google Scholar. 's genes (i.e., genetic factors). I went back to work the next day and acted as if nothing had happened. ('social stigma'/exp OR stigma*:ab,ti,kw OR 'mental health belief*':ab,ti,kw OR 'patient belief*':ab,ti,kw OR 'patients belief*':ab,ti,kw) AND ('migration'/exp OR 'migrant'/exp OR 'ethnic group'/exp OR 'minority group'/exp OR 'minority health'/exp OR 'refugee camp'/exp OR immigrant*:ab,ti,kw OR migrant*:ab,ti,kw OR ethnic*:ab,ti,kw OR minorit . Stigmas in Black Communities towards Mental Health. Bell CC, Jackson WM, Bell BH. Since there were many ethnic and religious groups in the included studies, we decided that the mutually exclusive category approach [28], re-allocating individuals in existing categories defined by the previous research [29], would be the most suitable. We conceptualised mental illness stigma based on the MISF [11]. perceived stigma). Epidemiol Psychiatr Serv. The stigma of seeking care and depression. Early research on the influence of ethnicity on the mental illness stigma indicated that compared to the White group, the non-White group perceived someone with mental illness as more dangerous [12] and expressed greater need for segregation than the White group [12]. was a typical man who enjoyed going out to dinner after work with his coworkers, and playing sports on the weekend with his friends. Psychiatry Res. 2nd ed. Much of the way African-Americans deal with mental health, or choose not to, is based on how we are socialized, says Shaun J. Fletcher, a professor at San Jose State University whose research covers health disparities among African-American men. Aust N Z J Psychiatry. But experts in genetics did find a genetic predisposition and family history of depression,and the majority of doctors concluded that J.S. The stigma surrounding mental illness in the black community is heavy as black people feel as though choosing to seek professional help, such as a therapist, is a sign of weakness. By Dana Givens Published Aug. 25, 2020 Updated April 30, 2021 I was a 22-year-old temp working for a high-profile company when I collapsed on the bathroom floor at work. OE conducted the analyses and wrote the draft of the papers. Because of J.S.s symptoms, the psychiatrist diagnosed him with depression and recommended that he enroll in treatment. Lynch HT. Tuesday, July 4, 2023. Regarding the participant characteristics, a total of 157,582 (81%) participants were from the majority racial groups and a total of 35,836 (19%) were from the minority racial groups. We expect that racial minorities have more mental illness stigma for CMDs compared to majorities. Background. This summer, between the disproportionate toll of the coronavirus on Black and Hispanic people and the social unrest associated with the Black Lives Matter movement, Black people have a new set of stresses. Even as an adult, I feared that if I went to a therapist, someone I knew would see me and tell my family and friends, so I hid in deep shame. J Gerontol Soc Work. The Impact of Stigma on Mental Health | McLean Hospital Soc Personal Psychol Compass. Steeped in Stigma. Gronholm PC, Henderson C, Deb T, Thornicroft G. Anti-stigma interventions: Theory and evidence. Oxford Textbook of Public Mental Health; 2019. p. 15973. 2003;121:3149. 2008;71(3):2108. PC and LdW contributed to the conception of the work. Reducing Suicide Stigma in the Black Community - Verywell Mind It could be that if there were more studies with low risk of bias, we might have found no racial differences in stigma for CMDs. The limitations of our study underscore the importance of investigating the intersection of race/ethnicity, degree of acculturation, presence of a mental illness diagnosis and the impact of mental health stigma. An alternative to the preceding is the multiple characteristics approach [28] taking into account the various aspects of ethnicity such as language, country of birth, nationality and religiosity [28]. fear of someone with CMDs and/or desire for social distance from an individual with CMDs) at individual and societal levels [24, 60,61,62,63]. 1 for the Prisma Flowchart). Other communities, she told me in a phone interview, have a lot longer of history of getting help. Privacy An important clinical implication of these findings would be to tailor anti-stigma strategies related with mental illnesses according to specific racial and/or ethnic backgrounds with the intention to improve mental health outreach. Furthermore, more prospective studies are needed to capture the changes in ethnic classification over time. Res Nurs Health. When the R&B artist Summer Walker revealed to fans last fall that she suffered from social anxiety, she faced criticism. Can J Psychiatr. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. You might start by talking to your doctor about treatment options. Conelly R, Gayle V, Lambert PS. Not only does it determine negative public opinion and discrimination against people with mental illnesses [7] but it also leads to not to seek or adequately participate in psychological treatment [8,9,10]. 2006;6:85762. World J Psychiatry. PDF Shining a light on mental health in Black communities When I was taken to a hospital, the doctor told me what I had experienced was a panic attack induced by severe stress. While Black Americans experience a wide range of attitudes toward mental health treatment, theres a stigma surrounding mental illness that prevents some people from getting help. Since CMDs are highly prevalent globally, it is important that psycho-social interventions focus on changing the negative stereotypes (e.g. If family members talk about a crazy uncle who had to get hospitalized, younger generations may grow to believe that having a mental illness means you cant function in society. We have decided to pool the studies together as stigmatizer perspective measuring the cognitive component of the stigma was over represented, whereas stigmatized perspective measuring how stigma was anticipated was under represented (see Table 1). Involuntary hospitalization and bias against marginalized groups. At present, recommended practices include psycho-educational campaigns aiming to improve the public knowledge on CMDs and individuals with CMDs [25, 68]. 10 Biggest Barriers To Black Mental Health Today - PsyCom At times, he would also feel completely worthless and even had thoughts about killing himself. 2015;5:15562. Google Scholar. Even though the CI of the study by Subramaniam and colleagues [22] did fall between the CI of the pooled effect sizes, the study did conceptualise stigma differently compared to the other studies. For instance, in a large scale study representative of the ethnic groups in Singapore, Subramaniam and colleagues found that, those of Indian ethnicity who also had low socio-economic status, perceived individuals with mental illness as more dangerous and unpredictable, and desired more social distance compared to those of Malay and Chinese backgrounds [22]. 2016;246:5006. Measuring inconsistency in meta-analyses. Psychiatr Serv. Social distance towards people with mental illness in southwestern Nigeria. 2010;24:4939. Further, we used multi-variate meta-regression analyses as implemented in CMA. Regarding the outcomes, (N=7) 24% used a vignette approach to measure stigmas whereas, (N=22) 76% used self-report questionnaires. Culture is the most resistant aspect to change., Dana Givens is an associate digital editor at Black Enterprise, a freelance journalist and host of the podcast Love and Passports., The Extra Stigma of Mental Illness for African-Americans, https://www.nytimes.com/2020/08/25/well/mind/black-mental-health.html, disproportionate toll of the coronavirus on Black and Hispanic people, unrest associated with the Black Lives Matter movement, Michelle Obama has said shes been dealing with low-grade depression, founded the Boris Lawrence Henson Foundation. The stigma of psychiatric disorders and the gender, ethnicity, and education of the perceiver. The results of the current meta-analysis indicate differences in mental illness stigma based on racial background and this result highlights the important role of racial and/ethnic background in shaping the mental illness stigma. Further, of all the participants from the racial minority groups, 11.30% (N=4051) were Hispanic, 57.09% (N=20,462) were Black, 23.11% (N=8285) were Asian, 9.31% (N=3338) were from other racial background. Verywell Mind's content is for informational and educational purposes only. Am Sociol Rev. Diversity and Health Equity Education. Shefer G, Rose D, Nellums L, Thornicroft G, Henderson C, Evans-Lacko SO. Rao D, Feinglass J, Corrigan P. Racial and ethnic disparities in mental illness stigma. 2007;195:10203. Latinx/Hispanic Communities and Mental Health Shamblaw AL, Botha FB, Dozois DJA. PubMed Fox AB, Taverna AC, Earnshaw VA, Vogt D. Conceptualizing and measuring mental illness stigma: the mental illness stigma framework and critical review of measures. Public stigma includes stereotypes and discrimination held by the general population. Often, there was no information about the psychometric properties of the vignettes with one exception. After many assessments, the majority of doctors were not able to come to a decision about what had caused J.S. Today, there is acritical shortage of practitionersthat disproportionately affects people of color, while prohibitive insurance and health care costs often make it more challenging for low-income individuals to access needed treatment. Mental Health in the Black Community - WebMD Eur Rev Soc Psychol. Int J Soc Psychiatry. Effect size of 0.8 was accepted as large, effect size of 0.5 was accepted as moderate and effect size of 0.2 was accepted as small [30]. Psychiatr Serv. Primary outcome was mental illness stigma defined by the MISF [11]. Stigma, as it relates to mental health, is when people who experience mental illness are viewed or view themselves in a negative light. Psychiatry. We conducted a comprehensive systematic literature search in the bibliographic databases PubMed, Embase.com and PsycINFO up to 20th December 2018, in collaboration with a medical librarian. Stigma, institutional racism, misdiagnoses, and financial hardship are just a few barriers to receiving . We are raised to believe that we have to walk outside with a tough skin at all times to survive in the world., Our culture has taught us that we do not have the privilege of being vulnerable like other communities; it has taught us to find strength in our faith. Owoo explains that many factors drive mental health disparities among Black communities, such as institutionalized racism, racial trauma, healthcare disparities, poor access to services, cultural . Understanding Mental Health in Black Communities | McLean Hospital I am incompetent) and/or discriminatory behaviours (e.g. Even though many people are affected by CMDs globally, there is a strong stigma attached to CMDs and those who have them [6]. One implication of this gap in the literature is the lack of information about the evidence base for developing culturally-relevant anti-stigma interventions [25]. Google Scholar. Cognitive (e.g. Aust N Z J Psychiatry. Its also important for mental health treatment providers to be equipped to care for individuals in the Black community. This systematic review and meta-analysis was aimed at comparing mental illness stigma associated with CMDs based on racial background. This contributes to the stigma, hostility, and lack of willingness to voluntarily seek care., Much of the research has found that the Black community has a high degree of stigma associated with mental illness. When only studies with standardized outcome measures were included, the effect size was slightly greater g=0.23 (95% CI: 0.10~0.36) and the heterogeneity remained high (I2=84, 95% CI: 75~89) (see figure 4 in Appendix 5 for the forest plot). 2002;37:4304. 2004;184:38692. As such, White said, prayer and faith are often seen as a salve for mental health woes and may be favored over formal medical treatment. When the vignette concerned an individual from a migrant background with depression, participants from migrant background expressed greater stigmatizing attitudes (e.g. Personal beliefs, attitudes and perceived anger for having a mental illness. PubMed 2004;18:17884. Wang D, Locke C, Chonody J. Internalized trauma The vignettes were developed based on the DSM criteria and the authors` clinical information of the CMDs. This is the first systematic review and meta-analysis summarizing the evidence on the impact of differences in mental illness stigma between racial minorities and majorities. It is not a topic that is talked about amongst friends or family. This requires a shift in the way we portray mental illness in film, TV shows and the media as a whole, White said. Cite this article, A Correction to this article was published on 01 September 2020. This limits our understanding of how contextual differences between continents influence the impact of mental illness stigma. Your privacy choices/Manage cookies we use in the preference centre. African American women's beliefs about mental illness, stigma, and preferred coping behaviors. For instance, the experiences of discrimination related with stigma might be different in Europe compared to America [23]. Recently, he started feeling very down and unhappy. KB, AK contributed to the interpretation of the findings. J Nerv Ment Dis. This phenomenon is known as the intersectional impact of stigma and it accounts for the underutilisation of mental health services among those who are affected [10, 63,64,65,66,67]. Link BG. Because there were many ethnic groups (e.g. MENTAL HEALTH STIGMA IN THE BLACK COMMUNITY Randl Dent, Ph.D. Health Equity Scholar Fitzhugh Mullan Institute for Health Workforce Equity George Washington University Mental Health Stigma in Black Communities: Shifting the Narrative Randl Dent, PhD A Safe Space to Dig Deep: Mental Health and Wellness in the Black Community June 30, 2020 Hickie IB, Davenport DA, Luscombe GM, Rong Y, Hickie ML, Bell MI. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Unfortunately, there are still countless barriers for the Black community when it comes to accessing care. The epidemiology of depression across cultures. Martin Luther King Jr. reportedly had severe depression during periods of his life and refused psychiatric treatment, even when urged to seek care by his staff. This would be the first of many attacks I had before I sought help for my anxiety disorder and moderate depression. There are many cultural factors, societal pressures, and stereotypes that may influence beliefs about mental health in the Black community. Parishioners worship during Sunday Mass at St. Augustine Catholic Church on August 15, 2021 in New Orleans, Louisiana. Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. The concept of race-ethnicity was defined based on the minority or majority classifications of the country of the included studies. As a woman of Nigerian descent, it's a sentiment I am all too familiar with. Springer Nature. Multivariate meta-regression analyses pointed to the possible moderating role of the number of studies with high risk of bias on the effect size. The relationship between shame and perceived biological origins of mental illness among South Asian and white American young adults. 2015;63:2919. Open conversations about mental health can help break down the stigma and encourage more people to seek help. Biometrics. Int J Epidemiol. For adolescent black girls, the suicide rate has increased 59%. Thompson-Sanders VL, Bazile A, Akbar M. African Americans' perceptions of psychotherapy and psychotherapists. Elsevier; 2019. p. 17392. 2007;18:89131. Education surrounding mental illness and normalizing mental health problems may help individuals recognize that treatment for a mental health problem doesnt have to be any more shameful than treatment for a physical health problem. 2009;29:44958. Correspondence to Conner K, Copeland VC, Grote NC, Koeske G, Reynolds CF, Brown C. Mental health treatment seeking among older adults with depression: the impact of stigma and race. J Soc Serv Res. It is important that we dont merely start the conversation but continue it by taking action, which is seeking out treatment. Individuals in the Black community likely experience distressing events that affect their mental health. These categories were: Black (African background), Asian, Hispanic (Latin American and Spanish background), Native American (referring to the indigenous people of North America), and White (Caucasian and white European) and other (people from racial-ethnic minority group who could not be identified in one of these categories). ("Social Stigma"[Mesh] OR stigma*[tiab] OR mental health belief*[tiab] OR patient belief*[tiab] OR patients belief*[tiab]) AND ("Transients and Migrants"[Mesh] OR "Emigrants and Immigrants"[Mesh] OR "Ethnic Groups"[Mesh] OR "Minority Groups"[Mesh] OR "Minority Health"[Mesh] OR "Refugees"[Mesh] OR "Refugee Camps"[Mesh] OR immigrant*[tiab] OR migrant*[tiab] OR ethnic*[tiab] OR minorit*[tiab] OR non-western[tiab] OR nonwestern[tiab] OR refug*[tiab] OR asylum[tiab]) AND ("Mental Disorders"[Mesh:noexp] OR "Stress, Psychological"[Mesh] OR "Mood Disorders"[Mesh:NoExp] OR "Anxiety Disorders"[Mesh] OR "Diagnostic and Statistical Manual of Mental Disorders"[Mesh] OR "Anxiety"[Mesh:NoExp] OR "Depression"[Mesh] OR "Depressive Disorder, Major"[Mesh] OR "Dysthymic Disorder"[Mesh] OR psychological distress[tiab] OR psychological stress[tiab] OR anxiety[tiab] OR anxieties[tiab] OR anxious[tiab] OR depress*[tiab] OR dysthymi*[tiab] OR phobi*[tiab] OR panic[tiab] OR common mental disorder*[tiab] OR "Stress Disorders, Traumatic"[Mesh:NoExp] OR "Stress Disorders, Post-Traumatic"[Mesh] OR "Stress Disorders, Traumatic, Acute"[Mesh] OR Acute Stress Disorder*[tiab] OR Post-Traumatic Stress Disorder*[tiab] OR PTSD[tiab] OR mood disorder*[tiab]), ('social stigma'/exp OR stigma*:ab,ti,kw OR 'mental health belief*':ab,ti,kw OR 'patient belief*':ab,ti,kw OR 'patients belief*':ab,ti,kw) AND ('migration'/exp OR 'migrant'/exp OR 'ethnic group'/exp OR 'minority group'/exp OR 'minority health'/exp OR 'refugee camp'/exp OR immigrant*:ab,ti,kw OR migrant*:ab,ti,kw OR ethnic*:ab,ti,kw OR minorit*:ab,ti,kw OR 'non-western':ab,ti,kw OR nonwestern:ab,ti,kw OR refug*:ab,ti,kw OR asylum:ab,ti,kw) AND ('mental disease'/de OR 'mental stress'/exp OR 'mood disorder'/de OR 'anxiety disorder'/exp OR 'diagnostic and statistical manual of mental disorders'/exp OR 'anxiety'/de OR 'depression'/de OR 'dysthymia'/exp OR 'major depression'/exp OR 'major affective disorder'/exp OR 'psychological distress':ab,ti,kw OR 'psychological stress':ab,ti,kw OR anxiety:ab,ti,kw OR anxieties:ab,ti,kw OR anxious:ab,ti,kw OR depress*:ab,ti,kw OR dysthymi*:ab,ti,kw OR phobi*:ab,ti,kw OR panic:ab,ti,kw OR 'common mental disorder*':ab,ti,kw OR 'acute stress disorder*':ab,ti,kw OR 'post-traumatic stress disorder*':ab,ti,kw OR ptsd:ab,ti,kw OR 'mood disorder*':ab,ti,kw), ( DE "Stigma" OR TI (stigma* OR "mental health belief*" OR "patient belief*" OR "patients belief*") OR AB (stigma* OR "mental health belief*" OR "patient belief*" OR "patients belief*") ) AND ( DE "Human Migration" OR DE "Refugees" OR DE "Asylum Seeking" OR DE "Immigration" OR DE "Racial and Ethnic Groups" OR DE "Minority Groups" OR TI (immigrant* OR migrant* OR ethnic* OR minorit* OR "non-western" OR nonwestern OR refug* OR asylum) OR AB (immigrant* OR migrant* OR ethnic* OR minorit* OR "non-western" OR nonwestern OR refug* OR asylum) ) AND ( DE "Mental Disorders" OR DE "Psychological Stress" OR DE "Diagnostic and Statistical Manual" OR DE "Anxiety Disorders" OR DE "Acute Stress Disorder" OR DE "Panic Disorder" OR DE "Phobias" OR DE "Post-Traumatic Stress" OR DE "Posttraumatic Stress Disorder" OR DE "Anxiety" OR DE "Affective Disorders" OR DE "Major Depression" OR DE "Dysthymic Disorder" OR DE "Depression (Emotion)" OR TI ("psychological distress" OR "psychological stress" OR anxiety OR anxieties OR anxious:ab,ti,kw OR depress* OR dysthymi* OR phobi* OR panic OR "common mental disorder*" OR "Acute Stress Disorder*" OR "Post-Traumatic Stress Disorder*" OR PTSD OR "mood disorder*") OR AB ("psychological distress" OR "psychological stress" OR anxiety OR anxieties OR anxious:ab,ti,kw OR depress* OR dysthymi* OR phobi* OR panic OR "common mental disorder*" OR "Acute Stress Disorder*" OR "Post-Traumatic Stress Disorder*" OR PTSD OR "mood disorder*") ).

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