Prevalence, risk, and protective factors of self-stigma for people living with depression: A systematic review and meta-analysis

Abstract

<h3>Background</h3><p>People living with depression are subjected to widespread stigmatization worldwide. Self-stigma may negatively affect patients' <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/therapeutic-procedure" title="Learn more about treatment from ScienceDirect's AI-generated Topic Pages">treatment</a>, recovery, and psychological well-being. This review aims to summarize and synthesize the evidence on the prevalence, risk, and protective factors of depression self-stigma.</p><h3>Methods</h3><p>Four online databases, PubMed, PsycINFO, Web of Science, and Embase, were searched to identify eligible studies. Fifty-six studies involving a total of 11,549 samples were included in the final analysis. Four reviewers independently screened the literature, extracted data, and assessed the risk of bias in eligible studies. Pearson's <em>r</em> was chosen as the effect size metric of risk and protective factors.</p><h3>Results</h3><p>The results showed that the global prevalence of depression self-stigma was 29 %. Levels of self-stigma varied across regions, but this difference was not significant. Two demographic factors were identified: ethnicity (<em>r</em> = 0.10, p < 0.05) and having a partner/married (<em>r</em> = −0.22, p < 0.001). Five risk factors were identified: depression severity (<em>r</em> = 0.33, p < 0.01), public stigma (<em>r</em> = 0.44, p < 0.001), <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/therapeutic-procedure" title="Learn more about treatment from ScienceDirect's AI-generated Topic Pages">treatment</a> stigma (<em>r</em> = 0.46, p < 0.001), perceived stigma (<em>r</em> = 0.37, p < 0.001), and enacted stigma (<em>r</em> = 0.71, p < 0.001). Five protective factors were identified: <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/quality-of-life" title="Learn more about quality of life from ScienceDirect's AI-generated Topic Pages">quality of life</a> (<em>r</em> = −0.38, p < 0.001), social relationship (<em>r</em> = −0.26, p < 0.05), self-esteem (<em>r</em> = −0.46, p < 0.001), extroversion (<em>r</em> = −0.32, p < 0.001), and social functioning (<em>r</em> = −0.49, p < 0.001).</p><h3>Limitations</h3><p>Heterogeneity was observed in some of the results. Causality cannot be inferred due to the predominance of cross-sectional designs among the included literature.</p><h3>Conclusions</h3><p>Risk and protective factors of depression self-stigma exist across many dimensions. Future research should examine the inner mechanisms and effectiveness of interventions to reduce stigma.</p>