Worldwide changes in self-stigma among people with mental illness from 2005 to 2023: A cross-temporal meta-analysis and systematic review.

Abstract

Background: Self-stigma in mental illness constitutes a growing public health imperative, with limited longitudinal data available to characterize its evolution over time. Here, we employed cross-temporal meta-analysis to systematically assess whether self-stigma levels have escalated, leveraging standardized measurement tools to quantify potential changes.

Methods: We searched six databases (inception to July 2024) for studies measuring self-stigma using the Internalized Stigma of Mental Illness Inventory (ISMI). Two researchers independently screened studies and extracted data. SPSS 25.0 and R 4.4.2 were used for correlation, regression, and quantification of self-stigma differences.

Results: 179 articles involving 33,046 people were identified. Self-stigma levels increased across all ISMI dimensions from 2005 to 2023 (β = 0.086-0.283), corresponding to small-to-large effect size (d = 0.30-0.89). Notably, stigma resilience increased significantly (d = 0.89), which is a noteworthy observation, suggesting a positive shift in their ability to cope with stigmatizing experiences. Subgroup analyses further revealed that people with mild mental illnesses experienced more severe and frequent self-stigma (d = 1.07-2.80) than those with severe mental illnesses (d = 0.13-1.02). Geographically, self-stigma increased in Asian regions (d > 0), while trends in other regions were mixed (d > 0 or < 0). Importantly, statistically significant differences (P^a <0.05 in ISMI and its dimensions) across illness severities and continents mental illness located further validated these subgroup findings.

Conclusions: Self-stigma within the studied age group has indeed increased from 2005 to 2023, underscoring an immediate need for intervention. Consequentially, continuous data is essential to monitor its persistence. Moreover, exploring self-stigma's social determinants to provide effective intervention strategies is necessary.