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Adults with depression report widespread discrimination

Lancet 2012; doi:10.1016/S0140-6736(12)61379-8 A survey of depressed adults from 35 countries suggests that discrimination is a common experience worldwide. Just under four fifths of the 1082 respondents (79%) reported discrimination in at least one area of their lives, most commonly their social and family lives or in the workplace. A third of respondents said they had been shunned by others because of their mental illness (34%). Fear of discrimination was also common and had prevented a third of respondents from embarking on a close personal relationship (37%), a quarter from applying for a job (25%), and a fifth from applying for education or training (20%). Researchers surveyed convenience samples of adults attending specialist mental health services, so these figures are not true prevalence rates, say the authors. But they are worrying and suggest levels of discrimination only slightly lower than those experienced by people with schizophrenia. The adults had a mean age of 45 years and had been in touch with mental health services for a mean of 10 years. Two thirds were women. In a series of cross sectional analyses, the researchers found significant associations between reported discrimination and poor social functioning, unwillingness to disclose the diagnosis, a higher number of depressive episodes, and inpatient treatment. It is impossible to know which direction these associations are operating in, however, and a linked comment calls for prospective longitudinal studies to try to find out (doi:10.1016/ S0140-6736(12)61457-3). Only then will we be able to develop effective ways to reduce discrimination and the fear of discrimination in all domains of life.