What are the adverse effects of stigmatisation on individuals with mental illness?

The literature review will critically evaluate and examine relevant literature on the impact of stigmatisation on individuals with mental illness. In achieving this, the study will use appropriate keywords and well-designed inclusion and exclusion criteria to identify literature focusing on the stigmatisation of mental health patients. Similarly, the selected articles will be critically appraised and synthesised their evidence using a critical appraisal tool. The literature review will evaluate professional practice based on the synthesised evidence and summarise the implications for practice.
1.1 Background
Mental illness is a public health issue, and its burden faces continuous growth with considerable effects on health and significant economic, human rights and social consequences globally (World Health Organisations, 2019). In the UK, one in every four people will experience a mental health issue yearly, while one in every six people will experience a common mental health problem weekly (McManus et al., 2016). Apart from the consequences of mental illness, such individuals often struggle with a double problem. They have to cope with the symptoms of the disease, often involving hallucinations, anxiety, delusions or mood swings (Hatzenbuehler et al., 2013). These symptoms could make it challenging for mental health patients to work, live independently or attain a satisfactory quality of life. Similarly, societal misunderstanding about different mental disorders leads to stigma (Connell et al., 2012).
Stigma is a profoundly discrediting attribute that limits an individual from a usual and whole individual to a discounted and tainted one (Ahmedani, 2011). This prompted Pescosolido (2013) to define stigma as a stereotype or negative perception attributed to an individual or groups of individuals when their characteristics or behaviours are considered inferior or alien to societal norms. Jones (1984) highlighted six stigma dimensions: peril, aesthetics, origin, concealability, disruptiveness and course. While they collectively impact mental health stigmas, Ahmedani (2011) contended that they fuel three types of stigma: self-stigma, social stigma and professional stigma. While stigma has undesirable consequences for patients with mental disorders, the understanding of mental health stigmatisation underpins the labelling theory. The theory postulated that the term used to classify or describe individuals might determine or influence their behaviour or self-identify (Sjöström, 2017; Walklate, 2020). While it is associated with stereotyping, it is rooted in the symbolic interactionist perspective (Blumer, 1969). The symbolic interactionist perspective is premised on the socially-constructed meanings of social objects, highlighting that social interaction’s responses are based on assigned meanings. Mental health stigmatisation has galvanised a vast body of literature exploring the impact of stigmatisation on individuals with mental health. Understanding such impacts would enable health professionals, especially the nursing team, to fashion out different strategies to curtail mental health stigma.
1.2 Aim and Objectives
The Nursing and Midwifery Council (NMC, 2018) mandated nurses to synthesis evidence and adopts current evidence in clinical practice. While several studies explore the impacts of mental health stigmatisation, the literature review aims to critically appraise literature exploring mental health stigma. This literature review will achieve this with the following objectives:
• Synthesises evidence relating to mental health stigmatisation.
• Explores impacts of stigmatisation on individuals with mental illness.
• Identifies strategies to curb mental health stigmatisation.
1.3 Research Questions
The critical appraisal of articles and synthesis of their evidence are critical elements of systematic literature reviews (Gray and Grove, 2016). However, Crowe and Sheppard (2011) highlighted identifying related articles requires crafting a search strategy, with the research question considered its foundation. A well-formulated research question must be focused on the research theme (Gray and Grove, 2016). Although various frameworks formulate a research question, the PEO (Population, Exposure and Outcomes) framework is commonly adopted. While the literature review focuses on mental health stigmatisation, Table 1 provides the PEO framework.
Table 1: PEO Framework
PEO Framework Remarks
Population Individuals with mental illness
Exposure Stigma
Outcomes Adverse effects of stigmatisation

Thus, the research question is: What are the adverse effects of stigmatisation on individuals with mental illness?
1.4 Parameters
Keywords are extracted from a well-formulated research question. These keywords are the basic concepts related to the research theme in the research question (Schneider et al., 2016). Three keywords – adverse effects, stigmatisation, and individuals with mental illness – are identified from the research questions. However, Gray and Grove (2016) asserted that incorporating these keywords with their synonyms will ensure a comprehensive search of related research articles. Such combination yielded a holistic list of keywords, as shown in Appendix 1. These keywords are combined in the search using two Boolean operators, AND and OR. Similarly, the search is enriched using a truncation symbol * to search for keywords with multiple endings. Thus, the use of Boolean operators and the truncation symbol will lead to the following search:
(“Adverse Effect*” OR “Effect* OR “Impact*” OR “Cosequence*”) AND (“Stigmatisation” OR “Stigma” OR “Discrimination”) AND (“Individuals with mental illness” OR “People with mental disorder* OR “Mental health patient*”).
The use of inclusion and exclusion criteria enhances the search, as it provides information on the expectation of the search process (Krainovich-Miller, 2017). Appendix 2 presents the inclusion and exclusion criteria used for the search. Although technology advances have propelled various scientific databases, the articles were searched in CINAHL. It is chosen because it hosts a vast collection of nursing and general health-related articles (Bramer et al., 2017). The preliminary search generates 1167 articles. However, using inclusion criteria on CINAHL databases reduced the articles to 21 articles. Such massive reduction allows for thorough evaluation using the PRISMA guidelines, as shown in Appendix 3. Reviewing the reference sections of the 21 articles leads to identifying additional three articles. Although the abstracts of eight articles showed that they investigate mental health stigmatisation, they did not explore the impact of stigmatisation on individuals with mental health. The removal of these articles leaves 16 articles for assessment. Similarly, four articles were systematic reviews, and two other articles were correspondences to journal editors. However, they were removed for not meeting the inclusion criteria. This leaves ten articles for synthesis. While the ten articles comprise six quantitative and four qualitative articles, they are summarised in Appendix 4.

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