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Table 3 Main Findings of Cultural Factors in the Reviewed Studies

From: Stigma of mental illness and cultural factors in Pacific Rim region: a systematic review

Author, year Main findings
Tsang et al., 2007 [34] Chinese employers were more likely to perceive that people with mental illness would exhibit a weaker work ethic and less loyalty to the company.
Tanaka et al., 2018 [35] Fatalism could help PMHP to remain hopeful. In addition, traditional communal unity alleviated some of the social exclusion associated with stigma.
Chiu et al., 2013 [17] Chinese caregiving was characterized by a lack of formal support, and such cultural concerned as loss of face and strong affiliated stigma.
Mirza et al.,2019 [12] South Asians reported higher beliefs in supernatural causes of psychosis than White British.
Mak et al., 2015 [18] Role of face concerned in affecting self-stigma and mental health among Chinese with substance use problems
Yang et al., 2007 [53] Stigma exerted its core effects by threatening the loss or diminution of what is most at stake, or by actually diminishing or destroying that lived value.
Fancher et al., 2010 [36] Four themes: (1) Stigma and face; (2) Social functioning and the role of the family; (3) Traditional healing and beliefs about medications; and (4) Language and culture.
WonPat-Borja et al., 2012 [19] Chinese Americans endorsed all four eugenic statements more strongly than European Americans
Luo et al., 2018 [37] Low levels of social acceptance of individuals with mental illness among medical students in China were largely related to fears of violence of and loss of face.
Chen et al., 2013 [38] Participants commonly suffered from stigma after disclosure. However, half of our participants reported situations where they experienced little discriminatory treatment and some experienced support and care as a result of cultural dynamics.
Abdullah & Brown, 2011 [11] Cultural values are important with regard to stigma, particularly for Asian Americans and African Americans.
Han et al., 2017 [39] The study findings revealed stigmatized beliefs (e.g., being dangerous, out of control, and abnormal) and behaviors (e.g., social distance) toward people with mental illness, as well as cultural values that reinforced the stigma in the Korean-immigrant community.
Yang, 2015 [48] Caregivers with higher face concern were more likely to internalize feelings of shame, self-blame and powerlessness and suffered poorer mental health.
Mak & Cheung, 2012 [20] Affiliate stigma was found to serve as a partial mediator between face concern and care- giver distress and a full mediator between face concern and subjective burden.
Ramli et al., 2017 [40] Most Malay caregivers experienced the stigma around mental health problems regardless of the type of mental illness.
Chiu et al., 2015 [21] The mediating role of affective stigma was confirmed.
Mascayano et al., 2015 [41] A key feature shaping stigma among females was the loss of ability to fulfill family roles (i.e. take care of children). For males, cultural value of ‘Machismo’ kept them from disclosing their psychiatric diagnosis as a means to maintain social status. This is attribute to ‘Familismo’.
Griffiths et al., 2006 [22] Personal stigma and social distance were considerably greater among the Japanese than the Australian public, which is connected to the perception of the attitudes and discriminatory behavior of others.
Hanzawa, 2012 [54] persons with mental illness had greater likelihood to isolate themselves, thus refusing contact with nonfamily members. Such kinds of behaviors increased caregivers’ burden. Japanese families did not allow others to care family members with mental illness.
Boge et al., 2018 [23] Gender differences in cultural and societal roles and expectations could account for higher levels of perceived stigma among female participants. A higher level of perceived stigma among female participants was attributed to cultural norms and female roles within a family or broader social system.
Interian et al., 2007 [43] Stigma resulted in negative social outcome and caused by cultural values.
Alvidrez et al., 2008 [42] Concerns about stigma caused most Black Americans initially to avoid treatment; They commonly were exposed to stigmatizing reactions from others when they accepted treatment.
Picco et al., 2016 [24] There was a negative association between quality of life and self-stigma, which may be expressed by cultural values and beliefs.
Ran et al., 2018 [2] Self-stigma among persons with mental illness was pervasive and severe in rural community in China. Ongoing evaluation and measurement of stigma in the Chinese context would play a crucial role in understanding culture-specific aspects of experiencing self-stigma.
Yang & Kleinman, 2008 [52] Stigma was embedded in the moral experience of participants across culture.
Mileva, Vázquez & Milev, 2013 [25] People with bipolar disorder experienced stigma and psychosocial effects. Canadian and Argentinean societies showed different family dynamics due to diverse cultures.
Marquez & Ramírez, 2013 [26] Familism, folk beliefs, and shame might result in Latinos’ lower service usage. Caregivers reported that cultural beliefs acted as barriers to mental health service use among Latinos
Lin et al., 2018 [27] Professional stigma was considerably lower in China than in the US, possibly indicating the cultural dominance of respect for professionals over stigma towards persons with mental illness.
Caplan, 2019 [44] The cultural values contributed to shaping stigma but also could be an important source to cope mental illness.
Bui et al., 2018 [45] Religion offered an important coping strategy to persons with mental illness. Mental health education and use of less stigmatizing language might facilitate early intervention by reducing stigma.
Pang et al., 2017 [28] The contexts of stigma and social tolerance were different between Asian cultures and Western cultures. Chinese youths displayed higher level of ‘physical threat’ and lower level of ‘social tolerance’ than their counterparts of other ethnicities.
Yang et al., 2014 [49] This study pointed out an initial but crucial approach to reduce stigma of mental illness among Asian Americans who influenced by stigma powerfully role.
Lee et al., 2005 [50] Stigma was common, hard to prevent and devastating to people with schizophrenia. Family support was required to be realized with the emphasis on relationship bonds in Chinese societies.
Haraguchi et al., 2009 [29] Social distance towards schizophrenia was widely common in both Beijing and Fukuoka, but the features of social distance was not similar between them.
Caplan et al., 2011 [30] Latino immigrants strongly endorsed that depression was caused by both malevolent spiritual forces and psychosocial issues, reflecting that they engage in a dual system of Western-medicine and spiritual beliefs.
Yang et al., 2013 [46] Stigma of mental illness endangered the males’ ability to protect their family honors, and the females’ ability to become holy and pure. What’s worse, it further threatened the family ability. Development of culture-specific stigma measures played an important role in implementation of community mental health care in Latin American contexts.
Keller et al., 2019 [47] Individualist orientation was more common for Caucasians, collectivist orientation was more common for Native Americans, indicating that it was necessary to address culture difference during the process of formulating programme to reduce stigma of mental illness.
Kurumatani et al., 2004 [31] Japanese and Taiwanese displayed similar knowledge, beliefs and attitudes with regard to schizophrenia with the general public in Western countries.
Papadopoulos, Foster & Caldwell, 2013 [32] Individualism contributed to more positive attitudes towards mental illness, while collectivism contributed to more stigmatizing attitudes towards mental illness.
Loya, Reddy, & Hinshaw, 2010 [33] The South Asian students displayed greater personal stigma towards mental illness than Caucasian students, which might be influenced by South Asians cultural values which emphasize a collectivist orientation and a hierarchical and family structure.
Mascayano et al., 2016 [51] Stigma was common across cultures and influenced by cultures profoundly. There was significantly local difference regarding stigma in Latin American contexts.