Structural concomitants of stigma and mental health service use: results from a cross-national comparative multilevel analysis.

Background: The stigma of mental illness is recognized as a global social problem. Although it is a phenomenon that seems universally present, cross-national differences exist. International comparative studies on the stigma of mental illness are very scarce however. The few studies available often compare only a few countries or convenience samples of countries. Moreover they are often sheer descriptive. Aim: This empirical study explores individual level and country level concomitants of stigma and mental health service use, using a multilevel research design. Methods: The Eurobarometer 248 on mental well-being (N= 29,248 individuals from 29 European countries) is used for the individual level variables. Stigma refers to negative stereotypes including dangerousness, unpredictability, blame and poor prognosis. Mental health is measured by the MHI-5. Mental health service use is measured by an item asking the respondents whether they seek help from a professional in respect of a psychological or emotional health problem during the last year. The measures at the country level are obtained from Eurostat. Multilevel analysis techniques are applied. Results: The results reveal that higher levels of income inequality, a higher unemployment rate, and a higher number of psychiatric beds in a country are related with more stigmatizing attitudes. Furthermore, income inequality and higher unemployment rates are related with more mental ill health complaints and less mental health service use, while the supply of services is related with more service use. The country level effects on mental health service use are independent from individual level stigma and mental health. Conclusion: The main result of this study is that cross-national differences in stigmatizing attitudes and mental health service use are related with structural characteristics of countries