Embarrassment when illness strikes a close relative: a World Mental Health Survey Consortium Multi-Site Study

Ahmedani, Brian K.; Kubiak, S.P.; Kessler, Ronald C.; de Graaf, Ron; Alonso Caballero, Jordi; Bruffaerts, Ronny; Zarkov, Zahari; Viana, Maria Carmen; Huang, Y. Q.; Hu, Chiyi; Posada Villa, José; Lepine, Jean-Pierre; Angermeyer, Matthias C.; Girolamo, Giovanni de; Karam, A. M.; Medina Mora, Maria Elena; Gureje, Oye; Ferry, F.; Sagar, R.; Anthony, James C.

doi:http://dx.doi.org/10.1017/S003329171200298X

Embarrassment when illness strikes a close relative: a World Mental Health Survey Consortium Multi-Site Study

Citation

Ahmedani BK, Kubiak SP, Kessler RC, de Graaf R, Alonso J, Bruffaerts R et al. Embarrassment when illness strikes a close relative: a World Mental Health Survey Consortium Multi-Site Study. Psychol Med. 2013;43(10):2191-202. DOI: 10.1017/S003329171200298X

Abstract

Background: In this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the afflicted individual but have not assessed family embarrassment in a large-scale study. Method: In 16 sites of the World Mental Health Surveys (WMHS), standardized assessments were completed including items on family embarrassment. Site matching was used to constrain local socially shared determinants of stigma-related feelings, enabling a conditional logistic regression model that estimates the embarrassment close relatives may hold in relation to family members affected by an ADMC, a GMC, or both conditions. Results: There was a statistically robust association such that subgroups with an ADMC-affected relative were more likely to feel embarrassed compared to subgroups with a relative affected by a GMC (p < 0.001), even with covariate adjustments for age and sex. Conclusions: The pattern of evidence from this research is consistent with conceptual models for interventions that target individual- and family-level stigma-related feelings of embarrassment as possible obstacles to effective early intervention and treatment for an ADMC. Macro-level interventions are under way but micro-level interventions may also be required among family members, along with care for each person with an ADMC.