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BackgroundStigma and discrimination are a significant public health concern and cause great distress to people with mental illness. Healthcare professionals have been identified as one source of this discrimination. In this article we describe the protocol of an international, multisite controlled study, evaluating the effectiveness of READ, an anti-stigma training for medical students towards patients with mental illness. READ aims to improve students’ ability to minimise perceived discriminatory behaviours and increase opportunities for patients, therefore developing the ability of future doctors to address and challenge mental illness related discrimination. READ includes components that medical education research has shown to be effective at improving attitudes, beliefs and understanding.Methods/designREAD training was developed using evidence based components associated with changes in stigma related outcomes. The study will take place in multiple international medical schools across high, middle and low income countries forming part of the INDIGO group network, with 25 sites in total. Students will be invited to participate via email from the lead researcher at each site during their psychiatry placement, and will be allocated to an intervention or a control arm according to their local teaching group at each site. READ training will be delivered solely to the intervention arm. Standardised measures will be used to assess students’ knowledge, attitudes and skills regarding discrimination in both the intervention and control groups, at baseline and at follow up immediately after the intervention. Statistical analyses of individual-level data will be conducted using random effects models accounting for clustering within sites to investigate changes in mean or percentages of each outcome, at baseline and immediately after the intervention.DiscussionThis is the first international study across high, middle and low income countries, which will evaluate the effectiveness of training for medical students to respond effectively to patients’ experiences and anticipation of discrimination. The results will promote implementation of manualised training that will help future doctors to reduce the impact of mental illness related discrimination on their patients. Limitations of the study are also discussed.

The adequate intake of dietary fibres is essential to human health. Hence, this work intended to evaluate the level knowledge of about food fibres and investigate what factors might be associated with it. It was undertaken a descriptive cross-sectional study on a sample composed of 6,010 participants from ten different countries. The survey was based on a questionnaire of self-response, approved and complying with all ethical issues. The data collected were subjected to factor analysis and cluster analysis techniques. Validation was made by splitting the data set into two equal parts for confirmation of the results. Factor analysis allowed concluding that ten from the 12 variables used to measure the knowledge about dietary fibre should be grouped into two dimensions or factors: one linked to health effects of dietary fibre (α =0.854) and the other to its sources (α =0.644). Cluster analysis showed that the participants could be divided into three groups: Cluster 1 – Good knowledge both about sources and health effects of dietary fibre; Cluster 2 – Good knowledge about the sources of dietary fibre but poor knowledge about its health effects; Cluster 3 – Poor knowledge both about sources and health effects of dietary fibre. The data was appropriate for analysis by means of factor and cluster analysis, so that two factors and three clusters were clearly identified. Moreover, the cluster membership was found varying mostly according to country, living environment and level of education but not according to age or gender. info:eu-repo/semantics/publishedVersion

Introduction: Dietary fibre (DF) is recognized as healthy for long, so that health claims are allowed by the European Food Safety Authority (EFSA) due to its proved benefits, extended but not only confined to many diseases of the gastrointestinal tract. Objective: This work intended to analyse the level of information about DF in 10 countries, situated in Europe, Africa and South America. Methods: A descriptive cross-sectional study was undertaken through a survey based on a questionnaire of self-response applied to a sample of 6010 participants. The data were lately treated by factor and cluster analyses, including validation methodologies. Results: Factor analysis showed that ten of the twelve items used to assess the knowledge about DF could be arranged into two factors: one related to health effects (α =0.854) and the other to the sources (α =0.644). Furthermore, cluster analysis showed that the participants could be divided into three groups: 1) Good knowledge about sources and health effects of DF; 2) Good knowledge about the sources of DF but poor knowledge about the health effects; 3) Poor knowledge about the sources and health effects of DF. Conclusions: The results clearly allowed identifying two factors and three clusters, and the variables that most influenced cluster membership were country, living environment and level of education. info:eu-repo/semantics/publishedVersion

Introduction: The ingestion of fruits, vegetables and cereals, especially whole grain, is associated with a healthy lifestyle and has been recognized as having multiple health benefits, associated, among others, to the ingestion of adequate amounts of dietary fibre. Objective: The aim of this work was to evaluate some eating habits related to fibre rich foods in six different countries: Argentina, Croatia, Hungary, Latvia, Portugal and Romania. Methods: A cross-sectional descriptive study was carried out by means of questionnaire survey applied to a sample of 4905 participants, all over the age of 18 years old. The preparation and application of the questionnaire followed the necessary ethical guidelines and the treatment was made by SPSS. Results: The results showed that for the global sample was observed a low ingestion of salads and vegetables (78.2%), being this particularly problematic for Croatia (86.6%). Regarding the consumption of fruits, for the whole sample the great majority also showed a low consumption (92.3%), and for Latvian participants the percentage is very much expressive (98.3%). As for the consumption of whole cereals, most participants also showed a low consumption, either for the global sample (72.6%) or in the different countries, and particularly for Latvia (90.0%). Some eating habits were also studied and it was observed that for the whole sample 71.9% showed a low frequency of meals ate out of home, while 88.6% revealed acceptable frequency of eating fast food, i.e, only once or twice a week. Conclusions: The results indicated that in the countries at study the ingestion of foods rich in dietary fibre is very low, and therefore it is necessary to implement strategies to increase the consumption of such foods. info:eu-repo/semantics/publishedVersion

Dietary fibre (DF) has been recognized as a major determinant for improvement of health. Hence the means of information through which people become aware of its benefits are crucial. This work aimed at studying the sources of information about DF, as a means to educate people about aspects related to healthy eating. Factors such as gender, level of education, living environment or country were evaluated as to their effect on the selection of sources and preferences. For this, a descriptive cross-sectional study by means of a questionnaire, applied to a non-probabilistic sample of 6010 participants from 10 countries in different continents (Europe, Africa and America), answered after informed consent by all participants. For the analysis were used several descriptive statistics tools, crosstabs and chi square test to assess the relations between some of the variables under study. The results showed that mostly the information about DF comes from the internet, but the participants recognize that television might be a most suitable way to disseminate information about DF. The results also indicated differences between genders, levels of education, living environments and countries. The internet, the preferred source of information, got highest scores for Hungary, for urban areas, for university level of education and for female gender. The radio, the least scored source of information, was preferred in Egypt, for men and with lower education (primary school). As a conclusion, people get information through the internet due to easy access. However, it is to some extent a risk given the impossibility to control de information made public on the internet. The role of health centers and hospitals as well as schools should definitely be increased, as a responsible way to ensure correct information.

Summary Background Many people with schizophrenia experience stigma caused by other people's knowledge, attitudes, and behaviour; this can lead to impoverishment, social marginalisation, and low quality of life. We aimed to describe the nature, direction, and severity of anticipated and experienced discrimination reported by people with schizophrenia. Methods We did a cross-sectional survey in 27 countries, in centres affiliated to the INDIGO Research Network, by use of face-to-face interviews with 732 participants with schizophrenia. Discrimination was measured with the newly validated discrimination and stigma scale (DISC), which produces three subscores: positive experienced discrimination; negative experienced discrimination; and anticipated discrimination. Findings Negative discrimination was experienced by 344 (47%) of 729 participants in making or keeping friends, by 315 (43%) of 728 from family members, by 209 (29%) of 724 in finding a job, 215 (29%) of 730 in keeping a job, and by 196 (27%) of 724 in intimate or sexual relationships. Positive experienced discrimination was rare. Anticipated discrimination affected 469 (64%) in applying for work, training, or education and 402 (55%) looking for a close relationship; 526 (72%) felt the need to conceal their diagnosis. Over a third of participants anticipated discrimination for job seeking and close personal relationships when no discrimination was experienced. Interpretation Rates of both anticipated and experienced discrimination are consistently high across countries among people with mental illness. Measures such as disability discrimination laws might, therefore, not be effective without interventions to improve self-esteem of people with mental illness. Funding South London and Maudsley NHS Foundation Trustees, UK Department of Health SHiFT programme, German Ministry of Education and Research.

BackgroundNo study has so far explored differences in discrimination reported by people with major depressive disorder (MDD) across countries and cultures.AimsTo (a) compare reported discrimination across different countries, and (b) explore the relative weight of individual and contextual factors in explaining levels of reported discrimination in people with MDD.MethodCross-sectional multisite international survey (34 countries worldwide) of 1082 people with MDD. Experienced and anticipated discrimination were assessed by the Discrimination and Stigma Scale (DISC). Countries were classified according to their rating on the Human Development Index (HDI). Multilevel negative binomial and Poisson models were used.ResultsPeople living in ‘very high HDI’ countries reported higher discrimination than those in ‘medium/low HDI’ countries. Variation in reported discrimination across countries was only partially explained by individual-level variables. The contribution of country-level variables was significant for anticipated discrimination only.ConclusionsContextual factors play an important role in anticipated discrimination. Country-specific interventions should be implemented to prevent discrimination towards people with MDD.

Background Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination. Methods In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data. Findings 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coeffi cient 0·20 [95% CI 0·09-0·32], p=0·001); at least one lifetime psychiatric hospital admission (0·29 [0·15-0·42], p=0·001); poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01-0·19], p=0·032; unpaid employed 0·34 [0·09-0·60], p=0·007; looking for a job 0·26 [0·09-0·43], p=0·002; and unemployed 0·22 [0·03-0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression; p lt 0·0001). Anticipated discrimination is not necessarily associated with experienced discrimination because 147 (47%) of 316 participants who anticipated discrimination in fi nding or keeping a job and 160 (45%) of 353 in their intimate relationships had not experienced discrimination. Interpretation Discrimination related to depression acts as a barrier to social participation and successful vocational integration. Non-disclosure of depression is itself a further barrier to seeking help and to receiving eff ective treatment. This finding suggests that new and sustained approaches are needed to prevent stigmatisation of people with depression and reduce the eff ects of stigma when it is already established. Funding European Commission, Directorate General for Health and Consumers, Public Health Executive Agency.

Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination. In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12 ; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data. 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coefficient 0·20 [95% CI 0·09-0·32], p=0·001) ; at least one lifetime psychiatric hospital admission (0·29 [0·15-0·42], p=0·001) ; poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01-0·19], p=0·032 ; unpaid employed 0·34 [0·09-0·60], p=0·007 ; looking for a job 0·26 [0·09-0·43], p=0·002 ; and unemployed 0·22 [0·03-0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression ; p

The aim of this study was to evaluate the level of anticipated discrimination in people with schizophrenia (n = 732) from 27 countries in the International Study of Discrimination and Stigma Outcomes (INDIGO).Anticipated discrimination was assessed through four questions of Discrimination and Stigma Scale. Twenty-five individuals were identified at each site who were reasonably representative of all such treated cases within the local area.Sixty-four per cent of the participants reported that they had stopped themselves from applying for work, training or education because of anticipated discrimination. Seventy-two per cent of them reported that they felt the need to conceal their diagnosis. Expecting to be avoided by others who know about their diagnosis was highly associated with decisions to conceal their diagnosis. Those who concealed their diagnosis were younger and more educated. The participants who perceived discrimination by others were more likely to stop themselves from looking for a close relationship. Anticipated discrimination in finding and keeping work was more common in the absence than in the presence of experienced discrimination, and the similar findings applied to intimate relationships.This study shows that anticipated discrimination among people with schizophrenia is common, but is not necessarily associated with experienced discrimination.