Stanculescu et al. (2008) 28 | Cross-sectional survey | National representative sample of the general population aged 18 years and over; (1070) Mental health experts; (98) Service users; | Vignettes from the MacArthur Mental Health Social Survey model covering four case vignettes (alcoholism, major depressive disorder, schizophrenia and a control- a mentally healthy individual that goes through hardships lately)72; interviews and focus groups with mental health professionals, service users and the general population; Stigmatization of people with mental illness was measured by replicating a study of Schomerus et al. 73, carried out in three locations (Slovakia, Germany and Russia). The study used the perceived devaluation and discrimination (PDD) scale developed by Link et al. (1987)74. | Romanian population is deficient regarding specific mental health terms but has good overall recognition of mental health problems that need psychiatric intervention and differentiation of multiple causes of mental illness. More than two-thirds of the population held negative stereotypes of dangerousness towards people with mental illness, especially towards schizophrenia and alcohol addiction while people with depression are more easily tolerated. People who have been hospitalized are in particular more stigmatized, the majority of the population having attitudes of devaluation and discrimination towards these people. Negative attitudes are maintained and enhanced by the mass media. Stigma and discrimination are higher in Romania compared to regions in Germany, Slovakia and Russia and affect most severely the labour and marital market. Stigma is also present in family, friends and healthcare professionals who frequently delay or avoid contact with psychiatric patients. | HIGH-QUALITY RESEARCH STROBE 19/22 Survey quality assessment 17/20 |
Euro-barometer survey (2006) 29 | Cross-sectional survey | National representative sample of the general population aged 15 years and over (1003) | Four items questionnaire regarding attitudes towards people with emotional and psychological problems. | 65% of the Romanian population believe people with mental health problems are unpredictable, 43% think they represent a danger to others, 20% believe they will never recover and 14% think they are to blame for their psychological problems. Stigmatizing attitudes were slightly more common in the Romanian population compared to the European average. | HIGH-QUALITY RESEARCH Survey quality Assessment 18/20 |
Evans-Lacko et al. (2012) 30 | Cross-sectional | General population –Eurobarometer survey in 14 countries (1003) Mental health service users in 14 European countries (1835) | Internalized Stigma of Mental Illness Scale (ISMI) 75; Perceived Devaluation and Discrimination Scale(PDD) 74; Boston University Empowerment Scale 76 (BUES); a scale with 4 items for assessing attitudes; Questionnaire evaluating help-seeking, access to information, antidepressant use and comfort when talking to someone with a mental health problem. | People with mental illness living in countries with less stigmatizing attitudes, higher rates of help-seeking and treatment use, and better-perceived access to information reported lower rates of self-stigma and perceived discrimination but not higher empowerment. Those living in countries where the public felt more comfortable talking to people with mental illness had lower levels of self-stigma and felt more empowered. Being employed and having a higher educational level were associated with less self-stigma. Less perceived discrimination was reported by individuals with depression compared to those with schizophrenia and women reported higher levels of perceived discrimination than men. Public attitudes endorsing recovery pessimism were associated with higher perceived discrimination by service users. Being employed and having a higher educational level were associated with higher empowerment scores. Women, however reported lower empowerment scores. | HIGH-QUALITY RESEARCH STROBE 20/22 |
Brouwers et al. (2015) 31 | Cross-sectional | People diagnosed with major depression in the previous year (834) | The Discrimination and Stigma scale (DISC-12) 77; Human Development Index (HDI) 78; ISMI scale 75 | Two-thirds (62.5%) of participants reported anticipated and/or experienced discrimination in the workplace related to their mental health problems. Almost 60% of participants have stopped themselves from applying for work or education because of anticipated discrimination. Participants in countries with a very high HDI reported significantly more often anticipated or experienced discrimination than participants in countries with moderate/low HDI. Experienced workplace discrimination was less frequently reported than anticipated discrimination and was independently associated with unemployment. Unemployment was also associated with lower education and admission to a psychiatric hospital. | HIGH-QUALITY RESEARCH STROBE 19/22 |
Corker et al. (2014) 32 | Cross-sectional survey | People diagnosed with major depression (25) or schizophrenia (23) in the previous year in seven countries. | DISC-12 scale 77 | Participants with depression reported more discrimination in regard to neighbours, dating, education, marriage, religious activities, physical health and acting as a parent than participants with schizophrenia. Participants with schizophrenia reported more discrimination with regard to the police compared to participants with depression. | HIGH-QUALITY RESEARCH STROBE 20/22 |
Krajewski et al. (2012) 33 | Cross-sectional | People with one or more psychiatric diagnosis in six countries (104) | PDD scale 74; ISMI scale 75; BUES scale 76 : only self-efficacy/self-esteem (SESE) and power/powerlessness (PP) subscales were used. | In Romania, self-stigma and PDD were inversely correlated, while SESE was not a significant predictor of self-stigma as compared to other countries. Significant predictors of high self-stigma were: being aged 50–59 years; being employed; having poor social support; and minimal-to-low SESE and PP scores. | HIGH-QUALITY RESEARCH STROBE 20/22 |
Zlati et al. (2011) 21 | Cross-sectional | High-school students (232) | Level of Familiarity Questionnaire 79; Questions extracted from the National Survey of Mental Health Literacy in Young People in reference to a vignette, which depicted an individual with typical symptoms of schizophrenia 80; PDD scale 74; Attribution Questionnaire 81; Treatment Seeking Behaviour Scale 82. | Adolescents have a low level of mental health literacy and have difficulties recognizing schizophrenia misidentifying it as depression. Teenagers are aware of the existing stereotypes and believe that most people stigmatize individuals with mental illnesses. | MEDIUM-QUALITY RESEARCH STROBE 15/22 |
Popescu et al. (2015) 22 | Controlled design with pre and post evaluation. Control group; No educational intervention or contact. | First and sixth year medical students (280) | Vignettes from the MacArthur Mental Health Social Survey model covering four case vignettes (alcoholism, major depressive disorder, schizophrenia and a control- a mentally healthy individual that goes through hardships lately72 social distance and dangerousness scales 74 were used to assess the attitudes of medical students towards mental illness. | Statistically significant improvements in attitudes towards people with mental illness after an educational intervention and contact with psychiatric patients. No significant change was observed in the control group. | LOW TO MEDIUM QUALITY RESEARCH STROBE 7/11 |
Popescu et al. (2017) 23 | Cross-sectional | First year Romanian and international medical students (322) | PDD scale 74 Vignettes including alcohol addiction, depression and schizophrenia were used to evaluate knowledge about mental illnesses. | Medical students reported negative attitudes towards people with mental illness and a moderate desire for social distance. Romanian medical students as compared to their international colleagues, express more desire for social distance and higher perceived violence towards people with alcohol addiction. International students have better knowledge regarding mental illness compared to Romanian students. Familiarity with mental illness was associated with lower levels of desire for social distance. | MEDIUM TO HIGH QUALITY RESEARCH STROBE 17/22 |
Todor et al. (2012) 24 | Cross-sectional | College students in Economics, Social work and Theology (150) | Opinions about Mental Illness Scale – evaluate the opinions and attitudes regarding etiology, treatment and prognosis of mental illness 83. The scale consist of five subscales: authoritarianism (the opinion that people with mental illnesses cannot be held accountable for their acts and they should be controlled by society) benevolence (an attitude that could be placed between tolerance and pity/compassion) mental hygiene ideology (the opinion that mental illness is similar to other illnesses and it should be treated adequately by specialists) social restrictiveness (the opinion that mentally ill people should be restricted in some social domains) interpersonal etiology (the belief that the real cause of a mental illness is problematic interpersonal relationships). | Students held stigmatizing attitudes towards people with mental illness reporting the highest scores in authoritarianism, benevolence and mental hygiene ideology subscales. Theology students scored highest in authoritarianism. All participants registered high scores in Social Restrictiveness reflecting attitudes of intolerance towards individuals with mental illness. | MEDIUM-QUALITY RESEARCH STROBE 13/22 |
Vogel et al. (2017) 25 | Cross-sectional | College students from ten countries (226) | Self-Stigma of Seeking Help Scale 84; Stigma Scale for Receiving Psychological Help 85; Attitudes Toward Seeking Professional Psychological Help Scale–Short Form 86; | Self-stigma mediated the relationship between public stigma and attitudes toward seeking psychological help among college students in each country. The relationship between public and self-stigma was weaker in Romanian students compared to students in other countries. | HIGH-QUALITY RESEARCH STROBE 19/22 |
Voinescu et al. (2010) 26 | Cross-sectional | Medical residents (112) | A questionnaire described by Balon et al. 87 assessing the attitudes towards psychiatry, as well as attitudes of health professionals towards psychiatric patients. | Although psychiatry is perceived to be lower in status compared to other residency programmes, the majority of medical residents also think psychiatry is a rapidly expanding, and valid medical branch that has made important progress in addressing mental illness. Psychiatry as well as mental illness is still significantly stigmatized in Romania. More than half (52%) of medical residents agreed that they felt uncomfortable with mentally ill patients, while the same proportion stated they have been discouraged by family, colleagues and mentors in choosing psychiatry in their medical training. Moreover, most trainees agreed that those who have not been admitted in other residency programmes would eventually chose psychiatry. | MEDIUM-QUALITY RESEARCH STROBE 14/22 |
Mihai et al. (2007) 27 | Cross-sectional | Medical students, medical personnel working in psychiatric settings, healthcare professionals (-) | Attitudes and beliefs about people with schizophrenia. | Healthcare professionals held negative attitudes towards people with mental illness and especially towards people with schizophrenia. The majority of healthcare professionals avoid contact with mentally ill patients, arguing they lack skills in approaching these patients. | LOW TO MEDIUM QUALITY RESEARCH STROBE 6/11 |
Tirintica et al. (2018) 34 | Cross-sectional | Mental health service (MHS) users Caregivers (close family members) Mental health providers in three east European countries (200) | A modified version of WHO Pathway Encounter Form questionnaire 88 was used to evaluate the delay to the first psychiatric consultation measured as the time between first appearance of symptoms and first contact with MHS. A second questionnaire assessed factors such as: mental health knowledge, attitudes towards psychiatry, mental illness or help-seeking, and social support. The second questionnaire was applied to patients, care givers and mental health providers. | Family was the one requesting a psychiatric consultation in 50% of cases in Romania and almost half accessed MHS directly. The majority of patients had a delay of up to 3 months, with 22% of them presenting with more than one year delay while under 10% sought help as soon as symptoms occurred. Longer delays were reported by those who accessed MHS through a doctor’s recommendation and had a diagnosis of alcohol addiction or psychotic disorder. Negative attitudes towards mental illness or seeking professional help were associated with longer delays in contrast to having good social support, which was associated with shorter delays. | HIGH-QUALITY RESEARCH STROBE 19/22 |
Beldie et al. (2012) 13 | Descriptive | Description of anti-stigma interventions by mental health experts in 14 European countries, using all available evidence regardless whether it was published or not. General population, high-school students, journalists. (-) | - | Four anti-stigma projects took place in different regions of Romania targeting the general population and subgroups such as high-school students and journalists. Campaigns involved people with lived experience of metal illness and used media channels to promote positive attitudes towards people with mental illness and better knowledge regarding mental health. No empirical evidence was published regarding these actions due to finacial reasons and a lack of personnel. | NA |