Estimating the effect of anticipated depression treatment-related stigma on depression remission among people with noncommunicable diseases and depressive symptoms in Malawi.



While mental health stigma research is sparse in Malawi, research in other settings suggests that stigma represents a barrier to mental health treatment and recovery. Accordingly, we conducted an analysis to understand the role of treatment-related stigma in depression care in Malawi by estimating the effect of patients' baseline anticipated treatment-related stigma on their 3-month probability of depression remission when newly identified with depression.


We conducted depression screening and treatment at 10 noncommunicable disease (NCD) clinics across Malawi from April 2019 through December 2021. Eligible cohort participants were 18-65 years with depressive symptoms indicated by a PHQ-9 score ≥5. Questionnaires at the baseline and 3-month interviews included a vignette-based quantitative stigma instrument that measured treatment-related stigma, i.e., concerns about external stigma because of receiving depression treatment. Using inverse probability weighting to adjust for confounding and multiple imputation to account for missing data, this analysis relates participants' baseline levels of anticipated treatment stigma to the 3-month probability of achieving depression remission (i.e., PHQ-9 score < 5).


Of 743 included participants, 273 (37%) achieved depression remission by their 3-month interview. The probability of achieving depression remission at the 3-month interview among participants with high anticipated treatment stigma (0.31; 95% Confidence Interval [CI]: 0.23, 0.39)) was 10 percentage points lower than among the low/neutral stigma group (risk: 0.41; 95% CI: 0.36, 0.45; RD: -0.10; 95% CI: -0.19, -0.003).


In Malawi, a reduction in anticipated depression treatment-related stigma among NCD patients initiating depression treatment could improve depression outcomes. Further investigation is necessary to understand the modes by which stigma can be successfully reduced to improve mental health outcomes and quality of life among people living with depression.





Published Version (Please cite this version)


Publication Info

Dussault, Josée M, Chifundo Zimba, Harriet Akello, Melissa Stockton, Sherika Hill, Allison E Aiello, Alexander Keil, Bradley N Gaynes, et al. (2023). Estimating the effect of anticipated depression treatment-related stigma on depression remission among people with noncommunicable diseases and depressive symptoms in Malawi. PloS one, 18(3). p. e0282016. 10.1371/journal.pone.0282016 Retrieved from

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Sherika N Hill

Adjunct Assistant Professor in the Department of Psychiatry and Behavioral Sciences

As a clinical epidemiologist, I conduct biopsychosocial research to better understand how social factors, biological mechanisms (epigenetics), or health outcomes relate to pediatric mental health and well-being. I am particularly interested in knowing the extent to which different developmental trajectories are driven by low socioeconomic status, rural geography, minority race/ethnicity, chronic childhood health conditions, or childhood maltreatment. 

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