Mental health stigma and its consequences: a systematic scoping review of pathways to discrimination and adverse outcomes

Current research evaluating the consequences of stigma towards people with mental illness is not nuanced in emphasizing the critical distinction between stigma as negative attitudes and discrimination as harmful behaviours that limit access to services, employment, and social inclusion. Understanding these distinctions is essential for designing targeted, evidence-based universal, targeted and indicated interventions to improve the quality of life and well-being. This review evaluates the evidence on the consequences of stigma towards people with mental illness. Using PRISMA guidelines, we analysed 448 studies (294 quantitative, 154 qualitative) investigating stigma's negative outcomes. Findings were categorized into health, service use, psychosocial, economic, and structural impacts. Although stigma is consistently associated with adverse outcomes across life domains, evidence of a causal link between negative attitudes and poorer outcomes for individuals with mental disorders remains limited. Furthermore, there is a striking scarcity of research from low- and middle-income countries, with significant regional gaps, and studies addressing structural stigma embedded in societal institutions are particularly rare. Efforts to combat stigma must distinguish between attitudes and behaviours, focusing on reducing discrimination while enhancing public mental health literacy and access to effective interventions. Tackling these challenges requires a comprehensive, evidence-informed approach to improving mental health outcomes for all.