490263

2013
ISP60410.1177/0020764013490263International Journal of Social PsychiatryHarangozo et al.

E CAMDEN SCHIZOPH

Article

International Journal of

Stigma and discrimination against Social Psychiatry

2014, Vol. 60(4) 359­–366
© The Author(s) 2013
people with schizophrenia related Reprints and permissions:
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to medical services DOI: 10.1177/0020764013490263

isp.sagepub.com

J Harangozo,1 B Reneses,2 E Brohan,3 J Sebes,4 G Csukly,5

JJ López-Ibor,2 N Sartorius,6 D Rose3 and G Thornicroft3

Abstract
Objective: To investigate whether people with schizophrenia experience discrimination when using health care services.
Methods: A cross-sectional survey in 27 countries in centres affiliated to the INDIGO Research Network, using face-
to-face interviews with 777 participants with schizophrenia (62% male and 38% female). We analysed the data related to
health issues, including health care, disrespect of mental health staff, and also personal privacy, safety and security, starting
a family, pregnancy and childbirth. Discrimination was measured by the Discrimination and Stigma Scale (DISC), which
consists of 36 items comprising three sub-scales: positive experienced discrimination; negative experienced discrimination;
and anticipated discrimination.
Results: More than 17% of patients experienced discrimination when treated for physical health care problems. More
than 38% of participants felt disrespected by mental health staff, with higher ratings in the post-communist countries.
Conclusions: Mental health service providers have a key role in decreasing stigma in their provision of health care,
and by doing more against stigmatizing and discriminating practices on the therapeutic and organizational level. This will
require a change of attitudes and practices among mental and physical health care staff.

Keywords
Stigma, discrimination, schizophrenia, health services, integrated care, mental health services

Introduction
Living with a mental disorder is related to a higher level of
stigma, which has a great negative influence on recovery
and outcome (Lasalvia et al., 2013; Thornicroft et al., 2009)
and in other fields of social live (Major & O’Brien, 2005).
People suffering from schizophrenia have a higher mor-
tality compared with the general population (Brown, 1997;
Capasso, Lineberry, Bostwick, Decker & St Sauver, 2008;
Harris & Barraclough, 1998), as well as a higher risk of
physical illnesses (Fleischhacker, Meise, Günter & Kurz,
1994; Leucht, Burkard, Henderson, Maj & Sartorius, 2007).
Studies of comorbidity with metabolic and cardiovascular
diseases have been especially emphasized (de Hert,
Thornicroft, Rose and Kassman (2007) have recently
reviewed the evidence related to the association between
low rates of help-seeking behaviour of people with mental
disorders and the poor quality of the attention to their
physical health. The diagnosis of physical illness remains
1Centre for Community Psychiatry, Semmelweis Medical University,
Budapest, Hungary
2Instituto de Psiquiatría, Instituto de Investigación biomédica del
Hospital Clínico San Carlos, Departamento de Psiquiatría, Universidad
Complutense, Madrid, Spain
3Health Service and Population Research Department, Institute of

Schreurs, Vancampfort & van Winkel, 2009; Saha, Chant & Psychiatry, King’s College London, UK
McGrath, 2007). The fact that physical diseases are even 4Department of Psychiatry, Bajcsy-Zsilinszky Hospital, Budapest,

more prevalent in people living in the community com- Hungary

5Department of Psychiatry and Psychotherapy, Semmelweis Medical
pared with those living in hospitals (Salokangas, 2007)
University, Budapest, Hungary
supports the idea that patients are less likely to receive ade- 6Association for the Improvement of Mental Health Programmes,

quate care, or even have difficulty accessing general medi-
cal services (Maj, 2009; Prince, 2007). A survey among 200
people with schizophrenia in Hungary showed that only
56% of patients had ever used a general practitioner (GP),
while 28% had wished to but did not receive that service
(Harangozó, Döme & Kristóf, 2005).
Geneva, Switzerland
Corresponding author:
B Reneses, Instituto de Psiquiatría, Instituto de Investigación biomédica
del Hospital Clínico San Carlos, Departamento de Psiquiatría, Universidad
Complutense, Av Prof. Martin Lago s/n 28040 Madrid, Spain.
Email: blanca@reneses.es
360 International Journal of Social Psychiatry 60(4)
concealed probably due to the attribution of complaints
about physical condition to a mental illness. Also no clear
consensus exists as to which physician should be in charge
of the prevention and care of comorbid physical illnesses,
which leads to the fragmentation of medical care
(Fleishhacker et al., 2008).
Studies about stigma in mental health professionals
show several data that point out stigmatizing attitudes fac-
ing patients with schizophrenia and other mental illnesses
in different cultures and countries (Arvaniti et al., 2009;
Des Courtis, Lauber, Costa & Cattapan-Ludewig, 2008;
Hori, Richards, Kawamoto & Kunugi, 2011; Lauber, Nordt,
Braunschweig & Rössler, 2006; Loch et al., 2012; Nordt,
Rössler & Lauber, 2006; Ucok, Sartorius, Erkoc & Atakli,
2004; Wahl, 1999). Stereotyped attitudes and attitudes of
prejudice from health care staff towards patients with
schizophrenia regarding their health may contribute to
increased self-stigmatization, having at the same time a
negative impact on the help-seeking behaviour for their
health problems (Björkman, Angelman & Jönson, 2008;
Horsfall, Cleary & Hunt, 2010).
There are scarce studies that have looked on how people
with mental disorders experience stigma in health settings.
They report that a negative discriminative attitude prevails
towards patients with schizophrenia (Lawrie et al., 1998;
Liggins & Hatcher, 2005; Wahl, 1999). Because these stud-
ies are limited, it is necessary to explore in a more detailed
and standardized way, how patients perceive stigma and
discrimination in medical services.
The main objective of this study is to investigate whether
people with schizophrenia experience discrimination or
anticipated discrimination when using health care services.
We hypothesized that discrimination by health profession-
als and services exists and that this may contribute to the
fact that patients underuse health services.
Methods
A cross-sectional interview study was conducted in 27
countries, led by G. Thornicroft in centres affiliated to the
INDIGO Research Network, by use of face-to-face inter-
views with 732 participants with schizophrenia (62%
male and 38% female) in 2006. The main findings of this
research project and the detailed description of the meth-
odology have already been published (Thornicroft et al.,
2009). Also in 2006, further data were added from
Hungary (n = 20) and Japan (n = 25), which increased the
sample to 777 patients.
In the current study we analysed the survey data that
related to health issues, including health care and dental
care, disrespect by mental health staff, and provision con-
cerning personal privacy, safety and security, starting a
family, pregnancy, childbirth and avoidance by others. In
addition, differences between post-communist countries
(Bulgaria, Hungary, Lithuania, Poland, Romania, Slovakia,
Slovenia, Tajikistan) and other countries (Cyprus,
Finland, France, Germany, Greece, India, Italy, Malaysia,
Netherlands, Norway, Portugal, Spain, Switzerland, UK)
and between different forms of health care (inpatient, out-
patient, home care, day care) were analysed. Discrimination
was measured by the validated Discrimination and Stigma
Scale (DISC), which consists of 36 items comprising three
sub-scales: positive experienced discrimination; negative
experienced discrimination; and anticipated discrimina-
tion. The scale was administered by an interviewer who
asked the participants, for a series of domains, whether
they have experienced discrimination because of their
mental illness; what the direction (positive or negative) of
such discrimination is; and how severe it is. The domains
address key areas of everyday life and social participation,
including work, marriage, parenting, housing, leisure and
religious activities.
Statistical analyses were evaluated by SPSS (version 15)
and SAS (version 9.2). Frequency tables were analysed by
χ2 test and Fisher’s exact test (if more than 50% of the cells
had counts less than 5). Associations between variables
were analysed by Spearman rank correlations.
Results
Descriptive results
Most of the participants (537 out of 718) reported that they
were not treated differently compared to other people for
physical problems. Among those who reported different
treatment, 47 (8.1%) experienced advantages and 123
(17%) disadvantages (Table 1).
Only 55 patients had received a disadvantageous experi-
ence when treated with dental problems; a further 70 expe-
rienced advantages and 569 reported that they had not
experienced any discrimination.
Approximately every fourth subject (183 out of 738)
reported disadvantageous experiences in the field of per-
sonal privacy, only 22 experienced advantages and a further
533 did not report any discrimination.
The results were rather worse in the field of personal
safety and security: 92 patients experienced strong, 59
moderate and 53 slight disadvantage. Most of the partici-
pants (473 out of 686) reported no discrimination in per-
sonal safety and security and only 12 experienced
advantages (see Table 1).
The question ‘Have you ever been treated differently
when wanting to start a family?’ was answered by only half
of the subjects, namely 388 out of 777. However, 216 did
not report any discrimination, 153 experienced strong (62),
moderate (47) or slight (44) disadvantage, while 19 had an
advantageous experience (Table 1).
Even fewer patients had any experience with preg-
nancy and childbirth: only 64 out of 777 answered the
question. More than every fourth subject (17 out of 64)
had a disadvantageous experience (strong: 11; moderate: 5;
Harangozo et al. 361

Table 1.  Stigma, self-stigma and discrimination related to health

issues (N = 777). Question Frequency (n) Percent of those
who answered the
Question Frequency (n) Percent of those question (%)a
who answered the Moderate disadvantage 22 9.6
question (%)a
Slight disadvantage 27 11.8
Ever treated differently for physical health problems No different treatment 123 53.7
Missing 59 N/A Slight advantage 1 0.4
Strong disadvantage 46 6.4 Moderate advantage 1 0.4
Moderate disadvantage 36 5 Strong advantage 3 1.3
Slight disadvantage 41 5.7 How much felt disrespected by mental health staff
No different treatment 537 74.8 Missing 14 N/A
Slight advantage 35 4.9 Not at all 465 60.9
Moderate advantage 12 1.7 A little 174 22.8
Strong advantage 11 1.5 A lot 124 16.3
Ever treated differently for dental problems How much been avoided by those who know about diagnosis
Missing 83 N/A Missing 18 N/A
Strong disadvantage 20 2.9 Not at all 333 43.9
Moderate disadvantage 15 2.2 A little 276 36.4
Slight disadvantage 20 2.9 A lot 150 19.8
No different treatment 569 82 How much feel need to conceal diagnosis
Slight advantage 31 4.5 Missing 12 N/A
Moderate advantage 19 2.7 Not at all 208 27.2
Strong advantage 20 2.9 A little 242 31.6
Ever treated differently in personal privacy A lot 315 41.2
Missing 39 N/A
Strong disadvantage 76 10.3 N/A = not applicable.
a100% = those who answered the given question.
Moderate disadvantage 51 6.9
Slight disadvantage 56 7.6
No different treatment 533 72.2
Slight advantage 11 1.5 slight: 1), 44 found no difference and only three felt posi-
Moderate advantage 4 0.5 tive discrimination.
Strong advantage 7 0.9
Among those, who experienced disadvantage when
Ever treated differently in personal safety or security
Missing 88 N/A
wanting to start a family, significantly more felt the need to
Strong disadvantage 92 13.4 conceal the diagnosis. Only 229 of the 777 subjects
Moderate disadvantage 59 8.6 answered the question ‘Ever treated differently in being
Slight disadvantage 53 7.7 able to act as a parent?’ and many (101) felt disadvantages
No different treatment 473 68.7 in this field.
Slight advantage 6 0.9 Need for concealing the diagnosis was reported by 557
Moderate advantage 4 0.6
(a little: 242; a lot: 315) and only 208 felt free to disclose
Strong advantage 2 0.3
Ever treated differently when wanting to start a family their diagnosis to others (Table 1).
Missing 389 N/A The question ‘How much did you feel disrespected by
Strong disadvantage 62 16 mental health staff?’ was answered by 763 of the 777 sub-
Moderate disadvantage 47 12.1 jects. More than half (465) did not feel disrespected, 174
Slight disadvantage 44 11.3 reported a little and 124 a lot, and 228 did not experience
No different treatment 216 55.7 disrespect by mental health staff at all (Table 1).
Slight advantage 5 1.3
Avoidance by those who know about the diagnosis was
Moderate advantage 9 2.3
Strong advantage 5 1.3 reported by 426 (a little: 276; a lot: 150) out of 759 (Table 1);
Ever treated differently during pregnancy and childbirth 333 subjects did not experience avoidance.
Not applicable 668 N/A Age group and gender had no significant effect on the
Strong disadvantage 11 17.2 answers to any of the above questions.
Moderate disadvantage 5 7.8
Slight disadvantage 1 1.6
No different treatment 44 68.8 Associations between discrimination related
Slight advantage 1 1.6 to physical health and discrimination related
Moderate advantage 1 1.6 to other life fields
Strong advantage 1 1.6
Ever treated differently in being able to act as a parent There was a significant association (p < .01) between disad-
Missing 548 N/A vantages related to physical health and disadvantages
Strong disadvantage 52 22.7 related to friendship, treatment by family, keeping a job,
(Continued) travel visas, welfare benefits and pension, opening a bank
362 International Journal of Social Psychiatry 60(4)

Table 2.  Association between discrimination related to physical health and discrimination related to other life fields (N = 777).

Question Correlation n p (two-tailed)

coefficient
Ever treated differently making or keeping friends 0.17 701 < .01
Ever treated differently in relationship with neighbours 0.05 678 .23
Ever treated differently in intimate or sexual relationships 0.07 570 .11
Ever treated differently with housing 0.07 519 .13
Ever treated differently in becoming homeless 0.13 147 .1
Ever treated differently in education 0.09 439 .06
Ever treated differently when dating 0.07 511 .12
Ever treated differently in terms of marriage or divorce 0.12 256 .06
Ever treated differently by your family 0.12 708 < .01
Ever treated differently in finding a job 0.05 509 .28
Ever treated differently in keeping a job 0.18 522 < .01
Ever treated differently when using public transport 0.04 644 .3
Ever treated differently when getting or keeping a driving licence 0 328 .94
Ever treated differently getting travel visas 0.18 214 .01
Ever treated differently getting welfare benefits or disability pensions 0.15 543 < .01
Ever treated differently opening a bank account 0.16 509 < .01
Ever treated differently with voting in elections 0.16 608 < .01
Ever treated differently getting any type of insurance 0.05 351 .34
Ever treated differently borrowing money or taking out a loan 0.03 295 .66
Ever treated differently in religious practices 0.18 539 < .01
Ever treated differently in social life 0.12 612 < .01
Ever treated differently by the police 0.15 538 < .01
Ever treated differently arranging payment for medical care 0.13 508 < .01
Ever treated differently for dental problems 0.24 664 < .01
Ever treated differently in personal privacy 0.08 688 .04
Ever treated differently in personal safety or security 0.08 649 .04
Ever treated differently when wanting to start a family 0.06 371 .28
Ever treated differently during pregnancy and childbirth 0.08  61 .53
Ever treated differently in being able to act as a parent 0.12 215 .07
Ever treated differently in any other important ways 0.09 518 .05
How much an advantage to have schizophrenia diagnosis 0.06 652 .12
How much stopped yourself from applying for work/training/education 0.01 684 .7
How much stopped yourself from looking for close relationship –0.04 683 .3
How much stopped yourself from doing something important –0.06 646 .15
How much felt disrespected etc. by mental health staff –0.16 706 < .01
How much been avoided etc. by those who know about diagnosis –0.06 703 .12
How much feel need to conceal diagnosis –0.06 707 .1
How often been able to take vacation –0.09 682 .02
How much been denied social or welfare benefits –0.05 561 .2
How much have you made friends outside mental health services 0.01 684 .85

account, voting in elections, religious practices, social life,
treatment by the police, arranging payment for medical
care, dental treatment, disrespectful treatment by mental
health staff and a significant association (p < .05) in being
treated differently in personal safety, security and personal
privacy. There was no association with disadvantages to
family and intimate/sexual relationships, dating, neigh-
bours, finding a job, housing and homeless services.
Interestingly, there was no association with self-stigma
when people stop doing something important because of
how others might respond to their mental health problem;
nor was there an association with the experience of being
avoided by others or with the need of concealing the diag-
nosis. Associations between discrimination related to phys-
ical health and discrimination related to other life fields are
shown in Table 2.
Comparison of different forms of health
services
A large proportion (42%) of the patients using home care
services felt more discrimination related to personal safety
Harangozo et al. 363

Table 3.  Some differences between post-communist and other European countries in level of discrimination and self-stigma
(N = 777).

Question Post-communist n (%)a Other countries n (%)a

Ever treated differently when wanting to start a family Fisher’s exact test, p = .02
Missing 73 316
Strong disadvantage 22 (23.4%) 40 (13.6%)
Moderate disadvantage 8 (8.5%) 39 (13.3%)
Slight disadvantage 16 (17.0%) 28 (9.5%)
No different treatment 44 (46.8%) 172 (58.5%)
Slight advantage 0 (0%) 5 (1.7%)
Moderate advantage 4 (4.3%) 5 (1.7%)
Strong advantage 0 (0%) 5 (1.7%)
Ever treated differently in personal privacy χ2 = 6, p = .42
Missing 4 35
Strong disadvantage 17 (10.4%) 59 (10.3%)
Moderate disadvantage 16 (9.8%) 35 (6.1%)
Slight disadvantage 8 (4.9%) 48 (8.3%)
No different treatment 119 (73.0%) 414 (72.0%)
Slight advantage 2 (1.2%) 9 (1.6%)
Moderate advantage 2 (1.2%) 4 (0.7%)
Strong advantage 1 (0.6%) 6 (1.0%)
How much felt disrespected by mental health staff χ2 = 6.2, p = .05
Missing 4 10
Not at all 97 (59.5%) 368 (61.3%)
A little 30 (18.4%) 144 (24.0%)
A lot 36 (22.1%) 88 (14.7%)
How much been avoided by those who know about diagnosis χ2 = 5.1, p = .08
Missing 4 14
Not at all 84 (51.5%) 249 (41.8%)
A little 53 (32.5%) 223 (37.4%)
A lot 26 (16.0%) 124 (20.8%)
a100% = those who answered the given question.

and security compared to those using inpatient (36%), out- Discussion

patient (27%) or day care services (34%) (χ2 = 27.4, p <
.01). Similarly, patients using home care services felt more
discrimination in personal privacy (44%) than subjects
using other forms of health care (inpatient: 26%; outpa-
tient: 27%; day care services; 27%; χ2 =27.9, p < .01).
Differences between post-communist and
other countries
Slightly more than half (53%) of the 94 patients from the
post-communist countries versus 41.5% of the 294 partici-
pants from other countries, felt discrimination when want-
ing to start a family. Severe discrimination was detected by
23% versus 14% of the participants in the post-communist
and other countries, respectively (Fisher’s exact test, p = .02)
(Table 3). Perceived disrespect was higher in the sample
from the post-communist countries compared to the other
countries (χ2 = 6.2, p = .05) (Table 3). Avoidance was mar-
ginally significantly lower in the post-communist countries
(χ2 = 5.1, p = .08) (Table 3).
More than 17% of patients experienced discrimination
when treated with physical problems, which can contrib-
ute to inappropriate results when treating the physical
symptoms of people with schizophrenia and also to
patients avoiding medical services (Harangozó et al.,
2005; Leucht et al., 2007; Mitchell & Mallone, 2006;
Salokangas, 2007). Professionals in mental health ser-
vices often believe that they do a lot to reduce stigma.
Our data do not support this. More than 38% of partici-
pants felt disrespected by mental health staff, with higher
ratings in the post-communist sample. This can contrib-
ute to the frequent avoidance of mental health services
by people who need them (Corrigan, 2004). Overall, par-
ticipants reported better experiences with dental treat-
ment. According to these results, mental health services
cause more stigma and discrimination than other medical
services, which is in contradiction with some results in
the literature that show less respectful attitudes of non-
psychiatric staff (Björkman et al., 2008).
364 International Journal of Social Psychiatry 60(4)
Several questions in the survey are indirectly related to
medical services. Nearly 25% of participants with schizo-
phrenia suffer from significant disadvantages in the field of
privacy and nearly 30% had disadvantages related to per-
sonal safety and security, many of those being patients who
use home care. Disadvantages in privacy also vary with dif-
ferent types of service. The results show that home care
services often do not support social recovery and are felt to
be intrusive by the patients.
About half of the respondents had no experience of
wanting to start a family, and only 64 participants had any
experience with pregnancy and childbirth, showing that
many of the respondents had no chance of having their own
family. Over a third (39%) of respondents experienced dis-
advantages when wanting to start a family, and about a
quarter at pregnancy and childbirth. Discrimination when
wanting to start a family was higher in the post-communist
sample. Stigma and discrimination might increase difficul-
ties when wanting to start a family.
Only 44% did not experience avoidance by those who
knew about their diagnosis and only 27% did not conceal
the diagnosis, showing a high level of experienced stigma,
discrimination and self-stigmatization.
Differences in the ratings of the post-communist sample
show more control over patients’ family plans and more
disrespect by mental health staff, indicating higher social
control over the lives of patients.
Conclusions
Stigma and discrimination are major risk factors for mental
ill health, eroding empowerment and contributing to the
poor prognosis of mental disorders (Vauth, Kleim, Wirtz &
Corrigan, 2007). Some data and opinions support the idea
that western psychiatry often provides treatment in a dehu-
manizing context lacking a holistic approach, which
increases stigma, self-stigma and discrimination and also
decreases empowerment and the possibility for patients to
think about themselves as individual and unique human
beings with unique human experiences (Rosen, 2006;
Wetters, 2010). In the current study, stigma and discrimina-
tion were frequently experienced by people with mental ill-
ness when using health services, particularly mental health
services. In this way, our data support the notion that ser-
vices often increase the burden of mental health problems
on patients and their families.
Mental health service providers could do much to pre-
vent or reduce stigma by improving the practices of acute
treatment and rehabilitation and by doing more to reduce
stigmatizing and discriminating practices at the therapeutic
and organizational level, following international guidelines
(WHO, 2008).
From an ethical and social perspective, people with schiz-
ophrenia should not receive lower-quality health care than
other citizens (Maj, 2009). Therefore, the authors recommend
an integration of medical and psychosocial care and the estab-
lishment of standards for recovery-based routine medical
practices in which anti-stigma strategies are planned, imple-
mented and monitored. Psychiatrists (and other health profes-
sionals) should always remember that while providing
treatment, they can either increase stigmatization or de-stig-
matize their patients (Schlosberg, 1993). Recovery-based ser-
vices are needed, where patients’ needs drive the efforts for
treatment and rehabilitation, and assertive communication
with staff and regular monitoring of staff behaviour may help
to avoid stigmatization and discrimination that contributes to
poor prognosis of mental disorder, loss of self-esteem and
poor chances for recovery. Medical service providers who
often focus on evidence-based interventions should recall that
values and contexts are also important parts of effective treat-
ment. Information obtained by qualitative research with the
involvement of service users can be of great value in building
mental health services.
Acknowledgements
The authors would like to thank the INDIGO study principal
investigators Professor Graham Thornicroft, Dr Diana Rose and
Professor Norman Sartorius. They would also like to thank the
INDIGO study group: Austria: Professor Heinz Katschnig, Dr
Marion Freidl. Belgium: Professor Dr Chantal Van Audenhove,
Gert Scheerder and Alison Hwong. Brazil: Cecilia Villares,
Fernanda de Almeida Pimentel, Valeska Janas Murier, Renata
Tosta and Professor Miguel R. Jorge. Bulgaria: Mrs Galina
Veshova, Dr Galina Petrova, Dr Vladimir Sotirov, Dr Svetlozar
Vassilev and Dimitar Germanov. Canada: Dr Roumen Milev and
Liane Tackaberry. Cyprus: Dr Yiannis Kalakoutas, Dr Maria
Tziongourou. England: Professor Graham Thornicroft, Dr Diana
Rose, Professor Norman Sartorius, Elaine Brohan, Dr Ann Law,
Dr Richard Church, James Fisher, Dr Morven Leese, Rosalind
Willis, Dr Anil Kumar, Aliya Kassam and Gabriele Schmid.
Finland: Professor Kristian Wahlbeck, Joel Lillqvist and Dr Carita
Tuohimäki. France: Dr Jean Luc Roelandt, Dr Jean Yves Giordana
and Nicolas Daumerie. Germany: Dr Anja Esther Baumann,
Harald Zäske, Julia Weber, Petra Decker, Professor Wolfgang
Gaebel and Professor Hans-Juergen Möller. Greece: Dr Marina
Economou, Christina Gramandani, Eleni Louki, Dimitrios
Kolostoumpis, Dimitri Spiliotis and Dr Lambros Yotis. Hungary:
Dr Judit Harangozo. India: Dr R. Thara. Italy (Verona): Alessia
Cicolini, Antonio Lasalvia, Davide Maggiolo, Alessandro Ricci
and Professor Michele Tansella. Italy (Brescia): Dr Giuseppe
Rossi, Dr Michela Vittorielli and Dr Chiara Buizza. Lithuania: Dr
Arunas Germanavicius, Natalja Markovskaja and Vida Pazikaite.
Malaysia: Dr Chee Kok Yoon and Dr Nor Hayati Ali. Netherlands:
Dr Jaap van Weeghel and Annette Plooy. Norway: Dr Jan Olav
Johannessen and Sveinung Dybvig. Poland: Dr Anna Bielañska,
Dr Andrzej Cechnicki and Hubert Kaszynski. Portugal: Dr Maria
Vargas-Moniz and Liliana Filipe. Romania: Dr Radu Teodorescu.
Slovakia: Marcela Barova. Slovenia: Dr Vesna Švab and Dr
Mateja Strbad. Spain: Dr Blanca Reneses, Dr José Luis Carrasco
and Professor Juan J. Lopez-Ibor. Switzerland: Professor Wulf
Rössler and Dr Christoph Lauber. Tajikistan: Alisher Latypov.
Turkey: Professor Alp Uçok and Dr Banu Aslantas. USA: Dr
Richard Warner.
Harangozo et al. 365
Authors’ Note
Two authors have been supported by the National Institute for
Health Research (NIHR) under its Programme Grants for Applied
Research scheme (RP-PG-0606-1053). The views expressed in
this publication are those of the author(s) and not necessarily
those of the National Health Service (NHS), the NIHR or the
Department of Health. One of the authors is also funded through
an NIHR Specialist Mental Health Biomedical Research Centre at
the Institute of Psychiatry, King’s College London and the South
London and Maudsley NHS Foundation Trust.
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