Background: Stigma related to mental illness is increasingly and more effectively addressed. Although more research is being conducted, there is relatively little from low and middle-income countries, with former Soviet bloc countries identified as a particular contributor to this evidence gap. Romania struggles with mental health stigma at many levels. The aim of this review was to bring together all relevant data regarding stigma and discrimination related to mental illness as well as actions to address these problems in Romania in order to prioritise further stigma research and identify priority targets for stigma reduction. Methods: A systematic literature search was conducted in three online databases and grey literature. After the analysis of full manuscripts, four were excluded based on lack of relevance or incomplete data reporting. Quality assessment was performed for included studies using the Mixed Methods Appraisal Tool (MMAT) and the narrative was synthesized based on the research questions. Results: The review included fifteen studies, the majority having a cross-sectional design. Stigma related to mental illness in Romania, has an impact on help-seeking attitudes and behaviours, workplace environment and social relationships of people with mental health problems. Negative stereotypes are maintained and validated by mass media reports. Significant stigma in healthcare and mental care settings has also been observed. Self-stigma was less frequently reported than public stigma. Despite a few stigma reduction actions, no rigorous evaluation of content, delivery and effectiveness has been conducted and no empirical evidence has been published. Conclusions: Based on this review, three lines of action are recommended in Romania. Increase research concerning stigma in healthcare and mental care settings and use behavioural outcomes. Develop and deliver evidence-based tailored interventions to reduce stigma in identified priority subgroups of the population and ensure rigorous evaluation and scientific dissemination. Elaborate guidelines for working with community stigma and advocate for structural changes.

Background: Despite the increased attention given to improvement of mental health-related knowledge and attitudes, rates of help-seeking for mental illness remain low even in countries with well-developed mental health services. This study examines the relationships between attitudes to mental illness, symptoms of common mental disorder and seeking-help and receiving medication for a mental health problem. Methods: We used data from the nationally representative Health Survey for England 2014 to design three logistic regression models to test for the effects of attitudes to mental illness (measured by a shortened version of the Community Attitudes toward the Mentally Ill, CAMI scale) on: recent contact with a doctor for a mental health problem; use of any type of mental health service in the last 12 months; and having antidepressants currently prescribed, while controlling for symptoms of common mental disorder (measured by the General Health Questionnaire, GHQ). We also tested for an interaction between attitudes to mental illness and symptoms of common mental disorder on the outcomes. Results: A significant but very small effect of CAMI score was found on ‘antidepressants currently prescribed’ model (OR = 1.01(1.00, 1.02) but not on the two indicators of help-seeking. We also found a significant but very small interaction between CAMI and GHQ scores on recent contact with a doctor (OR = 0.99, 95% CI (0.990, 0.998); adjusted Wald test P = 0.01)). Knowing someone with a mental illness had a significant positive effect on help-seeking indicated by: (a) recent contact with a doctor (2.65 (1.01, 6.98)) and (b) currently prescribed antidepressant (2.67 (1.9, 3.75)) after controlling for attitudes to mental illness. Conclusions: Our results suggest that knowing someone with a mental health problem seems to have a further positive effect on help-seeking, beyond improving attitudes to mental illness. Furthermore, multiple different types and aspects of stigma may contribute to help-seeking behaviours, consequently multi-faceted approaches are likely to be most efficient.

Background Stigma associated with mental illness is a critical barrier to effective care, and emerging evidence suggests that stigmatizing attitudes exist even among mental health professionals. In Romania, cultural and systemic factors may exacerbate this issue, yet research examining stigma within this group is limited. This mixed-methods study investigated the attitudes and behaviors of Romanian psychiatry trainees toward individuals with mental illness, their knowledge of mental health stigma, and their perspectives on its causes and potential anti-stigma strategies. Methods Qualitative data were collected through individual interviews, and a quantitative assessment was conducted using the Mental Health Provider Stigma Inventory (MHPSI), with 20 participating trainees. Qualitative data were analyzed using thematic analysis, and mean differences were assessed for the total and subscale scores of the MHPSI. Results Quantitative analysis revealed moderate overall levels of stigma, with no significant differences in total or subscale scores across academic years. Statistically significant differences between males and females were observed for the total score (T(17) = 2.19, p = 0.04) and the “coworker influence” subscale (T(18) = 3.13, p = 0.002), with males scoring higher than females. Qualitative findings indicated that manifestations of stigma, such as diagnostic overshadowing and avoidance, were readily recognized among healthcare professionals. However, only a minority of psychiatry trainees acknowledged stigma in their own clinical practice, particularly in the form of judgmental attitudes and a lack of empathy. Key factors contributing to stigma included insufficient stigma education, institutional culture, and burnout. Trainees highlighted the need for targeted interventions to reduce stigma in clinical interactions. Conclusions These findings underscore that both individual and systemic factors contribute to stigma among psychiatry trainees. Addressing this issue requires comprehensive, context-specific anti-stigma interventions integrated into medical curricula and residency programs, with a focus on stigma training and reflective practice.

Background: Stigma toward people with mental illness remains a major barrier to quality care, persisting even among mental health professionals. This study evaluated the effectiveness and feasibility of a structured anti-stigma intervention for psychiatry trainees. Methods: Outcomes were assessed at baseline, post-intervention, and 3-month follow-up using a knowledge quiz, the Attitudes to Addressing Stigma and Discrimination Scale (ASTAD), and an Objective Structured Clinical Examination (OSCE). Feasibility outcomes were also evaluated. Results: Significant improvements were observed across all measures immediately after training, with medium to large effect sizes. Knowledge scores increased post-intervention (+6.68; 95% CI 5.86–7.50) and remained significantly higher at follow-up (+6; 95% CI 4.99–7.01). Total ASTAD scores improved post-intervention (+5; 95% CI 3.26–6.74) but did not maintain at follow-up. OSCE scores increased by 0.95 points (95% CI 0.62–1.28) post-training. The intervention reached 40% of eligible trainees, with high satisfaction and perceived relevance to clinical practice. Participants reported increased awareness of stigma, improved communication skills, and greater confidence in addressing stigma in patient interactions. Experiential learning methods, including role-play and case discussions, were identified as the most impactful components. Barriers to participation included workload, scheduling constraints, and limited institutional support. Participants recommended integrating the intervention into formal training curricula. Conclusions: The intervention was feasible, acceptable, and effective in improving stigma-related knowledge, attitudes, and clinical skills among psychiatry trainees. While knowledge gains were sustained, attitudinal and behavioral changes were only partially maintained, highlighting the need for longitudinal integration and ongoing reinforcement.

Background/Objectives: Intraocular pressure measurements are influenced by corneal biomechanical properties, but their contribution to discrepancies between different tonometric methods remains poorly understood. This study evaluated the influence of corneal hysteresis (CH) on differences between corneal-compensated IOP (IOPcc), non-contact (NCT), and rebound tonometry, while adjusting for age and central corneal thickness (CCT). Methods: This cross-sectional study included 134 eyes. IOP was measured using NCT, iCare Pro rebound tonometry, and the Ocular Response Analyzer, which provided IOPcc and CH. Central corneal thickness was measured by spectral-domain optical coherence tomography. Agreement was assessed using regression-based Bland–Altman analysis. Multivariable linear regression evaluated CH, CCT, and age as determinants of the tonometric differences. Inter-method differences were also compared across CH tertiles. Results: Mean biases were +0.15 mmHg for IOPcc–NCT, +1.68 mmHg for IOPcc–iCare, and +1.18 mmHg for NCT–iCare. After adjustment for CCT and age, each 1-mmHg decrease in CH was associated with a 1.56-mmHg increase in the IOPcc–NCT difference and a 2.23-mmHg increase in the IOPcc–iCare difference (both p<0.001). Differences involving IOPcc progressively increased across decreasing CH tertiles. In the lowest CH tertile, the mean IOPcc–NCT difference was 2.50 ± 2.05 mmHg, whereas the mean IOPcc–iCare difference reached 5.51 ± 3.11 mmHg, indicating clinically relevant discrepancies in eyes with low CH. Conclusions: Lower corneal hysteresis was associated with greater discrepancies between biomechanically compensated and the other tonometric methods. While mean differences were small in the overall cohort, they became clinically relevant in eyes with low CH. These findings suggest that considering CH in addition to CCT may support a more accurate interpretation of IOP measurements in biomechanically vulnerable eyes.

Background: Despite the increased attention given to improvement of mental health-related knowledge and attitudes, rates of help-seeking for mental illness remain low even in countries with well-developed mental health services. This study examines the relationships between attitudes to mental illness, symptoms of common mental disorder and seeking-help and receiving medication for a mental health problem. Methods: We used data from the nationally representative Health Survey for England 2014 to design three logistic regression models to test for the effects of attitudes to mental illness (measured by a shortened version of the Community Attitudes toward the Mentally Ill, CAMI scale) on: recent contact with a doctor for a mental health problem; use of any type of mental health service in the last 12 months; and having antidepressants currently prescribed, while controlling for symptoms of common mental disorder (measured by the General Health Questionnaire, GHQ). We also tested for an interaction between attitudes to mental illness and symptoms of common mental disorder on the outcomes. Results: A significant but very small effect of CAMI score was found on ‘antidepressants currently prescribed’ model (OR=1.01(1.00, 1.02) but not on the two indicators of help-seeking. We also found a significant but very small interaction between CAMI and GHQ scores on recent contact with a doctor (OR= 0.99, 95% CI (0.990, 0.998); adjusted Wald test P=0.01)). Knowing someone with a mental illness had a significant positive effect on help-seeking indicated by: (a) recent contact with a doctor (2.65 (1.01, 6.98)) and (b) currently prescribed antidepressant (2.67 (1.9, 3.75)) after controlling for attitudes to mental illness. Conclusions: Our results suggest that knowing someone with a mental health problem seems to have a further positive effect on help-seeking, beyond improving attitudes to mental illness. Furthermore, multiple different types and aspects of stigma may contribute to help-seeking behaviours, consequently multi-faceted approaches are likely to be most efficient.