{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:06:02Z","timestamp":1789538762938,"version":"build-2803163510"},"reference-count":75,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Soc Psychiatry"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Perceived stigma in Major Depressive Disorder (MDD) is a well-established barrier to help-seeking, social functioning, and quality of life. However, little is known about how stigma is shaped by cultural context and which psychosocial resources may buffer its effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>This study aimed to examine the relationship between perceived stigma and key protective factors \u2013 spirituality, resilience, quality of life, and social functioning \u2013 in patients with MDD from Austria and Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>A total of 101 patients diagnosed with MDD (51 from Austria, 50 from Japan) completed validated measures of perceived stigma, spirituality, resilience, quality of life, and social functioning. Correlational analyses, multiple regression, and interaction term models were used to assess the predictive value of psychosocial variables and country moderation effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Spirituality and resilience were negatively associated with perceived stigma across both samples, though only spirituality significantly predicted stigma in regression analyses, increasing to 48% after controlling for age and depression severity. Country-specific models revealed a stronger predictive power in the Japanese sample. While stigma correlated strongly with reduced quality of life in both groups, its association with social functioning varied by stigma dimension and country. The relationship between resilience and financial insecurity was stronger among Japanese study participants than among Austrian participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In summary, spirituality emerged as a central protective factor against stigma in MDD patients, particularly in Japan, underscoring its cultural significance. Additionally, our findings reveal a context-specific relationship between economic stress and psychosocial coping strategies. Despite differences in how stigma is expressed across countries, its adverse impact on quality of life was universal. These results suggest that culturally informed approaches can effectively reduce stigma associated with depression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00207640261473300","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:51:23Z","timestamp":1786006283000},"page":"1569-1583","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cross-Cultural Comparison of Perceived Stigma in Major Depressive Disorder: The Role of Spiritual Well-Being, Resilience, and Quality of Life in Austria and Japan"],"prefix":"10.1177","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2050-5281","authenticated-orcid":false,"given":"Nataliia","family":"Maronchuk","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kie","family":"Nomoto","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan"},{"name":"Department of Psychiatry, Tokyo Musashino Hospital, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5393-1268","authenticated-orcid":false,"given":"Maya","family":"Shirakura","sequence":"additional","affiliation":[{"name":"College of Science, Virginia Polytechnic Institute and State University, Blacksburg, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9321-5018","authenticated-orcid":false,"given":"Sota","family":"Tomiyama","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0891-7035","authenticated-orcid":false,"given":"Jean Lillian","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabienne","family":"Post","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4299-021X","authenticated-orcid":false,"given":"Ellen B.","family":"Rubinstein","sequence":"additional","affiliation":[{"name":"Department of Sociology and Anthropology, North Dakota State University, Fargo, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6757-7862","authenticated-orcid":false,"given":"Timo","family":"Schurr","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3531-8006","authenticated-orcid":false,"given":"Yuya","family":"Mizuno","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan"},{"name":"Department of Psychosis Studies, Institute of Psychiatry, Psychology &amp; Neuroscience, King\u2019s College London, UK"},{"name":"East London NHS Foundation Trust, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Tutzer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0628-7036","authenticated-orcid":false,"given":"Hiroyuki","family":"Uchida","sequence":"additional","affiliation":[{"name":"Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5834-4258","authenticated-orcid":false,"given":"Alex","family":"Hofer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Alqahtani R. Pringle A. (2024). The general impact of self-stigma of mental illness on adult patients with depressive disorders: A systematic review. BMC Nursing 23(1) Article 432. https:\/\/doi.org\/10.1186\/s12912-024-02047-z","DOI":"10.1186\/s12912-024-02047-z"},{"key":"e_1_3_3_3_1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (DSM-5-TR ed.). https:\/\/doi.org\/10.1176\/appi.books.9780890425787","DOI":"10.1176\/appi.books.9780890425787"},{"key":"e_1_3_3_4_1","doi-asserted-by":"crossref","unstructured":"Ando S. Yamaguchi S. Aoki Y. Thornicroft G. (2013). Review of mental-health-related stigma in Japan. Psychiatry and Clinical Neurosciences 67(7) 471\u2013482. https:\/\/doi.org\/10.1111\/pcn.12086","DOI":"10.1111\/pcn.12086"},{"key":"e_1_3_3_5_1","doi-asserted-by":"crossref","unstructured":"Babyak M. A. (2004). What you see may not be what you get: A brief nontechnical introduction to overfitting in regression-type models. Biopsychosocial Science and Medicine 66(3) 411\u2013421. https:\/\/doi.org\/10.1097\/01.psy.0000127692.23278.a9","DOI":"10.1097\/00006842-200405000-00021"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.17433\/978-3-17-039819-1"},{"key":"e_1_3_3_7_1","doi-asserted-by":"crossref","unstructured":"Borges C. C. dos Santos P. R. Alves P. M. Borges R. C. M. Lucchetti G. Barbosa M. A. Porto C. C. Fernandes M. R. (2021). Association between spirituality\/religiousness and quality of life among healthy adults: A systematic review. Health and Quality of Life Outcomes 19(1) Article 246. https:\/\/doi.org\/10.1186\/s12955-021-01878-7","DOI":"10.1186\/s12955-021-01878-7"},{"key":"e_1_3_3_8_1","doi-asserted-by":"crossref","unstructured":"Canada A. L. Murphy P. E. Fitchett G. Peterman A. H. Schover L. R. (2008). A 3-factor model for the FACIT-Sp. Psychooncology 17(9) 908\u2013916. https:\/\/doi.org\/10.1002\/pon.1307","DOI":"10.1002\/pon.1307"},{"key":"e_1_3_3_9_1","doi-asserted-by":"crossref","unstructured":"Cerit C. Filizer A. Tural U. Tufan A. E. (2012). Stigma: A core factor on predicting functionality in bipolar disorder. Comprehensive Psychiatry 53(5) 484\u2013489. https:\/\/doi.org\/10.1016\/j.comppsych.2011.08.010","DOI":"10.1016\/j.comppsych.2011.08.010"},{"key":"e_1_3_3_10_1","doi-asserted-by":"crossref","unstructured":"Chen C. C. Sun X. F. Liu Z. Y. Jiao M. R. Wei W. H. Hu Y. L. (2023). The relationship between resilience and quality of life in advanced cancer survivors: Multiple mediating effects of social support and spirituality. Frontiers in Public Health 11 Article 1207097. https:\/\/doi.org\/10.3389\/fpubh.2023.1207097","DOI":"10.3389\/fpubh.2023.1207097"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.4324\/9780203771587"},{"key":"e_1_3_3_12_1","doi-asserted-by":"crossref","unstructured":"Conner K. O. Copeland V. C. Grote N. K. Koeske G. Rosen D. Reynolds C. F.III. Brown C. (2010). Mental health treatment seeking among older adults with depression: The impact of stigma and race. The American Journal of Geriatric Psychiatry 18(6) 531\u2013543. https:\/\/doi.org\/10.1097\/JGP.0b013e3181cc0366","DOI":"10.1097\/JGP.0b013e3181cc0366"},{"key":"e_1_3_3_13_1","doi-asserted-by":"crossref","unstructured":"Corrigan P. (2004). How stigma interferes with mental health care. American Psychologist 59(7) 614\u2013625. https:\/\/doi.org\/10.1037\/0003-066x.59.7.614","DOI":"10.1037\/0003-066X.59.7.614"},{"key":"e_1_3_3_14_1","doi-asserted-by":"crossref","unstructured":"Corrigan P. W. Watson A. C. (2002). The paradox of self-stigma and mental illness. Clinical Psychology-Science and Practice 9(1) 35\u201353. https:\/\/doi.org\/10.1093\/clipsy\/9.1.35","DOI":"10.1093\/clipsy.9.1.35"},{"key":"e_1_3_3_15_1","doi-asserted-by":"crossref","unstructured":"Corrigan P. W. Watson A. C. Barr L. (2006). The self\u2013stigma of mental illness: Implications for self\u2013esteem and self\u2013efficacy. Journal of Social and Clinical Psychology 25(8) 875\u2013884. https:\/\/doi.org\/10.1521\/jscp.2006.25.8.875","DOI":"10.1521\/jscp.2006.25.8.875"},{"key":"e_1_3_3_16_1","doi-asserted-by":"crossref","unstructured":"Dewi D. S. E. Hamzah H. B. (2019). The relationship between spirituality quality of life and resilience. Proceedings of the 6th International Conference on Community Development (ICCD 2019). https:\/\/doi.org\/10.2991\/iccd-19.2019.39","DOI":"10.2991\/iccd-19.2019.39"},{"key":"e_1_3_3_17_1","doi-asserted-by":"crossref","unstructured":"Eichhorn S. Mehnert A. Stephan M. (2015). German version of the social impact scale (SIS-D)\u2014pilot testing of an instrument for measuring experienced stigmatization in a sample of cancer patients. Psychotherapie Psychosomatik Medizinische Psychologie 65(5) 183\u2013190. https:\/\/doi.org\/10.1055\/s-0034-1398523","DOI":"10.1055\/s-0034-1398523"},{"key":"e_1_3_3_18_1","doi-asserted-by":"crossref","unstructured":"Fife B. L. Wright E. R. (2000). The dimensionality of stigma: A comparison of its impact on the self of persons with HIV\/AIDS and cancer. Journal of Health and Social Behavior 41(1) 50\u201367. https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10750322","DOI":"10.2307\/2676360"},{"key":"e_1_3_3_19_1","doi-asserted-by":"crossref","unstructured":"Gaebel W. Z\u00e4ske H. Baumann A. (2006). The relationship between mental illness severity and stigma. Acta Psychiatrica Scandinavica 113 41\u201345. https:\/\/doi.org\/10.1111\/j.1600-0447.2005.00716.x","DOI":"10.1111\/j.1600-0447.2005.00716.x"},{"key":"e_1_3_3_20_1","doi-asserted-by":"crossref","unstructured":"Goldberg D. (2011). The heterogeneity of \u201cmajor depression.\u201d World Psychiatry 10(3) Article 226. https:\/\/doi.org\/10.1002\/j.2051-5545.2011.tb00061.x","DOI":"10.1002\/j.2051-5545.2011.tb00061.x"},{"key":"e_1_3_3_21_1","doi-asserted-by":"crossref","unstructured":"Graham J. W. (2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology 60(1) 549\u2013576. https:\/\/doi.org\/10.1146\/annurev.psych.58.110405.085530","DOI":"10.1146\/annurev.psych.58.110405.085530"},{"key":"e_1_3_3_22_1","doi-asserted-by":"crossref","unstructured":"Griffiths K. M. Crisp D. A. Barney L. Reid R. (2011). Seeking help for depression from family and friends: A qualitative analysis of perceived advantages and disadvantages. BMC Psychiatry 11(1) Article 196. https:\/\/doi.org\/10.1186\/1471-244X-11-196","DOI":"10.1186\/1471-244X-11-196"},{"key":"e_1_3_3_23_1","doi-asserted-by":"crossref","unstructured":"Hawke L. D. Michalak E. E. Maxwell V. Parikh S. V. (2014). Reducing stigma toward people with bipolar disorder: Impact of a filmed theatrical intervention based on a personal narrative. International Journal of Social Psychiatry 60(8) 741\u2013750. https:\/\/doi.org\/10.1177\/0020764013513443","DOI":"10.1177\/0020764013513443"},{"key":"e_1_3_3_24_1","doi-asserted-by":"crossref","unstructured":"Hawke L. D. Parikh S. V. Michalak E. E. (2013). Stigma and bipolar disorder: A review of the literature. Journal of Affective Disorders 150(2) 181\u2013191. https:\/\/doi.org\/10.1016\/j.jad.2013.05.030","DOI":"10.1016\/j.jad.2013.05.030"},{"key":"e_1_3_3_25_1","doi-asserted-by":"crossref","unstructured":"Henderson C. Evans-Lacko S. Thornicroft G. (2013). Mental illness stigma help seeking and public health programs. American Journal of Public Health 103(5) 777\u2013780. https:\/\/doi.org\/10.2105\/AJPH.2012.301056","DOI":"10.2105\/AJPH.2012.301056"},{"key":"e_1_3_3_26_1","doi-asserted-by":"crossref","unstructured":"Hofer A. Kachel T. Plattner B. Chernova A. Conca A. Fronthaler M. Haring C. Holzner B. Huber M. Marksteiner J. Miller C. Pardeller S. Perwanger V. Pycha R. Schmidt M. Sperner-Unterweger B. Tutzer F. Frajo-Apor B. (2022). Mental health in individuals with severe mental disorders during the covid-19 pandemic: a longitudinal investigation. Schizophrenia (Heidelb) 8(1) 17. https:\/\/doi.org\/10.1038\/s41537-022-00225-z","DOI":"10.1038\/s41537-022-00225-z"},{"key":"e_1_3_3_27_1","doi-asserted-by":"crossref","unstructured":"Hofer A. Mizuno Y. Frajo-Apor B. Kemmler G. Suzuki T. Pardeller S. Welte A. S. Sondermann C. Wartelsteiner F. Fleischhacker W. W. (2016). Resilience internalized stigma self-esteem and hopelessness among people with schizophrenia: Cultural comparison in Austria and Japan. Schizophrenia Research 171(1\u20133) 86\u201391. https:\/\/doi.org\/10.1016\/j.schres.2016.01.027","DOI":"10.1016\/j.schres.2016.01.027"},{"key":"e_1_3_3_28_1","doi-asserted-by":"crossref","unstructured":"Hofer A. Mizuno Y. Wartelsteiner F. Fleischhacker W. W. Frajo-Apor B. Kemmler G. Mimura M. Pardeller S. Sondermann C. Suzuki T. Welte A. Uchida H. (2017). Quality of life in schizophrenia and bipolar disorder: The impact of symptomatic remission and resilience. European Psychiatry 46 42\u201347. https:\/\/doi.org\/10.1016\/j.eurpsy.2017.08.005","DOI":"10.1016\/j.eurpsy.2017.08.005"},{"key":"e_1_3_3_29_1","doi-asserted-by":"crossref","unstructured":"Hofer A. Post F. Pardeller S. Frajo-Apor B. Hoertnagl C. M. Kemmler G. Fleischhacker W. W. (2019). Self-stigma versus stigma resistance in schizophrenia: Associations with resilience premorbid adjustment and clinical symptoms. Psychiatry Research 271 396\u2013401. https:\/\/doi.org\/10.1016\/j.psychres.2018.12.029","DOI":"10.1016\/j.psychres.2018.12.029"},{"key":"e_1_3_3_30_1","unstructured":"IBM Corp. (2022). IBM SPSS Statistics for Windows (Version 29.0.0). https:\/\/www.ibm.com\/products\/spss-statistics"},{"key":"e_1_3_3_31_1","volume-title":"Japanese Version of PSP (Personal and Social Performance Scale) Assessment","author":"Inada T.","year":"2011","unstructured":"Inada T., Yamamoto N., Aizawa R., Inagaki A. (2011). Japanese Version of PSP (Personal and Social Performance Scale) Assessment [Training Sheet Ver.1.0.]. The Japanese Society of Psychiatric Rating Scales."},{"key":"e_1_3_3_32_1","doi-asserted-by":"crossref","unstructured":"Juckel G. Schaub D. Fuchs N. Naumann U. Uhl I. Witthaus H. Hargarter L. Bierhoff H.-W. Br\u00fcne M. (2008). Validation of the Personal and Social Performance (PSP) Scale in a German sample of acutely ill patients with schizophrenia. Schizophrenia Research 104(1\u20133) 287\u2013293. https:\/\/doi.org\/10.1016\/j.schres.2008.04.037","DOI":"10.1016\/j.schres.2008.04.037"},{"key":"e_1_3_3_33_1","doi-asserted-by":"crossref","unstructured":"Juergensen V. Peter L.-J. Steyrl D. Lor C. S. Bui A. P. McLaren T. Muehlan H. Tomczyk S. Schmidt S. Schomerus G. (2024). The help-seeking process and predictors of mental health care use among individuals with depressive symptoms: A machine learning approach. Frontiers in Public Health 12 Article 1504720. https:\/\/doi.org\/10.3389\/fpubh.2024.1504720","DOI":"10.3389\/fpubh.2024.1504720"},{"key":"e_1_3_3_34_1","doi-asserted-by":"crossref","unstructured":"Kim H. S. Sherman D. K. Taylor S. E. (2008). Culture and social support. American Psychologist 63(6) 518\u2013526. https:\/\/doi.org\/10.1037\/0003-066X","DOI":"10.1037\/0003-066X"},{"key":"e_1_3_3_35_1","unstructured":"Kioulos K. T. Bergiannaki J. D. Glaros A. Vassiliadou M. Alexandri Z. Papadimitriou G. (2015). Religiosity dimensions and subjective health status in Greek students. Psychiatrike = Psychiatriki 26(1) 38\u201344. https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25880382"},{"key":"e_1_3_3_36_1","doi-asserted-by":"crossref","unstructured":"Koenig H. G. (2009). Research on religion spirituality and mental health: A review. The Canadian Journal of Psychiatry 54(5) 283\u2013291. https:\/\/doi.org\/10.1177\/070674370905400502","DOI":"10.1177\/070674370905400502"},{"key":"e_1_3_3_37_1","doi-asserted-by":"crossref","unstructured":"Koenig H. G. (2015). Religion spirituality and health: A review and update. Advances in Mind-Body Medicine 29(3) 19\u201326. https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26026153","DOI":"10.1016\/B978-0-12-811282-3.00001-X"},{"key":"e_1_3_3_38_1","doi-asserted-by":"crossref","unstructured":"Krendl A. C. Pescosolido B. A. (2020). Countries and cultural differences in the stigma of mental illness: The East-West divide. Journal of Cross-Cultural Psychology 51(2) 149\u2013167 Article 0022022119901297. https:\/\/doi.org\/10.1177\/0022022119901297","DOI":"10.1177\/0022022119901297"},{"key":"e_1_3_3_39_1","doi-asserted-by":"crossref","unstructured":"Kurihara T. Kato M. Sakamoto S. Reverger R. Kitamura T. (2000). Public attitudes towards the mentally ill: A cross-cultural study between Bali and Tokyo. Psychiatry and Clinical Neurosciences 54(5) 547\u2013552. https:\/\/doi.org\/10.1046\/j.1440-1819.2000.00751.x","DOI":"10.1046\/j.1440-1819.2000.00751.x"},{"key":"e_1_3_3_40_1","volume-title":"Statistical analysis with missing data","author":"Little R. J.","year":"2019","unstructured":"Little R. J., Rubin D. B. (2019). Statistical analysis with missing data. John Wiley & Sons."},{"key":"e_1_3_3_41_1","doi-asserted-by":"crossref","unstructured":"Livingston J. D. Boyd J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social Science & Medicine 71(12) 2150\u20132161. https:\/\/doi.org\/10.1016\/j.socscimed.2010.09.030","DOI":"10.1016\/j.socscimed.2010.09.030"},{"key":"e_1_3_3_42_1","doi-asserted-by":"crossref","unstructured":"Ma K. (2020). The role of spirituality in cultural adjustment of Asian Interna-tional students. Journal of International Education and Practice 3(01&02) 18\u201326. https:\/\/doi.org\/10.30564\/jiep.v3i1and2.2375","DOI":"10.30564\/jiep.v3i1and2.2375"},{"key":"e_1_3_3_43_1","doi-asserted-by":"crossref","unstructured":"Mackenzie C. S. Gekoski W. L. Knox V. J. (2006). Age gender and the underutilization of mental health services: The influence of help-seeking attitudes. Aging and Mental Health 10(6) 574\u2013582. https:\/\/doi.org\/10.1080\/13607860600641200","DOI":"10.1080\/13607860600641200"},{"key":"e_1_3_3_44_1","doi-asserted-by":"crossref","unstructured":"Markus H. R. Kitayama S. (2014). Culture and the self: Implications for cognition emotion and motivation. In Altbach P. G. Arnold K. King I. C. (Eds.) College student development and academic life (pp. 264\u2013293). Routledge. https:\/\/doi.org\/10.1037\/0033-295X.98.2.224","DOI":"10.4324\/9781315051888-16"},{"key":"e_1_3_3_45_1","doi-asserted-by":"crossref","unstructured":"Mizuno Y. Hofer A. Frajo-Apor B. Wartelsteiner F. Kemmler G. Pardeller S. Suzuki T. Mimura M. Fleischhacker W. W. Uchida H. (2018). Religiosity and psychological resilience in patients with schizophrenia and bipolar disorder: An international cross-sectional study. Acta Psychiatrica Scandinavica 137(4) 316\u2013327. https:\/\/doi.org\/10.1111\/acps.12838","DOI":"10.1111\/acps.12838"},{"key":"e_1_3_3_46_1","doi-asserted-by":"crossref","unstructured":"Montgomery S. A. \u00c5sberg M. (1979). A new depression scale designed to be sensitive to change. The British Journal of Psychiatry 134(4) 382\u2013389. https:\/\/doi.org\/10.1192\/bjp.134.4.382","DOI":"10.1192\/bjp.134.4.382"},{"key":"e_1_3_3_47_1","doi-asserted-by":"crossref","unstructured":"Morosini P. L. Magliano L. Brambilla L. Ugolini S. Pioli R. (2000). Development reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica 101(4) 323\u2013329. https:\/\/doi.org\/10.1111\/j.1600-0447.2000.tb10933.x","DOI":"10.1034\/j.1600-0447.2000.101004323.x"},{"key":"e_1_3_3_48_1","doi-asserted-by":"crossref","unstructured":"Murphy P. E. Canada A. L. Fitchett G. Stein K. Portier K. Crammer C. Peterman A. H. (2010). An examination of the 3-factor model and structural invariance across racial\/ethnic groups for the FACIT-Sp: A report from the American Cancer Society\u2019s Study of Cancer Survivors-II (SCS-II). Psychooncology 19(3) 264\u2013272. https:\/\/doi.org\/10.1002\/pon.1559","DOI":"10.1002\/pon.1559"},{"key":"e_1_3_3_49_1","doi-asserted-by":"crossref","unstructured":"Nishi D. Uehara R. Kondo M. Matsuoka Y. (2010). Reliability and validity of the Japanese version of the Resilience Scale and its short version. BMC Research Notes 3(1) Article 310. https:\/\/doi.org\/10.1186\/1756-0500-3-310","DOI":"10.1186\/1756-0500-3-310"},{"key":"e_1_3_3_50_1","doi-asserted-by":"crossref","unstructured":"Nowotny M. (2020). Bestandserhebung der anti-stigma-aktivit\u00e4ten in \u00f6sterreich 2019 [Survey of Anti-Stigma Activities in Austria 2019]. Das Gesundheitswesen 82(05) 445\u2013446. https:\/\/doi.org\/10.1055\/s-0040-1708940.","DOI":"10.1055\/s-0040-1708946"},{"key":"e_1_3_3_51_1","unstructured":"Nowotny M. Strizek J. Puhm A. (2025). Empfehlungen zur Reduktion kultureller Stigmatisierung psychischer Erkrankungen. Zwischenbericht der Kompetenzgruppe Entstigmatisierung [Recommendations for Reducing the Cultural Stigmatization of Mental Illness: Interim Report of the Competence Group on Destigmatization]. Gesundheit \u00d6sterreich GmbH Vienna. https:\/\/jasmin.goeg.at\/id\/eprint\/4347\/."},{"key":"e_1_3_3_52_1","unstructured":"Ociskova M. Prasko J. Holubova M. Latalova K. Sollar T. Zatkova M. Slepecky M. Bocek J. (2023). Self-stigma in patients with schizophrenia: Impact and management. Neuro Endocrinology Letters 44(6) 368\u2013383. https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/37776554"},{"key":"e_1_3_3_53_1","doi-asserted-by":"crossref","unstructured":"Pardeller S. Kemmler G. Hoertnagl C. M. Hofer A. (2020). Associations between resilience and quality of life in patients experiencing a depressive episode. Psychiatry Research 292 113353 Article 113353. https:\/\/doi.org\/10.1016\/j.psychres.2020.113353","DOI":"10.1016\/j.psychres.2020.113353"},{"key":"e_1_3_3_54_1","volume-title":"Spiritually integrated psychotherapy: Understanding and addressing the sacred","author":"Pargament K. I.","year":"2011","unstructured":"Pargament K. I. (2011). Spiritually integrated psychotherapy: Understanding and addressing the sacred. Guilford Press."},{"key":"e_1_3_3_55_1","volume-title":"APA handbook of psychology, religion, and spirituality (Vol 1): Context, theory, and research","author":"Pargament K. I.","year":"2013","unstructured":"Pargament K. I., Exline J. J., Jones J. W. (2013). APA handbook of psychology, religion, and spirituality (Vol 1): Context, theory, and research. American Psychological Association."},{"key":"e_1_3_3_56_1","doi-asserted-by":"crossref","unstructured":"Pescosolido B. A. (2013). The public stigma of mental illness: What do we think; what do we know; what can we prove? Journal of Health and Social Behavior 54(1) 1\u201321. https:\/\/doi.org\/10.1177\/0022146512471197","DOI":"10.1177\/0022146512471197"},{"key":"e_1_3_3_57_1","doi-asserted-by":"crossref","unstructured":"Pescosolido B. A. Martin J. K. Long J. S. Medina T. R. Phelan J. C. Link B. G. (2010). \u201cA disease like any other\u201d? A decade of change in public reactions to schizophrenia depression and alcohol dependence. American Journal of Psychiatry 167(11) 1321\u20131330. https:\/\/doi.org\/10.1176\/appi.ajp.2010.09121743","DOI":"10.1176\/appi.ajp.2010.09121743"},{"key":"e_1_3_3_58_1","doi-asserted-by":"crossref","unstructured":"Peterman A. H. Fitchett G. Brady M. J. Hernandez L. Cella D. (2002). Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy\u2014Spiritual Well-being Scale (FACIT-Sp). Annals of Behavioral Medicine 24(1) 49\u201358. https:\/\/doi.org\/10.1207\/S15324796ABM2401_06","DOI":"10.1207\/S15324796ABM2401_06"},{"key":"e_1_3_3_59_1","doi-asserted-by":"crossref","unstructured":"Post F. Buchta M. Kemmler G. Pardeller S. Frajo-Apor B. Hofer A. (2021). Resilience Predicts Self-Stigma and Stigma Resistance in Stabilized Patients With Bipolar I Disorder. Front Psychiatry 12 678807. https:\/\/doi.org\/10.3389\/fpsyt.2021.678807","DOI":"10.3389\/fpsyt.2021.678807"},{"key":"e_1_3_3_60_1","doi-asserted-by":"crossref","unstructured":"Post F. Pardeller S. Frajo-Apor B. Kemmler G. Sondermann C. Hausmann A. Fleischhacker W. W. Mizuno Y. Uchida H. Hofer A. (2018). Quality of life in stabilized outpatients with bipolar I disorder: Associations with resilience internalized stigma and residual symptoms. Journal of Affective Disorders 238 399\u2013404. https:\/\/doi.org\/10.1016\/j.jad.2018.05.055","DOI":"10.1016\/j.jad.2018.05.055"},{"key":"e_1_3_3_61_1","doi-asserted-by":"crossref","unstructured":"R\u00fcsch N. Angermeyer M. C. Corrigan P. W. (2005). Mental illness stigma: Concepts consequences and initiatives to reduce stigma. European Psychiatry 20(8) 529\u2013539. https:\/\/doi.org\/10.1016\/j.eurpsy.2005.04.004","DOI":"10.1016\/j.eurpsy.2005.04.004"},{"key":"e_1_3_3_62_1","doi-asserted-by":"crossref","unstructured":"Sawab S. Yusuf A. Fitryasari R. Arifin H. (2024). Spirituality and recovery from severe mental disorders: A systematic review. Journal of Psychosocial Nursing and Mental Health Services 62(8) 11\u201317. https:\/\/doi.org\/10.3928\/02793695-20240227-01","DOI":"10.3928\/02793695-20240227-01"},{"key":"e_1_3_3_63_1","doi-asserted-by":"crossref","unstructured":"Schafer J. L. Graham J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods 7(2) 147\u2013177. https:\/\/doi.org\/10.1037\/1082-989X.7.2.147","DOI":"10.1037\/1082-989X.7.2.147"},{"issue":"2","key":"e_1_3_3_64_1","first-page":"51","article-title":"Studies of the reliability and validity of the German version of the Montgomery-Asberg Depression Rating Scale (MADRS)","volume":"139","author":"Schmidtke A.","year":"1988","unstructured":"Schmidtke A., Fleckenstein P., Moises W., Beckmann H. (1988). Studies of the reliability and validity of the German version of the Montgomery-Asberg Depression Rating Scale (MADRS). Schweizer Archiv fur Neurologie und Psychiatrie (Zurich, Switzerland: 1985), 139(2), 51\u201365.","journal-title":"Schweizer Archiv fur Neurologie und Psychiatrie (Zurich, Switzerland: 1985)"},{"key":"e_1_3_3_65_1","doi-asserted-by":"crossref","unstructured":"Schomerus G. Van der Auwera S. Matschinger H. Baumeister S. E. Angermeyer M. C. (2015). Do attitudes towards persons with mental illness worsen during the course of life? An age-period-cohort analysis. Acta Psychiatrica Scandinavica 132(5) 357\u2013364. https:\/\/doi.org\/10.1111\/acps.12401","DOI":"10.1111\/acps.12401"},{"issue":"1","key":"e_1_3_3_66_1","first-page":"16","article-title":"Die resilienzskala\u2013ein fragebogen zur erfassung der psychischen widerstandsf\u00e4higkeit als personmerkmal","volume":"53","author":"Schumacher J.","year":"2005","unstructured":"Schumacher J., Leppert K., Gunzelmann T., Strau\u00df B., Br\u00e4hler E. (2005). Die resilienzskala\u2013ein fragebogen zur erfassung der psychischen widerstandsf\u00e4higkeit als personmerkmal [The Resilience Scale: A Questionnaire for Assessing Psychological Resilience as a Personality Trait]. Zeitschrift f\u00fcr Klinische Psychologie, Psychiatrie und Psychotherapie, 53(1), 16\u201339.","journal-title":"Zeitschrift f\u00fcr Klinische Psychologie, Psychiatrie und Psychotherapie"},{"key":"e_1_3_3_67_1","doi-asserted-by":"crossref","unstructured":"Southwick S. M. Bonanno G. A. Masten A. S. Panter-Brick C. Yehuda R. (2014). Resilience definitions theory and challenges: Interdisciplinary perspectives. European Journal of Psychotraumatology 5(1) Article 25338. https:\/\/doi.org\/10.3402\/ejpt.v5.25338","DOI":"10.3402\/ejpt.v5.25338"},{"key":"e_1_3_3_68_1","doi-asserted-by":"crossref","unstructured":"Takahashi N. Tomita K. Higuchi T. Inada T. (2004). The inter-rater reliability of the Japanese version of the Montgomery\u2013Asberg depression rating scale (MADRS) using a structured interview guide for MADRS (SIGMA). Human Psychopharmacology: Clinical and Experimental 19(3) 187\u2013192. https:\/\/doi.org\/10.1002\/hup.576","DOI":"10.1002\/hup.576"},{"key":"e_1_3_3_69_1","doi-asserted-by":"crossref","unstructured":"Tutzer F. Schurr T. Frajo-Apor B. Pardeller S. Plattner B. Schmit A. Conca A. Fronthaler M. Haring C. Holzner B. Huber M. Marksteiner J. Miller C. Perwanger V. Pycha R. Schmidt M. Sperner-Unterweger B. Hofer A. (2024). Relevance of spirituality and perceived social support to mental health of people with pre-existing mental health disorders during the COVID-19 pandemic: A longitudinal investigation. Social Psychiatry and Psychiatric Epidemiology 59(8) 1437\u20131448. https:\/\/doi.org\/10.1007\/s00127-023-02590-1","DOI":"10.1007\/s00127-023-02590-1"},{"key":"e_1_3_3_70_1","doi-asserted-by":"crossref","unstructured":"Uchino T. Fukui E. Takubo Y. Iwai M. Katagiri N. Tsujino N. Imamura H. Fujii C. Tanaka K. Shimizu T. Nemoto T. (2023). Perceptions and attitudes of users and non-users of mental health services concerning mental illness and services in Japan. Front Psychiatry 14 Article 1138866. https:\/\/doi.org\/10.3389\/fpsyt.2023.1138866","DOI":"10.3389\/fpsyt.2023.1138866"},{"key":"e_1_3_3_71_1","unstructured":"Wagnild G. M. Young H. M. (1993). Development and psychometric evaluation of the Resilience Scale. Journal of Nursing Measurement 1(2) 165\u2013178. https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/7850498"},{"key":"e_1_3_3_72_1","doi-asserted-by":"crossref","unstructured":"Wang J. Mann F. Lloyd-Evans B. Ma R. Johnson S. (2018). Associations between loneliness and perceived social support and outcomes of mental health problems: A systematic review. BMC Psychiatry 18(1) Article 156. https:\/\/doi.org\/10.1186\/s12888-018-1736-5","DOI":"10.1186\/s12888-018-1736-5"},{"key":"e_1_3_3_73_1","doi-asserted-by":"crossref","unstructured":"Whoqol Group WHO. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine 28(3) 551\u2013558. https:\/\/doi.org\/10.1017\/s0033291798006667","DOI":"10.1017\/S0033291798006667"},{"key":"e_1_3_3_74_1","unstructured":"World Health Organization. (2021). Comprehensive mental health action plan 2013\u20132030. https:\/\/www.who.int\/publications\/i\/item\/9789240031029."},{"key":"e_1_3_3_75_1","doi-asserted-by":"crossref","unstructured":"Yang L. H. Kleinman A. Link B. G. Phelan J. C. Lee S. Good B. (2007). Culture and stigma: Adding moral experience to stigma theory. Social Science & Medicine 64(7) 1524\u20131535. https:\/\/doi.org\/10.1016\/j.socscimed.2006.11.013","DOI":"10.1016\/j.socscimed.2006.11.013"},{"key":"e_1_3_3_76_1","doi-asserted-by":"crossref","unstructured":"Zeldovich M. Pieh C. Humer E. (2025). Help-seeking and help-receiving behavior in the Austrian general population and the impact of self-stigma: A cross-sectional study. Journal of Public Health 33 1\u201311. https:\/\/doi.org\/10.1007\/s10389-025-02502-4","DOI":"10.1007\/s10389-025-02502-4"}],"container-title":["International Journal of Social Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00207640261473300","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00207640261473300","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00207640261473300","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:48:40Z","timestamp":1789537720000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00207640261473300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":75,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1177\/00207640261473300"],"URL":"https:\/\/doi.org\/10.1177\/00207640261473300","relation":{},"ISSN":["0020-7640","1741-2854"],"issn-type":[{"value":"0020-7640","type":"print"},{"value":"1741-2854","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]}}}