Studies have shown that the stigma of the most common mental disorder, namely depression, expose people with these disorders to a substantial amount of stigmatization in the workplace. Apart from the descriptive assessment of the magnitude of stigma, it is also important to investigate the dynamics of the stigma process. Agreeing with Dr. Stuart, three approaches to research on stigma and the workplace are proposed. The first is the dimension of social stigma, i.e., knowledge, attitudes and practices of employers. The second is the perspectives of the patients, i.e., self-stigmatization. The third is legal and policy frameworks, i.e., structural discrimination.

It is certainly true that research on stigma has focused mainly on serious mental illnesses such as schizophrenia. However, there are a few studies from our department on the stigma of depression or obsessive-compulsive disorder, which provide evidence that people with these disorders are also exposed to a substantial amount of stigmatization at the work place. For example, 81.5% of patients with a depressive episode and 82.0% of patients with OCD expected to be discriminated against because of their mental illness when applying for a job. Furthermore, 67.3% of patients with a depressive episode and 80.0% of those with OCD were advised to keep the mental illness a secret when applying for a job (Angermeyer et al. 2004; Stengler-Wenzke et al. 2004).

Two important findings regarding stigma have crystallised from the many surveys we have conducted: First, stigma appears to be persistent over time. A representative survey among the general population in West Germany revealed that 62% of the respondents participating in the 1990 survey agreed with the statement that most employers will pass over the application of a former mental patient in favour of another applicant. The proportion of those who shared this view remained virtually unchanged in 2001 (63.3%) (Angermeyer and Matschinger in press).

Second, an international comparison of data from surveys conducted in Germany, Slovakia and Russia suggests that former mental patients are perceived as being discriminated against in the world of work. In all three countries, a similarly high percentage of respondents agreed with the statement that most employers will pass over an application from a former mental patient in favour of another applicant (Germany 64.2%, Slovakia 65.5% and Russia 70.4%) (Angermeyer et al. unpublished results). It is very likely that research would find similar results in Canada. However, since results cannot be generalized because of different laws, unemployment rates, etc., the situation needs to be assessed in Canada.

Apart from the descriptive assessment of the amount of stigma, it is important to investigate the dynamics of the stigma process, and more importantly, to learn more about the stigma processes operating for mental disorders other than schizophrenia. Many questions need to be answered: Why are employers unwilling to hire people with mental illness? Which stereotypes are responsible? What reactions are elicited?, etc. Only if we shed light on these processes will we be able to design interventions to reduce stigma at the workplace.

As has been suggested by Dr. Stuart, research on stigma and the workplace should focus on three particular topics: first, the dimensions of social stigma, i.e., knowledge, attitudes and practices of employers; second, the perspectives of the patients, i.e., self-stigmatization and third, legal and policy frameworks, i.e., structural discrimination.

Many anti-stigma programs have been established around the globe, but only a few of them target stigmatization in the workplace. These programs are necessary, but they cannot be designed without a solid theoretical foundation and empirical evaluation. Therefore, I greatly appreciate and support Dr. Stuart's initiative, for I am sure that not only patients in Canada but also those in the rest of the world would benefit from this kind of research.

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