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.

BACKGROUND

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.

AIMS: This study aimed to examine the relationship between perceived stigma and key protective factors - spirituality, resilience, quality of life, and social functioning - in patients with MDD from Austria and Japan.

METHOD: 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.

RESULTS

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.

CONCLUSIONS

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.