Experienced Stigma Related to Common Mental Illness and Alcohol Use Disorder in Rural Uganda: A Qualitative Study.

BACKGROUND

Stigma remains a major barrier to mental health care in low- and middle-income countries (LMICs), yet little is known about how stigma operates for common mental illnesses (CMIs) and alcohol use disorder (AUD) in rural Uganda.

METHODS

We conducted 80 in-depth interviews (IDIs) with individuals and family members affected by CMIs (n=34) or AUD (n=46) in Buyende District, Uganda. Interviews were analyzed inductively using the framework method to identify cross-cutting themes.

RESULTS

Three interlocking themes emerged: Internal Dysphoria, Community Dynamics, and Family Burden. Internalized stigma manifested as denial, concealment, shame, and helplessness. AUD participants resisted moral judgment through denial, while those with CMIs internalized stigma through concealment. Communities perpetuated stigma via misinformation, moralization, indifference, and alienation-framing AUD as moral failure and CMIs as irrational or contagious. Families faced emotional exhaustion, economic strain, and religious or moral conflict. AUD households reported sharper public condemnation and financial collapse, while CMI households experienced chronic caregiving stress and hidden grief.

CONCLUSIONS

Stigma toward people with CMIs and AUD in rural Uganda is pervasive, multilayered, and sustained by moral and structural factors. AUD is publicly moralized, while CMIs are concealed and pathologized. Stigma-reduction strategies should integrate psychoeducation, community and religious engagement, family-centered support, and economic empowerment to disrupt cycles of exclusion and improve care uptake.