Religiosity and stigmatization related to mental illness among African-Americans and Black immigrants: cross-sectional observational study and moderation analysis

Objectives Stigma about mental illness is a known barrier to engagement in mental health services. This study aimed to estimate the associations between religiosity and mental illness stigma among Black adults. Design We conducted an online cross-sectional study of Black adults in the United States (n=269, ages 18-65) from diverse ethnic backgrounds. Results Most (n=248 [92%]) participants attended religious services; while 21 (8%) never attended. Social distance was assessed as an index of past or current stigmatizing behavior. After adjusting for demographic factors, respondents with higher attendance at religious services or greater engagement in religious activities (e.g., prayer, meditation or Bible study) reported greater proximity to people living with mental health problems (RR=1.72; 95% CI: 1.14, 2.59 and RR=1.82; CI: 1.18, 2.79 respectively). Despite reporting greater past or current social proximity, respondents with higher religiosity indices also reported greater future intended stigmatizing behavior (or lower future intended social proximity) (RRs=0.92-0.98). Ethnicity moderated the association between religiosity and future intended stigmatizing behavior. Black immigrants with higher religiosity reported lower future intended stigmatizing behavior (RR=1.16 CI: 1.02-1.32) whereas African-Americans with higher religiosity reported greater future intended stigmatizing behavior (RR=0.83 CI: 0.76, 0.91). Conclusions Higher indices of religiosity were associated with lower past or current stigmatizing behavior towards individuals living with mental health problems but not lower future intended stigmatizing behavior. Focusing specifically on future intended stigmatizing behavior and the respondents level of religiosity, age, and ethnicity may be critical for designing effective stigma-reducing interventions for Black adults.