Article Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries Franco Mascayano 1 , Josefina Toso-Salman 1 , Yu Chak Sunny Ho 1 , Saloni Dev 1 , Thamara Tapia 1 , Graham Thornicroft 2 , Leopoldo J Cabassa 3 , Akwatu Khenti 4 , Jaime Sapag 4,5,6 , Sireesha J Bobbili 4 , Rube ´ n Alvarado 7 , Lawrence Hsin Yang 1,8 and Ezra Susser 1,8 Abstract Stigma is one of the main barriers for the full implementation of mental health services in low- and middle-income countries (LMICs). Recently, many initiatives to reduce stigma have been launched in these settings. Nevertheless, the extent to which these interventions are effective and culturally sensitive remains largely unknown. The present review addresses these two issues by conducting a comprehensive evaluation of interventions to reduce stigma toward mental illness that have been implemented in LMICs. We conducted a scoping review of scientific papers in the following databases: PubMed, Google Scholar, EBSCO, OVID, Embase, and SciELO. Keywords in English, Spanish, and Portuguese were included. Articles published from January 1990 to December 2017 were incorporated into this article. Overall, the studies were of low-to-medium methodological quality—most only included evaluations after intervention or short follow-up periods (1–3 months). The majority of programs focused on improving knowledge and attitudes through the education of healthcare professionals, community members, or consumers. Only 20% (5/25) of the inter- ventions considered cultural values, meanings, and practices. This gap is discussed in the light of evidence from cultural studies conducted in both low and high income countries. Considering the methodological shortcomings and the absence of cultural adaptation, future efforts should consider better research designs, with longer follow-up periods, and more suitable strategies to incorporate relevant cultural features of each community. Keywords interventions, low- and middle-income countries, mental illness, stigma Introduction Over one-fifth of the global burden of disease has been attributed to neuropsychiatric disorders such as depres- sion, schizophrenia, and substance use disorders (Whiteford, Degenhardt, Murray, Vos, & Lopez, 2014). About three-quarters of this burden is experi- enced in low- and middle-income countries (LMICs). Nonetheless, over 80% of those persons living in LMICs who are in need of mental health care do not receive any effective treatment, due to the scarcity of skilled healthcare staff, persistent social inequalities, and the stigma associated with mental illness 1 Columbia University 2 King’s College London 3 Washington University in St. Louis 4 IMHPR, Centre for Addiction and Mental Health 5 Mental Health, Catholic University of Chile 6 Dalla Lana School of Public Health, University of Toronto 7 Universidad de Chile 8 New York University College of Global Public Health Corresponding author: Franco Mascayano, Columbia University Mailman School of Public Health, 722 West 168th St., Room 1030, New York, NY 10032, USA. Email: fm2582@cumc.columbia.edu Transcultural Psychiatry 0(0) 1–21 ! The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1363461519890964 journals.sagepub.com/home/tps