Associations between Beliefs about the Causes of Mental Disorders and Stigmatizing Attitudes: Results of a Mental Health Literacy and Stigma Survey of the Japanese Public

This study aimed to examine the associations between beliefs about the causes of depression and schizophrenia and stigmatizing attitudes towards people with these disorders. In 2013, a web-based survey was carried out with 1,000 Japanese adults. Participants were presented with a case vignette describing either depression, depression with suicidal thoughts, early schizophrenia, or chronic schizophrenia and asked about their beliefs about the causes of these disorders and also about their personally-held stigmatizing attitudes, stigmatizing attitudes perceived in others, and the desire for social distance from the person described in the vignette. The results suggested that perceived stigma was significantly associated with several biogenetic, psychosocial, and personality explanations for both depression and schizophrenia. When respondents believed that psychosocial factors caused depression, they were less likely to perceive them as weak rather than sick. Believing that depression and schizophrenia were caused by personality characteristics was associated with stronger personal beliefs about the ill person’s dangerousness and unpredictability. Future research could aim to examine the influence of personality-based causes of mental illnesses in greater detail.     

Familiarity with mental illness and social distance from people with schizophrenia and major depression: testing a model using data from a representative population survey

OBJECTIVES: The main purpose of this study is to examine whether the relationship between familiarity with mental illness and stigmatizing attitudes about mental illness, which had been observed in a previous study based on a sample of community college students (Psychiatr. Serv. 52 (2001) 953), can be replicated using data from a representative population survey. METHODS: In spring 2001, a representative survey was carried out in Germany (n=5025). A personal, fully structured interview was conducted which began with the presentation of a vignette depicting someone with either schizophrenia or major depression. Respondents were asked to respond to measures assessing familiarity, perception of dangerousness, fear, and social distance. Path analysis with manifest variable structural modeling techniques was applied to test the model used in the previous study. RESULTS: Despite differences in methods, most findings of the previous study were replicated. Respondents who were familiar with mental illness were less likely to believe that people with schizophrenia or major depression are dangerous. Weaker perceptions of dangerousness corresponded closely with less fear of such people, which in turn was associated with less social distance. The effect of familiarity was somewhat pervasive: respondents who reported to be familiar with mental illness expressed a less strong desire for social distance. There is also a relatively strong relationship between perceived dangerousness and social distance. CONCLUSIONS: Our findings fully support the notion that approaches to social change which increase the public's familiarity with mental illness will decrease stigma.     

Prejudice and schizophrenia: a review of the 'mental illness is an illness like any other' approach

OBJECTIVE: Many anti-stigma programmes use the 'mental illness is an illness like any other' approach. This review evaluates the effectiveness of this approach in relation to schizophrenia. METHOD: The academic literature was searched, via PsycINFO and MEDLINE, to identify peer-reviewed studies addressing whether public espousal of a biogenetic paradigm has increased over time, and whether biogenetic causal beliefs and diagnostic labelling are associated with less negative attitudes. RESULTS: The public, internationally, continues to prefer psychosocial to biogenetic explanations and treatments for schizophrenia. Biogenetic causal theories and diagnostic labelling as 'illness', are both positively related to perceptions of dangerousness and unpredictability, and to fear and desire for social distance. CONCLUSION: An evidence-based approach to reducing discrimination would seek a range of alternatives to the 'mental illness is an illness like any other' approach, based on enhanced understanding, from multi-disciplinary research, of the causes of prejudice.     

Determinants of the public's preference for social distance from people with schizophrenia.

OBJECTIVE: To examine the extent to which the public's desire for social distance from people with schizophrenia is influenced by beliefs about the disorder and stereotypes about those suffering from it. METHODS: In spring 2001, we carried out a representative survey of individuals of German nationality aged 18 years and over (n = 5025). Each subject was given a fully structured interview that began with the presentation of a vignette. RESULTS: Both labelling and beliefs about the disorder's causes and prognosis, as well as the perception that those suffering from it are unpredictable and dangerous, had an impact on the public's desire for social distance. However, the latter proved to be more important. As expected, respondents who identified the disorder depicted in the vignette as mental illness, those who blamed the individual for its development, and those who anticipated a poor prognosis expressed a stronger desire for social distance. Endorsing biological factors as a cause was also associated with increased social distance. CONCLUSIONS: Our findings have important implications for interventions aimed at reducing stigma and discrimination related to schizophrenia. Targeting the stereotype of unpredictability and dangerousness appears to be particularly important.     

Stigma in America: has anything changed? Impact of perceptions of mental illness and dangerousness on the desire for social distance: 1996 and 2006

Data from the 1996 and 2006 General Social Survey were analyzed to examine the relationship between the desire for social distance from individuals with mental illness and a number of factors that were thought to contribute to it, including perceptions of mental illness and dangerousness. Random samples of participants were assigned to one of four experimental conditions, in which they were read a vignette describing a character who presented with alcoholism, depression, schizophrenia, or minor problems. The desire for social distance from characters whose presenting problems were alcoholism or depression was significantly lower in 2006 than in 1996. The participants' perceptions that the character was mentally ill and/or dangerous to others partially mediated the association between presenting problem and social distance. Participants who were younger, white, better educated, and attended religious services more often required less social distance from the vignette characters than did their counterparts.     

The Important Role of Stereotypes in the relation between Mental Health Literacy and Stigmatization of Depression and Psychosis in the Community

Increased mental health literacy (MHL) has not reduced stigmatization of people with mental disorder. Thus, we examined the role of stereotypes in the interplay of MHL (correct labelling, causal explanations) and the wish for social distance (WSD) from people with depressive and psychotic symptoms in a community sample of 1526 German-speaking participants in the Swiss ‘Bern Epidemiological At-Risk’ study (age 16–40 years; response rate: 60.1%). Following the presentation of an unlabelled case vignette of depression or psychosis, MHL, stereotypes and WSD were assessed in a questionnaire survey. Their interrelations were studied using structural equation modelling. MHL was not directly linked to WSD, only the psychosocial causal model was directly negatively associated with WSD. Perceived dangerousness particularly increased WSD, this was increased by a biogenetic causal model and decreased by a psychosocial causal model. Awareness-campaigns that, next to biological causes, emphasize psychosocial causes of mental disorders might better reduce stigmatization.

     

Stigmatising attitudes towards people with mental disorders: changes in Australia over 8 years

The aim of the study was to investigate whether Australians' stigmatising attitudes towards people with mental disorders have changed over an 8-year period. In 2011, telephone interviews were carried out with 6019 Australians aged 15 or over. The survey interview used the same questions as those of the 2003/4 national mental health literacy survey, in which participants were presented with a case vignette describing either depression, depression with suicidal thoughts, early schizophrenia or chronic schizophrenia. Questions were asked about stigmatising attitudes, including personal and perceived stigma and social distance. Results showed decreases in social distance scores for all vignettes other than chronic schizophrenia and increases in beliefs about dangerousness and unpredictability. Campaigns to improve mental health literacy and reduce stigmatising attitudes may have had beneficial effects in reducing the desire for social distance from those with mental disorders. However, increase in beliefs about the dangerousness and unpredictability of those with these disorders is of concern and points to the need for public education to address these aspects of stigma.     

Public beliefs about schizophrenia and depression: similarities and differences

OBJECTIVE: Stigma research in psychiatry has mainly focused on mental illness per se. However, recent studies suggest that considerable differences exist between the various disorders. Therefore, we set out to examine similarities and differences of the public's conceptions of schizophrenia and major depression. METHODS: In the spring of 2001, a representative survey was carried out in Germany involving individuals of German nationality who were at least 18 years old and who were living in private households (n = 5,025). RESULTS: Both disorders have in common that they are identified by the majority of the public as an indication of mental illness, that acute stress is most frequently endorsed as cause, that from most respondents a poor natural course is expected which contrasts with a remarkably favorable treatment prognosis, and that people suffering from the two disorders most frequently evoke pity and a desire to help. The perception of dangerousness is closely associated with increased fear and anger, and decreased pity. One of the most notable differences between the two disorders is that while in the case of schizophrenia, labeling as mental illness primarily affects respondents' emotional reactions negatively, in the case of major depression a positive effect prevails. People with schizophrenia are, by far, more frequently considered as dangerous and unpredictable. They evoke more fear while people with major depression evoke more pro-social reactions. CONCLUSION: The described similarities and differences of public beliefs and attitudes with regard to schizophrenia and major depression have important implications for the planning of anti-stigma programs and may help to develop more tailor-made interventions.     

The public’s stigmatizing attitudes towards people with mental disorders: how important are biomedical conceptualizations?

Objective: This study examined hypotheses that stigmatizing attitudes are increased by use of psychiatric labels, by conceptualization of symptoms as a medical illness and by belief in genetic causes. Method: A survey of 3998 Australian adults asked questions about one of four vignettes: early schizophrenia, chronic schizophrenia, depression and depression with suicidal thoughts. Attitudes were measured by a social distance scale and a question about likely dangerousness. Results: Social distance was unrelated to the hypothesized factors. For schizophrenia (but not depression), belief in dangerousness was predicted by medical illness conceptualizations and genetic causal attribution. However, more important factors were the behaviours in the vignette and the belief that they are because of weakness of character. Conclusion: Biomedical conceptualizations are not the major cause of stigma, rather it is the behaviour associated with mental illness and the belief that this is because of personal weakness.     

Biogenetic explanations and public acceptance of people with eating disorders

Purpose

It has been assumed that biogenetic causal models may improve public attitudes toward people with mental illnesses. The present study examines whether biogenetic attributions are positively associated with acceptance of people suffering from these disorders.

Methods

Population surveys were conducted in two large German cities. Respondents were presented with a vignette depicting a young female suffering from either anorexia nervosa (N = 680) or bulimia nervosa (N = 667), followed by a fully structured interview including questions on causal attributions, emotional reactions and desire for social distance.

Results

Attribution to hereditary factors showed hardly any relationship with attitudes toward people with symptoms of eating disorders. Respondents who endorsed brain disease as a cause tended more to hold those afflicted responsible for their condition, they also expressed more negative emotions and a stronger preference for social distance.

Conclusions

Our results do not support the notion that promulgating biogenetic causal models of eating disorders helps decrease the stigma surrounding these illnesses; it may even entail the risk of increasing it.     

Public beliefs about the causes of mental disorders revisited

When the lay public is asked to prioritize their causal beliefs for a vignette depicting either schizophrenia or depression, psychosocial causes are most popular for depression, but a large proportion of respondents prefers biological causes for schizophrenia. Recognition of the vignette as mental illness enhances the likelihood to endorse brain disease as a cause and reduces choices of certain psychosocial causes.     

Labeling—stereotype—discrimination

AIM: Using Link and Phelan's concept of the stigma process, public attitudes towards people with schizophrenia are examined. METHOD: In the spring of 2001, a representative population survey was conducted in Germany (n=5025). A fully structured personal interview was carried out, beginning with the presentation of a case vignette. RESULTS: Labeling as mental illness increased the likelihood that someone suffering from schizophrenia was considered as being unpredictable and dangerous. This, in turn, led to an increase of the preference for social distance. Although much weaker, labeling also had a positive effect on public attitudes insofar as it was associated with a decrease of the tendency to attribute the responsibility for the occurrence of the disorder to the afflicted person. However, this had no significant impact on the desire for social distance. There was no significant association between labeling and the anticipation of poor prognosis. There were some differences between respondents who are familiar with mental illness and those who are not. CONCLUSION: Our findings have some implications for the planning of interventions aimed at reducing stigma and discrimination because of schizophrenia. These interventions should primarily address the stereotypes of unpredictability and dangerousness since they are most likely to have a negative impact on the public's willingness to engage in social relationships with those suffering from this disorder. The interventions should also be tailored according to whether the target population is familiar with mental illness or not.     

Stigmatising attitudes towards people with mental disorders: Results from a survey of Japanese high school students

The aim of the current study was to assess the stigmatising attitudes of Japanese high school students towards people with depression, social phobia and psychosis/schizophrenia. In 2011, 311 students aged 15–18 years filled out an anonymous self-report questionnaire, which included a case vignette describing either depression, schizophrenia or social phobia and two questionnaires to assess stigmatising attitudes towards people with these disorders. Exploratory Structural Equation Modelling (ESEM) was used to determine the dimensionality and loading pattern of the stigma items in the two scales, to establish dimensions of stigma and to compare levels on these dimensions between genders. Stigmatising attitudes towards people with mental disorders in young Japanese people are substantial. ESEM revealed that the structure of stigmatising attitudes in young Japanese people is comparable in personal and perceived attitude stigma, with each forming distinct dimensions and each comprising ‘weak not sick’ and ‘dangerous/unpredictable’ components. The social distance dimension of stigma was separate from other components. Stigmatising attitudes relating to dangerousness/unpredictability were the lowest for social phobia and highest for schizophrenia. Females had lower stigmatising attitudes than males. These findings echo those of Australian studies and extend them by demonstrating a similar structure of stigma in another cultural group, namely young Japanese people.     

The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder

OBJECTIVE: Aim of the study is to examine the impact of labelling on public attitudes towards people with schizophrenia and major depression. METHOD: In Spring 2001, a representative survey was carried out in Germany involving adults of German nationality (n = 5025). RESULTS: Labelling as mental illness has an impact on public attitudes towards people with schizophrenia, with negative effects clearly outweighing positive effects. Endorsing the stereotype of dangerousness has a strong negative effect on the way people react emotionally to someone with schizophrenia and increases the preference for social distance. By contrast, perceiving someone with schizophrenia as being in need for help evokes mixed feelings and affects people's desire for social distance both positively and negatively. Labelling has practically no effect on public attitudes towards people with major depression. CONCLUSION: Our findings illustrate the need for differentiation, differentiation between the different components of stigma as well as differentiation between the various mental disorders.     

Exclusion or Concern: Lawyers' and Community Members' Perceptions of Legal Coercion,Dangerousness and Mental Illness

Forty-six legal professionals and 44 members of the community responded to a questionnaire regarding their perception of the need for legal coercion for treatment for 3 hypothetical vignette characters described as having symptoms of schizophrenia, depression and 'being troubled', [a control] condition. A further condition incorporated in the design was whether or not the vignette character had a comorbid substance abuse issue (alcohol or heroin). Both lawyers and community members over-estimated the schizophrenia and depression vignette characters' potential dangerousness when compared with recent research on the topic. Most legal and community respondents thought legal coercion for treatment was necessary, particularly when there was danger to the individual or to others. However, lawyers were less likely to see a need for legal coercion for treatment than were community members. Contrary to existing research evidence, co-morbid substance abuse for the vignette characters did not significantly increase either lawyers' or community members' perception of vignette characters as being more dangerous to themselves or others.     

No matter of etiology: Biogenetic,psychosocial and vulnerability-stress causal explanations fail to improve attitudes towards schizophrenia

Many anti-stigma campaigns emphasize biogenetic causes to convey that schizophrenia is an “illness like others”. A growing body of studies shows that although biogenetic explanations reduce blame, they tend to reinforce prognostic pessimism and harsher treatment of people with schizophrenia. In contrast, psychosocial explanations attenuate prognostic pessimism and perceived otherness, but seem less suitable to reduce blame. We hypothesized that a vulnerability-stress model that combines biogenetic and psychosocial explanations would yield clearer stigma-reducing effects than the mono-causal models. In an online-experiment, 416 participants from the general population randomly received either a vulnerability-stress, biogenetic, psychosocial or control-intervention, which consisted of information text and video presentation of a case-example. Causal beliefs, stereotypes and desired social distance were assessed by self-report. Baseline causal beliefs were weakly associated with stereotypes. The vulnerability-stress intervention did not reduce stigma more effectively than the biogenetic or psychosocial intervention and was less effective in reducing perceived blame than the biogenetic intervention. Compared to the control-intervention, no intervention showed significant stigma-reducing effects, but the psychosocial and vulnerability-stress conditions both increased blame. We found no evidence for vulnerability-stress explanations as a mean to reduce stigma. We propose further research to identify more effective ways to tackle stigma.     

Mental health literacy and attitude towards people with mental illness: A trend analysis based on population surveys in the eastern part of Germany

BackgroundThere is growing evidence that mental health literacy has improved in western countries in recent years. The question arises as to whether this trend is paralleled by an improvement of attitudes towards people with mental illness.AimTo examine the development of mental health literacy and the desire for social distance towards people with schizophrenia and major depressive disorder in Eastern Germany over a time period of eight years.MethodA trend analysis was carried out using data from two population surveys conducted in the eastern part of Germany in 1993 and 2001. By means of a fully structured interview psychiatric labelling, causal beliefs, help-seeking and treatment recommendations as well as the desire for social distance was assessed.ResultsWhile there was an increase in the mental health literacy of the public, the desire for social distance from people with major depression and schizophrenia remained unchanged or even increased.ConclusionsThe assumption underlying a number of anti-stigma campaigns, namely that educating people about mental disorders may automatically lead to the improvement of their attitudes towards the mentally ill, appears questionable.     

Continuum beliefs and stigmatizing attitudes towards persons with schizophrenia,depression and alcohol dependence

Separation is a central step in the process of stigmatizing persons with mental disorders. We examine whether belief in a continuum of symptoms from mental health to mental illness is associated with less stigmatizing attitudes. In a representative population survey in Germany (n=3642), using case-vignettes of persons suffering from schizophrenia, depression or alcohol dependence, we measured belief in a continuity of symptoms, emotional reactions and desire for social distance related to the person described in the vignette. While 42% of respondents agreed in symptom continuity for depression, this percentage was 26% for schizophrenia and 27% for alcohol dependence. Continuum beliefs were associated in general with more positive emotional reactions and less desire for social distance. This relationship was strongest for schizophrenia, followed by alcohol dependence. Continuum beliefs thus seem to be associated with less stigmatizing attitudes, particularly regarding schizophrenia and alcohol dependence. Educational information on the continuous nature of most psychopathological phenomena could usefully be integrated in anti-stigma messages.     

Can Antistigma Campaigns Be Improved? A Test of the Impact of Biogenetic Vs Psychosocial Causal Explanations on Implicit and Explicit Attitudes to Schizophrenia

Antistigma campaigns have been promoting a medical view of schizophrenia. Given the growing body of research finding negative associations between biogenetic (BG) causal attributions and stigmatizing attitudes, this approach must be reappraised. The present study investigates the impact of different psychoeducational interventions on the etiology of schizophrenia (BG and psychosocial [PS], vs a neutral condition) and on stigmatizing attitudes in medical (n = 60) and psychology students (n = 61). Information was presented via information brochures and a video presentation. Attitudes were assessed before and after the interventions on an explicit level using the stereotype questionnaire and the Social Distance Scale as well as on an implicit level, using the Implicit Association Test. Both educational interventions produced a significant decrease in several stereotype components, which was not the case in the neutral condition. The BG intervention decreased the attribution of blame in both groups. It also decreased the stereotype unpredictability/incompetence and social distance in the medical students but increased the negative outlook on prognosis in the psychology students. The PS intervention reduced the widespread stereotype of dangerousness as well as social distance in the group of medical students. While further research into antistigma interventions is necessary, the proposal for antistigma campaigns is to take a multidimensional and balanced approach, which is adapted to target groups and provides additional facts that challenge the myths maintaining stigma.     

Associations between stigma and help-seeking intentions and beliefs: Findings from an Australian national survey of young people

To reduce stigma and improve help seeking by young people for mental illness, we need a better understanding of the associations between various dimensions of stigma and young people's help-seeking intentions and helpfulness beliefs for various sources of help and for different disorders. This study assessed stigmatizing attitudes and help-seeking intentions and helpfulness beliefs via a national telephone survey of 3021 youths aged 15–25. Five stigma scales were used: social distance, personally held weak-not-sick and dangerousness beliefs, and weak-not-sick and dangerousness beliefs perceived in others. Respondents were presented with a vignette of a young person portraying depression, depression with suicidal thoughts, depression with alcohol abuse, post-traumatic stress disorder, social phobia, or psychosis. Beliefs that mental illness is a sign of personal weakness and preference for social distance were associated with less intention to seek professional help and less endorsement of their helpfulness. In contrast, dangerousness/unpredictability beliefs were associated with more intention to seek professional help and more endorsement of their helpfulness. Findings highlight the importance of examining the associations between different dimensions of stigma with different sources of help, specifically for various mental disorders, to better inform future efforts to reduce stigma and increase help seeking in young people.