Familiarity with and social distance from people who have serious mental illness.

OBJECTIVES: This study examined the effects of familiarity with and social distance from persons who have serious mental illness on stigmatizing attitudes about mental illness. METHODS: A total of 208 community college students completed three written measures about familiarity, perception of dangerousness, fear, and social distance. Path analysis with manifest-variable structural modeling techniques was used to test a version of a model in which familiarity influences the perception of dangerousness, which in turn influences fear, which influences social distance from persons with serious mental illness. RESULTS: Most of the participants reported experience with mental illness. Scores on the three written measures largely supported the path model. Correlations between the perception of dangerousness and fear as well as between fear and social distance were particularly strong. CONCLUSIONS: Approaches to social change that increase the public's familiarity with serious mental illness will decrease stigma. Further studies are warranted that focus on how contact between members of the general public and persons who have serious mental illness may be facilitated.     

The relationship between biogenetic causal explanations and social distance toward people with mental disorders: results from a population survey in Germany

AIMS: Several studies have found an inverse relationship between people's readiness to endorse biogenetic causal explanations of mental disorder and their desire for social distance from people with mental disorders. The aim of this study is to examine why this may be the case. METHOD: In the spring of 2001, a population survey was carried out among German citizens aged 18 years and older, living in private households. A total of 5025 interviews were conducted, reflecting a response rate of 65.1%. At the beginning of the personal, fully structured interview, respondents were presented with a vignette containing a diagnostically unlabelled psychiatric case history, either depicting a case of schizophrenia or major depressive disorder. Using five-point Likert scales, causal attributions as well as perceived dangerousness, fear and the desire for social distance were assessed. RESULTS: The more respondents endorse a brain disease as a cause, the more dangerous they believe the person with schizophrenia or major depression to be. Respondents who perceive the individual in the vignette as being dangerous express a higher degree of fear and a greater preference for social distance from these individuals. As compared with brain disease, the relationships between heredity and perceived dangerousness are less pronounced for both disorders. CONCLUSIONS: Our analysis showed that endorsing biogenetic explanations decreases the likelihood of social acceptance of people with schizophrenia and major depression. Rejecting behavioural responses in the form of social distance desired from people with schizophrenia and major depression result from cognitive emotional processes in which biogenetic causal attributions are linked to lack of self-control, unpredictability and dangerousness, which, in turn, are associated with fear of these 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.     

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.     

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.     

Changes in the public's social distance toward individuals with schizophrenia in six German cities. Results of representative pre- and postinterventional telephone surveys from 2001 to 2004

BACKGROUND: In several German cities various programmes and initiatives have been conducted during recent years aimed at reducing the stigma attached to mental illness, especially schizophrenia. So far only single interventions in specific target groups have been evaluated but not their effectiveness in the general population. METHODS: Two representative telephone surveys with repeated measurements were conducted in six German cities (n 7,225/4,622). Social distance towards people with schizophrenia and knowledge of antistigma projects were assessed. RESULTS: Between 2001 and 2004 the social distance toward persons with schizophrenia decreased in the general population. Persons familiar with antistigma projects or who lived in cities with such projects showed lower social distance. CONCLUSIONS: For the first time evidence has been found that antistigma interventions are successful in reducing the stigma attached to schizophrenia in the general population.     

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.     

Social distance and perceived dangerousness across four diagnostic categories of mental disorder

OBJECTIVES: To examine whether laypersons make categorical distinctions between psychoses, neuroses, and addictive behaviours relative to desired social distance and whether degree of familiarity and perceived dangerousness influences social distance judgements. METHOD: Two studies were undertaken using the mental health literacy framework. The first study involved surveying lay beliefs and perceptions of a mentally ill person who exhibited behavioural cues of one of the following: schizophrenia, depression, alcohol abuse, or substance dependence. The second study involved a partial replication and refinement of the first study to determine whether discriminate judgements across diagnostic categories were influenced by perceived dangerousness. RESULTS: Findings from study 1 indicated that laypersons do differentiate between psychological disorders and respond to them differently relative to social distance. Results from study 2 confirmed those of study 1 and in addition suggested that perceived dangerousness influences social distance, largely with respect to schizophrenia. CONCLUSIONS: Laypersons make categorical distinctions between different types of disorders. Perceived dangerousness is more strongly associated with schizophrenia, than is warranted when considered against acts of violence and aggression committed by individuals with alcohol abuse and substance dependence problems.     

The stereotype of schizophrenia and its impact on discrimination against people with schizophrenia: results from a representative survey in Germany

This study aims at assessing the prevalence of different components of the stereotype of schizophrenia among the general public and examining their impact on the preference for social distance and the acceptance of structural discrimination--that is, imbalances and injustices inherent in legal regulations and the provision of health care. In spring 2001, a representative survey was carried out in Germany involving individuals of German nationality aged 18 years and older and living in noninstitutional settings (n = 5,025). A personal, fully structured interview was conducted, including a list of items covering the various aspects of the stereotype, a social distance scale, and items assessing respondents' agreement with structural discrimination. Among the five stereotype components, the perception of people with schizophrenia as being unpredictable and incompetent was most frequently endorsed by the public, followed by perceived dangerousness. While the desire for social distance was best predicted by these two stereotype components, holding the individual responsible for the illness was the most powerful predictor of the acceptance of structural discrimination.     

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.     

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.     

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.     

Dispelling the stigma of schizophrenia: II. The impact of information on dangerousness.

This study addressed a relatively neglected topic in schizophrenia: identifying methods to reduce stigma directed toward individuals with this disorder. The study investigated whether presentation of information describing the association between violent behavior and schizophrenia could affect subjects' impressions of the dangerousness of both a target person with schizophrenia and individuals with mental illness in general. Subjects with and without previous contact with individuals with a mental illness were administered one of four "information sheets" with varying information about schizophrenia and its association with violent behavior. Subjects then read a brief vignette of a male or female target individual with schizophrenia. Results showed that subjects who reported previous contact with individuals with a mental illness rated the male target individual and individuals with mental illness in general as less dangerous than did subjects without previous contact. Subjects who received information summarizing the prevalence rates of violent behavior among individuals with schizophrenia and other psychiatric disorders (e.g., substance abuse) rated individuals with a mental illness as less dangerous than did subjects who did not receive this information. Implications of the findings for public education are discussed.     

How adolescents perceive the stigma of mental illness and alcohol abuse

OBJECTIVES: Research among adults has yielded three sets of conclusions about the stigma of mental illness. First, people with mental illness are stigmatized more severely than those with physical health conditions; those who abuse alcohol are viewed more harshly than those with mental illness. Second, stereotypes of mental illness related to responsibility and dangerousness lead to negative emotional reactions and discriminatory behaviors. Third, familiarity with people with mental illness tends to diminish stigma. This study attempted to validate these findings with a large and diverse sample of adolescents. METHODS: A total of 303 adolescents completed a revised version of the Attribution Questionnaire (rAQ) that presented four vignettes, each describing a different type of peer: a peer with mental illness, with mental illness caused by a brain tumor, with alcohol abuse problems, and with leukemia. The rAQ comprises seven Likert scale items of agreement that research participants rated for each vignette. Items included pity, danger, fear, responsibility, anger, help, and avoidance. Participants also completed a revised Level of Contact Report to assess their familiarity with mental illness. RESULTS: As with adults, adolescents stigmatized peers who abuse alcohol most severely, followed by those with mental illness. Peers with leukemia were treated more benignly than the other groups. Having a brain tumor mediated the stigmatizing effect of mental illness. Adolescents who agreed that persons with mental illness are responsible for their illness and are dangerous demonstrated more discrimination toward these persons. However, this finding was not supported for alcohol abuse. Familiarity yielded an unexpected effect among adolescents; those who reported more familiarity with mental illness were more likely to endorse stigma of mental illness. CONCLUSIONS: Adolescents tended to discriminate among conditions, viewing substance abuse more harshly than the other disorders. Blame and dangerousness were important variables leading to discrimination, and contact with persons with mental illness led to more discrimination.     

The relationship of multiple aspects of stigma and personal contact with someone hospitalized for mental illness, in a nationally representative sample

The stigma of mental illness has been shown to be affected by personal contact with mental illness and by a belief in the genetic heritability of mental illness. We use data from a nationally representative survey to test whether the relationship of stigma with contact remains after taking into account the effects of genetic beliefs and other background characteristics. Contact was defined as a history of psychiatric hospitalization among respondents themselves, their family members, or their friends. Respondents answered questions about a vignette character with a mental illness. We found that respondents with contact felt less anger and blame toward the character, thought that the character had a more serious problem, and would want less social distance from the character, including both casual and intimate aspects of social distance. Respondents with contact were not significantly different from the general population in the degree to which they expressed sympathy, thought the problem would last a lifetime, or wanted to restrict reproduction. Thus, contact is associated with having a less ostracizing, critical attitude toward a stranger with mental illness. The results underscore the importance of this experienced group as a resource in fighting stigma in society. Since many people who have had a psychiatric hospitalization have not told their friends or family members about it, this lower-stigma group could be enlarged.     

Effects of labelling on public attitudes towards people with schizophrenia: are there cultural differences?

OBJECTIVE: A representative survey which was recently conducted in Germany came to the conclusion that labelling as mental illness has an impact on public attitudes towards people with schizophrenia, with negative effects clearly outweighing positive effects. In this study, we will examine whether this result can be replicated in other countries. METHOD: In the summer of 2002, representative surveys were carried out in Novosibirsk (Russia) and in Ulaanbaatar (Mongolia), using the same sampling procedure and interview as in Germany. RESULTS: As in Germany, in Novosibirsk and Ulaanbaatar labelling as mental illness was positively correlated with the endorsement of the belief that the individual depicted in the vignette is in need for help. However, unlike in Germany, labelling had no significant effect on the endorsement of the stereotype of dangerousness. CONCLUSION: Our findings support the notion that labelling effects are culture-related. Therefore, anti-stigma efforts need to be tailored to the specific conditions in a particular country.     

Familiarity with mental illness and approval of structural discrimination against psychiatric patients in Germany

Structural discrimination against psychiatric patients may occur as a result of distribution of resources in the health system. We examine whether familiarity with mental illness, which reduces discrimination on the individual level, also moderates the approval of structural discrimination in health care funding. We conducted a representative survey of the German population (N=5025) in 2001 using a fully structured personal interview, including a measure of preferences for the allocation of health resources and an assessment of familiarity with mental illness. The approval of structural discrimination was inversely related to the individual's familiarity with mental illness in depression and, to a lesser extent, in schizophrenia. This relationship was absent for alcoholism and generally weak for contacts to mentally ill persons outside one's own family. Strategies successful in reducing individual discrimination are thus not necessarily suitable for combating structural discrimination and need to be tailored to their specific target.     

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.     

Prejudice, social distance, and familiarity with mental illness

In this study, the paths between two prejudicial attitudes (authoritarianism and benevolence) and a proxy measure of behavioral discrimination (social distance) were examined in a sample drawn from the general public. Moreover, the effects of two person variables (familiarity with mental illness and ethnicity) on prejudice were examined in the path analysis. One hundred fifty-one research participants completed measures of prejudice toward, social distance from, and familiarity with mental illness. Goodness-of-fit indexes from path analyses supported our hypotheses. Social distance is influenced by both kinds of prejudice: authoritarianism (the belief that persons with mental illness cannot care for themselves, so a paternalistic health system must do so) and benevolence (the belief that persons with mental illness are innocent and childlike). These forms of prejudice, in turn, are influenced by the believers' familiarity with mental illness and their ethnicity. We also discuss how these findings might contribute to a fuller understanding of mental illness stigma.     

Knowledge about schizophrenia and social distance toward individuals with schizophrenia: a survey among predominantly low-income, urban, African American community members

This study surveyed 111 urban African American community members regarding their level of familiarity with mental illness, knowledge about schizophrenia, and social distance toward individuals with schizophrenia. The participants were predominantly Protestant, with relatively low educational attainment and low income. Knowledge and social distance scores were not significantly correlated. Independently significant predictors of knowledge about schizophrenia, which accounted for 49% of the variance in scores, included level of educational attainment, gender, having a friend with a history of psychiatric treatment, and having known someone with schizophrenia. Independent predictors of social distance scores included family history of psychiatric treatment and family history of schizophrenia, which accounted for 14% of variance in scores. Further research involving specific racial, ethnic, cultural, and socioeconomic groups is needed to better understand the complex associations underlying knowledge about schizophrenia and stigma.