The role of perceived norms in the stigmatization of mental illness

Prototypes of People With Depression

This article investigates the content and the consequences of the prototypes of people with depression in a multimethod fashion. Fourteen preregistered studies (total N = 5,023, with U.S. American, British, and French adult participants) show that laypeople consider people with depression as having specific psychological, social, and physical features (e.g., unattractive, overweight, unsuccessful, introverted). Target prototypicality influences how much laypeople believe others have depression, how much observers believe that depression-like symptoms cause someone to experience psychological pain, and how much professional mental health care is appropriate for others. This effect was not reduced by instructing people to focus on the symptoms and ignore the target features yet was weakly reduced by informing them of the effect. We discuss theoretical implications for the understanding of prototypes of people with depression and practical implications for alleviating the impact of prototypes.

Gaming disorder and stigma-related judgements of gaming individuals: An online randomized controlled trial

BACKGROUND AND AIMS

The inclusion of gaming disorder (GD) in the International Classification of Diseases 11th Revision (ICD-11) has generated scholarly debate, including claims about its potential stigmatizing effects on the wider gaming population. The present study aimed to estimate the effect of addiction-based and non-addiction-based conceptualizations of problem gaming on stigma of gamers.

DESIGN

This preregistered experiment involved a 2 (health information: addiction-related or non-addiction-related) × 3 (vignette: problem, regular or casual gamer) randomized, between-subjects design.

SETTING

An international sample of participants was recruited via Prolific in June and July 2021.

PARTICIPANTS

Participants were eligible (n = 1228) if they were aged 35 to 50 years, played video games for no more than 6 hours per week and did not endorse DSM-5 or ICD-11 criteria for GD.

INTERVENTION AND COMPARATOR

Participants were provided with an explanation of problem gaming as related to either an addictive disorder (i.e. 'addiction' explanation) or personal choice and lifestyle factors (i.e. 'non-addiction' explanation).

MEASUREMENTS

The Attribution Questionnaire (AQ) and Universal Stigma Scale (USS) assessed stigma toward each gamer vignette. Vignettes described a problem gamer (with features of GD); a regular gamer (frequent gaming; some life interference); and a casual gamer (infrequent gaming; no life interference).

FINDINGS

Problem gamer vignettes (mean [M] = 113.3; 95% CI = 111.5-115.4) received higher AQ stigma ratings than regular (M = 94.0; 95% CI = 91.9-95.9) and casual gamers (M = 80.1; 95% CI = 78.2-82.1). Although significant, the effect of health information type on AQ stigma ratings was negligible (addiction group [M = 97.6; 95% CI = 95.9-99.1], non-addiction group [M = 94.1; 95% CI = 92.6-95.8]). However, the addiction information group scored lower on USS blame and responsibility than the non-addiction information group with at least a small effect (99.1% confidence).

CONCLUSIONS

Framing of problem gaming as an addictive disorder or non-addictive activity appears to have a negligible effect on stigma of different gamers among middle-age adults with minimal gaming experience. The concept of 'gaming addiction' seems unlikely to be an important influence on public stigma of gaming.

The effect of survey administration mode on youth mental health measures: Social desirability bias and sensitive questions

Aim

Research on trends in youth mental health is used to inform government policy and service funding decisions. It often uses interviewer-administered surveys, which may be affected by mode effects related to social desirability bias. This study sought to determine the impact of survey administration mode on mental health measures, comparing mode effects for sensitive mental health measures (psychological distress and wellbeing) and non-sensitive (physical activity) measures.

Methods

Data were from two large national community samples of young Australians aged 12-25 years conducted in 2020 (N = 6238) and 2022 (N = 4122), which used both interviewer-administered and self-report modes of data collection.

Results

Results showed participants reported lower psychological distress and higher wellbeing in the interviewer-assisted compared with the self-report mode. No mode effects were found for the non-sensitive physical activity measures. No interaction between mode and gender was found, but an age group by mode interaction revealed that those in the 18-21 and 22-25-year age groups were more strongly affected than younger adolescents.

Conclusions

These findings suggest underestimates of mental health issues from interview survey formats, particularly for young adults. The results show how even a weak mode effect can have a large impact on mental health prevalence indicators. Researchers and policy makers need to be aware of the impact social desirability bias can have on mental health measures and consider taking steps to mitigate this effect.

The relationships between perceived mental illness prevalence, mental illness stigma, and attitudes toward help-seeking

Previous research suggests that, despite the commonality of mental illness in the United States, the majority of U.S. individuals with mental illness do not seek treatment. One important factor that contributes to this lack of treatment utilization is mental illness stigma. Such stigma may result, in part, from many individuals in the U.S. underestimating the prevalence of mental illness. To test whether this is the case, 638 adults from across the U.S. completed measures related to perceived prevalence of mental illness, private stigma, perceived public stigma, and help-seeking. Findings indicated participants significantly underestimated the given-year prevalence rate of mental illness. The perceived given-year prevalence rate was significantly correlated with lower private stigma and more positive attitudes towards help-seeking. Personal stigma significantly predicted attitudes towards help-seeking. Findings also suggested that individuals who have received mental health services have a higher perceived prevalence rate of mental illness, as well as lower levels of personal stigma and more positive attitudes towards help-seeking. These findings support the notion that helping the general public recognize the true prevalence rate of mental illness could reduce personal mental illness stigma and facilitate help-seeking behaviors. However, future experimental studies are needed to test this hypothesis.

Continuum beliefs of mental illness: a systematic review of measures

PURPOSE

The continuum of mental health/illness has been subject to scientific debate for decades. While current research indicates that continuum belief interventions can reduce mental health stigma and improve treatment seeking in affected populations, no study has yet systematically examined measures of continuum beliefs.

METHODS

This preregistered systematic review summarizes measures of continuum beliefs. Following the PRISMA statement, three scientific databases (PubMed, PsycInfo and PsycArticles via EBSCOhost, Web of Science) are searched, instruments are described and discussed regarding their scope, and methodological quality.

RESULTS

Overall, 7351 records were identified, with 35 studies reporting relevant findings on 11 measures. Most studies examined general population samples and used vignette-based measures. Schizophrenia and depression were most commonly examined, few studies focused on dementia, ADHD, OCD, eating disorders, and problematic alcohol use, or compared continuum beliefs across disorders. Validity was very good for most measures, but reliability was rarely tested. Measures mostly assessed beliefs in the normality of mental health symptoms or the normality of persons with such symptoms but rarely nosological aspects (i.e., categorical v continuous conceptualization of mental disorders).

CONCLUSIONS

Current research provides psychometrically sound instruments to examine continuum beliefs for a variety of mental disorders. While studies suggest utility for general population samples and mental health professionals, more research is necessary to corroborate findings, for instance, regarding age (e.g., in adolescents), gender, or type of mental disorder. Future research should also compare self-report ratings, and vignette-based measures, include measures of nosological concepts to fully grasp the continuum concept of mental illness.

PREREGISTRATION

PROSPERO: CRD42019123606.

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.

Social distance and stigma towards persons with serious mental illness among medical students in five European Central Asia countries

The study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in the Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students' responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of enhanced range of integrated training opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them.

Validation of a tool to assess effectiveness of peer-recruitment for hepatitis C testing and linkage to care among people who inject drugs

OBJECTIVE

People who inject drugs (PWID) have high hepatitis C virus (HCV) infection prevalence but low rates of HCV treatment uptake. To better harness the potential of peer-led social network-based interventions to increase HCV treatment uptake among PWID, simple tools that can help identify individuals with the potential to function effectively as peer-mentors who support network members to get HCV tested and linked to care are needed.

METHODS

Data from a survey administered to index PWID enrolled in a social network-based intervention, in which they were invited to recruit drug use network members for HCV testing and linkage to care, was analyzed. Constructs derived from exploratory factor analysis were validated through confirmatory factor analysis (CFA). We used logistic regression analysis to assess the association between scores in identified constructs and subsequent effectiveness in the peer mentor role, defined as recruiting at least one network member for HCV testing and linkage to care in the 12 weeks following survey completion.

RESULTS

Among 100 PWID with median age 53 years, 74% male, and 71% Black, CFA resulted in a multidimensional three-factor survey with 4 questions related to opinion leadership, 3 questions related to perceived HCV-related stigma, and 3 questions related to HCV communication comfort and care support willingness. Only self-designated opinion leadership was associated with effectiveness in the peer mentor role (adjusted odds ratio 3.76 (95% Confidence interval CI 1.01, 14.0)).

CONCLUSION

We developed and validated a simple tool with potential to ease and improve the efficiency of peer-led social network interventions.

Advancing Research to Eliminate Mental Illness Stigma: The Design and Evaluation of a Single-Arm Intervention Among University Students in Singapore

Background

Anti-stigma interventions for school and college students have been studied in several countries, but to the best of our knowledge, this has not been addressed in Singapore. The current study was designed to address this lacuna and aimed to evaluate the effectiveness of an anti-stigma intervention focusing on depression among university students in Singapore.

Methods

A one-off intervention comprising education and personal contact with a person with lived experience of depression was carried out in nine consecutive sessions over 6 months (October 2018 to April 2019) among 390 university students. Knowledge of depression and extent of stigma toward mental illness were assessed pre- and post-intervention as well as at 3-month follow-up.

Results

The intervention was effective in improving depression knowledge (d = 1.09; p < 0.001), as well as reducing social distancing (d = 0.54; p < 0.001) and personal stigma (dangerous/undesirable: d = 0.60; p < 0.001 and weak not sick: d = 0.10; p < 0.033) pre- to post-intervention as well as pre- intervention to 3-month follow-up (p < 0.005).

Limitations

While 3-month follow-up data indicates favorable medium-term impact on knowledge and stigma; the study lacks long-term follow-up to examine the impact of anti-stigma interventions across time. The data were collected through self-report measures; however, social desirability bias is possible despite the assurances of confidentiality.

Conclusion

Given the impact of the intervention, there is a need to consider the feasibility, challenges, and enablers of implementation of such interventions into the curriculum of university students to ensure a broader and sustained outreach and stigma reduction.

Factors determining social distance toward people with depression among community pharmacists

Objective

The aim of the present study was to measure stigma among community pharmacists regarding patients with depression, using social distance as a proxy measure. Furthermore, factors influencing stigmatization were identified.

Methods

A survey consisting of questions regarding social distance, cognitive attitude components, stereotypical beliefs and behavioural tendencies towards pharmaceutical care for patients with depression was carried out. The survey was completed by 149 community pharmacists with a response rate of 82%. Multiple linear regression analysis was applied to the results of the survey.

Results

Most pharmacists endorsed social distance towards patients with depression. The social distance further increased the more the situation described implied “social closeness”. Age, depression care attitude, the stereotypical belief “danger to others” and the level of involvement pharmacists showed towards patients with depression were found to predict social distance. The present model explains 32.3% of the variance in social distance.

Conclusion

The results showed that community pharmacists have a stigmatizing attitude towards patients with depression. The determinants found to influence these stigmatizing attitudes might be addressed when trying to reduce stigmatization of patients with depression.

Stigmatizing Attitudes Towards Mental Disorders Among Non-Mental Health Professionals in Six General Hospitals in Hunan Province

Background: There have been few studies on the stigma associated with mental disorders among non-mental health professionals in general hospitals in China. This study seeks to explore mental health-related stigma and the desire for social distance among non-mental health professionals in general hospitals in Hunan Province in China. Methods: The study was carried out with 1123 non-mental health professionals in six general hospitals in Hunan Province by using a questionnaire with a case vignette describing either schizophrenia, depression, or generalized anxiety disorder (GAD). Questions were asked about the attitudes of participants and other people towards individuals with mental disorders and the willingness to come into contact with them. Results: The people described in the vignette were considered dangerous by 84.4% of participants for schizophrenia, 72.0% of participants for depression, and 63.1% of participants for GAD. Besides being dangerous, people with schizophrenia were perceived as unpredictable and as the least suitable for voting for as a politician or employing. Around 50% of participants believed the problems described in the vignette were due to personal weakness. Over 70% of the non-mental health professionals were not willing to have the people described in the vignette marry into their family. The participants had gained their mental health-related knowledge mainly through the media, mostly from newspapers. Conclusions: The current study found a significant stigma towards individuals with mental disorders and a desire for social distance from such people among non-mental health professionals in general hospitals in Hunan Province. Anti-stigma interventions should focus on addressing non-mental health professionals' beliefs on dangerousness and unpredictability.

An examination of perceptions of individuals with an intellectual disability, with and without co-morbid schizophrenia: effects of labels on stigma

BACKGROUND

Research demonstrates negative perceptions of individuals with intellectual disabilities (ID) and individuals with schizophrenia, but no study has examined ID with a co-morbid psychiatric disorder. The present study examined the social distance desired from and perceptions of dangerousness of ID, schizophrenia and co-morbid schizophrenia and ID and examined the impact of providing a label for the behaviours presented in a vignette.

METHODS

A total of 160 participants, all university students, were randomly assigned to one of six vignettes detailing a person with schizophrenia, ID, or a person with both presenting problems. Half of the participants were randomly assigned to read vignettes that had a label provided for the behaviours of the target.

RESULTS

Participants desired more social distance from the unlabelled than labelled targets. Presence of schizophrenia resulted in increased social distance, but co-morbid ID and schizophrenia elicited less desire for social distance than schizophrenia alone. Schizophrenia resulted in more perceived danger, but labelled co-morbid schizophrenia and ID resulted in little perceived danger.

CONCLUSIONS

Labels resulted in positive outcomes, particularly, when ID was co-morbid with schizophrenia. Schizophrenia stigma appears to be impacted by an ID label, indicating educating the public about the spectrum of co-morbidity may be useful.

The predictive effect of empathy and social norms on adolescents' implicit and explicit stigma responses

Research indicates that adolescents who experience mental health difficulties are frequently stigmatised by their peers. Stigmatisation is associated with a host of negative social and psychological effects, which impacts a young person's well-being. As a result, the development of effective anti-stigma strategies is considered a major research priority. However, in order to design effective stigma reduction strategies, researchers must be informed by an understanding of the factors that influence the expression of stigma. Although evidence suggests that empathy and social norms have a considerable effect on adolescents' social attitudes and behaviours, research has yet to examine whether these factors significantly influence adolescents' responses toward their peers with mental health difficulties. Thus, this study aims to examine whether empathy (cognitive and affective) and peer norms (descriptive and injunctive) influence adolescents' implicit and explicit stigmatising responses toward peers with mental health problems. A total of 570 (221 male and 348 female; 1 non-specified) adolescents, aged between 13 and 18 years (M = 15.51, SD = 1.13), participated in this research. Adolescents read vignettes describing male/female depressed and 'typically developing' peers. Adolescents answered questions assessing their stigmatising responses toward each target, as well as their empathic responding and normative perceptions. A sub-sample of participants (n=173) also completed an IAT assessing their implicit stigmatising responses. Results showed that descriptive norms exerted a substantial effect on adolescents' explicit responses. Cognitive empathy, affective empathy and injunctive norms exerted more limited effects on explicit responses. No significant effects were observed for implicit stigma. Overall, empathy was found to have limited effects on adolescents' explicit and implicit stigmatising responses, which may suggest that other contextual variables moderate the effects of dispositional empathy on responding. In conclusion, these findings suggest that tackling the perception of negative descriptive norms may be an effective strategy for reducing explicit stigmatising responses among adolescents.

Reducing the Stigma of Depression Among Asian Students

In North America, Asians reliably report higher levels of stigma toward people with depression than do Europeans. Possible methods of reducing this discrepancy have rarely been explored. Asian undergraduate students ( n = 132) were presented with one of four antistigma videos with two actresses: one portraying a student with depression and the other a professor. The videos used the concept of social proof, presenting either positive or negative descriptive norms, to effect change in stigma, measured by social distance. It was hypothesized that the positive descriptive norms intervention would show significantly greater positive change in social distance compared with the negative descriptive norms intervention. All videos were effective in reducing preferred social distance toward people with depression relative to the control condition. The effectiveness of the positive descriptive norm video was mediated through descriptive norms and self-efficacy. The effectiveness of the negative descriptive norm video was mediated through injunctive norms and perceived value of support. The findings can help guide interventions that aim to encourage social engagement with people with depression among Asian student populations. Manipulating social norms and increasing self-efficacy may be especially effective.

Psychiatric disorder and work life: A longitudinal study of intra-generational social mobility

BACKGROUND

Intra-generational social mobility, which describes the mobility within an individual's own working life, is seldom studied among employees with psychiatric disorders (EPD). There is need of knowledge of the intra-generational mobility patterns, in a broader perspective, among EPD.

AIMS

To investigate intra-generational social mobility in employed individuals diagnosed with affective disorder, personality disorder, schizophrenia and drug dependence in a national Swedish cohort.

METHOD

We identified a national sample of employed Swedish adults born in 1939-1949 (N = 876, 738), and among them individuals with a first-time hospital admission for affective psychosis, neurosis and personality disorder, alcoholism, drug dependence or schizophrenia in 1964-1980 (N = 18, 998). Employed individuals without hospital admission for such diagnoses were utilised as a comparison group (N = 866, 442). Intra-individual social class changes between 1980 and 1990 among EPD and the comparison group were described through summary statistics and graphs.

RESULTS

EPD more often held Low manual occupations at baseline in 1980 than the comparison group (44% vs. 28%), although parental social class was similar. In 1990, 19% of EPD and 4% of the comparison group had lost contact with the labour market. Social stability was less common among EPD (49 %) than in the comparison group (67%). Mobility out of the labour force increased and social stability decreased by number of inpatient admissions. Employees diagnosed with affective psychosis or neurosis and personality disorder fared better in the labour market than employees with schizophrenia.

CONCLUSION

Employees suffering from psychiatric disorder do not maintain their social class or remain in the labour force to the same extent as individuals without those problems, irrespective of their parental class. Our results support the social drift hypothesis that individuals with poor psychiatric health move downward in the social hierarchy.

Accounting for Differences in Depression Stigma Between Canadian Asians and Europeans

Stigma is an important barrier to recovery from depression. Individuals of Asian origin show greater levels of depression stigma compared with individuals of European origin. This study examined the mediators of the relationship between ethnicity and depression stigma in a North American context. A sample of university students, including 199 Canadian Europeans and 249 Canadian Asians, completed a variety of measures through an online study. Stigma toward an individual with depression was measured using both the Depression Attribution Questionnaire-27 and a Social Distance Scale. The perception of social norms, the belief that depression brings shame to one’s family, a social dominance orientation, and conservative values mediated the relationship between ethnicity and depression stigma with perceived norms and familial shame having the largest indirect effects. These findings are consistent with social identity theory and suggest avenues for anti-stigma interventions.

Personal and perceived stigmatization of depression: a comparison of data from the general population, participants of a depression congress and job placement officers in Germany

Personal and perceived depression stigma was assessed with Griffiths and colleagues׳ Depression Stigma Scale in 1509 German adults. The sample comprised three groups of participants: attendees of a depression congress, job placement officers and a representative general population sample. In all groups, personal stigma was lower than perceived stigma. Personal stigma was significantly higher in the general population than in the placement officers, and lowest in congress attendees. Perceived stigma was lower in congress attendees than in the general population. Personal stigma was lower in women decreased with age. The finding of lower personal stigma compared to perceived stigma might reflect effects of social desirability. Those with less contact with persons with depression, i.e. job placement officers and the general population, may be less tolerant and lack understanding of depression, resulting in higher levels of personal stigma. These findings support the notion that depression campaigns should be tailor-made to address gender and age-specific differences in personal and perceived stigma.

Beliefs and attitudes among Italian high school students toward people with severe mental disorders

The negative attitudes surrounding mental disorders and their treatment are a major obstacle to the correct identification and treatment of emerging psychopathologies. The purpose of this study was to investigate mental health literacy in a large and representative sample of high school students in Italy, via a booklet containing several questionnaires delivered to 1032 teenagers. The items in the questionnaires probed knowledge about mental health and illness, stigmatization, stereotypes, behaviors, opinions, and attitudes. In general, the students had a reasonable knowledge of mental disorders and were able to distinguish these from somatic disorders. However, a large portion of the students nourished some misconceptions about mental disorders and was also rather skeptical about the effectiveness of treatment or the chance of recovery for people with severe mental disorders. Nevertheless, roughly half of the students reported being willing to provide help to someone with a mental disorder when in need. Poor mental health literacy is a major barrier to seeking help and receiving effective treatment. Young people are the ideal target of raising awareness and antistigma campaigns because they are at a higher risk for developing a psychopathology.

Belief in the dangerousness of people with mental disorders: a review

BACKGROUND

The scientific literature on stigma has been confused because there are multiple components of stigma with different correlates. In order to help make sense of this confusion, the present review focuses on research on one of the most commonly measured components - belief in dangerousness.

METHOD AND RESULTS

The review examines: measurement of belief in dangerousness; prevalence of belief in dangerousness; characteristics of people who believe in dangerousness; experiences associated with belief in dangerousness; characteristics of people that elicit belief in dangerousness; the effects of psychiatric labelling; the effects of causal explanations; interventions to reduce belief in dangerousness; and effects on help-seeking.

CONCLUSION

It is concluded that future research needs to focus on rigorous evaluation of interventions to reduce belief in dangerousness and the impact of this belief on people affected by mental disorders.

Responses to mental health stigma questions: the importance of social desirability and data collection method

OBJECTIVE

To evaluate the impact on the general public of England's Time to Change program to reduce mental health-related stigma and discrimination using newly developed measures of knowledge and intended behaviour regarding people with mental health problems, and an established attitudes scale, and to investigate whether social desirability affects responses to the new measures and test whether this varies according to data collection method.

METHOD

The Mental Health Knowledge Schedule (MAKS) and Reported and Intended Behaviour Scale (RIBS) were administered together with the 13-item version of the Marlowe-Crowne Social Desirability Scale to 2 samples (each n = 196) drawn from the Time to Change mass media campaign target group; one group was interviewed face to face, while the other completed the measures as an online survey.

RESULTS

After controlling for other covariates, interaction terms between collection method and social desirability were positive for each instrument. The social desirability score was associated with the RIBS score in the face-to-face group only (β = 0.35, 95% CI 0.14 to 0.57), but not with the MAKS score in either group; however, MAKS scores were more likely to be positive when data were collected face to face (β = 1.53, 95% CI 0.74 to 2.32).

CONCLUSIONS

Behavioural intentions toward people with mental health problems may be better assessed using online self-complete methods than in-person interviews. The effect of face-to-face interviewing on knowledge requires further investigation.

Stigma of Mental Illness-1: Clinical reflections

Although the quality and effectiveness of mental health treatments and services have improved greatly over the past 50 years, therapeutic revolutions in psychiatry have not yet been able to reduce stigma. Stigma is a risk factor leading to negative mental health outcomes. It is responsible for treatment seeking delays and reduces the likelihood that a mentally ill patient will receive adequate care. It is evident that delay due to stigma can have devastating consequences. This review will discuss the causes and consequences of stigma related to mental illness.

Examining differences in the stigma of depression and schizophrenia

BACKGROUND

Although there is evidence of greater stigmatization of schizophrenia in comparison to depression, there has been little investigation of the reasons for this difference.

AIMS

To examine the role of beliefs about depression and schizophrenia in mediating the difference in preferred social distance towards individuals with these two disorders.

METHODS

In Study I, 200 undergraduates completed questionnaires concerning beliefs about depression or schizophrenia and willingness to interact with an individual who has one of the two disorders. In Study II, 103 members of a community service club completed similar measures.

RESULTS

For both samples, beliefs about likely appropriateness of social behaviour showed evidence of mediating differences in preferred level of social distance. In addition, differences in perceived danger may have been a mediator for the undergraduate sample and perceived prognosis for the service club respondents.

CONCLUSIONS

Beliefs about social appropriateness, danger and prognosis, which have implications for likely costs and benefits of interaction, are more likely to mediate differences in social distance towards the disorders than beliefs concerning causation or continuity with normal experience.

Violence among persons diagnosed with schizophrenia: how pharmacists can help

Violence among those diagnosed with schizophrenia has been reported but is not a diagnostic component of the disorder. The position of the courts regarding fulfillment of the requisite intent to commit violent acts has not been extensively reported. This article discusses the impact of a diagnosis of schizophrenia in an individual and how the pharmacist can help integrate information into the health care system. The recent Supreme Court case of Clark versus Arizona and the older case of Patterson versus Cockrell are discussed with respect to the concept of intent (to commit the act) and the implications this has on an individual in the midst of a psychotic episode. Quality of life, the perception of the stigma associated with a diagnosis of schizophrenia, and pharmacotherapy are briefly discussed. The origin of schizophrenia is multifactorial. Persons with schizophrenia are not innately violent, but alteration in perception may precipitate aggressive acts. Given the complex and diverse nature of schizophrenia and the fact that even with successful pharmacological treatment residual symptoms may still be present, there is a need to provide information to health care practitioners and the court.

How the relationship of attitudes toward mental health treatment and service use differs by age, gender, ethnicity/race and education

BACKGROUND

Promoting help-seeking for mental health problems can result in improved treatment rates. For the most impact, social marketing interventions need to be tailored to targeted demographic subgroups. We investigated the influence of interactions between attitudes toward treatment and age, gender, ethnicity/race and education for both general medical and specialty care.

METHOD

Cross-sectional data from the 2001-2003 National Comorbidity Survey Replication (NCS-R) were analyzed using multivariate models adjusted for the sampling design and controlled for relevant clinical and sociodemographic factors.

RESULTS

Greater comfort talking to a professional was associated with greater past-year specialty care across all demographic groups, while strongest for non-Latino whites and not evident for those 50-64 years old. For all demographic groups, reported willingness to seek professional help was associated with general medical care. However, for specialty care the association was much stronger for men compared to women. For African Americans, but not non-Latino whites, the perceived efficacy of mental health treatment improved the likelihood of past-year specialty use.

CONCLUSION

Our analyses suggest both the importance of understanding demographic differences in relevant attitudes and potential directions for marketing campaigns.

Attitudes and physical distance to an individual with schizophrenia: the moderating effect of self-transcendent values

BACKGROUND

There is evidence that personal value priorities may influence prejudicial behaviors. In particular, it has been hypothesized that those who place a high priority on values such as equality, benevolence and social justice may be less likely to express any prejudicial personal attitudes in behavior. In the present study, we tested this hypothesis in the context of physical distance with reference to a person with schizophrenia. Self-transcendent value priorities and attitudes toward a young woman described as having schizophrenia were assessed in 95 university students. They were then led to anticipate meeting the person and the distance they sat from the expected location of the ill person was assessed.

RESULTS

Women sat closer to the anticipated seat of the person with schizophrenia. In addition, there was a significant interaction between priority placed on self-transcendent values and attitude toward the person in predicting seating distance. There was a significant relationship between favorability of attitudes and sitting closer for those who were low in self-transcendent values, but attitudes did not predict physical proximity for those with high self-transcendent values.

CONCLUSION

The impact of attitudes toward an individual with schizophrenia and subtle aspects of behavior such as physical proximity appear to be moderated by self-transcendent personal values. The role of implicit in comparison to explicit attitudes in explaining these results is worthy for further investigation.

Predicting behavioural intentions to those with mental illness: the role of attitude specificity and norms

BACKGROUND

Social psychological research suggests that prediction of behavioural intentions towards those with mental illness could be increased by assessing attitudes towards specific actions or behaviours and by including a measure of perceived normative expectations by others concerning such behaviours.

AIMS

To investigate whether attitudes towards specific behaviours and perceived normative expectations improve prediction of behavioural intentions towards a person with mental illness.

METHODS

Two studies were carried out; one with university undergraduates and one with community service club members. Each included assessments of attitudes towards a person described as having a mental illness; attitudes towards specific behaviours reflecting social distance; perceived descriptive and injunctive norms with reference to those behaviours; and behavioural intentions.

RESULTS

Attitude towards the specific behaviour frequently showed a higher correlation with behavioural intentions than did attitude towards the person. Inclusion of perceived norms also improved prediction of behavioural intention.

CONCLUSIONS

The prediction of behavioural intentions towards those with mental illness may be improved by increasing the specificity of the attitude measures to the behavioural intentions being predicted and including measures of perceived norms. Furthermore, the effectiveness of efforts to reduce the stigma of mental illness may be increased by addressing their impact on perceived norms.

Are attitudes towards mental health help-seeking associated with service use? Results from the European Study of Epidemiology of Mental Disorders

OBJECTIVE

To investigate the prevailing attitudes towards mental health help-seeking in Europe, their correlates, and whether these attitudes are associated with actual service use for mental health problems.

METHOD

Data were derived from the European Study of Epidemiology of Mental Disorders, a survey representative of the adult population of six countries: Belgium, France, Germany, Italy, the Netherlands and Spain (n = 8,796). The World Mental Health Composite International Diagnostic Interview was used to assess attitudes and DSM-IV diagnoses. The attitudes referred to beliefs that the respondents would seek professional help when faced with a serious emotional problem, would feel comfortable talking about personal problems with a professional, would not be embarrassed if friends knew about the professional help, and respondents' perceived effectiveness of mental health care.

RESULTS

Almost a third of the respondents held the view that professional care was worse than or equal to no help when faced with serious emotional problems. Female gender, being younger than 65 years of age, high income, living in Spain or Italy, presence of mood disorder and previous service use were associated with at least two of the four assessed attitudes towards mental health help-seeking. All four attitudes were significantly associated with mental health care use, also after adjustment for previous service use.

CONCLUSION

The low perceived effectiveness of professional care calls for serious action aiming to improve the visibility and credibility of the mental health care sector.

Attitudes towards health among patients and staff in mental health services: a comparison of ratings of importance of different items of health

BACKGROUND

In mental health services, the concept of health is often perceived, from a biomedical perspective, as the absence of disease, involving several negative consequences together with a lack of systematic health-promoting activities. The subjective experiences of health among patients in mental health services are crucial to reinforce the experience of health throughout different phases of life. Positive dimensions of health include interaction between the individual and the environment, subjective experience of individual power as well as possibilities to influence important aspects of the life situation. The aim of the study was to describe and compare attitudes to health among patients and staff in mental health services in terms of the importance of health as measured by the attitude version of the Health Questionnaire.

METHODS

A cross-sectional study including a randomly selected sample of 141 outpatients in contact with the mental health services and 140 mental health staff was performed.

RESULTS

Patients and staff share most attitudes towards health, which indicates that health is a concept that applies to human beings irrespective of mental disease in the context of mental health services.

CONCLUSIONS

The possibility to be able to define, measure, and compare positive dimensions of health may be important in the attempts to divert the focus towards one that promotes health and resources in mental health services and away from one on illness and deficits.

Desire for social distance from people with mental disorders

The scientific literature on stigma has been confused because there are multiple components of stigma with different correlates. In order to make sense of this confusion, the present review focuses on research on the most commonly measured component: social distance. The review examines measurement of social distance; characteristics of people who desire greater social distance; experiences that affect social distance; characteristics of people that elicit social distance; the effects of psychiatric labelling; the effects of causal explanations for mental disorders; and interventions to reduce social distance. It is concluded that future research on social distance needs to focus on better evaluation of interventions and examine discriminatory and supportive behaviours in real life rather than in hypothetical situations.