Medicalizing versus psychologizing mental illness: what are the implications for help seeking and stigma? A general population study

Patients with severe mental illness and their carers' expectations for GPs' communication skills: a qualitative approach in Spain

BACKGROUND

Effective communication with GPs (General Practitioners) enables higher rates of patient satisfaction and adherence to treatment plans. People with severe mental illness (SMI) and their caregivers present unique characteristics that present difficulties in the GP-carer-patient communication process.

AIM

To explore the expectations of patients with SMI and their caregivers regarding GPs' communication skills in primary care consultations.

DESIGN & SETTING

Face-to-face interviews, using focus group methodology, which were undertaken in southern Spain.

METHOD

Forty-two participants took part in 21 paired semi-structured interviews with an average duration of 19±7.2 minutes. Information was audio-recorded and transcribed verbatim. Qualitative content analysis was undertaken, obtaining a codification in categories by means of triangulation.

RESULTS

Four themes emerged from the analysis. Theme 1 was interviewer communication characteristics. The ability of GPs to use a language that was colloquial and adapted to each person was perceived as a determinant of the quality of care provided. An empathetic attitude, low reactivity, and efficient time management were the most valued communication skills. Theme 2 was telemedicine: telephone consultation and video consultation. The telephone consultation was perceived as a useful tool to care for people with SMI. Video consultation was valued as a requirement in isolated rural areas. Theme 3 was the role of the caregiver during the clinical interview. The caregiver was considered by the patients as an ally who improves the clinical interview. Theme 4 was the perceived barriers and facilitators during the clinical interview. The continuity of care, defined by a low turnover of GPs, determined the quality perceived by those who required care.

CONCLUSION

Themes emerging from this study have suggested that people with SMI require an inclusive, collaborative, and personalised approach in the care they receive from the public health system. Improved communication between GPs and patients with SMI is an essential requirement for quality medical care.

Beliefs about mental health in incarcerated males: a qualitative interview study

Introduction

Beliefs about mental health are shaped by the sociocultural context. Prisons have unique environmental and social features, and the prevalence of mental health problems in incarcerated populations is exceptionally high. These features make prisons especially interesting settings for exploring health beliefs. The aim of this study was to explore the conceptualizations of mental health and coping preferences in a prison environment.

Methods

Individual in-depth interviews were conducted with fifteen incarcerated males from three prisons in Northern Norway. The design draws on central elements from Grounded Theory.

Results

Mental health was perceived as distinct from mental illness by many of the participants. They coped with the prison environment by focusing on the things that gave them a sense of meaning and autonomy - this also formed their conceptualization of mental health. Furthermore, social interaction and activities were perceived as important to enhance and maintain mental well-being, however there were institutional barriers to using these coping strategies. The prison environment was integrated in the participants conceptualizations of mental health problems, and psychosocial stressors were emphasized in causal attributions. Biological and dispositional factors were less frequently mentioned. The participants preferred non-medical management for mental health problems and most displayed a reserved attitude towards psychotropic medications. The exception was attention-deficit hyperactivity disorder, for which they held neurobiological causal beliefs, together with a corresponding preference for medication as treatment.

Conclusion

The main finding was a firm integration of the prison context in in the participants' beliefs about mental health. We theorize that fusion of prison conditions and mental health beliefs were brought on by the processes of prisonization, observing mental distress in peers and attempts to protect self-esteem by externalizing the causes for mental health problems. Access to activities, social time, and "someone to talk to" were perceived to be crucial for improving and preserving mental health.

Stigmatization of people diagnosed with a mental disorder in secondary mental health centers in Chile: An ethnographic study

To understand how stigmatization of people diagnosed with a mental disorder occurs in secondary mental healthcare staff in mental healthcare centers in Chile was the objective of the study. A descriptive qualitative and interpretative design with an ethnographic approach was used. Participants' observations, ethnographic, and semi-structured interviews were conducted with professionals at three secondary mental health centers. Qualitative descriptive and interpretative content analysis was used. Stigmatization of users is shaping up in their trajectory in the health center. Identity changes from person to "patient," which generates dependence on the expert role of healthcare professionals. Stigma is expressed in the interactions between a health institution, a professional team, and a user, reproducing power and control relationships associated with the biomedical model and reinforcing a cycle of chronification in the user. Health teams are stressed by discrepancies between the current mental health policy and the user's biomedical understanding.

Unemployed + Sick = More Deserving? A Survey Experiment on How the Medicalization of Unemployment Affects Public Opinion

The literature on the social legitimacy of welfare benefits has shown that sick persons are perceived more deserving than unemployed individuals. However, these studies examine sick and unemployed persons as distinct groups, while unemployment and sickness are in fact strongly related. Policymakers across Europe have been increasingly concerned with discouraging a medicalization of unemployment and activating sick unemployed persons. Therefore, it is crucial to understand welfare attitudes toward this group. Using a factorial survey fielded with a representative sample of German-speaking adults (N=2,621), we investigate how sickness affects attitudes toward a hypothetical unemployed person on three dimensions: benefit levels, conditions, and sanctions. Respondents allocated similar benefit levels to unemployed persons regardless of whether they have an illness. Yet, they were more hesitant to apply existing conditions (e.g., active job search, job training) or sanction benefits when the unemployed person was also sick. This is except for conditions that tie benefits to obligatory health services (back training or psychological counseling) which was supported by the majority of respondents. Our research shows that the German public is not more generous and only partially more lenient toward sick unemployed persons as there is strong support for conditions targeted at overcoming ill health for this group. The findings underscore that sickness matters for how unemployed persons are perceived, but the impact varies across different dimensions of welfare attitudes.

Mental Disorders and Beyond in the Quest to Understand Suicide: A Reply to Joiner and Robison

We reply to the thoughtful commentary by Joiner and Robison (this issue) about the documentary Robin's Wish. Joiner and Robison suggest that a major depressive episode may have been a proximal cause of Robin Williams' suicide, but that stigma surrounding mental illness led the documentary to eschew a role for depression. We find this perspective compelling and important. Mental illness can be an important cause of suicide, and stigma can harm our ability to understand and treat mental illness and suicide risk. As a complementary perspective, we discuss research and theory suggesting that mental illness does not explain all deaths by suicide. We present research and theory suggesting that suicide is motivated by pain and hopelessness, and that pain and hopelessness can be caused not only by mental illness but by other factors such as overwhelming interpersonal struggles or loss, seemingly insurmountable financial problems, chronic medical conditions, and systematic discrimination and persecution. Finally, we reaffirm Joiner and Robison's belief that understanding and preventing suicide requires the pursuit of accurate knowledge, unburdened by stigma that can harm progress and people.

Burdens in mental health recovery: Causal beliefs and their relation to stigma and help seeking recommendations

BACKGROUND

Lay attitudes are often seen as potential barriers to mental health recovery. But apart from perceiving them as potential barriers, they can also play an important role in stimulating individuals to consult (in)formal help sources, in particular through the process of help referral. Where existing research mainly focusses on actual help seeking behaviour, this study will focus on lay publics' referral behaviour.

AIMS

This study analyses the relation between causal beliefs and stigmatising attitudes and social distance on the one hand, and (in)formal help seeking recommendations on the other.

METHODS

Data from a survey carried out in 2019, assessing the attitudes of Public Health Insurance Provider (HIP) members towards mental health problems, was used. Part of the survey questions was based on a quantitative quasi-experimental design, using hypothetical written vignettes. The weighted data represent a sample of the adult Flemish population (22-94 years, N = 5675). Multiple linear regression analysis was used to examine the relation between causal beliefs and stigma, while binominal logistic regression analysis was used to investigate the relation between causal beliefs and help seeking recommendations.

RESULTS

The results reveal that causal beliefs significantly associate with stigma, measured by stigmatising attitudes and social distance: personal- or biogenetic beliefs associate with more stigma, where psychosocial beliefs associate with less stigma. Concerning help seeking recommendations, psychosocial beliefs associate with recommending psychological or psychotherapeutic care, biogenetic beliefs associate with advising help from general practitioners and suggesting psychiatric help, while personal beliefs negatively associate with recommending formal help. Meanwhile, biogenetic beliefs associate with less informal help seeking recommendations (e.g. family, friends and online self-help), where personal beliefs associate with more informal help seeking recommendations and psychosocial beliefs only associate with online help referral.

CONCLUSION

This study highlights the importance of causal beliefs in affecting public stigma and help seeking recommendations.

Recovery priorities of people with psychosis in acute mental health in-patient settings: a Q-methodology study

BACKGROUND

Personal recovery from psychosis has been explored extensively in community samples but there has been little exploration with people currently receiving care from an acute mental health in-patient setting.

AIMS

The aim of this study was to explore the personal recovery priorities of people experiencing psychosis who are currently receiving care from an acute mental health in-patient ward.

METHOD

A Q-methodology mixed-methods approach was adopted. Thirty-eight participants were recruited from an outer London acute mental health hospital. They were required to sort 54 statements regarding personal recovery from most important to least important to reflect their recovery priorities. Thirty-six were included in the final analysis.

RESULTS

Analysis revealed four distinct viewpoints relating to factors that promote recovery in the acute mental health in-patient setting. These were: stability, independence and 'keeping a roof over your head'; hope, optimism and enhancing well-being; personal change, self-management and social support; and symptom reduction through mental health support.

CONCLUSIONS

Acute mental health in-patient wards need to ensure that they are considering the personal recovery needs of in-patients. Symptom reduction was valued by some, but broad psychosocial factors were also of priority.

The beliefs of non-psychiatric doctors about the causes, treatments, and prognosis of schizophrenia

OBJECTIVES

To examine the causal beliefs about schizophrenia of non-psychiatric doctors and whether differential belief in biogenetic vs. psychosocial causes influences doctors' views about treatments and prognosis.

DESIGN AND METHODS

Three hundred and five non-psychiatric doctors working in outpatient community centres completed the 'Opinions on mental disorders Questionnaire' after reading a clinical description of people with schizophrenia.

RESULTS

The factors most frequently reported as causes of schizophrenia were heredity (65.2%) and use of street drugs (54.1%). Seventy-five per cent of participants endorsed both one or more biological causal factors and one or more psychosocial causal factors. Of the 264 participants who expressed their opinion about the most important cause of schizophrenia, 53.8% indicated a biogenetic cause. Fifty-two per cent of respondents thought it 'completely true' that drugs are useful in schizophrenia, and 33.9% thought it 'completely true' that people with schizophrenia must take drugs all their life. Participants stating that the most important cause was biogenetic more frequently recommended a psychiatrist and less frequently a psychologist. Compared to doctors who indicated a psychosocial cause as the most important one, those who indicated a biogenetic cause were more sceptical about recovery, more confident in the usefulness of drugs, and more convinced of the need of lifelong pharmacological treatments in schizophrenia.

CONCLUSIONS

These findings suggest the need to provide some doctors with training on the multiple, interacting causes of schizophrenia and the efficacy of the broad range of available treatments. The education of health professionals regarding stigma and its effects on clinical practice is also needed.

PRACTITIONER POINTS

Viewing schizophrenia as mainly due to a biological cause is associated with greater confidence in the usefulness of drugs, higher belief in the need for lifelong pharmacological treatments, and greater prognostic pessimism. Belief in a biologically oriented model of schizophrenia may lead doctors to underestimate the value of psychologists. Prognostic pessimism among doctors may negatively influence clinical decisions, the information doctors provide to their clients, and clients' own beliefs about their chances of recovery. Belief in the need for lifelong pharmacological treatments in schizophrenia may lead doctors to resist drug withdrawal in case of severe side effects.

Cost-Effectiveness Evaluations of Psychological Therapies for Schizophrenia and Bipolar Disorder: A Systematic Review

OBJECTIVES

This review aims to assess the cost-effectiveness of psychological interventions for schizophrenia/bipolar disorder (BD), to determine the robustness of current evidence and identify gaps in the available evidence.

METHODS

Electronic searches (PsycINFO, MEDLINE, Embase) identified economic evaluations relating incremental cost to outcomes in the form of an incremental cost-effectiveness ratio published in English since 2000. Searches were concluded in November 2018. Inclusion criteria were: adults with schizophrenia/BD; any psychological/psychosocial intervention (e.g., psychological therapy and integrated/collaborative care); probability of cost-effectiveness at explicitly defined thresholds reported. Comparators could be routine practice, no intervention, or alternative psychological therapies. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms. Results were summarized qualitatively. The protocol was registered on the PROSPERO database (CRD42017056579).

RESULTS

Of 3,864 studies identified, 12 met the criteria for data extraction. All were integrated clinical and economic randomized controlled trials. The most common intervention was cognitive behavioral therapy (CBT, 6/12 studies). The most common measure of health benefit was the quality-adjusted life-year (6/12). Follow-up ranged from 6 months to 5 years. Interventions were found to be cost-effective in most studies (9/12): the probability of cost-effectiveness ranged from 35-99.5 percent. All studies had limitations and demonstrated uncertainty (particularly related to incremental costs).

CONCLUSIONS

Most studies concluded psychological interventions for schizophrenia/BD are cost-effective, including CBT, although there was notable uncertainty. Heterogeneity across studies makes it difficult to reach strong conclusions. There is a particular need for more evidence in the population with BD and for longer-term evidence across both populations.

A theory of youth mental health recovery from a parental perspective

BACKGROUND

Mental health disorders have a negative impact on the individual, society and global economy. The prevalence of mental disorders is increasing in young people, if unaddressed, they may develop into severe and chronic illnesses. Despite this, research into youth mental health recovery is limited. The current study aims to develop a theoretical framework of recovery in youth mental health and identify what facilitates this process.

METHODS

Fourteen parents of children engaged with the Child and Adolescent Mental Health Service were interviewed in relation to their understanding of youth mental health recovery. The transcripts of these interviews were analysed using the constructivist grounded theory approach.

RESULTS

A theoretical model of youth mental health was developed. The model provides an understanding of (a) the characteristics of youth mental health recovery, (b) the facilitators of recovery and (c) the barriers to recovery. The theory suggests that due to developmental factors youth mental health recovery occurs within the ecological context of complex social systems.

CONCLUSIONS

The theory reflects elements of existing developmental and recovery research and provides a novel understanding of youth mental health recovery. This model may inform social, government and service attitudes and policy, and highlights areas for future research.

Public beliefs and attitudes toward schizophrenia and depression in Taiwan: A nationwide survey

Beliefs about and attitudes toward mental illness may be influenced by cultural- or country-specific contexts. Through a national survey, the current study investigated beliefs and attitudes toward people with schizophrenia and depression among the general public in Taiwan. A random-digit-dialing telephone-based cross-sectional survey was administered to Taiwanese adults aged 20-64 years (n = 1600). The data were analyzed through binary logistic regressions to test for differences between these disorders in causal beliefs, stereotypes, emotional reactions, desire for social distance, and help-seeking behavior. The results revealed that respondents were more concerned with biogenetic causal explanations for people with schizophrenia than for those with depression. Significantly more respondents perceived people with schizophrenia as more likely to be unpredictable and violent toward others. A similar trend was observed for the desire for social distance. For both disorders, respondents were significantly more likely to express compassion than to express anger toward the person described in the vignette. Respondents also expressed more desire for social distance from someone like the vignette who have received psychiatric treatment. These findings provide useful directions for the implementation of optimal psychoeducation among such communities. .

Evidence for the Influence of Social Dominance Orientation and Intergroup Relations on the Stigma of Schizophrenia

Abstract. The stigma of schizophrenia is an intergroup phenomenon associated with issues of social power. We consider that the concept of stigma power should be extended to include intergroup relations that go beyond the aspect of the relation between “schizophrenic” and “normal.” With the present study, we intend to demonstrate that perceivers hold more stigmatizing attitudes toward a person with schizophrenia belonging to the outgroup and that especially when the perceiver has a higher Social Dominance Orientation (SDO). One hundred and sixty-one participants from the general population participated in our study (50.3% male, Mage = 39.14, SD = 16.36), which was based on a 2 (Sex of Target: male vs. female) × 2 (Sex of Participant: male vs. female) × SDO between-subjects design. The participants read a standardized vignette used in previous research, depicting a person presenting the symptoms of schizophrenia, and were then asked to complete questionnaires about SDO and intention to discriminate against the depicted individual. Our analysis showed the main effect of SDO on discriminating intentions. Simple slope analysis revealed that SDO predicts male participants’ discriminating intentions when the target is a woman, while this relation is not significant when the target is a man. The exact reverse pattern was observed among female participants. Our results suggest intergroup relations and ideological motivations underpin the stigma of schizophrenia. We conclude that different group belongings of individuals with schizophrenia as well as the public’s ideological motivations should be further considered by future research and anti-stigma efforts.

Social distance in Lithuanian psychology and social work students and professionals

PURPOSE

This cross-sectional study aimed to compare desire for social distance from people with mental illness in the disciplines of social work and psychology, and among students and professionals having different professional experience.

METHODS

948 respondents (715 students and 233 professionals) from Lithuanian educational and mental health-care institutions participated in an anonymous survey. Social distance was measured using Lithuanian Social Distance Scale which was created for this study. Participants also answered questions about familiarity with mental illness. Bias of social desirability was measured using the balanced inventory of desirable responding.

RESULTS

Series of ANCOVA analysis revealed that psychology and social work master's and PhD students reported less social distance from people with mental illness when compared with bachelor's students. Familiarity with mental illness was significantly related to less social distance in the student sample, but not in professionals' sample. The strongest desire for social distance in the professionals' sample was observed in social workers having less than 5 years of professional practice and most experienced psychologists with more than 10 years of professional practice.

CONCLUSIONS

Social distance from people with mental illness decreases through the study years; however, results of professional psychologists and social workers illustrate different trajectories in social distance through the professional career. The results of this study support the need for anti-stigma programmes and initiatives orientated towards mental health professionals.

Stigma related to bipolar disorder in the perception of psychiatrists from Belo Horizonte, Minas Gerais State, Brazil

This research sought to understand meanings and implications of the stigma related to bipolar disorder in relation to social processes and local cultural value systems. Seven semidirected individual interviews were performed with psychiatrists (from Belo Horizonte city, Minas Gerais State, Brazil) and analyzed with referential from the Medical Anthropology. Some potential stigmatizing views about bipolar disorder patients were endorsed by respondents related to biomedical model of bipolar disorder. They claimed about the extreme trivialization of this diagnosis nowadays and observed that, in spite of the mitigation of stigma related to bipolar disorder over time, it remains an important issue, especially at labor fields and as a cause of refusal of treatment.

Stigma, Social Structure, and the Biomedical Framework: Exploring the Stigma Experiences of Inpatient Service Users in Two Belgian Psychiatric Hospitals

The study discusses the stigma experiences of service users in mental health care, within the debate on the role of the biomedical framework for mental health care and power relations in society. Interview data of inpatient users ( n = 42) and care providers ( n = 43) from two Belgian psychiatric hospitals were analyzed using a constructivist grounded theory approach: Findings offer insight into how stigma experiences are affected by social structure. Stigma seemed to be related to the relation between care providers and service users their social position. The concept "mental health literacy" is used to frame this finding. In paying attention to the specific cultural and normative context, which influences the relationship between mental health literacy and stigma, it is further possible to cast some light on the meaning of the biomedical model for the construction and maintenance of power relations in mental health care and broader society.

Treatment recommendations for schizophrenia, major depression and alcohol dependence and stigmatizing attitudes of the public: results from a German population survey

In addition to mental health literacy, several potentially conflicting emotions and attitudes among the public are hypothesized to guide their recommendations for specific mental health treatments. It is unclear whether evidence-based treatment strategies are guided by pro-social or stigmatizing attitudes and emotions. In a representative population survey in Germany (n = 3642), we asked respondents to what extent they would recommend psychotropic medication, psychotherapy and relaxation techniques for a person with mental illness described in an unlabelled vignette. For each treatment recommendation, we used multinomial logistic regression analyses to obtain predicted probabilities. Predictors comprised illness recognition, vignette condition, causal beliefs (current stress, childhood adversities, biogenetic), emotions (fear, anger, pro-social reactions), social distance, age, gender and education. Fear predicted greater probability for recommending psychotropic drugs in all investigated illnesses (p < 0.001), whereas associations of fear with recommending psychotherapy were generally lower and no associations with the recommendation for relaxation techniques were found. Anger was related to fewer recommendations for psychotherapy in all illnesses (p < 0.01). Pro-social reactions were predominantly related to the recommendation of relaxation techniques for a person with schizophrenia or major depression (p < 0.001). Higher desire for social distance predicted fewer recommendations for relaxation techniques in all three vignette conditions (p < 0.05). Our study corroborates findings that treatment recommendations are not necessarily linked to pro-social reactions or mental health literacy. The recommendation for a treatment modality like psychotropic medication or psychotherapy can be linked to underlying fear, possibly reflecting a public desire for protection against people with mental illness.

Stigma: The Perspective of Workers on Community Mental Health Services-Brazil

In this study, we have surveyed how professionals from multidisciplinary teams at psychosocial care centers (CAPS), in the city of São Paulo, understand the concept of mental illness stigma. The aim of the survey was to characterize the actions developed by the team to overcome stigma and, thus, contribute to develop strategies that incorporate overcoming stigma in the territory. Our objective is to get acquainted to the concepts about stigma shared by the participants. This survey was based on the theory of stigma by Erving Goffman; data were collected through semi-structured interviews with mental health professionals belonging to the CAPS teams. Results indicate that social exclusion is understood as a synonym to stigma, and that proximity of CAPS to society in the territory facilitates social inclusion and the overcoming of the mental illness stigma.

Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta-analysis of population surveys

Public attitudes towards psychiatry are crucial determinants of help-seeking for mental illness. It has been argued that psychiatry as a discipline enjoys low esteem among the public, and a "crisis" of psychiatry has been noted. We conducted a systematic review and meta-analysis of population studies examining public attitudes towards various aspects of psychiatric care. Our search in PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on population surveys conducted since 2000 and published no later than 2015. We found that professional help for mental disorders generally enjoys high esteem. While general practitioners are the preferred source of help for depression, mental health professionals are the most trusted helpers for schizophrenia. If respondents have to rank sources of help, they tend to favor mental health professionals, while open questions yield results more favorable to general practitioners. Psychiatrists and psychologists/psychotherapists are equally recommended for the treatment of schizophrenia, while for depression psychologists/psychotherapists are more recommended, at least in Europe and America. Psychotherapy is consistently preferred over medication. Attitudes towards seeking help from psychiatrists or psychologists/psychotherapists as well as towards medication and psychotherapy have markedly improved over the last twenty-five years. Biological concepts of mental illness are associated with stronger approval of psychiatric help, particularly medication. Self-stigma and negative attitudes towards persons with mental illness decrease the likelihood of personally considering psychiatric help. In conclusion, the public readily recommends psychiatric help for the treatment of mental disorders. Psychotherapy is the most popular method of psychiatric treatment. A useful strategy to further improve the public image of psychiatry could be to stress that listening and understanding are at the core of psychiatric care.

Investigating stereotypes of social anxiety

BACKGROUND AND OBJECTIVES

This paper consists of two studies that test for the presence and content of stereotypes of highly socially anxious individuals.

DESIGN

The current studies examined traits that comprise social anxiety stereotypes, and then tested whether undergraduate students held part of this stereotype via an implicit-association test (IAT).

METHODS

In Study 1, a sample of undergraduate students (n = 635) was asked to generate descriptors of people who are highly socially anxious. These descriptors were utilized to create the Social Anxiety Stereotype Measure (SASM) and the underlying factor structure of the SASM was analyzed. In Study 2, a different sample of undergraduate students (n = 87) was given an IAT to further test for the presence of one of the factors obtained in Study 1.

RESULTS

Factor analyses indicated the presence of two social anxiety stereotypes: social inhibition and oddity (comparative fit index = .97, Tucker-Lewis Index = .95, root mean square error of approximation = .07, standardized root mean square residual = .06). Oddity as a stereotype of social anxiety was further supported via an IAT: Participants reacted more quickly when oddity (vs. normality) words were paired with social anxiety (vs. social confidence) words (D = -1.15, SD = .26; t(85) = -41.50, p < .001).

CONCLUSIONS

Factor analyses revealed two social anxiety stereotypes: social inhibition and oddity. Further testing of the oddity stereotype was supported via an IAT.

Exploring identity dynamics in mental help-seeking trajectories: an ethnographic study among inpatient service users of two Belgian psychiatric hospitals

Using an ethnographic approach, in combining interviews with forty-two inpatient service users and participant observations, this research explored service users' experiences of their help seeking trajectories in an effort to uncover identity dynamics by which these are informed. They described both identity dynamics that made them postpone their search for help, like their belief in the essential difference between themselves and mental health service users; and dynamics that catalyzed their hospitalization, like the loss of social roles. Their accounts illustrate how experiences of barriers and facilitators for help seeking are closely intertwined with identity and therefore context related dynamics.

Public opinion on imposing restrictions to people with an alcohol- or drug addiction: a cross-sectional survey

PURPOSE

Alcohol- and drug addiction tends to evoke disapproval and rejection among people. This study provides insight into the origin of people's negative attitudes towards these people. Corrigan's attribution model is used to examine intentions of the Dutch public to impose restrictions to people who are addicted to alcohol or illicit drugs.

METHODS

Data were derived from a cross-sectional survey among a representative panel of the Dutch population (N = 2,793). Path analyses were conducted to test the influence of attribution beliefs, emotional responses and familiarity with addictions on people's intentions to impose restrictions to these people.

RESULTS

More than half of the respondents agreed with imposing restrictions to someone with an addiction such as excluding from taking public office or forbid to care for children. Corrigan's attribution model was partially applicable to explain people's intentions to impose restrictions, since only a rather small percentage of the variance in people's intentions was explained by the model. The perception of personal responsibility for an addiction and high expectancy of aggressiveness have a positive influence on intentions to impose restrictions. Feelings of anger and fear were also predictors of intentions to impose restrictions.

CONCLUSIONS

The Dutch public showed high intentions to restrict people with an alcohol- or drug addiction which has an extensive impact on their life opportunities. Perceived aggressiveness, feeling of anger and fear, and perceived responsibility were associated with higher intentions to impose restrictions.