Prejudice, social distance, and familiarity with mental illness

Bold, smart, dangerous and evil: perceived correlates of core psychopathic traits among jury panel members

Relatively few studies have investigated how laypersons perceive psychopathy, what factors they believe to be commonly associated with this disorder, or what rater personality characteristics might predict perceived psychopathic traits of the target person. An ethnically diverse sample of 285 US community members attending jury duty reviewed a case vignette regarding a capital murder trial and then rated (1) their perceptions of the defendant's psychopathic characteristics loosely based on trait indicators from the Psychopathy Checklist-Revised; (2) other characteristics of the defendant that might be associated with psychopathy (e.g. intelligence, violence potential); and (3) their own personality, using a very brief measure of Five Factor traits. Multivariate regression analyses indicated that participant ratings of psychopathy pertaining to the defendant were strongly associated with ratings on measures of his perceived boldness (i.e. social dominance and fearlessness), intelligence, violence potential, and perceptions that he was 'evil'. Big Five personality characteristics of the layperson raters, however, were only modestly associated with their ratings of psychopathy for the defendant. We review these results in terms of the potential stigmatization of individuals labelled as 'psychopaths' in forensic settings.

Does labeling matter? An examination of attitudes and perceptions of labels for mental disorders

PURPOSE

Labeling research in various domains has found that attitudes and perceptions vary as a function of the different labels ascribed to a group (e.g., overweight vs. obese). This type of research, however, has not been examined extensively in regards to labels for mental disorders. The present study examined whether common psychiatric labels (i.e., mental disease, mental disorders, mental health problems, and mental illness) elicited divergent attitudes and perceptions in a group of participants. These labels were also compared to the specific label of depression.

METHODS

Undergraduate psychology students (N = 124) were given identical questionnaire packages with the exception of the label used. That is, each participant received a set of questionnaires that referred to only one of the five labels. The questionnaire package contained various quantitative measures of attitudes and social distance, in addition to a short qualitative measure.

RESULTS

Analyses demonstrated equivalence among the four general psychiatric labels on measures of attitudes, social distance, and general perceptions. However, results also suggested that the general labels diverged from the depression label, with the latter being generally more negatively perceived. Some analyses demonstrated that participants' understanding of the terminology might be incorrect. The results of the investigation are discussed with a focus on its relationship with current research in stigma.

CONCLUSION

Within the current sample, general psychiatric labels did not appear to distinguish themselves from each other on measures of attitude and social distance but did so when compared to a relatively more specific term. Future research should examine the underlying mechanism driving this finding, with the ultimate goal of reducing the stigma faced by those with mental disorders.

Stigmatizing attitudes towards individuals with anorexia nervosa: an investigation of attribution theory

BACKGROUND

Guided by Attribution Theory, this study assessed stigmatizing attitudes towards an individual with anorexia nervosa (AN) compared to obesity and skin cancer, and examined the extent to which manipulating a target individual's level of blameworthiness affects levels of stigmatizing attitudes. One hundred and thirty-five female undergraduate students were randomly assigned to one of three conditions. Before and after receiving blameworthy or non-blameworthy information relating to the target's condition, participants completed a series of self-report inventories measuring their emotional reactions, desire for social distance, and causal attributions regarding the target.

RESULTS

Participants reported a significantly greater desire for social distance from the target with AN compared to targets with obesity or skin cancer, and yet (contrary to Attribution Theory) attributed less blame to the target with AN. There were significant increases in stigmatization towards targets described as blameworthy relative to targets described as non-blameworthy.

CONCLUSION

The findings provide insight into the elevated levels of stigmatizing attitudes held towards individuals with AN, and the role of Attribution Theory in partially accounting for this stigma.

Stigma among Iranian family caregivers of patients with Alzheimer's disease: A hermeneutic study

Although there is evidence of stigmatization of patients with Alzheimer's disease, few studies have evaluated stigma among family caregivers. This study was aimed at understanding the experiences of family caregivers of persons with Alzheimer's disease within Iran. We conducted a qualitative study using hermeneutic phenomenology. Semistructured in-depth interviews with 10 Iranian family caregivers of persons with Alzheimer's were audiotaped and transcribed. The transcriptions were then analyzed using Van Manen's method. Family stigma emerged as one of the most important themes in this study. It consisted of two subthemes of "feeling of shame due to the unusual behaviors and speech of the patients" and "fear of judgments made by others." An understanding of the experience of family stigma may lead to the development of supportive strategies to manage this problem among the caregivers. Educating families of patients about the disease plays a critical role in facilitating the process of caregiving. In addition, promoting public awareness about Alzheimer's disease can diminish stigma and prejudice toward patients and their caregivers. Educating caregivers on stigma management may also be an important factor in alleviating their stress.

Fighting psychiatric stigma in the classroom: the impact of an educational intervention on secondary school students' attitudes to schizophrenia

BACKGROUND

Adolescents constitute an appealing target group for fighting stigma and discrimination surrounding mental illness, since it is during this developmental period that adult attitudes about mental illness are formed and consolidated.

AIM

The aim of the present study was twofold, to explore adolescents' beliefs and attitudes to schizophrenia and to evaluate the effectiveness of an anti-stigma intervention in altering them.

METHODS

A total of 616 high school students participated in the study, divided into a control condition and an anti-stigma intervention group. Data were collected at three time points: before the intervention, upon its completion and at a 12-month follow-up.

RESULTS

Baseline measurements indicated that students espoused certain stereotypical beliefs about patients with schizophrenia and were reluctant to interact with them on some occasions. Upon completion of the intervention, positive changes were recorded in students' beliefs, attitudes and desired social distance; however, only the changes in beliefs and attitudes were maintained after one year.

CONCLUSION

For anti-stigma interventions to be effective, they should be continuously delivered to students throughout the school years and allow for an interaction between students and patients. Health promotion programmes might be an appropriate context for incorporating such interventions.

Effects of labeling and interpersonal contact upon attitudes towards schizophrenia: implications for reducing mental illness stigma in urban China

PURPOSE

As mental illness stigma contributes to poor outcomes for schizophrenia in China, locating strategies to reduce public stigma is imperative. It is currently unknown whether diagnostic labeling and contact with different help-seeking sources increase or decrease public stigma in China. Further, it remains unresolved whether prior personal contact acts to reduce stigma in this context. Advancing understanding of these processes may facilitate stigma-reduction strategies.

METHODS

We administered an experimental vignette randomly assigning one of four labeling conditions to respondents to assess social distance towards a psychotic vignette individual in a sample of 160 Northern, urban Chinese community respondents.

RESULTS

As expected, respondents given a "non-psychiatric, indigenous label" + "lay help-seeking" condition endorsed the least social distance. Unexpectedly, the labeling condition with a "psychiatric diagnostic label" + "lay help-seeking" condition elicited the greatest social distance. Unlike Western studies, personal contact did not independently decrease community stigma. However, prior contact reduced social distance to a greater extent in the labeling condition with a "non-psychiatric, indigenous label" + "lay help-seeking" condition when compared with all other labeling conditions.

CONCLUSION

The results indicate that cultural idioms do provide some protection from stigma, but only among respondents who are already familiar with what mental illness is. Our finding that the condition that depicted untreated psychosis elicited the greatest amount of stigma, while the "treated psychosis" condition was viewed relatively benignly in China, suggests that improved access to mental health services in urban China has the potential to decrease public stigma via labeling mechanisms.

A first national survey of knowledge, attitudes and behaviours towards schizophrenia, bipolar disorders and autism in France

BACKGROUND

In order to support evidence-based policies for reduction of stigma, a better understanding of its components: ignorance (knowledge), prejudice (attitude) and discrimination (behaviour) is necessary. This study explores public perceptions and quantifies stigma for three chronic mental disorders: autism, schizophrenia and bipolar disorders in France.

METHODS

Survey of 1000 adults selected from an established market research panel. The 21-item questionnaire explored knowledge, attitudes and behaviours toward each disorder.

RESULTS

Although 95% respondents recognized the names of each disorder fewer than 70% could report specific characteristics and only 33% considered that publically available information was adequate; most respondents identified the media as their main resource. Labeling of conditions in a negative way was frequent (61%) when referring to mental disorders in general, but fell significantly (18%) when linked to an individual with a disorder. Individuals with schizophrenia are assumed to be dangerous; 65% respondents would engage in social distancing from such an individual, versus 29% for bipolar disorders and 7% for autism (p < 0.001). In contrast to other disorders, discrimination against schizophrenia was only partly attenuated in those with familiarity with mental disorders (through personal or family illness).

CONCLUSION

This first population-based survey in France shows that attitudes towards bipolar disorders and autism are less prejudicial than towards schizophrenia. However, most public attitudes and behaviours towards different disorders appear to be based on assumptions rather than knowledge or evidence suggesting a generic information or anti-stigma programme is unlikely to be effective.

Laypersons' choices and deliberations for mental health coverage

Insurance coverage for mental health services has historically lagged behind other types of health services. We used a simulation exercise in which groups of laypersons deliberate about healthcare tradeoffs. Groups deciding for their "community" were more likely to select mental health coverage than individuals. Individual prioritization of mental health coverage, however, increased after group discussion. Participants discussed: value, cost and perceived need for mental health coverage, moral hazard and community benefit. A deliberative exercise in priority-setting led a significant proportion of persons to reconsider decisions about coverage for mental health services. Deliberations illustrated public-spiritedness, stigma and significant polarity of views.

Cultural influences on stigmatization of problem gambling: East Asian and Caucasian canadians

Cultural influences on problem gambling stigma were examined using a between subject vignette study design. Students of East Asian (n = 64) and Caucasian (n = 50) ancestry recruited from a Canadian University rated a vignette describing either an East Asian problem gambler or a Caucasian problem gambler on a measure of attitudinal social distance. In accordance with the hypothesis, a factorial ANOVA revealed that East Asian Canadians stigmatize problem gambling more than Caucasian Canadians. Moreover, East Asian participants stigmatized the East Asian individual described in the vignette more than they did the Caucasian individual. Individuals with gambling problems were generally not perceived as being dangerous. However, participants who perceived problem gambling as a dangerous condition wanted more social distance than those who did not perceive individuals with a gambling problem as dangerous.

Factors affecting public prejudice and social distance on mental illness: analysis of contextual effect by multi-level analysis

OBJECTIVES

While there have been many quantitative studies on the public's attitude towards mental illnesses, it is hard to find quantitative study which focused on the contextual effect on the public's attitude. The purpose of this study was to identify factors that affect the public's beliefs and attitudes including contextual effects.

METHODS

We analyzed survey on the public's beliefs and attitudes towards mental illness in Korea with multi-level analysis. We analyzed the public's beliefs and attitudes in terms of prejudice as an intermediate outcome and social distance as a final outcome. Then, we focused on the associations of factors, which were individual and regional socio-economic factors, familiarity, and knowledge based on the comparison of the intermediate and final outcomes.

RESULTS

Prejudice was not explained by regional variables but was only correlated with individual factors. Prejudice increased with age and decreased by high education level. However, social distance controlling for prejudice increased in females, in people with a high education level, and in regions with a high education level and a high proportion of the old. Therefore, social distance without controlling for prejudice increased in females, in the elderly, in highly educated people, and in regions with a high education and aged community.

CONCLUSIONS

The result of the multi-level analysis for the regional variables suggests that social distance for mental illness are not only determined by individual factors but also influenced by the surroundings so that it could be tackled sufficiently with appropriate considering of the relevant regional context with individual characteristics.

Disclosure of Psychiatric Disabilities in Vocational Rehabilitation

Vocational professionals aware of the stigma associated with psychiatric disability, generally exercise caution when disclosing psychiatric or disability related information to employers. However, few professionals directly address stigma or specify disclosure strategies in vocational rehabilitation plans. Integrated information tailored to vocational professionals is needed to guide this aspect of vocational rehabilitation practice. We review recent evidence with legal and ethical information relevant to vocational rehabilitation. Key elements of disclosure and stigma-countering strategies are identified which can be incorporated into the career planning, job preparation, job securing and job retaining phases of vocational rehabilitation plans.

Perceived Rights of and Social Distance to People with Alzheimer’s Disease

The present study investigated how laypeople and professionals (N = 185) judge the rights of someone affected with Alzheimer’s disease (AD) and whether social distance exists toward this person. Participants completed a questionnaire after reading a vignette describing a target person with an early stage of AD. Half of the participants responded to a female target, the other half to a male target. Results showed that the rights and competencies of the persons are rated high and social distance is exhibited only to a minor degree, although there was a significant difference between the male and female targets. Furthermore, health professionals approved more rights than laypeople, which suggests that there is a need for more detailed information about this disease in the general population.

Disease avoidance as a functional basis for stigmatization

Stigmatization is characterized by chronic social and physical avoidance of a person(s) by other people. Infectious disease may produce an apparently similar form of isolation-disease avoidance-but on symptom remission this often abates. We propose that many forms of stigmatization reflect the activation of this disease-avoidance system, which is prone to respond to visible signs and labels that connote disease, irrespective of their accuracy. A model of this system is presented, which includes an emotional component, whereby visible disease cues directly activate disgust and contamination, motivating avoidance, and a cognitive component, whereby disease labels bring to mind disease cues, indirectly activating disgust and contamination. The unique predictions of this model are then examined, notably that people who are stigmatized evoke disgust and are contaminating. That animals too show avoidance of diseased conspecifics, and that disease-related stigma targets are avoided in most cultures, also supports this evolutionary account. The more general implications of this approach are then examined, notably how it can be used to good (e.g. improving hygiene) or bad (e.g. racial vilification) ends, by yoking particular labels with cues that connote disease and disgust. This broadening of the model allows for stigmatization of groups with little apparent connection to disease.

The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients' views

PURPOSE

Stigma is a frequent accompaniment of mental illness leading to a number of detrimental consequences. Most research into the stigma connected to mental illness was conducted in the developed world. So far, few data exist on countries in sub-Saharan Africa and no data have been published on population attitudes towards mental illness in Ghana. Even less is known about the stigma actually perceived by the mentally ill persons themselves.

METHOD

A convenience sample of 403 participants (210 men, mean age 32.4±12.3 years) from urban regions in Accra, Cape Coast and Pantang filled in the Community Attitudes towards the Mentally Ill (CAMI) questionnaire. In addition, 105 patients (75 men, mean age 35.9±11.0 years) of Ghana's three psychiatric hospitals (Accra Psychiatry Hospital, Ankaful Hospital, Pantang Hospital) answered the Perceived Stigma and Discrimination Scale.

RESULTS

High levels of stigma prevailed in the population as shown by high proportions of assent to items expressing authoritarian and socially restrictive views, coexisting with agreement with more benevolent attitudes. A higher level of education was associated with more positive attitudes on all subscales (Authoritarianism, Social Restrictiveness, Benevolence and Acceptance of Community Based Mental Health Services). The patients reported a high degree of experienced stigma with secrecy concerning the illness as a widespread coping strategy. Perceived stigma was not associated with sex or age.

DISCUSSION

The extent of stigmatising attitudes within the urban population of Southern Ghana is in line with the scant research in other countries in sub-Saharan Africa and mirrored by the experienced stigma reported by the patients. These results have to be seen in the context of the extreme scarcity of resources within the Ghanaian psychiatric system. Anti-stigma efforts should include interventions for mentally ill persons themselves and not exclusively focus on public attitudes.

Relationships between interpersonal contact as a volunteer companion and stigma

OBJECTIVE

Previous studies overseas have suggested that the Compeer volunteer companion programme lowers expressions of stigma among volunteers. We used an Australian sample to examine the hypotheses that being a Compeer volunteer is associated with a lower expression of stigma and that stronger Compeer friendships are also associated with lower expressions of stigma.

METHOD

Volunteers from the Compeer program were surveyed regarding their attitudes to mental illness (using the Social Distance Scale, Affect Scale and Dangerousness Scale), the strength of their Compeer friendship (Match Bond Scale) and previous levels of contact with mental illness (Contact Scale).

RESULTS

Volunteers showed low overall levels of stigma with no demographic variation in stigma levels. Lower levels of stigma were also associated with stronger friendships.

CONCLUSIONS

Compared to similar US studies, Compeer volunteers show low overall levels of stigma. Stronger friendship bonds were associated with more positive attitudes.

Development and psychometric properties of the reported and intended behaviour scale (RIBS): a stigma-related behaviour measure

BACKGROUND

Although stigma in relation to mental health has been defined as including components of knowledge, attitudes and behaviour, no psychometrically tested instrument to assess behavioural discrimination at the population level has been developed. This paper presents details of the development and psychometric properties of the Reported and Intended Behaviour Scale (RIBS), an instrument based on the Star Social Distance Scale, to assess reported (past and current) and intended (future) behavioural discrimination among the general public against people with mental health problems.

METHODS

Three studies were carried out to evaluate psychometric properties of the RIBS (Study 1, n = 92; Study 2, n = 37; Study 3, n = 403). Adults aged 25-45 in socio-economic groups: B, C1 and C2 (middle-income groups) took part in development and testing of the RIBS.

RESULTS

Internal consistency and test-retest reliability is moderate/substantial. Strong consensus validity was found, as rated by service users/consumers and international experts in stigma research.

CONCLUSIONS

Use of a behavioural outcome may be important to evaluate the effectiveness of interventions intended to reduce stigma and/or discrimination related to mental illness. The RIBS was found to be a brief, feasible and psychometrically robust measure for assessing mental health-related reported and intended behavioural discrimination.

A mental health training program for community health workers in India: impact on knowledge and attitudes

Background

Unmet needs for mental health treatment in low income countries are pervasive. If mental health is to be effectively integrated into primary health care in low income countries like India then grass-roots workers need to acquire relevant knowledge and skills to be able to recognise, refer and support people experiencing mental disorders in their own communities. This study aims to provide a mental health training intervention to community health workers in Bangalore Rural District, Karnataka, India, and to evaluate the impact of this training on mental health literacy.

Methods

A pre-test post-test study design was undertaken with assessment of mental health literacy at three time points; baseline, completion of the training, and three month follow-up. Mental health literacy was assessed using the interviewer-administered Mental Health Literacy Survey. The training intervention was a four day course based on a facilitator's manual developed specifically for community health workers in India.

Results

70 community health workers from Doddaballapur, Bangalore Rural District were recuited for the study. The training course improved participants' ability to recognize a mental disorder in a vignette, and reduced participants' faith in unhelpful and potentially harmful pharmacological interventions. There was evidence of a minor reduction in stigmatizing attitudes, and it was unclear if the training resulted in a change in participants' faith in recovery following treatment.

Conclusion

The findings from this study indicate that the training course demonstrated potential to be an effective way to improve some aspects of mental health literacy, and highlights strategies for strengthening the training course.

Disease-avoidant behaviour and its consequences

Medical conditions that are non-contagious, but that appear contagious, seem to result in the sufferer being avoided. Error management theory (EMT), suggests that such false alarms occur because the cost of infection poses a greater threat to ones fitness than avoidance. Study 1 attempted to demonstrate a disease-related false alarm effect by asking participants, to evaluate a series of vignettes, featuring people with infectious diseases, non-infectious diseases that looked infectious and non-infectious diseases that did not. Judgements of contracting infection under varying levels of contact, and desire to avoid were obtained. Consistent with EMT, a false alarm effect was evident. Study 2 examined the importance of the face as a key indicator of real and apparent infection, by determining whether facial symptoms result in a greater desire to avoid people with infectious and non-infectious diseases. Consistent with expectation, participants reported a greater desire to avoid people with facially displayed symptoms. Together, these results support the idea that humans have evolved a general tendency to avoid individuals with disease signs, especially if displayed upon the face. One consequence is that where a facially displayed disease sign persists, even if known to be benign, its bearer will experience chronic avoidance.

Natural contact and stigma towards schizophrenia in African Americans: is perceived dangerousness a threat or challenge response?

This research extends our understanding of the relationship of social contact theory to stigma in a sample of mainly African American college students. In Phase 1, 75 participants with high levels of contact reported significantly lower negative affect and less social distance toward the mentally ill as compared to 89 participants with low contact. Despite this, the high contact group attributed significantly higher levels of dangerousness to the mentally ill. Thus while social contact was associated with reductions in some dimensions of stigma, it was associated with higher levels of self-reported perceived dangerousness. These results were obtained while controlling for social desirability bias in the self-report measures of stigma. The results from Phase 1 of this study may indicate fundamental differences between incidental social contact and that which occurs in an assistive context. In Phase 2, a subset of convenience from the high contact group (n=27) and the low contact group (n=38) were compared on cardiovascular reactivity measures while imagining social interactions with people labeled with schizophrenia. Post hoc testing revealed that when participants from the high contact group imagined interacting with people labeled as schizophrenic they exhibited significant decreases in total peripheral resistance (TPR), the challenge pattern, compared to their reactions when they imagined interacting with unstigmatized people. This finding suggests the higher dangerousness ratings of the mentally ill sometimes found in African American samples may be related to factors other than direct threat.

Strategies and future attempts to reduce stigmatization and increase awareness of mental health problems among young people: a narrative review of educational interventions

There is a need to reduce stigma and increase awareness in order to prevent social exclusion of people with mental illness and to facilitate the use of mental health services in young people. The purpose of this review was to examine the effects of educational interventions to reduce stigmatization and improve awareness of mental health problems among young people. An electronic search using MEDLINE, PsycINFO and Academic Search Complete was carried out for studies that evaluated the effectiveness of educational interventions. Forty eligible studies were identified. There were three types of educational interventions (Educational condition, Video-based Contact condition and Contact condition). Eighteen of 23 studies reported significant improvements in knowledge, 27 of 34 studies yielded significant changes in attitudes towards people with mental illness. Significant effects in social distance were found in 16 of 20 studies. Two of five studies significantly improved young people's awareness of mental illness. However, six studies reported difficulties in maintaining improved knowledge, attitudes and social distance in young people. Furthermore, the majority of studies did not measure the actual behavioral change. From the comparison of the three types of educational interventions, direct contact with people with mental illness (Contact condition) seems to be key in reducing stigmatization, while the components of Education and Video-based contact conditions are still arguable. Despite the demonstration of the positive effects of each educational intervention, their long-term effects are still unclear. Further research needs to involve measuring actual behavioral change and performing a long-term follow up.

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.

Beliefs about psychosocial consequences of schizophrenia and depression: a comparative study in a sample of secondary school students

Aims — Description of students' opinions about schizophrenia and depression. Methods — The study was carried out on a sample of 445 secondary school students, randomly allocated to a “schizophrenia” or a “depression” group (N=221 and N=224, respectively). Each respondent was asked to read a case—vignette describing a case of schizophrenia or depression, and then to fill the Questionnaire on the Opinions about Mental Illness — General Population's version (QO—GP). Results — 35% of students in “schizophrenia” group vs. 85% in “depression” group attributed a correct diagnosis to case—vignette. 19% of students in the “schizophrenia” group vs. 39% in the “depression” group believed that these mental disorders can recover. Affective and civil rights were more frequently acknowledged to patients with depression than to those with schizophrenia. In both groups, the majority of students stated that mentally ill patients were unpredictable and socially dangerous. Students who reported TV stories on people with mentally ill were more frequently convinced on their unpredictability and social dangerousness. Conclusions — These results outline the need to: a) plan educational campaigns for students on mental disorders; b) alert media professionals on the impact that the way they present crimes committed by mentally ill patients may have on general population.

Declaration of Interest: None of the authors has had any interest or she has received any form of support, including that from drug companies and honoraria for lectures and consultancies potentially in conflict with this scientific work in the last two years. None of the authors has received any form of fee for her participation in this study.

Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

Background

The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes.

Methods

General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants.

Results

Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356) gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298).

Conclusions

Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented through survey method is required to support these conclusions.

Feasibility, acceptability, and initial efficacy of a knowledge-contact program to reduce mental illness stigma and improve mental health literacy in adolescents

The purpose of this school-based cluster-randomized trial was to determine the initial acceptability, feasibility, and efficacy of an existing community-based intervention, In Our Own Voice, in a sample of US adolescent girls aged 13-17 years (n = 156). In Our Own Voice is a knowledge-contact intervention that provides knowledge about mental illness to improve mental health literacy and facilitates intergroup contact with persons with mental illness as a means to reduce mental illness stigma. This longitudinal study was set in two public high schools located in a southern urban community of the U.S. Outcomes included measures of mental illness stigma and mental health literacy. Findings support the acceptability and feasibility of the intervention for adolescents who enrolled in the study. Findings to support the efficacy of In Our Own Voice to reduce stigma and improve mental health literacy are mixed. The intervention did not reduce mental illness stigma or improve mental health literacy at one week follow up. The intervention did not reduce mental illness stigma at 4 and 8 weeks follow up. The intervention did improve mental health literacy at 4 and 8 weeks follow up. Previous studies have assessed the preliminary efficacy In Our Own Voice among young adults; rarely has In Our Own Voice been investigated longitudinally and with adolescents in the United States. This study provides initial data on the effects of In Our Own Voice for this population and can be used to further adapt the intervention for adolescents.

An elective psychiatric course to reduce pharmacy students' social distance toward people with severe mental illness

OBJECTIVE

To determine whether an elective course on mental health could reduce pharmacy students' social distance toward people with severe mental illness.

DESIGN

Course activities included assigned readings, class discussions, student presentations, review of video and other media for examples of social distance, presentations by patients with mental illness, and visits to hospitalized patients in a variety of psychiatric settings.

ASSESSMENT

The Social Distance Scale (SDS) was administered at the beginning and end of the semester to students enrolled in the elective and to a comparator group of students not enrolled in the course. Pharmacy students who did not complete the elective had significantly higher SDS scores than students who completed the elective (18.7 vs. 15.6, p < 0.001). Students enrolled in the course had lower precourse SDS scores, were more likely than their peers to have a personal association with mental illness, and had a decrease in precourse to postcourse scores.

CONCLUSION

A course designed to reduce stigma towards the mentally ill can reduce pharmacy students' social distance.

College students' perceptions of individuals with anorexia and bulimia nervosa

OBJECTIVE

Eating disorders (EDs) are highly stigmatized conditions. This study explored factors hypothesized to influence this stigmatization including ethnicity, gender, ED subtype, and proposed etiology.

METHOD

Undergraduates (N = 235) read scenarios depicting fictional characters varying on ethnicity, gender ED subtype, and etiology. Participants reported perceptions of each character, and completed the EAT-26 and the Level-of-Contact scale.

RESULTS

Characters with BN were viewed as more responsible for their ED and more self-destructive than those with AN, who were viewed as more self-controlled. Characters with a sociocultural etiology were rated as most likely to recover. Characters with a biological etiology were viewed as more likeable than characters with an ambiguous etiology. Characters in the ambiguous group were viewed as more self-destructive, more responsible for their ED, and less self-controlled. Differences in participants' perceptions of the characters also emerged when examining ethnicity and gender. Finally, participants' own ED symptoms and their level of contact with EDs were associated with viewing characters as more similar and self-controlled.

DISCUSSION

Findings highlight the need for increased education about ED etiology and course.

Public knowledge, beliefs and attitudes towards patients with schizophrenia: Buenos Aires

OBJECTIVE

The purpose of our study was to assess the knowledge, social distance and perception of social discrimination towards persons with schizophrenia in the general adult population of Buenos Aires, Argentina.

METHODS

One thousand two-hundred fifty-four persons were surveyed at different neighborhoods of the city of Buenos Aires. Their knowledge about schizophrenia, personal social distance and perception of social discrimination were assessed with several questions. Afterwards, a scale for each one of these measures was built.

RESULTS

Almost half of the general population believed that patients with schizophrenia suffer from split personality and that most of them are dangerous and violent. Knowledge about schizophrenia in the general population was moderate and it was associated with age and education. Almost 80% of the population had less than one-third of the maximum possible social distance score, but their perception of social discrimination was high. Social distance was greater in the elderly. Knowledge was correlated weakly with social distance. Respondents directly related with patients suffering from schizophrenia were more knowledgeable about the illness, but had the same social distance and perception of social discrimination than the rest of the general population.

CONCLUSIONS

The persons surveyed felt their own attitudes are more favorable to people with schizophrenia than 'most other people's' attitudes. The elderly should be specifically addressed in specially designed anti-stigma campaigns.

Stigma and treatment for alcohol disorders in the United States

Among a nationally representative sample of adults with an alcohol use disorder, the authors tested whether perceived stigmatization of alcoholism was associated with a lower likelihood of receiving alcohol-related services. Data were drawn from a face-to-face epidemiologic survey of 34,653 adults interviewed in 2004-2005 who were aged 20 years or older and residing in households and group quarters in the United States. Alcohol abuse/dependence was diagnosed by using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, version (AUDADIS-IV). The stigma measure used was the Perceived Devaluation-Discrimination Scale. The main outcome was lifetime intervention including professional services and 12-step groups for alcohol disorders. Individuals with a lifetime diagnosis of an alcohol use disorder were less likely to utilize alcohol services if they perceived higher stigma toward individuals with alcohol disorders (odds ratio = 0.37, 95% confidence interval: 0.18, 0.76). Higher perceived stigma was associated with male gender (β = -0.75; P < 0.01), nonwhite compared with non-Hispanic white race/ethnicity, lower income (β = 1.0; P < 0.01), education (β = 1.48; P < 0.01), and being previously married (β = 0.47; P = 0.02). Individuals reporting close contact with an alcohol-disordered individual (e.g., relative with an alcohol problem) reported lower perceived stigma (β = -1.70; P < 0.01). A link between highly stigmatized views of alcoholism and lack of services suggests that stigma reduction should be integrated into public health efforts to promote alcohol treatment.

Community attitudes toward individuals with traumatic brain injury

Explicit and implicit attitudes toward people who have sustained traumatic brain injury (TBI) were investigated to determine if negative attitudes exist and if the terminology used (brain vs. head injury) exacerbated predicted negativity. Participants (n = 103) rated Tony (brain/head injury) and Peter (limb-injury) on 10 characteristics using a 7-point scale. Familiarity with brain injury was also measured. Implicit Association Tests (IAT) assessed potential negative bias. Tony (M = 36.84) was judged more negatively than Peter (M = 31.69). The term "brain" versus "head" injury resulted in more negative evaluations (Ms = 38.72 vs. 34.78). Participants familiar with TBI were more positive toward Tony than those unfamiliar (Ms = 34.98 vs. 39.80). Only those unfamiliar with TBI demonstrated implicit negative bias. Negative attitudes toward TBI are expressed explicitly with individuals openly endorsing less desirable characteristics. When people have more knowledge about or experience with brain injury, they are less likely to endorse negative stereotypes.

Examining perceived alcoholism stigma effect on racial-ethnic disparities in treatment and quality of life among alcoholics

OBJECTIVE

The aim of this study was to examine racial-ethnic differences in perceived stigmatization of former alcoholics and their effect on associations of race-ethnicity with treatment history and psychological function among lifetime alcoholics.

METHOD

Logistic regression analyses were conducted using data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of U.S. adults 18 years or older.

RESULTS

Stigma scores were lowest for Whites and Native Americans, higher for Blacks, and highest for Asians and Hispanics, both in the total population and among lifetime alcoholics. Neither race-ethnicity nor stigma was associated with treatment utilization. Psychological function was negatively associated with stigma, but the impact of stigma on racial-ethnic differences in psychological function fell short of statistical significance.

CONCLUSIONS

Stigma may reduce quality of life among those with alcohol dependence, but there is no clear evidence that it affects racial-ethnic differences in quality of life.

SELF-STIGMA AND COMING OUT ABOUT ONE'S MENTAL ILLNESS

Self-stigma can undermine self-esteem and self-efficacy of people with serious mental illness. Coming out may be one way of handling self-stigma and it was expected that coming out would mediate the effects of self-stigma on quality of life. This study compares coming out to other approaches of controlling self-stigma. Eighty-five people with serious mental illness completed measures of coming out (called the Coming Out with Mental Illness Scale, COMIS), self-stigma, quality of life, and strategies for managing self-stigma. An exploratory factor analysis of the COMIS uncovered two constructs: benefits of being out (BBO) and reasons for staying in. A mediational analysis showed BBO diminished self-stigma effects on quality of life. A factor analysis of measures of managing self-stigma yielded three factors. Benefits of being out was associated with two of these: affirming strategies and becoming aloof, not with strategies of shame. Implications for how coming out enhances the person's quality of life are discussed.

Attitudes to people with mental disorders: a mental health literacy survey in a rural area of Maharashtra, India

INTRODUCTION

People with mental disorders experience discrimination as a consequence of stigmatising attitudes that are largely socio-culturally constructed. Thus, there is a need to understand local contexts in order to develop effective programs to change such attitudes. We undertook a mental health literacy survey in rural Maharashtra, India, prior to developing a mental health training program for village health workers (VHWs) in a primary health care setting.

METHODS

A cross-sectional mental health literacy survey was undertaken in late 2007, which involved interviewer-administration of a questionnaire to 240 systematically sampled community members, and 60 purposively sampled VHWs. Participants were presented with two vignettes describing people experiencing symptoms of mental disorders (depression, psychosis), and were asked about attitudes towards, and desired social distance from, the people in the vignettes (the latter being a proxy measure for stigma). Linear regression modelling was undertaken to identify predictors of social distance.

RESULTS

Although the community was relatively accepting of people with mental disorders, false beliefs and negative attitudes were still evident. Desired social distance was consistently greater for the person depicted in the psychosis vignette compared to the depression vignette. For both vignettes, the main predictor of greater social distance was perceiving the person as dangerous, and the predictors of reduced social distance were being a VHW, and seeing the problem as a sign of personal weakness. For depression, believing the cause to be family tensions also reduced social distance. For psychosis, labelling the disorder as a mind/brain problem, and believing the cause to be lack of control over life or genetic factors increased social distance. The vast majority did not agree that the problems experienced in the vignettes were 'a real medical illness'.

CONCLUSION

Promoting bio-medical explanations for mental disorders in this setting may exacerbate discriminatory attitudes. Provision of contextually relevant mental health training for the VHWs so that they are able to communicate, model and shape more positive attitudes is the next step.

Health service staff's attitudes towards patients with mental illness

INTRODUCTION

Stereotypes and prejudices against patients with mental illness are widespread in many societies. The aim of the present study is to investigate such attitudes among the staff and medical students, including employees and trainees, in a general university hospital.

METHOD

Six hundred individuals (361 employees, 231 students) completed the following questionnaires: Level of Contact Report (LCR), Authoritarianism Scale (AS), and Opinion about Mental Illness (OMI), a scale yielding five factors (social discrimination, social restriction, social care, social integration, and aetiology). Multivariate linear regression models were applied in order to search for the simultaneous effect of many variables on the scores of OMI factors.

RESULTS

An important part of the sample held negative attitudes especially concerning social discrimination and restriction of the patients. Women, older and less educated staff, nursing staff, and people scoring higher on authoritarianism were more prejudiced. Higher scores on familiarity were associated with less negative attitudes.

CONCLUSION

The results indicate the need to develop sensitisation and training programs considering mental health topics among health service employees.

[Stigmatization of patients with schizophrenia: the influence of university courses on the attitudes of prospective psychologists and doctors]

BACKGROUND

Some studies revealed that psychiatrists have more negative attitudes than psychologists towards patients with schizophrenia. This raises the question of whether different models of the aetiology of schizophrenia and the amount of personal contact influence the attitudes of mental health professionals.

SAMPLE AND METHODS

Explicit and implicit attitudes towards schizophrenia were assessed in medical and psychology students (n=60 and n=61, respectively) as well as their familiarity with the disorder and their subjective models of its aetiology.

RESULTS

Medical and psychology students showed a substantial level of negative attitudes. Personal contact was negatively associated with stereotypes among medical students and positively associated among psychology students. Positive attitudes were related to biogenetic causal beliefs among medical students and to psychosocial causal beliefs among psychology students.

CONCLUSIONS

The results emphasise the need to adapt antistigma campaigns to target groups. They also indicate the superiority of a multidimensional aetiology over monocausal aetiological models in reducing stigma.

Gainful employment reduces stigma toward people recovering from schizophrenia

Stigma impedes the social integration of persons recovering from psychiatric disability, especially those with criminal histories. Little is known about factors that lessen this stigma. Four hundred and four adults listened to one of four vignettes describing a 25-year-old male with schizophrenia and responded to a standard set of items measuring social distance. The individual who was gainfully employed (vs. unemployed), or who had a prior misdemeanor (vs. felony) criminal offense, elicited significantly less stigma. Employment may destigmatize a person coping with both psychiatric disability and a criminal record. Mental health services should encourage paid employment and other paths to community integration.

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.

What factors influence attitudes towards people with current depression and current mania?

BACKGROUND

Previous studies have detected different variables influencing the attitude towards mentally ill individuals but they have never addressed mania. Furthermore, it is not known whether the same factors affect attitudes towards individuals experiencing major depressive or manic episodes.

AIMS

Besides factors such as familiarity with mental illness, we were interested whether vulnerability to psychosis and mood disorders as well as social desirability can affect attitudes towards major depressive episodes and manic episodes.

METHODS

Subjects were presented with a case vignette describing an individual experiencing either a major depressive episode or a manic episode (n = 188, age 16-34 years). Their attitudes towards that person were assessed. Furthermore, factors potentially influencing these attitudes have been assessed such as personal vulnerability factors (i.e. cyclothymia and magical ideation) and social desirability bias.

RESULTS

Familiarity with the phenomenon of mental illness turned out to influence the attitude towards affective episodes, whereas the influence of the other potential predictors such as their own experience of affective or schizotypal symptoms failed to appear to be of significance.

CONCLUSIONS

Whereas ;familiarity' turned out to be a factor positively influencing the attitude towards depression, it turned out to have a rather negative influence on the attitude towards mania. This result could have important implications for anti-stigma campaigns.