Are continuum beliefs about psychotic symptoms associated with stereotypes about schizophrenia?

Public Stigma and Continuum Beliefs Across Personality Disorder Severity Levels

Stigmatizing attitudes toward persons with personality disorders are common. Preliminary evidence suggests that continuum beliefs (the view that presented symptoms lie on a continuum with normality) are associated with reduced personality disorder stigma. This study aimed to evaluate whether this association holds across the entire spectrum of personality disorder severity and whether greater personality disorder severity is linked to higher stigma. A general population sample (N = 848) completed questions about a vignette depicting mild, moderate, or severe personality disorder severity. Higher continuum beliefs were associated with a lower desire for social distance from persons with mild, moderate, or severe personality disorder. In addition, continuum beliefs were higher, and the desired social distance was lower toward a person with mild than a person with moderate or severe personality disorder. Thus, fostering continuum beliefs might aid in combating personality disorder stigma, including toward severely affected persons who experience strong stigmatization.

Associations of continuum beliefs with personality disorder stigma: correlational and experimental evidence

PURPOSE

A pervasive and deeply entrenched stigma of personality disorders exists. For other mental disorders, a large body of research suggests that continuum beliefs (i.e., the endorsement of continuum perspectives on mental health and psychopathology) stimulate more favorable attitudes toward affected persons. Additionally, mental disorder classification systems increasingly incorporate continuous personality disorder models. Yet, it is unclear how continuum beliefs are related to personality disorder stigma. This study evaluated the link of continuum beliefs with personality disorder stigma based on correlational and experimental data.

METHODS

A large general population sample (N = 848) completed self-report measures of continuum beliefs regarding personality disorders, desired social distance, and prejudice toward persons with personality disorders. Additionally, participants were randomly presented with information supporting a continuous or a dichotomous view of personality disorders.

RESULTS

Continuum beliefs were associated with lower desired social distance (r = - 0.19) and prejudice (r = - 0.22). Additionally, the brief continuum intervention was associated with increased continuum beliefs (d = 0.99) and decreased desired social distance (d = - 0.14) and prejudice (d = - 0.17). Finally, the intervention effects on desired social distance and prejudice were mediated by continuum beliefs.

CONCLUSION

This study suggests that highlighting continuum views on personality disorders in public communication and interventions might reduce personality disorder stigma.

Exploring Continuum and Categorical Conceptualisations of Mental Health and Mental Illness on Australian Websites: A Systematic Review and Content Analysis

It is important to explore the types of conceptualisations and causes presented in online mental health promotion given the implications that these presentations may have on mental health stigma. This study systematically reviewed 92 Australian webpages focused on either mental health, mental illness, depression, or schizophrenia, to explore the types of conceptualisations and aetiologies presented. A minority of mental health and mental illness webpages (n = 8, 8.70%) explicitly presented continuum conceptualisations, with none providing explicit categorical conceptualisations. No depression or schizophrenia webpages presented explicit conceptualisations of any kind. All four webpage foci had a greater proportion of continuum than categorical conceptualisations. Moreover, both depression and schizophrenia webpages presented many mixed conceptualisations which included both continuum and categorical messaging. Most webpages mentioned biological and social causes equally across webpage foci. These findings suggest that Australian mental health websites predominantly present continuum conceptualisations of mental health and mental illness.

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.

Changes in continuum beliefs for depression and schizophrenia in the general population 2011-2020: a widening gap

PURPOSE

The public discourse about mental health and mental illness seems to have become more open over the last decade, giving rise to the hope that symptoms of mental illness have become more relatable. We examine whether continuum beliefs regarding schizophrenia and depression have increased on a population level over a period of 9 years, and whether notions of unfamiliarity and incomprehensibility have decreased.

METHODS

In 2011 (n = 2455) and 2020 (n = 3042), two methodologically identical cross-sectional population surveys were conducted in Germany. After the presentation of an unlabeled case vignette depicting someone with schizophrenia or depression, we asked about continuum beliefs, perceived unfamiliarity and perceived incomprehensibility of the person described.

RESULTS

Multinomial logit models holding sociodemographic variables fixed at their means for both surveys showed that agreement with continuum beliefs increased in depression from 43 to 46% [change 4%; 95% confidence interval (CI) 0; 8], but decreased in schizophrenia from 26 to 20% (change - 6%, 95% CI - 9; - 3). Unfamiliarity (change - 4%; 95% CI - 7; 0) and incomprehensibility (change - 7%, 95% CI - 10; - 4) decreased for depression, while remaining largely unchanged for schizophrenia.

CONCLUSION

An already pronounced gap in the perception of both disorders with regard to continuity of symptom experiences and perceived otherness further widened over the last decade. While the public's increasing familiarity with symptoms of depression might be further aided by using continuum beliefs as part of anti-stigma messages and awareness campaigns, promulgating continuity models for schizophrenia seems more challenging.

Understanding stigma toward schizophrenia

Schizophrenia is arguably one of the most stigmatized psychiatric disorders, with patients frequently seeing the burden of stigmatization as a "second illness." Thus, the purpose of this study was to investigate the relationships among the main aspects of the stigma toward schizophrenia. This study used a vignette methodology with 2053 individuals from the general population in Italy. The main aspects of stigma - causal beliefs, recommended treatments, social distance, perception of dangerousness, and avoidance - were investigated through participants' responses, and a latent variable structural equation model (SEM) approach was used to test the relationships among them. Perceived dangerousness predicts the desire for social distancing from an individual with schizophrenia, which predicts the desire for avoidance. In addition, biogenetic causal beliefs of schizophrenia and position on the appropriate medical treatment predict the perception of dangerousness and thus a greater desire for social distance. This study contributes to the literature on the stigmatization of mental health by improving our understanding of the phenomenon. Highlighting the relationships between aspects of stigma allows for a discussion of the implications for anti-stigma interventions.

Adolescents’ Continuum and Categorical Beliefs, Help-seeking Intentions, and Stigma Towards People Experiencing Depression or Schizophrenia

The present study investigated the relationships between continuum and categorical beliefs, stigma, and help-seeking in response to vignettes depicting depression and schizophrenia. Participants were 193 adolescents aged 13-18 years. Results showed no relationships between continuum beliefs and stigma or help-seeking intentions for the depression vignette when controlling for other predictors. Stronger categorical beliefs were associated with greater social distance, and endorsement of dangerousness, avoidance, and fear. For the schizophrenia vignette, higher continuum beliefs predicted lower prognostic pessimism, social distance, and stigmatising attitudes. Surprisingly, continuum beliefs predicted greater intentions to not seek help. Categorical beliefs were associated with greater prognostic pessimism, social distance, and stigmatising attitudes. Future research is needed to explore the effect of continuum belief interventions on adolescent mental health stigma.

Changing Attitudes Towards Voice Hearers: A Literature Review

Auditory verbal hallucinations, or voice hearing, is increasingly understood as a common experience. Despite this, voice hearers still experience a great deal of stigma, which can have serious negative impacts on the person's experience of their voices, and their recovery. Research has demonstrated that healthcare professionals may be a major source of the stigma surrounding voice hearing, with service-level implications for the development and delivery of evidence-based interventions. Therefore, reducing this stigma is a critical intervention target. The purpose of this narrative review is to examine evidence for interventions aimed at reducing stigma towards people who hear voices, in populations of healthcare professionals, students, and the general public. The available evidence supports the use of anti-stigma interventions based around direct contact with voice hearers and education about voice hearing. However, further research is necessary in this area to confirm these findings.

Continuum beliefs and mental illness stigma: a systematic review and meta-analysis of correlation and intervention studies

BACKGROUND

Promulgating a continuum model of mental health and mental illness has been proposed as a way to reduce stigma by decreasing notions of differentness. This systematic review and meta-analysis examines whether continuum beliefs are associated with lower stigma, and whether continuum interventions reduce stigma.

METHODS

Following a pre-defined protocol (PROSPERO: CRD42019123606), we searched three electronic databases (PubMed, Web of Science, and PsycINFO) yielding 6726 studies. After screening, we included 33 studies covering continuum beliefs, mental illness, and stigma. Of these, 13 studies were included in meta-analysis.

RESULTS

Continuum beliefs are consistently associated with lower stigma. Interventions were effective at manipulating continuum beliefs but differ in their effects on stigmatising attitudes.

CONCLUSIONS

We discuss whether and to what extent attitudes towards people with mental illness can be improved by providing information on a mental health-mental illness continuum. It appeared to be relevant whether interventions promoted a feeling of 'us' and a process of identification with the person with mental illness. We discuss implications for the design of future interventions.

How continuum beliefs can reduce stigma of schizophrenia: The role of perceived similarities

Growing evidence has shown continuum beliefs as a promising tool to reduce psychiatric stigma in the general population, but data still lack regarding mechanisms underlying this effect. This study aims at testing the hypothesis that continuum beliefs affect public stigma and self-stigma by increasing perceived similarities between oneself and people with schizophrenia. Perceiving such similarities may reduce public stigma and increase self-stigma in the general population. The current study was preregistered on OSF. Data were collected via an on-line survey (N = 565). Participants were randomly assigned to one of the three experimental conditions. Continuum beliefs were induced with short videos supporting either a continuum viewpoint of schizophrenia, a categorial viewpoint of schizophrenia, or a neutral video. A scale of Perceived similarities between oneself and people with schizophrenia was administered. Public stigma was measured with an Essentialism scale and Self-stigma with a scale of self-stereotype association. Mediation analyses showed that the effects of categorial and continuum beliefs on essentialism and self-stereotype association were mediated by perceived similarities. Our results suggest that continuum beliefs about schizophrenia act as a recategorization mechanism, by enhancing perceived similarities with the stereotyped group.

Predictors of shared decision making with people who have a serious mental illness and who are under justice supervision in the community

Shared decision making (SDM) can be an effective method for promoting service involvement among persons with serious mental illness (SMI). This survey study sought to identify predictors of positive attitudes toward the use of SDM with people with SMI who are living under probation and parole supervision. Supervising officers' (n = 291) perceptions of the capabilities of supervisees with SMI to contribute to their supervision plans, and their familiarity with recovery-oriented mental health services, were positively associated with attitudes toward using SDM. Training officers in common human goals and mental health recovery may advance SDM with supervisees with SMI.

Perceived stress and psychosis: The effect of perceived stress on psychotic-like experiences in a community sample of adolescents

AIMS

Psychotic-like experiences (PLE) are sub-threshold, non-clinical forms of psychosis which can place an individual at greater risk of development of a psychotic disorder. Subtypes of PLE have also been shown to exist (bizarre experiences, persecutory ideation, perceptual abnormalities and magical thinking). Perceived stress relates to how two individuals may deal with the same objectively stressful event in different ways. The objective of our study was to investigate the extent to which perceived stress is associated with PLE in a community sample of adolescents, whether certain subtypes of PLE correlate more with perceived stress than others and to explore the role of depression with these associations.

METHODS

A total of 655 students completed the community assessment of psychic experiences (CAPE) and perceived stress scale (PSS). Pearson's correlation was used to investigate the relationship between PSS and CAPE and also between perceived stress and the four subtypes of PLE. Regression then explored the effect of perceived stress on PLE when accounting for depressive symptomatology.

RESULTS

Positive correlation was found between PSS and total CAPE (r = 0.405, P = 0.000). Positive significant correlation was also found between PSS and each subtype of PLE, with persecutory ideation correlating the strongest and magical thinking the least. Perceived stress was significantly associated with PLE even after adjusting for depression.

CONCLUSIONS

We recommend that more regular screening of perceived stress in adolescent populations could lead to earlier recognition of PLE. Early treatment has shown to reduce rates of transition to psychosis, and so could benefit our adolescent community in the future.

The stigma of mental illness: Testing for the implicit bias in diagnostic labels

Several models that attempt to explain stigmatization of people with mental illness emphasize the relevance of social categorization. However, research on illness-based social categories has been limited to explicit self-report measures. In this study, we explored whether implicit social categorization based on mental illness labels can be assessed with the "Who-Said-What" (WSW)-paradigm. In this paradigm, participants have to allocate a large number of statements to individuals who belong to different social groups (e.g., mentally ill vs. healthy). Due to the amount of statements, errors in allocation are to be expected. A disproportionate amount of erroneous allocation to individuals within a social group is interpreted to indicate implicit social categorization. In three studies, we (1) pilot-tested a WSW-paradigm for mental illness categorization (n = 24), (2) replicated these findings in an independent, larger sample (n = 85), and (3) aimed to rule out alternative explanations for the implicit categorization effects with a modified WSW-task and novel stimulus material (n = 137). We found consistent implicit categorization effects with overall medium to large effect sizes (range: 0.41 ≤ d ≤ 1.01). Implicit components of mental illness based social categorization can be assessed with the WSW-paradigm. Future research needs to explore the interrelations of implicit categorization, implicit vs. explicit stigmatization and discriminating behavior.

Decreasing Stigmatization: Reducing the Discrepancy Between "Us" and "Them". An Intervention for Mental Health Care Professionals

Objective: Stigmatization has negative consequences for people with mental health disorder diagnosis. Studies indicate that professionals have stigmatizing attitudes and behavior towards clients. Continuum beliefs are associated with less stigmatizing attitudes. The effect of a workshop to diminish stigmatizing attitudes and to enhance continuum beliefs is examined. Method: A total of 202 mental health professionals from (Functional) Assertive Community Treatment [(F)ACT] teams were randomly assigned to a workshop or a waiting list control group. Stigmatizing attitudes and continuum beliefs were assessed in both conditions at baseline and follow-up. Results: Compared to baseline, the workshop group showed an increase on continuum beliefs. However, there was no effect of the intervention on stigmatizing attitudes. Contrary to the expectations, stigmatizing attitudes increased in the waiting list condition. Conclusion: Communicating the continuity aspect can be valuable in decreasing the "us and them" discrepancy between professionals and people with mental health disorders. Further research on continuum beliefs is needed.

On continuum beliefs and psychiatric stigma: Similarity to a person with schizophrenia can feel too close for comfort

Continuum belief interventions that blur boundaries between "normal" individuals and individuals with psychiatric problems have shown promise in reducing psychiatric stigma. Interventions to date have afforded participants considerable psychological distance from individuals with mental illness. An intervention that compels psychological closeness to individuals with mental illness may lead to increased anxiety/threat and an attenuated intervention effect on stigma. In a randomized experiment, one hundred thirty-five participants listened to a bogus interview involving an ostensible person with schizophrenia who shared numerous characteristics in common with participants. In the interview, the target person (1) did not verbally broach issues of similarity to "normal" people, (2) endorsed a continuum view, or (3) endorsed a categorical view. Participants then read a bogus research article on schizophrenia that (1) was agnostic with respect to the continuum/categorical distinction, (2) attested to a continuum view, or (3) attested to a categorical view. Correlational analyses demonstrated that greater endorsement of continuum beliefs predicted less stigma. Experimental analyses demonstrated that the continuum intervention had no effect on stigma. The continuum intervention increased participants' feelings of anxiety/threat, measured via self-report and a lexical decision task. These findings might usefully inform the design of stigma reduction programming centered on continuum beliefs.

Paranoid beliefs and realistic expectations of victimization: Data from the survey of police-public encounters

BACKGROUND

The anticipation of threat or victimization is a core feature of paranoia. Cognitive theories of paranoia suggest that paranoid thoughts may arise as a psychological response to trauma exposure, which likewise may lead to greater anticipation of subsequent victimization. Little is known, however, about the relation between paranoid beliefs and anticipated victimization when accounting for past victimization experience. The present study aimed to address whether the experiences of past victimization contribute to the link between paranoid beliefs and the anticipation of threat or victimization, with a particular focus on exposure to police violence.

METHODS

Data were collected through the Survey of Police-Public Encounters (N=1615), a cross-sectional, general population survey study conducted in four Eastern U.S. cities. Associations between paranoia and anticipated victimization were assessed using linear regression models, with and without adjustment for past victimization exposure.

RESULTS

Paranoid beliefs were positively associated with police victimization expectations (β=0.19, p<0.001), but these associations were statistically better explained by past exposures to similar victimization such that paranoia was no longer associated with anticipated victimization in adjusted models (β=0.02, p=0.451). To assess for the specificity of past exposures to victimization, adjusting for past exposure to intimate partner violence (as a control condition) did not eliminate the association between paranoia and expected police victimization.

CONCLUSIONS

The overall findings are consistent with cognitive theories of paranoia in which paranoid beliefs may be a severe but normative reaction to past victimization exposures in some cases.

Friendship and money: A qualitative study of service users' experiences of participating in a supported socialisation programme

BACKGROUND

Social opportunities can be limited in the lives of people with enduring mental illness (EMI) due to psychiatric stigma, restricted home environments and employment barriers. Supported socialisation programmes have the potential to redress the impact of social isolation.

AIM

To explore the experiences of service users with EMI taking part in a supported socialisation programme, using written diary entries.

METHODS

This article reports on the qualitative component of a randomised controlled trial of supported socialisation for people with EMI (published previously in this journal). Trial participation involved (1) being matched with a volunteer partner and engaging in social/leisure activities while receiving a stipend of €20 or (2) receiving this stipend only and engaging in self-driven socialisation. Participants completed written diaries documenting their perspectives on their experiences of supported socialisation. Data were analysed using Thematic Analysis.

RESULTS

Experiences of participation were characterised by involvement 'normalising' life, fostering a sense of connectedness, improving physical health, and facilitating engagement with culture. Taking part helped participants integrate socialising into their identity, enhanced their perceived capacity to be social, and cemented/expanded social networks. Participants also experienced significant obstacles to socialisation.

CONCLUSION

Supported socialisation can increase confidence, social competence and self-agency; buffer against psychiatric stigma; build social capital; and afford opportunities to enhance social integration, inclusion and belonging.

Do continuum beliefs reduce schizophrenia stigma? Effects of a laboratory intervention on behavioral and self-reported stigma

BACKGROUND AND OBJECTIVES

Correlational research shows that belief in a continuum of psychiatric problems predicts decreased public stigma. However, the correlational findings fail to inform the stigma reduction prospects of manipulating continuum beliefs. All extant experimental work has been executed online. This study examined effects of a laboratory-based continuum intervention on behavioral and self-report measures of psychiatric stigma.

METHODS

Sixty-nine undergraduates believed that they would meet a man with schizophrenia. They then read a bogus scientific article that attested to a categorical view of schizophrenia, a continuum view, or that merely described schizophrenia. Some participants then completed a task that required reflection on their differences from (categorical group) or similarities to (continuum group) the man with schizophrenia. Participants eventually moved to an adjacent room and sat in one of several seats that varied in their proximity to a seat ostensibly occupied by the man with schizophrenia.

RESULTS

The continuum intervention decreased self-reported social distance and the categorical intervention increased endorsement of damaging stereotypes. Seat selection was unaffected by our manipulation, but we obtained evidence of significant links to validated stigma measures.

LIMITATIONS

Our sample was small, and our behavioral stigma measure could be modified to maximize variability in participants' seat selection.

CONCLUSIONS

The study offers modest support of the stigma reduction effect of continuum belief intervention. It offers new evidence of the pernicious consequences of interventions that inflate perceptions of the "otherness" of individuals with psychiatric problems. Finally, it shines new light on stigma-related behavior measurable in the laboratory.

Continuum beliefs and stigmatising beliefs about mental illness: results from an Asian community survey

OBJECTIVES

To establish the prevalence and correlates of continuum beliefs for five mental illnesses in a multiethnic population and to explore its association with stigma.

DESIGN

A community-based, cross-sectional study.

SETTING

A national study in a multiethnic Asian country.

PARTICIPANTS

A comprehensive study of 3006 Singapore residents (Singapore citizens and permanent residents) aged 18-65 years who were living in Singapore at the time of the survey.

OUTCOME MEASURES

Parameters assessed included belief in a continuum of symptom experience, stigma dimensions and causal beliefs in mental illness. Statistical analyses included descriptive statistics and multiple linear regression (MLR).

RESULTS

About half of the population indicated agreement with a continuum of symptoms for depression (57.9%) and dementia (46.8%), whereas only about one in three respondents agreed with it for alcohol abuse (35.6%), schizophrenia (32.7%) and obsessive-compulsive disorder (OCD) (36.8%). MLR analyses revealed that students (β=0.28; 95% CI 0.05 to 0.50; p=0.018) and those who were unemployed (β=0.60; 95% CI 0.26 to 0.95; p=0.001) (vs employed) as well as those who had previous contact with people with mental illness (β = 0.31; 95% CI 0.18 to 0.45; p<0.001) and believed stress, family arguments, difficulties at work or financial difficulties to be a cause for mental illness (β=0.43; 95% CI 0.13 to 0.73; p=0.005) were associated with a higher belief in a continuum of symptom experience. Continuum beliefs were related to lower desire for social distance in alcohol abuse, OCD and schizophrenia; however, they were associated with higher scores on 'weak-not-sick' stigma dimension in dementia and schizophrenia.

CONCLUSIONS

Perceiving that a person with a mental illness is similar to themselves may reduce social distancing by the public. Thus, the approach may lend itself well to public education aimed at reducing stigma.

A social paradigm in psychiatry - themes and perspectives

AIMS

Psychiatry as science is underpinned by paradigms. Considering whether a social paradigm may help to advance the current state of psychiatry, the review provides a reference to the rich, but fragmented past of related initiatives in the history of psychiatry and a personal view of themes, challenges and perspectives of using a social paradigm in psychiatry.

METHODS

Major themes are the evidence on social determinants of mental health; the value-based importance of integrating people with mental disorders in society; options to overcome the social isolation and improve the networks of psychiatric patients; utilising a systemic approach for interventions in families and communities; and understanding group and one-to-one treatments in psychiatry primarily as social interactions. Whilst all these themes open up perspectives for future action and/or research, there are also conceptual challenges through the limitations of the current construct of mental disorders and the dominating terminology.

RESULTS

Initiatives for using a social paradigm in psychiatry may refer to important achievements in the past, but need to go beyond this and consider on-going societal changes.

CONCLUSION

Innovation may benefit from close collaboration with social sciences and humanities.

Continuum beliefs in the stigma process regarding persons with schizophrenia and depression: results of path analyses

Background

Individuals with mental illness often experience stigmatization and encounter stereotypes such as being dangerous or unpredictable. To further improve measures against psychiatric stigma, it is of importance to understand its components. In this study, we attend to the step of separation between “us” and “them” in the stigma process as conceptualized by Link and Phelan. In using the belief in continuity of mental illness symptoms as a proxy for separation, we explore its associations with stereotypes, emotional responses and desire for social distance in the stigma process.

Methods

Analyses are based on a representative survey in Germany. Vignettes with symptoms suggestive of schizophrenia (n = 1,338) or depression (n = 1,316) were presented to the respondents, followed by questions on continuum belief, stereotypes, emotional reactions and desire for social distance. To examine the relationship between these items, path models were computed.

Results

Respondents who endorsed the continuum belief tended to show greater prosocial reactions (schizophrenia: 0.07; p < 0.001, depression: 0.09; p < 0.001) and less desire for social distance (schizophrenia: −0.13; p < 0.001, depression: −0.14; p < 0.001) toward a person with mental illness. In both cases, agreement with the stereotypes of unpredictability and dangerousness was positively associated with feelings of anger and fear as well as desire for social distance. There were no statistically significant relations between stereotypes and continuum beliefs.

Discussion

Assumptions regarding continuum beliefs in the stigma process were only partially confirmed. However, there were associations of continuum beliefs with less stigmatizing attitudes toward persons affected by either schizophrenia or depression. Including information on continuity of symptoms, and thus oppose perceived separation, could prove helpful in future anti-stigma campaigns.

Continuum beliefs about psychotic symptoms are a valid, unidimensional construct: Construction and validation of a revised continuum beliefs questionnaire

Growing evidence supports a continuum model of psychosis, with mild psychotic symptoms being frequently experienced by the general population. Moreover, believing in the continuum model correlates with less stigmatization of schizophrenia. This study explores whether continuum beliefs are a valid construct and develops a continuum beliefs scale. First, expert-generated items were reduced to a candidate scale (study 1, n=95). One-dimensionality was tested using confirmatory factor analysis (study 2, n=363). Convergent validity was tested with a previous continuum beliefs scale, essentialist beliefs, and stigmatization (study 2), while self-reported psychotic experiences (i.e. frequency and conviction) served to test discriminant validity (study 3, n=229). A nine item questionnaire that assesses continuum beliefs about schizophrenia symptoms showed acceptable to good psychometric values, high correlations with a previous continuum beliefs scale and small correlations with essentialist beliefs, stereotypes, and desired social distance. No correlations with psychotic experiences were found. Thus, continuum beliefs can be considered a valid construct. The construed CBQ-R asks about symptoms rather than the abstract category "schizophrenia", which may increase understandability of the scale. Validation confirms previous studies and highlights the difference between continuum beliefs and personal psychotic experiences.

The potential of continuum versus biogenetic beliefs in reducing stigmatization against persons with schizophrenia: An experimental study

OBJECTIVE

A central aspect of previous anti-stigma campaigns was the promotion of biogenetic causes of schizophrenia. Although biogenetic beliefs have been shown to reduce the blame given to persons with schizophrenia, they tend to increase discrimination and stereotypes such as dangerousness and unpredictability. A novel anti-stigma approach is to incorporate continuum beliefs in order to oppose the perceived separation, which is a main component of the stigma process. The aim of the study was to compare the effects of a continuum, a biogenetic, and a control intervention on stereotypes, fear, and social distance towards persons with schizophrenia. Furthermore, it was intended to replicate earlier findings on the associations between continuum beliefs, biogenetic beliefs, and different facets of stigmatization.

METHOD

In an online-experiment, 1189 participants from the general population randomly received either a continuum, a biogenetic, or a control intervention, which consisted of written information texts.

RESULTS

The continuum group showed less endorsement of the stereotype incompetence/unpredictability than the biogenetic group. The biogenetic group ascribed less blame to persons with schizophrenia than the other groups. The correlation analyses indicated continuum beliefs to be consistently associated with lower stereotype scores, less fear, and less preferred social distance.

LIMITATIONS

The sample was not fully representative and the experimental manipulations in our study consisted of relatively short information texts.

CONCLUSION

It is concluded that continuum beliefs have the potential to reduce stigmatization against persons with schizophrenia. However, future studies need to investigate the effects of more powerful interventions to promote them.

An online intervention using information on the mental health-mental illness continuum to reduce stigma

BACKGROUND

A core component of stigma is being set apart as a distinct, dichotomously different kind of person. We examine whether information on a continuum from mental health to mental illness reduces stigma.

METHOD

Online survey experiment in a quota sample matching the German population for age, gender and region (n=1679). Participants randomly received information on either (1) a continuum, (2) a strict dichotomy of mental health and mental illness, or (3) no information. We elicited continuity beliefs and stigma toward a person with schizophrenia or depression.

RESULTS

The continuum intervention decreased perceived difference by 0.19 standard deviations (SD, P<0.001) and increased social acceptance by 0.18 SD (P=0.003) compared to the no-text condition. These effects were partially mediated by continuity beliefs (proportion mediated, 25% and 26%), which increased by 0.19 SD (P<0.001). The dichotomy intervention, in turn, decreased continuity beliefs and increased notions of difference, but did not affect social acceptance.

CONCLUSION

Attitudes towards a person with mental illness can be improved by providing information on a mental health-mental illness continuum.

The public stigma of mental illness means a difference between you and me

Social desirability can influence reports of stigma change in that subscribing to stigmatizing attitudes might pose a threat to personal beliefs of open-mindedness, while endorsing difference might not be as troubling. A measure is needed that assesses stigma change but is less susceptible to desirability effects. This study examined the psychometrics of various assessments of perceived difference from a person with mental illness. A total of 460 participants were recruited online using Amazon's Mechanical Turk. Four measures of difference, the Likert Scale of Difference, Semantic Differential: Similar-Different Scale, Semantic Differential: Mental Illness versus Other Illness scale, and Cause of Perceived Difference Scale were compared to measures of stereotypes, affirming attitudes, and care seeking. A vignette describing a person with mental illness anchored the Difference Scale and a measure of stereotype. Results showed that measures of difference yielded significantly higher endorsements than measures of stereotypes; the Semantic Differential Scale: Similar-Different was endorsed at a higher rate than other difference scales. Difference scores were positively related to stereotypes and inversely related to affirming attitudes. Difference was also found to influence empowerment separate from, and in addition to stereotype. These results suggest a new domain as an efficient and sensitive measure of stigma change.