Biogenetic explanations and public acceptance of mental illness: Systematic review of population studies

Centre for Public Mental Health, Gösing am Wagram, Austria.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 11/2011; 199(5):367-72. DOI: 10.1192/bjp.bp.110.085563
Source: PubMed


Biological or genetic models of mental illness are commonly expected to increase tolerance towards people with mental illness, by reducing notions of responsibility and blame.
To investigate whether biogenetic causal attributions of mental illness among the general public are associated with more tolerant attitudes, whether such attributions are related to lower perceptions of guilt and responsibility, to what extent notions of responsibility are associated with rejection of people who are mentally ill, and how prevalent notions of responsibility are among the general public with regard to different mental disorders.
A systematic review was conducted of representative population studies examining attitudes towards people with mental illness and beliefs about such disorders.
We identified 33 studies relevant to this review. Generally, biogenetic causal attributions were not associated with more tolerant attitudes; they were related to stronger rejection in most studies examining schizophrenia. No published study reported on associations of biogenetic causal attributions and perceived responsibility. The stereotype of self-responsibility was unrelated to rejection in most studies. Public images of mental disorder are generally dominated by the stereotypes of unpredictability and dangerousness, whereas responsibility is less relevant.
Biogenetic causal models are an inappropriate means of reducing rejection of people with mental illness.

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    • "Most studies, however, analyse the two types of beliefs separately (Angermeyer et al., 2011, 2013; Kvaale et al., 2013; Pilkington et al., 2013; Read et al., 2013a,b; Walker and Read, 2002). An advantage of this approach is illustrated by a study that adopted both approaches (Read and Harre, 2001). "
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    ABSTRACT: Background Public beliefs about the causes of mental health problems are related to desire for distance and pessimism about recovery, and are therefore frequently studied. The beliefs of people receiving treatment are researched less often. Method An online survey on causal beliefs about depression and experiences with antidepressants was completed by 1829 New Zealand adults prescribed anti-depressants in the preceding five years, 97.4% of whom proceeded to take antidepressants. Results The most frequently endorsed of 17 causal beliefs were family stress, relationship problems, loss of loved one, financial problems, isolation, and abuse or neglect in childhood. Factor analysis produced three factors: ‘bio-genetic’, ‘adulthood stress’ and ‘childhood adversity’. The most strongly endorsed explanations for increases in antidepressant prescribing invoked improved identification, reduced stigma and drug company marketing. The least strongly endorsed was ‘Anti-depressants are the best treatment’. Regression analyses revealed that self-reported efficacy of the antidepressants was positively associated with bio-genetic causal beliefs, negatively associated with childhood adversity beliefs and unrelated to adulthood stress beliefs. The belief that ‘People cannot׳ get better by themselves even if they try’ was positively associated with bio-genetic beliefs. Limitations The convenience sample may have been biased towards a favourable view of bio-genetic explanations, since 83% reported that the medication reduced their depression. Conclusions Clinicians׳ should consider exploring patients׳ causal beliefs. The public, even when taking antidepressants, continues to hold a multi-factorial causal model of depression with a primary emphasis on psycho-social causes. A three factor model of those beliefs may lead to more sophisticated understandings of relationships with stigma variables.
    Journal of Affective Disorders 10/2014; 168:236–242. DOI:10.1016/j.jad.2014.06.010 · 3.38 Impact Factor
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    • "With both disorders, there was no statistically significant association between the endorsement of hereditary factors as a cause and social distance. By and large, our results are in line with what had been observed in previous studies (Angermeyer et al. 2011; Schomerus et al. 2014): Biogenetic explanations and social distance either are unrelated or the first are associated with an increase of the latter. This congruence suggests that it matters little whether an unlabelled or a labelled vignette is used when examining the relationship between biogenetic causes and social distance. "
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    ABSTRACT: Aims. Previous population-based studies did not support the view that biological and genetic causal models help increase social acceptance of people with mental illness. However, practically all these studies used un-labelled vignettes depicting symptoms of the disorders of interest. Thus, in these studies the public's reactions to pathological behaviour had been assessed rather than reactions to psychiatric disorders that had explicitly been labelled as such. The question arises as to whether results would have been similar if respondents had been confronted with vignettes with explicit mention of the respective diagnosis. Methods. Analyses are based on data of a telephone survey in two German metropolises conducted in 2011. Case-vignettes with typical symptoms suggestive of depression or schizophrenia were presented to the respondents. After presentation of the vignette respondents were informed about the diagnosis. Results. We found a statistically significant association of the endorsement of brain disease as a cause with greater desire for social distance from persons with schizophrenia. In major depression, this relation was absent. With both disorders, there was no statistically significant association between the endorsement of hereditary factors as a cause and social distance. Conclusions. Irrespective of whether unlabelled or labelled vignettes are employed, the ascription to biological or genetic causes seems not to be associated with a reduction of the public's desire for social distance from people with schizophrenia or depression. Our results corroborate the notion that promulgating biological and genetic causal models may not help decrease the stigma surrounding these illnesses.
    Epidemiology and Psychiatric Sciences 04/2014; 24(04):1-7. DOI:10.1017/S2045796014000262 · 3.91 Impact Factor
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    • "The second possible reason is that the content of the educational program might make the audience hesitate, become discouraged, or feel hopeless because of the complexity and incomprehensibility of schizophrenia. This “side effect” of schizophrenia literacy has been confirmed by several recent studies [31-33], and might explain why levels of stigma towards schizophrenia sometimes remain unchanged or worsen following an educational program [34,35]. Specially, as parents of adolescents confront this complicated illness, associating the symptoms with negative aspects of people with schizophrenia, their fear of the illness and worries about their children may be stimulated. "
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    ABSTRACT: The stigma of schizophrenia constitutes a major barrier to early detection and treatment of this illness. Anti-stigma education has been welcomed to reduce stigma among the general public. This study examined the factors associated with the effectiveness of a web-based educational program designed to reduce the stigma associated with schizophrenia. Using Link's Devaluation-Discrimination Scale to measure stigma, the effect of the program was measured by the difference in pre- and post-program tests. In the present study, we focused on program participants whose stigma towards schizophrenia had considerably improved (a reduction of three points or more between pre- and post-program tests) or considerably worsened (an increase of three points or more). The study participants were 1,058 parents of middle or high school students across Japan, including 508 whose stigma had significantly decreased after the program and 550 whose stigma had significantly increased. We used multiple logistic regression analysis to predict a considerable reduction in stigma (by three or more points) using independent variables measured before exposure to the program. In these models, we assessed the effects of demographic characteristics of the participants and four measures of knowledge and views on schizophrenia (basic knowledge, Link's Devaluation-Discrimination Scale, ability to distinguish schizophrenia from other conditions, and social distance). Participants' employment status, occupation, basic knowledge of schizophrenia, pre-program Link's Devaluation-Discrimination Scale score, and social distance were significant factors associated with a considerable decrease in the stigma attached to schizophrenia following the educational program. Specifically, full-time and part-time employees were more likely to experience reduced stigma than parents who were self-employed, unemployed, or had other employment status. Considerable decreases in stigma were more likely among parents working in transportation and communication or as homemakers than among other occupational groups. In addition, parents with higher pre-program levels of stigma, lower basic knowledge, or lower social distance were more likely to have reduced levels of stigma. Based on the regression analysis results presented here, several possible methods of reducing stigma were suggested, including increasing personal contact with people with schizophrenia and the improvement of law and insurance systems in primary and secondary industries.
    BMC Public Health 03/2014; 14(1):258. DOI:10.1186/1471-2458-14-258 · 2.26 Impact Factor
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