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To explore whether the increase in knowledge about the biological correlates of mental disorders over the last decades has translated into improved public understanding of mental illness, increased readiness to seek mental health care and more tolerant attitudes towards mentally ill persons. A systematic review of all studies on mental illness-related beliefs and attitudes in the general population published before 31 March 2011, examining the time trends of attitudes with a follow-up interval of at least 2 years and using national representative population samples. A subsample of methodologically homogeneous studies was further included in a meta-regression analysis of time trends. Thirty-three reports on 16 studies on national time trends met our inclusion criteria, six of which were eligible for a meta-regression analysis. Two major trends emerged: there was a coherent trend to greater mental health literacy, in particular towards a biological model of mental illness, and greater acceptance of professional help for mental health problems. In contrast, however, no changes or even changes to the worse were observed regarding the attitudes towards people with mental illness. Increasing public understanding of the biological correlates of mental illness seems not to result in better social acceptance of persons with mental illness.
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Meta-analysis
Evolution of public attitudes about mental
illness: a systematic review and meta-analysis
Introduction
The last decades have witnessed tremendous
advancements of our understanding of the biolog-
ical correlates of mental disorders. Not only has
the knowledge of researchers and mental health
professionals expanded, but the public, too, has
been increasingly exposed to information on
Schomerus G, Schwahn C, Holzinger A, Corrigan PW, Grabe HJ, Carta
MG, Angermeyer MC. Evolution of public attitudes about mental
illness: a systematic review and meta-analysis.
Objective: To explore whether the increase in knowledge about the
biological correlates of mental disorders over the last decades has
translated into improved public understanding of mental illness,
increased readiness to seek mental health care and more tolerant
attitudes towards mentally ill persons.
Method: A systematic review of all studies on mental illness-related
beliefs and attitudes in the general population published before 31
March 2011, examining the time trends of attitudes with a follow-up
interval of at least 2 years and using national representative population
samples. A subsample of methodologically homogeneous studies was
further included in a meta-regression analysis of time trends.
Results: Thirty-three reports on 16 studies on national time trends
met our inclusion criteria, six of which were eligible for a meta-
regression analysis. Two major trends emerged: there was a coherent
trend to greater mental health literacy, in particular towards a
biological model of mental illness, and greater acceptance of
professional help for mental health problems. In contrast, however, no
changes or even changes to the worse were observed regarding the
attitudes towards people with mental illness.
Conclusion: Increasing public understanding of the biological
correlates of mental illness seems not to result in better social
acceptance of persons with mental illness.
G. Schomerus
1
, C. Schwahn
2
,
A. Holzinger
3
, P. W. Corrigan
4
,
H. J. Grabe
1
, M. G. Carta
5
,
M. C. Angermeyer
5,6
1
Department of Psychiatry and Psychotherapy,
2
Center
of Oral Health, Department of Prosthetic Dentistry,
Gerostomatology and Dental Materials, University of
Greifswald, Greifswald, Germany,
3
Department of
Psychiatry and Psychotherapy, Medical University of
Vienna, Vienna, Austria,
4
Illinois Institute of Technology,
Chicago, IL, USA,
5
Centro di Psichiatria di Consultazione
e Psicosomatica, Universit degli Studi di Cagliari, AOU
Cagliari, Italy and
6
Center for Public Mental Health,
Gçsing am Wagram, Austria
Key words: mental health literacy; stigma; trends;
depression; schizophrenia; genetics
Dr Georg Schomerus, Department of Psychiatry,
University of Greifswald, Rostocker Chaussee 70,
18437 Stralsund, Germany.
E-mail: georg.schomerus@uni-greifswald.de
Accepted for publication December 16, 2011
Summations
A more biological public understanding of mental illness parallels greater acceptance of professional
treatment, including psychiatric medication.
Social rejection of mentally ill persons remained disturbingly stable over the last 20 years.
Increasing public literacy about the biological correlates of mental disorders seems no remedy against
stigmatization and discrimination of persons with mental illness.
Considerations
Time-trend analyses of mental illness–related public attitudes have only been conducted in
industrialized, first-world countries, and developments in other parts of the world are unknown.
This review focuses on broad, long-term developments of public attitudes on a national level. The
evaluation of anti-stigma and awareness campaigns, frequently accomplished by short-term and local
studies, was not the focus of this review.
Acta Psychiatr Scand 2012: 125: 440–452
All rights reserved
DOI: 10.1111/j.1600-0447.2012.01826.x
2012 John Wiley & Sons A/S
ACTA PSYCHIATRICA
SCANDINAVICA
440
symptoms, biochemical and genetic etiological
theories and to the basic argument that the
mental illnesses are diseases no different from
other diseases, amenable to effective medical
treatment (1). As part of a widely recognized
effort to Ôenhance public awareness of the benefits
to be derived from brain researchÕ(2), the US
Congress and President George H.W. Bush desig-
nated the 1990s ÔDecade of the BrainÕ. An analysis
of the portrayal of depression in high circulating
magazines in the United States and in Canada has
shown that indeed depression moved from a
problem explained in a variety of ways in the
1980s to a primarily biomedical phenomenon in
the 1990s and 2000s (3). The coverage of the use of
neurotechnology for diagnosis or therapy in neu-
ropsychiatric disorders increased between 1995 and
2004 in major United States and UK English-
language news sources and was generally optimistic
(4).
It was hoped that the promulgation of mental
illness as a ÔrealÕbrain disease would challenge the
omnipresent stigma attached to mental disorders.
Instead of blaming persons with mental illness for
their disorders, people endorsing a biological
causal model of mental illness might be more
inclined to see the symptoms of mental illness as a
result of biological illness not under voluntary
control (5). In turn, more knowledge and less
stigma would lead to greater openness about
seeking out treatment or staying in treatment.
Many anti-stigma initiatives like that launched by
the US National Alliance on Mental Illness
(NAMI) have thus incorporated a medicalizing
view on mental illness, portraying mental disorders
explicitly as medical diseases, for example major
depression as Ôa biological, medical illnessÕ(6), or
schizophrenia as an illness Ôlike many other medical
illnesses such as cancer or diabetesÕ(7). Taken
together, these developments nourished the expec-
tation that people will become more knowledge-
able about mental disorders, professional help and
psychiatric treatment will be more accepted, neg-
ative stereotypes about mentally ill people will
diminish, and social acceptance of people with
mental illness will improve.
In this review, we look at population studies on
public attitudes to find out whether attitudes have
indeed developed in the expected direction. Over
the last twenty years, many studies have investi-
gated public beliefs about mental disorders, help-
seeking and attitudes towards persons with mental
illness. Most of these studies are cross-sectional
reports on single surveys. To arrive at valid
conclusions about attitude changes at population
level, studies need to compare responses to
identical items at two (or more) time points, and
all surveys analysed within one study need to be
based on identical sampling procedures employed
in the same population. In this review, we look at
such population studies which we identified in a
systematic review. Time-trend studies have been
conducted in different countries, cover different
time frames, and use a variety of methods to
measure public attitudes. To find out whether there
is a common trend of public attitudes across
different countries and time frames, we selected a
subgroup of studies using similar measures. With
these studies, we performed a series of meta-
regression analyses to identify any supranational
trend of public attitudes related to mental illness.
Aims of the study
To find out whether, over the last decades, the
general public has become more knowledgeable
about mental disorders and more accepting of
professional help-seeking and whether negative
stereotypes and social rejection of persons with
mental illness have diminished.
Methods
We conducted a systematic review of all represen-
tative population-based studies on public attitudes
regarding mental disorders and people with mental
illness that have appeared until 31st March 2011.
Specifically, we looked for time-trend analyses,
that is, studies that enquire on public attitudes at
least at two occasions with identical methodology.
Besides reports published in scientific journals or
books, we include also documents published online
and so-called Ôgrey literatureÕ, that is, reports not
published in commercially available books or
journals. To detect all relevant studies, we took a
stepwise approach according to the systematic
literature review guidelines of the Centre for
Reviews and Dissemination (8) and the Cochrane
Collaboration (9).
Searching methods
To find all studies examining public attitudes
regarding mental illness on a population level, we
conducted a literature search in the electronic
databases Pubmed, PsychINFO and Web of
Science, using the terms (Ômental illnessÕOR
Ômental disorderÕOR schizophrenia OR depression
OR alcoholism OR Ôalcohol abuseÕOR Ôalcohol
depend*ÕOR alcoholic OR Ôanxiety disorderÕOR
Ôobsessive compulsive disorderÕOR dementia OR
ÔAlzheimerÕs diseaseÕ) AND (attitudes OR stigma
Evolution of public attitudes
441
OR Ômental health literacyÕOR Ôcausal beliefsÕOR
Ôcausal attributionsÕOR stereotype OR Ôsocial
distanceÕ) AND (representative OR population).
No restrictions regarding the language of the
indexed articles were applied. We expanded this
initial search by screening the bibliographies of all
relevant reports and by performing electronic
searches for further relevant articles by the first
author of any identified study. Additionally, we
contacted the experts in the field of psychiatric
attitude research and asked them about any
relevant study not published in peer-reviewed
journals or other relevant Ôgrey literatureÕknown
to them. Finally, based on all reports identified by
this procedure, we conducted a full-text search of
all reports specifically looking for eligible time-
trend analyses of public attitudes and beliefs.
The initial database search was conducted by
GS. Two researchers (GS and MCA) then inde-
pendently screened titles, abstracts and, where
appropriate, the full text of all identified reports
to minimize the possibility of discarding poten-
tially relevant reports. AH and MCA screened
bibliographies of all relevant reports and con-
ducted electronic searches for further relevant
articles by all first authors. MCA contacted
experts in the field of psychiatric attitude research.
Finally, the full-text analysis of all previously
identified reports was carried out independently
by MCA and AH, looking for reports on trend
analyses of public beliefs and attitudes about
mental illness. At this stage, native speakers were
contacted to provide translations of reports if
necessary. Disagreement about inclusion of indi-
vidual reports was resolved by discussion at both
stages (screening and full-text analysis for eligi-
bility).
Study selection
We retained all reports on studies that met the
following criteria: first, the focus of the study was
on the general public. Studies investigating beliefs
or attitudes of particular subgroups such as con-
sumers of mental health services, health profes-
sionals or students were excluded. Second, to avoid
selection effects, we only included studies based on
representative population samples obtained by
either random or quota sampling methods. Third,
we included only studies conducted on a national
level (as opposed to local surveys), with a follow-up
interval of at least 2 years, as we were interested in
broad, sustained time trends of public beliefs and
attitudes. The methodological quality of included
studies was assessed with regard to sample sizes
and response rates.
Data extraction and meta-regression analysis
Corresponding to our research question, data on
four domains of attitudes were extracted: informa-
tion on beliefs about causes and definition of
mental disorder, attitudes towards help-seeking,
prevalence of negative stereotypes, and social
acceptance of persons with mental illness. Study
methodology varied considerably: answer formats
comprised open-ended questions, yes no answers,
and Likert-type scales. Items were phrased using
diagnostic labels (Ômental illnessÕ,ÔdepressionÕ,
Ômental health problemsÕand Ôday-to-day stressÕ
etc.) or referring to an unlabelled brief description
of a person with a specific disorder, a case vignette.
Among all studies, we identified a group of studies
using a coherent methodological approach with
unlabelled case vignettes of either schizophrenia or
depression which were appropriate to a meta-
regression of time trends. In these studies, answers
to items relevant to this review were elicited with
Likert-type scales with anchors such as Ôagree
completely disagree completelyÕor Ôvery likely
very unlikelyÕ. All studies collapsed answers on the
approval side of the midpoint of the scale into
ÔagreeÕor ÔlikelyÕ, and this was the outcome entered
into our meta-analysis. Two studies reported
disagreement with statements on the willingness
to engage in several forms of social contact (Ôdesire
for social distanceÕ) (10–13). We contacted the
authors of these studies who kindly provided the
respective results on agreement with these state-
ments (social acceptance). Aim of the meta-regres-
sion analysis was to test whether there were
significant supranational trends in attitude-change
and to estimate their magnitude. Our systematic
review thus yields two types of results for each of
the four attitudinal domains: results of a meta-
regression analysis of a selection of methodologi-
cally homogeneous studies and a narrative sum-
mary of results from other, methodologically
heterogeneous studies.
Statistical analyses were performed using
stata se software, release 10 (Stata Corporation,
College Station, TX, USA). In contrast to common
meta-analysis, we focused on the annual change of
the attitude of interest (rather than on the overall
attitude). Therefore, only studies with at least two
time points were selected. The unit of analysis of
our meta-regression was the aggregate-level data
for one time point of each study, namely the
proportion of respondents endorsing the attitude
of interest in one survey. To estimate the overall
attitude change per year, we used the revised
version of the ÔmetaregÕcommand (14), which
performs a random effect meta-regression analysis
Schomerus et al.
442
using aggregate-level data. For each attitude,
change was adjusted for country (unless stated
otherwise), allowing for differing country-specific
baselines for any attitude change. All reported
P-values are two sided. For our figures and tables,
proportions (values between 0 and 1) were trans-
formed into percent (0–100) to be congruent with
the reporting of percentages in the single studies.
While tables show results of all meta-regressions
conducted, figures illustrate those analyses where
the estimation of overall attitude change was
statistically significant.
In our figures, circles are positioned to depict the
time point and the results of individual surveys,
thus representing the units of analysis. Associated
surveys conducted in the same population are
represented by similar colours. Circle sizes are
proportional to sample sizes (and hence the weight)
of the respective study. The slope of the regression
line represents average change per year across all
countries and illustrates thus the core outcome of
our meta-regression. The y-axis intercept of the
regression line depicts the estimate for the reference
category, Germany (West). West Germany was
used as the reference category as this study
comprised the largest sample, the longest time
period (11 years), and started earliest (1990).
Results
Our initial database search identified 7360 poten-
tially relevant documents. Exclusion of duplicates,
of documents not dealing with attitudes of the
general population, and of documents not based
on representative population samples yielded 324
potentially relevant reports, citation-chasing and
first-author searches resulted in another 209
reports that met our inclusion criteria. Twenty-six
further reports were identified by contacting
experts. Thus, the first step of our search strategy
yielded in total 559 reports, 102 of which were
written in languages other than English. From
these 559 reports, we identified 33 reports on 16
national time-trend analyses of beliefs and atti-
tudes about mental illness, covering periods from
three to 46 years. Four of these studies originate
from the United States, five from the UK or
Scotland, and one each from Australia, Austria,
the Netherlands, Poland, New Zealand and East-
and West Germany. Studies from Germany
reported separately for East- and West Germany.
Given that both regions constituted different
countries with very different political and social
structures until unification in 1990, this separate
consideration of attitude changes seemed appro-
priate. Data from a Scottish study were reported
separately for results obtained with a female and a
male case vignette (15); hence, in our meta-regres-
sion analysis, this study is treated as two separate
studies. Eleven studies deal with mental illness in
general, ten with schizophrenia, seven with depres-
sion and two with other mental disorders. Seven
studies (from Australia, Austria, and UK Scot-
land) were conducted pre and post anti-stigma
campaigns. Six studies (from Australia, Austria,
USA, Scotland, and East West Germany) used
case vignettes and were thus included in our meta-
analysis. Except for one study, sample sizes were
generally >1000 respondents, but owing to split-
ting of samples in studies examining different
conditions or using male female case vignettes,
subsample sizes varied from 230 (15) to 6000 (16).
Studies reported response rates from 65% to 85%.
Four studies did not report this measure, three of
which were research reports not published in peer-
reviewed journals. Table 1 provides a synopsis with
further details of all studies included in our review.
Beliefs about causes and definition of mental disorder
Six studies used case vignettes to elicit causal
beliefs for depression and schizophrenia (1, 10, 12,
13, 15, 17–19) and were entered in our meta-
regression analysis. Causal beliefs were assessed by
offering respondents a list of causes for the
problem described in the vignette and asking
them to rate the likelihood of each cause. Because
data from Scotland were reported separately for
male and female characters depicted in the vign-
ette, they are treated as two studies in our analyses.
Figure 1 summarizes results of the analysis for two
causal beliefs (Ôinherited geneticÕand Ôbrain dis-
easeÕ). Together, the studies covered 16 years
(1990–2006, x-axis). Agreement with Ôinher-
ited geneticÕincreased by 1.3% per year in schizo-
phrenia (P< 0.001) and by 1.2% in depression
(P= 0.007). The estimated increase over the entire
time period across all studies was thus 20.8%
(schizophrenia) and 19.2% (depression). This
increase in biological causal beliefs was not accom-
panied by decreasing support for a psychosocial
aetiology of schizophrenia and depression:
endorsement of stress as a cause remained
unchanged at a high level (Table 2).
The meta-regression analysis also yielded coeffi-
cients for each country. They signify the differences
of the estimates for each country in relation to the
reference category, that is, the amount the regres-
sion line needed to be moved up or down on the
y-axis to depict estimates for the respective coun-
try. As the predictions for individual countries are
not the focus of this study, we omit these
Evolution of public attitudes
443
Table 1. Synopsis of national trend analyses of public knowledge about mental disorders, attitudes towards help-seeking and treatment and attitudes towards mentally ill people
Country Time period Sample size
Response
rate (%)
Age
range
(years) Stimulus
Mental
illness
unspecified
Schizo-
phrenia Depression
Other
disorder Knowledge
Attitudes
towards
help-seeking
treatment
Attitudes
towards the
mentally
ill
Anti-stigma
awareness
campaign References
USA 1950–1996 352 658 ? 71 25+ L (22)
the Netherlands 1976–1987–1997 1018 1925 2232 ? L (33, 61)
UK 1990–1997 ? 1804 –* 15+ L  (23)
USA 1990–2003 5388 4319 82 71 18–54 L (28)
UK 1991–1995–1997 2009 2050 1946 –* 15+ L  (21)
Poland 1993–1999–2005–2008 1088 1003 1037 1107 ? L  (35–38)
England and
Scotland
1994–1995–1996–
1997–2000–2003
2000 2000 6000
6000 2000 2000
–* L ()(16)
UK 1998–2003 1737 1725 67 65 16+ L à(31)
USA 1998–2006 1387 1437 76 71 18+ L (29)
New Zealand 1999–2002 1017 65 ?L   (32)
Germany (West) 1990–2001 6165 4005 66 65 18+ V    (10, 11, 13,
25, 30, 62–64)
Germany (East) 1993–2001 1564 1020 71 65 18+ V    (12)
Austria 1999–2007 1042 988 –* 16+ V (24)
Australia 1995–2003 2004 2031 1832 85 ? 18–74 V    ( (18, 20, 26, 27)
USA 1996–2006 1444 1523 76 71 18+ V   (1, 17, 65)
Scotland 2002–2004–2006 1381 1401 1216 ? 16+ V  (15, 19)
*Quota sampling.
Only in Scotland.
àAlcoholism, eating disorder, dementia.
Alcoholism.
§Only in some states L Diagnostic label V Case vignette (included in meta-regression analysis).
Schomerus et al.
444
additional coefficients in our table. Country coef-
ficients as well as all individual data extracted for
our meta-analyses are available from the authors
on request.
Two of the vignette-based trend analyses, from
East Germany (12) and Australia (20), additionally
examined whether the respondents were able to
correctly identify the unlabelled case vignette as
ÔdepressionÕor ÔschizophreniaÕrespectively. Both
studies used open-ended questions to elicit the
respondentsÕproblem definition. They show
increasing illness recognition in both countries:
from 1993 to 2001 (East Germany) and 1995 to
2003 2004 (Australia), correct recognition of
schizophrenia increased from 17% to 22% and
from 27% to 43% respectively. Recognition of
depression increased in East Germany to 38%
(+11%) and in Australia to 67% (+27%).
Similar trends towards increased mental health
literacy were found in studies with different meth-
odology. In Great Britain (in the context of the
Defeat Depression Campaign), the proportion of
respondents endorsing Ôbiological changes in the
brainÕas cause for ÔdepressionÕincreased from 33%
in 1991 to 43% in 1997, and for stress from 71% to
83% (21). Two further studies explored public
conceptions of general mental illness. One study,
covering the exceptionally long time from 1950 to
1996 (22), showed a broadening of conceptions of
mental illness, respondents mentioning a greater
proportion of non-psychotic disorders when asked
about their definition of mental illness in 1996 than
in 1950. The comparison of two surveys conducted
in Great Britain in 1990 and 1997 revealed an
increase of 14% in the proportion of respondents
spontaneously mentioning a specific mental disor-
der when asked what types of mental illness they
can think of (23).
Attitudes towards help-seeking and treatment preferences
Figure 2 shows the results of the meta-regression
analysis of two important beliefs about help-
seeking for schizophrenia and depression, based
on four studies (1, 12, 17, 24–27). Recommenda-
tion to visit a psychiatrist for the problem
described in the case vignette increased signifi-
cantly for depression (change per year 1.3%,
P= 0.008) and, from a higher baseline, just
below significance in schizophrenia (change per
year 0.9%, P= 0.06). Similarly, drug treatment
became significantly more popular for both disor-
ders (change per year: 1.7%, P= 0.017 in schizo-
phrenia; 1.3%, P= 0.03 in depression). Between
1990 and 2006, this amounts to an estimated
increase of recommending drug treatment for
schizophrenia of 27.2%. Particularly with regard
to drug treatment, Figure 2 shows that the direction
20
30
40
50
60
70
80
90
100
1990 1995 2000 2005
Year
Germany W Germany E
Australia United States
Scottland (F) Scottland (M)
20
30
40
50
60
70
80
90
100
1990 1995 2000 2005
Year
1990 1995 2000 2005
Year
1990 1995 2000 2005
Year
Schizophrenia Depression
Inherited/genetic
Brain disease
P < 0.001 P < 0.01
P < 0.01P < 0.05
%
%
Fig. 1. Evolution of causal explanations for schizophrenia and depression. Results from representative, national trend studies using
unlabelled case vignettes. Agreement to a specific cause, meta-regression analysis controlled for study site, reference category: West
Germany. The position of each circle represents the result (y-axis) and year (x-axis) of one national survey, and circle size is
proportional to sample size. Surveys from different countries trend analyses are distinguished by different shades of grey. Germany
W: West Germany (old FRG); Germany E: East Germany (former GDR); F: Female vignette; M: Male vignette.
Evolution of public attitudes
445
of attitude change is similar even in countries with
very different rates of approval (position of the
circle in relation to the y-axis). Table 2 shows that
recommendation of a GP, a psychotherapist or
psychotherapy did not change significantly.
Studies with differing methodological approaches
yielded similar results: a trend analysis from the
United States (1990–2003) explicitly focussing on
the attitudes towards professional mental health
treatment also showed that the American public
became more accepting in this respect: while in
1990–1992, 36% reported that they would Ôdefi-
nitely goÕfor professional help, this number was
41% in 2001–2003 (28). Respondents in the more
recent survey were also more comfortable talking
with a professional about personal problems. A
second study demonstrated improving attitudes
towards psychiatric medication 1998–2006. More
participants in 2006 than in 1998 thought that
medications help people to deal with day-to-day
stresses (83% vs. 78%), make things easier in
relation with family and friends (76% vs. 68%)
and help people feel better about themselves (68%
vs. 60%) (29). Similarly, a trend analysis from
Germany using surveys from 1990 and 2001 showed
that anticipation of negative effects from psycho-
tropic drugs declined significantly (30).
Stereotypes about persons with mental illness
Stereotypes play a crucial role in theoretical models
of stigmatization, because they supposedly trigger
negative emotional responses and discrimination.
Table 2 shows the results of a meta-regression of
trends for two common mental illness stereotypes,
being dangerous and being to blame for the
problem (13, 17, 18, 24, 31). These analyses are
based on three studies only (being dangerous in
schizophrenia: four studies), and neither trend
reached statistical significance, although there was
a trend towards reduced blame in schizophrenia
and depression (P= 0.10 and 0.11).
Inconsistent results were found in other studies:
in two surveys using diagnostic labels and con-
ducted in the context of the Changing Minds
Campaign of the Royal College of Psychiatrists in
Table 2. Meta-regression analyses of time trends of causal beliefs, treatment recommendations, negative stereotypes and social acceptance 1990–2006, based on studies
using case vignettes of schizophrenia or depression
Schizophrenia Depression
Change per year adjusted
for country*
Intercept (estimation
for Germany West in
1990)
Change per year adjusted
for country*
Intercept (estimation
for Germany West in
1990)
% 95% CI P-value % 95% CI % 95% CI P-value % 95% CI
Causal beliefs (n=6)
Inherited or genetic 1.32 0.82–1.82 <0.001 43.8 38.3–49.3 1.24 0.05–2.0 0.007 31.2 22.7–39.7
Brain diseaseà1.22 0.11–2.35 0.037 53.9 42.1–65.7 1.01 0.04–1.60 0.006 32.7 26.6–38.8
Stress 0.06 –0.20–0.33 0.61 71.9 68.8–75.1 0.29 )0.11–0.69 0.13 73.2 68.4–78.0
Treatment recommendations (n=4)
Psychiatrist 0.92 )0.09–1.93 0.06 69.2 57.9–80.5 1.28 0.64–1.92 0.008 51.0 43.9–58.0
Psychotherapist§ 1.17 )0.33–2.66 0.10 64.8 51.9–77.8 1.56 )0.21–3.33 0.07 52.1 36.8–67.5
GP 0.14 )1.53–1.82 0.80 65.0 46.8–83.3 0.30 )1.30–1.91 0.59 68.7 51.2–86.1
Drug treatment 1.68 0.57–2.78 0.02 35.0 23.0–47.1 1.26 0.23–2.30 0.03 27.5 16.3–38.6
Psychotherapy§ 0.59 )0.02–0.04 0.61 66.0 40.3–91.7 0.58 )3.45–4.60 0.71 52.5 17.8–87.2
Stereotypes (n=3)
Dangerous 0.43)0.90–1.75 0.44 52.3** 34.6–70.0 )1.02 )3.41–1.37 0.34 32.9** 0.4–65.4
To be blamed )1.12 )2.56–0.32 0.10 49.3 34.9–63.8 )0.85 )1.99–0.29 0.11 50.2 38.8–61.6
Social acceptance (n=6)
Co-workeràà )1.11 )2.08 to )0.13 0.033 51.3 41.2–61.5 )0.07 )1.90–1.76 0.93 54.3 35.3–73.3
Neighbour )0.97 )1.47 to )0.47 0.002 46.3 40.7–52.0 )0.06 )1.11–0.99 0.90 54.3 43.3–65.3
Friendàà )0.89 )2.08–0.30 0.12 28.0 15.7–40.3 )0.51 )2.02–1.01 0.44 33.9 18.0–49.7
Marrying to family )0.03 )0.48–0.42 0.87 12.5 7.6–17.4 0.45 )0.69–1.59 0.37 16.0 4.3–27.7
*Estimated change of agreement to a specific cause, treatment recommendation, stereotype or willingness to engage in a specific form of social contact (per year, %) across
all studies included.
Estimated baseline for any change in 1990 for the reference category, West-Germany (%).
àn=5.
§n= 3, not adjusted for country because of the small number of observations.
n=4.
**Estimation for United States in 1996 (no published data for West Germany).
Not adjusted for country because of the small number of observations.
ààn=5.
Schomerus et al.
446
Great Britain 1998 and 2003, the perception of
dangerousness decreased for both schizophrenia
and depression, and blame slightly decreased (from
8% to 6%) for schizophrenia (31). Conversely, two
studies examining general mental illness showed an
increase in perceived dangerousness. The first study
(US, 1950–1996) showed that the perception of
mentally ill people being violent or frightening had
substantially increased (22). A study from New
Zealand (1999–2002) also showed a growing
notion that people with mental illness are more
likely to be dangerous than other people (32).
Social acceptance of people with mental illness
The final outcome of most theoretical models on
stigma is social rejection and discrimination of
persons with mental illness. In population surveys,
this outcome is usually measured as Ôdesire for
social distanceÕ, using items assessing the willing-
ness or reluctance of respondents to engage in
specific forms of everyday contact. Most studies
using social distance scales reported willingness to
engage socially with mentally ill persons, thus
generating information about social acceptance (as
opposed to social rejection). We included those
items in our meta-regression analysis that were
used most consistently across six studies assessing
social distance towards a person depicted in a case
vignette of either schizophrenia or depression (12,
13, 15, 17, 24): accepting someone as a co-worker,
as a neighbour, as a friend, and as someone
marrying into ones family. Figure 3 shows a
significant decline in accepting persons with
schizophrenia as a neighbour (P= 0.002) and as
a co-worker (P= 0.03), while no significant
changes occurred in depression. Over the 16-year
period covered by our meta-regression analysis,
the estimated decline for accepting someone with
schizophrenia as a neighbour accumulated to
15.5% and to 17.8% for acceptance as a colleague
at work. Table 2 shows that acceptance of more
intimate relationships (acceptance as a friend and
as someone marrying into ones family) did not
change significantly for both disorders. In schizo-
phrenia, this could indicate a Ôbottom effectÕ,
because the acceptance of these relationships
was low from the beginning (estimated baseline
in West Germany in 1990: 28% and 13%
respectively).
Other studies investigated how attitudes toward
people with mental illness in general developed
over time. They found all either no change or
inconsistent trends or even a trend towards a
deterioration of public attitudes. Neither study
showed evidence of a substantial increase in the
publicÕs acceptance of people with mental illness
over the last decades.
20
30
40
50
60
70
80
90
100
1990 1995 2000 2005
Year
Germany W Germany E
Australia United States
20
30
40
50
60
70
80
90
100
1990 1995 2000 2005
Year
1990 1995 2000 2005
Year
1990 1995 2000 2005
Year
Schizophrenia Depression
PsychiatristDrug treatment
n.s.
P < 0.01
P < 0.05 P < 0.05
%
%
Fig. 2. Evolution of treatment recommendations for schizophrenia and depression. Results from representative, national trend
studies using unlabelled case vignettes. Recommendation of a specific treatment, meta-regression analysis controlled for study site,
reference category: West Germany. The position of each circle represents the result (y-axis) and year (x-axis) of one national survey,
and circle size is proportional to sample size. Surveys from different countries trend analyses are distinguished by different shades of
grey. Germany W: West Germany (old FRG); Germany E: East Germany (former GDR).
Evolution of public attitudes
447
In the Netherlands, the public had become more
acceptant of former psychiatric patients between
1976 and 1987, but in 1997, it had again grown
more reluctant to receiving ex-patients into their
private life. For instance, while 51% accepted a
psychiatric ex-patient as teacher for little children
in 1976 and the percentage had increased to 66% in
1987, it dropped again to 56% in 1997 (33). In
England and Scotland, surveys were carried out
1994–1997 annually, in 2000 and in 2003, using an
adapted version of the Community Attitudes
Towards the Mentally Ill (CAMI) survey (34).
Over the 9 years, responses to two of 25 items
improved and responses to two items deteriorated
for both England and Scotland. Comparing the
years 2000 and 2003, that is, the data collected
immediately before and immediately after the Ôsee
meÕScotland campaign, there was significant
deterioration for 17 25 items in England and
only for 4 25 items in Scotland. (16). In Poland,
four surveys have been conducted over a time
period of 12 years (1996, 1999, 2005 and 2008),
showing no substantial changes in the respondentsÕ
desire for social distance in personal relationships,
but somewhat more tolerant attitudes concerning
the access of ex-patients to social roles such as
mayor, politician, teacher or priest. Fewer people
responded friendly towards the mentally ill in 2008
than in 1996 (35–38).
Discussion
Our systematic review and meta-analysis revealed a
consistent evolution of public attitudes across
different countries. Two distinct developments
emerged: first, the publicÕs literacy about mental
disorders clearly has increased. Second, at the same
time, attitudes towards persons with mental illness
have not changed for the better, and have even
deteriorated towards persons with schizophrenia.
Throughout, the results of our meta-regression
analysis of studies using a similar methodological
approach based on unlabelled case vignettes of
schizophrenia and depression were corroborated
by the findings from other studies using different
methods. This apparent validity of our findings is
limited, however, by two factors: first, we cannot
rule out that studies not indexed in one of the
major English-language databases PubMed,
PsychINFO and Web of Science escaped our
attention. We tried to overcome the dominance
of English scientific literature by additionally
asking international experts on psychiatric attitude
research for any studies they were aware of, and by
30
40
50
60
70
80
20
100
90
1990 1995 2000 2005
Year
Germany W Germany E
Austria United States
Scottland (F) Scottland (M)
30
40
50
60
70
80
100
90
20
1990 1995 2000 2005
Year
1990 1995 2000 2005
Year
1990 1995 2000 2005
Year
Schizophrenia Depression
Acceptance as co-workerAcceptance as neighbor
P < 0.01
P < 0.05 n.s.
n.s.
%
%
Fig. 3. Evolution of social acceptance of persons with schizophrenia or depression. Results from representative, national trend
studies using unlabelled case vignettes. Willingness to engage in specific forms of social contact, meta-regression analysis controlled
for study site, reference category: West Germany. The position of each circle represents the result (y-axis) and year (x-axis) of one
national survey, and circle size is proportional to sample size. Surveys from different countries trend analyses are distinguished by
different shades of grey. Germany W: West Germany (old FRG); Germany E: East Germany (former GDR); F: female vignette;
M: male vignette.
Schomerus et al.
448
careful citation tracking within the literature we
found. In fact, results of three of the 16 studies
identified in this review (from Austria, the Neth-
erlands and Poland) were published in their native
language. Still, this does not overcome the second
limitation: all studies identified originated from
industrialized, first-world countries, and hence, no
conclusions on the evolution of attitudes in other
countries is permissible.
While in some instances, results from different
countries were numerically quite similar (regard-
ing, for example, the role of heredity genetics for
the aetiology of depression or schizophrenia), we
found considerable national differences in other
respects (approval of drug treatment, social accep-
tance of persons with depression or schizophrenia).
It is not possible to determine to what extent
methodological differences like asking about Ôpre-
scription medicationÕin general in the US (1, 17) or
specifically for ÔantipsychoticsÕfor schizophrenia
and ÔantidepressantsÕfor depression in Australia
(20) contributed to differing results, and to what
extent they represent true national particularities.
National differences, however, are not the subject
of this review, but changes over time, and compel-
lingly, even from very different baselines, changes
frequently occurred in similar direction.
The first development, the apparent increase in
mental health literacy, illustrates that a biomedical
model of mental disorders enjoys growing popu-
larity, which is consistent with the enormous efforts
and achievements within psychiatry in understand-
ing the biological correlates of mental illness and
conceptualizing mental illness as Ôbrain diseaseÕ.
Little change occurred in the publicÕs strong
endorsement of psychosocial stress as a major
cause of mental disorders. This could be inter-
preted as an indication of a balanced view includ-
ing psychosocial and biogenetic causal
explanations, equivalent, for example, to a vulner-
ability-stress model of mental disorders. However,
a study from Germany asking respondents to
indicate the most and second most important
cause for either depression or schizophrenia
found most respondents supporting either two
biological or two psychosocial causes, suggesting
that if people need to prioritize their causal beliefs,
they prefer either biological or psychosocial expla-
nations, but usually not a combination of both
(39).
Our findings also suggest that conceptualizing
mental disorder as a brain disease or a medical
problem facilitates the acceptance of a medical-
professional solution for this problem. There has
been a general increase in the belief that mental
illness requires professional help. The growing
popularity of psychotropic medications is thereby
not accompanied by a decrease in the popularity of
psychotherapy, which the public still favours over
drug treatment for mental disorders. This trend in
attitudes is reflected in increased use of mental
health services (40) and sales of psychotropic
medication (41).
This apparent success story of psychiatric
research and educational work is, however, incom-
plete. The second development evident from this
review does not fuel optimism: attitudes towards
persons with mental illness have not changed for
the better. Although there were insignificant trends
towards reduced blame in schizophrenia and
depression, notions of dangerousness did not
change. Most strikingly, social acceptance of men-
tally ill persons did not increase since 1990, instead,
acceptance of persons with schizophrenia as a co-
worker or neighbour diminished and acceptance as
a friend or in-law remained at low levels. Obvi-
ously, a better biological understanding of mental
illness has not translated into greater social accep-
tance of mentally ill persons. The persistence of
negative attitudes is even more sobering given that
attitudes towards other minorities in Western
industrialized societies have indeed improved: for
example, attitudes towards homosexuals have
become considerably more tolerant in many
countries (42–44).
How can this failure to improve social accep-
tance of mentally ill persons be explained?
Recently, it has been argued that a biogenetic
causal model of mental illness is unlikely to
improve attitudes towards persons with mental
illness for both theoretical and empirical reasons:
While a biogenetic illness model is commonly
hypothesized to reduce perceived responsibility
and thereby the rejection of mentally ill persons,
there is so far no evidence supporting this claim
(45). Instead, attention has been drawn to poten-
tially negative effects of biogenetic causal explana-
tions on the stigma of mental disorders, because
they may enhance notions of ÔothernessÕ, reduce
treatment optimism and aggravate anticipations of
unexpected and dangerous behaviour (46–50). This
could be particularly true for schizophrenia, where
we found a deterioration of attitudes in some
respects. As we found neither a worsening nor an
improvement of social rejection in depression, a
potential association between biogenetic illness
models and social acceptance is probably less
relevant for this disorder. A population study
from Germany examining the relation between
social distance and causal beliefs regarding schizo-
phrenia and depression points towards this direc-
tion (51), showing stronger associations between
Evolution of public attitudes
449
biological causal beliefs and negative attitudes in
schizophrenia than in depression. However, these
illness-specific effects need further exploration. On
an individual level, qualitative studies among
patients with affective disorders and their relatives
have even indicated that biogenetic causal expla-
nations are associated with reduced perceptions of
stigma (52), but so far, quantitative studies have
not supported such findings (53).
Our results thus provoke far reaching conclu-
sions. While the approach to depict mental disor-
der as an Ôillness like any otherÕand to emphasize
its biological correlates seems useful to enhance the
acceptance of professional medical treatment for
mental disorders, it is not suitable to improve
social tolerance towards those suffering from
mental illness. Dissemination of biological knowl-
edge is not a solution to discrimination and
stigmatization of persons with mental illness.
Instead, it seems necessary to re-evaluate the
public image of mental disorders psychiatry creates
and to arrive at communicating a more balanced,
truly biopsychosocial disease model of mental
disorders. Along this line, concerns have been
voiced whether the Ôillness like any otherÕapproach
is generally appropriate to depict mental disorders
(54). It has been argued, for example, that the
Ôchemical imbalanceÕexplanation for depression
does not adequately represent the multitude of
biological and social determinants of its onset and
course (55) or that the Ômental disorders are brain
disordersÕnarrative carries an unduly Ôeliminative
reductionist perspectiveÕ(56).
This seems especially important to anti-stigma
and awareness campaigns. During the time covered
by our analyses, many local and national cam-
paigns have worked at improving public attitudes
towards persons with mental illness (57). Seven
studies included in our review were conceptualized
to evaluate national campaigns. Overall, no con-
sistent differences were observed between the
results of these studies and those not explicitly
connected to any interventions. However, as the
evaluation of anti-stigma and awareness programs
was not the focus of our review, no definite
conclusions on their effectiveness can be drawn.
An appropriate review of such campaigns would
have needed to include both local and short-term
studies, which we excluded to elicit broader and
sustained time trends of attitudes. It is also
important to note that the last survey included in
a trend study dated from 2006. As actions to fight
the stigma of mental illness have continued and
intensified since, new trend analyses tracking pres-
ent and future attitude changes are necessary. They
would provide further feedback for the ongoing
efforts to increase social acceptance of those
suffering from mental disorders. It seems clear
from our review, however, that education about
biological correlates of mental disorders is not
sufficient to improve attitudes towards persons
with mental illness. Effective anti-stigma programs
need to embrace other strategies, centred for
example on consumer contact (58). Recent large-
scale anti-stigma activities follow this rationale (59,
60), giving hope to finally arrive at improving
attitudes and not merely increasing knowledge
about mental illness.
Acknowledgement
We thank Sarah von Saß for assistance in conducting our
database search.
Declaration of interest
H. J. Grabe: Speakers honoraria from Bristol-Myers Squibb,
Eli Lilly, Novartis, Eisai, Wyeth, Pfizer, Boehringer Ingel-
heim, Servier and travel funds from Janssen-Cilag, Eli Lilly,
Novartis, AstraZeneca and SALUS-Institute for Trend-
Research and Therapy Evaluation in Mental Health. M. C.
Angermeyer: Lecturer fees from AstraZeneca, Janssen-Cilag,
Eli Lilly, and Pfizer. Research grants from GlaxoSmithKline
and Lundbeck. All other authors declare no conflicts of
interest.
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... However, there are a series of disadvantages associated with either pathway to admission. Schomerus et al. (2012) highlighted the prevalence of stigmatisation to those admitted to an inpatient mental health hospital still present in an ever-aware society. Further to this, Schomerus et al. (2012) spoke about the risk of increased impairment to vocational and social functioning following treatment. ...
... Schomerus et al. (2012) highlighted the prevalence of stigmatisation to those admitted to an inpatient mental health hospital still present in an ever-aware society. Further to this, Schomerus et al. (2012) spoke about the risk of increased impairment to vocational and social functioning following treatment. The stigma of admission, high costs of inpatient treatment, and possible deterioration of functioning create a strong case for providing comprehensive community support. ...
Article
One aspect of the NHS Long Term Plan is to establish a more comprehensive community-based mental health crisis response. NHS trusts have therefore looked to new services to help alleviate in-patient bed pressures. Intensive Outpatient Programmes (IOPs) have been previously used to help support people living with substance-misuse or eating disorders. More recently IOPs have been utilised to support people living with depression and anxiety. The Acute Community Service (ACS) was established as an IOP to support older adults in crisis by providing psychological, nursing, occupational, and physiotherapy interventions. Initial findings are consistent with previous research showing significant improvements in mood, levels of anxiety, and quality of life, with some service users being suitable for discharge to primary care. The ACS looks to build on these promising findings by working towards understanding the impact of the service on the frequency and length of in-patient admissions. Additionally, we would aim to understand the longer term impact of the ACS on service users and re-referrals rates.
... Indeed, one of the main rationales behind the promotion of the medical model of depression has been that, if depression is seen as an illness outside of the control of individuals, this will reduce stigma and encourage help-seeking (Barney et al., 2009;Jorm & Griffiths, 2008). However, whilst increases in biomedical explanations for depression among the public have been found to reduce blame and perceptions of dangerousness, they have not resulted in increased social acceptance (Schomerus et al., 2012;Sarbin & Mancuso, 1970). ...
Article
Depression has been the subject of increased awareness and concern in Australia, but there has been little research into how depression is constructed on mental health websites, which have become a major resource for mental health information among the general public. In this study, critical discursive psychology was employed to analyse the informational content of eight major Australian mental health websites concerning depression. Four interpretative repertoires were identified – a biomedical, a self-optimization, a normal-natural and a societal-structural repertoire. The biomedical and self-optimization repertoires were the most prevalent, constructing depression as an illness within an individual occurring as a result of a biological or psychological deficit. Whilst previous studies have identified the predominance of a biomedical repertoire of depression on official websites, this study highlights the growing prominence of a self-optimization repertoire alongside the biomedical. Whilst it appeared that the aim of the websites was to challenge stigma and encourage help-seeking, it is argued that this way of understanding depression may have counter-productive effects in that the problem is located within the individual rather than with society, and individuals may be positioned as responsible for managing their own mental health, under the guidance of experts. The implications of understanding depression in this way, and not in alternative ways, are discussed.
... 14 Several studies have evaluated community attitudes, investigating what people would do or what they think most people would do, such as when confronted with a neighbor or a co-worker with mental illness. 15,16 Research has also compiled the impact of stigma, assessing its consequences in various aspects, 17 considering intercultural factors and the type of society. 18 Some studies say that developing countries have a more significant stigma associated with mental illness, unlike developed countries. ...
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Stigma remains a feature that influences the lifestyle of people with mental illness. Negative attitudes, stereotypes, and discrimination are still prevalent in these people's life. Stigma is considered a public health problem that occurs unconsciously in society, categorizing people. Portugal is the seventh-worst country concerning stigma in Mental Health. There have been few improvements in reducing stigma over time, and there is a great need to create investigations and validate instruments that measure stigma in the population. This study aims to address the gaps in the level of studies and normative instruments that measure the stigma of the Portuguese population in the face of mental illness. It, therefore, aims to adapt and validate community attitudes toward people with mental illness (CAMI) culturally and examine its psychometric properties. The 27-item version of CAMI was translated and back-translated into English, which was analyzed and evaluated by a panel of experts. A sociodemographic survey and CAMI were applied in an online format, in which participated 427 adults representing the Portuguese population in general. Finally, the reliability and validity of the instrument were analyzed. CAMI showed positive values of reliability and validity but not optimal. The confirmatory factor analysis values satisfactory values that indicate good quality of fit: x 2/df=3.296; comparative fit index = 0.601; goodness of fit index = 0.817; and root mean square error of approximation = 0.073, indicates good quality of fit. Cronbach alpha was different for each factor, but it was positive. Spearman coefficient (ρ = –0.343) obtained a negative but consistent value. This study contributed to the achievement and validation of new measures to assess the stigma of the general population related to people with mental illness. We must continue to analyze this theme, complete the validation of this instrument, and understand the existing levels of stigma, its predominance in society, and the possible creation and implementation of new measures that support literacy in mental illness and anti-stigma.
... Help-seeking has particular salience for enhancing capacity in the demand for services and supporting efforts to contribute to closing the significant treatment gap in LMICs [6]. We have expressly included attitudes and beliefs that promote recognition, incorporating stigma, as there is inconsistent evidence of the interrelationship between mental health knowledge and stigma [20][21][22]. Current evidence from a meta-analysis demonstrates that stigmatising attitudes towards people with mental illness significantly predicts actively seeking treatment for mental health problems [23] and as such is a significant barrier to accessing adequate treatment. ...
Article
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Mental illnesses are the leading cause of disease burden among children and young people (CYP) globally. Low-and middle-income countries (LMIC) are disproportionately affected. Enhancing mental health literacy (MHL) is one way to combat low levels of help-seeking and effective treatment receipt. We aimed to synthesis evidence about knowledge, beliefs and attitudes of CYP in LMICs about mental illnesses, their treatments and outcomes, evaluating factors that can enhance or impede help-seeking to inform context-specific and developmentally appropriate understandings of MHL. Eight bibliographic databases were searched from inception to July 2020: PsycInfo, EMBASE, Medline (OVID), Scopus, ASSIA (ProQuest), SSCI, SCI (Web of Science) CINAHL PLUS, Social Sciences full text (EBSCO). 58 papers (41 quantitative, 13 qualitative, 4 mixed methods) representing 52 separate studies comprising 36,429 participants with a mean age of 15.3 [10.4-17.4], were appraised and synthesized using narrative synthesis methods. Low levels of recognition and knowledge about mental health problems and illnesses, pervasive levels of stigma and low confidence in professional healthcare services, even when considered a valid treatment option were dominant themes. CYP cited the value of traditional healers and social networks for seeking help. Several important areas were under-researched including the link between specific stigma types and active help-seeking and research is needed to understand more fully the interplay between knowledge, beliefs and attitudes across varied cultural settings. Greater exploration of social networks and the value of collaboration with traditional healers is consistent with promising, yet understudied, areas of community-based MHL interventions combining education and social contact.
... Interestingly, some studies have reported a change in public attitudes toward mental illness. A meta-analysis of national surveys, conducted mainly in western countries, showed that attitudes toward mental illness have remained unchanged or worsened over the last few decades, despite considerable improvements in mental health literacy [33]. One study that investigated changing attitudes in Sweden over almost 40 years concluded that the stigma associated with mental illness had increased [34]. ...
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Background The psychiatric treatment gap is substantial in Korea, implying barriers in seeking help. Objectives This study aims to explore barriers of seeing psychiatrists, expressed on the internet by age groups. Methods A corpus of data was garnered extensively from internet communities, blogs and social network services from 1 January 2016 to 31 July 2019. Among the texts collected, texts containing words linked to psychiatry were selected. Then the corpus was dismantled into words by using natural language processing. Words linked to barriers to seeking help were identified and classified. Then the words from web communities that we were able to identify the age groups were additionally organized by age groups. Results 97,730,360 articles were identified and 6,097,369 were included in the analysis. Words implying the barriers were selected and classified into four groups of structural discrimination, public prejudice, low accessibility, and adverse drug effects. Structural discrimination was the greatest barrier occupying 34%, followed by public prejudice (27.8%), adverse drug effects (18.6%), and cost/low accessibility (16.1%). In the analysis by age groups, structural discrimination caused teenagers (51%), job seekers (64%) and mothers with children (43%) the most concern. In contrast, the public prejudice (49%) was the greatest barriers in the senior group. Conclusions Although structural discrimination may most contribute to barriers to visiting psychiatrists in Korea, variation by generations may exist. Along with the general attempt to tackle the discrimination, customized approach might be needed.
... Secondary and university students between the ages of 15 and 24 years have been shown to have similar negative attitudes toward people with mental illness as adults [8,9]. Although the general public's knowledge about mental illness has improved, a negative attitude among Jordanian adolescents remains [8,10]. Gender, level of education, previous mental health training, having a family history with a mental illness, and/or socio-economic status were found to predict stigma among teachers and their students [11,12]. ...
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Abstract Aim: The current study aimed to assess and compare the level of knowledge and attitude towards mental illness between secondary school students and their teachers in Oman. Methods: An online survey was carried out to collect data from 400 students and 411 teachers about their knowledge and attitudes toward people with mental illness. Two independent case studies about depression and schizophrenia were also tested. Results: Students have a poor knowledge of mental illness compared with their teachers, as more than half scored less than 60% compared with 16.5% of the teachers. More than two-thirds of the students (80%) and teachers (76.4%) have a low or minor positive attitude toward people with mental illness. The study identified significant differences in knowledge in favour of teachers, although the opposite was found regarding attitudes. Conclusions: Since students spend a significant amount of time in school, bridging the gap between teachers’ and students’ knowledge and attitudes toward mental illness is an essential part in enhancing the knowledge and attitudes of the students. In addition, knowledgeable teachers with positive attitude can assist in early identification of mental illnesses and help students when needed. In turn, students who possess knowledge and positive attitude toward mental illness can share their concerns with their teachers. In the presence of such accepting and cooperative environment, the stigma can be decreased and early detection of mental illness and help-seeking behaviour can be promoted. Keywords: Knowledge, Attitude, Secondary school students, Secondary school teachers, Adolescents
... Secondary and university students between the ages of 15 and 24 years have been shown to have similar negative attitudes toward people with mental illness as adults [8,9]. Although the general public's knowledge about mental illness has improved, a negative attitude among Jordanian adolescents remains [8,10]. Gender, level of education, previous mental health training, having a family history with a mental illness, and/or socio-economic status were found to predict stigma among teachers and their students [11,12]. ...
Article
Full-text available
Aim: The current study aimed to assess and compare the level of knowledge and attitude towards mental illness between secondary school students and their teachers in Oman. Methods: An online survey was carried out to collect data from 400 students and 411 teachers about their knowledge and attitudes toward people with mental illness. Two independent case studies about depression and schizophrenia were also tested. Results: Students have a poor knowledge of mental illness compared with their teachers, as more than half scored less than 60% compared with 16.5% of the teachers. More than two-thirds of the students (80%) and teachers (76.4%) have a low or minor positive attitude toward people with mental illness. The study identifed signifcant diferences in knowledge in favour of teachers, although the opposite was found regarding attitudes. Conclusions: Since students spend a signifcant amount of time in school, bridging the gap between teachers’ and students’ knowledge and attitudes toward mental illness is an essential part in enhancing the knowledge and attitudes of the students. In addition, knowledgeable teachers with positive attitude can assist in early identifcation of mental illnesses and help students when needed. In turn, students who possess knowledge and positive attitude toward mental illness can share their concerns with their teachers. In the presence of such accepting and cooperative environment, the stigma can be decreased and early detection of mental illness and help-seeking behaviour can be promoted
Article
No study, best of our knowledge, has been conducted on assessing the validity and reliability of community attitudes toward the mentally ill (CAMI) inventory in Iran. The questionnaire was translated into Persian and then returned to English. Content validity ratio (CVR), content validity index (CVI), impact score (IS) to assess content validity, Cronbach's alpha, and test-retest reliability was used to prove the internal and external reliabilities, respectively. The questionnaires were distributed to 130 people from different levels of society. Some were in contact with at least one patient with mental illness and some others had no connection. After 2 weeks, the questionnaires were resent to 50 participants to evaluate the reliability using the test-retest method. All questions had CVI (>0.79) and CVR (>0.49) except for three questions (Q 10, 24, and 30), which were excluded from the questionnaire. The questions were relevant, clear, simple, and valid. The IS was more than 1.5. The Cronbach's alpha values of four subscales including authoritarianism, benevolence, social restrictiveness, and community mental health ideology were recorded as 0.61, 0.49, 0.64, and 0.76, respectively. The CAMI scale is a valid and sustainable tool over time to assess the negative attitude toward mental illness.
Article
Introduction the COVID-19 pandemic had an impact on hospital admissions. The clinical profiles of patients referred to liaison psychiatry teams (LPT) remained stable over the last few decades. We postulate changes in patient profiles due to the COVID-19 pandemic. Materials and methods a total of 384 patients admitted to a tertiary care University Hospital in Madrid (Spain) and referred to LPTs were recruited. Patients referred 5 months before and after the first admission for COVID-19 were included. Clinical and sociodemographic characteristics were collected, and non-parametric hypothesis contrast tests were used to study possible differences between both periods. Results patients referred during the pandemic were significantly older (U = 2.006; p = .045), most of them were admitted to medical hospitalization units (χ2 (2) = 5.962; p =.015), and with a different reason for admission. There was an increase in the rate of adjustment disorders (χ2 (1) =7.893; p =.005) and delirium (χ2 (1) =9.413; p =.002), as well as psychiatric comorbidity (χ2 (2) = 9.930; p = .007), and a reduction in the proportion of patients treated for substance misuse (χ2 (5) = 19.152; p = .002). The number of deaths increased significantly (χ2 (1) = 6.611; p = .010). In persons over 65 years inappropriate prescription was significantly lower (χ2 (1) = 8.200; p = .004). Conclusions the pandemic had an impact on the activity of the LPTs due to the change in the clinical profile and evolution of referred patients, maintaining standards of care that are reflected through prescription.
Article
Résumé La stigmatisation existe depuis l’antiquité. Il n’en demeure pas moins qu’elle persiste encore aujourd’hui et apporte son lot de conséquences négatives. Les aspects structuraux, interpersonnels et intrapersonnels s’entrecroisent et affectent la vie de plusieurs personnes en termes d’accès aux soins, de rétablissement et de qualité de vie. Même si la réduction et la prévention de la stigmatisation furent une priorité pour les chercheurs et les intervenants du milieu au moyen de campagne de sensibilisation, les résultats demeurent mitigés. S’il est difficile d’expliquer un tel échec, nous pensons que la philosophie peut être utile pour explorer d’autres possibilités. Nous introduirons une perspective philosophique selon la pensée de Georges Canguilhem et de Judith Butler afin d’aborder autrement la stigmatisation. Pour conclure, nous pensons qu’il devient nécessaire d’introduire de nouvelles manières de pratiquer la médecine, la psychiatrie, la psychologie et la sociologie en évitant le piège de la logique binaire du tiers exclu et en élargissant le spectre des possibilités. Promouvoir la subjectivation peut devenir une manière d’aider les personnes à comprendre leur maladie comme une réalité qui favorise le changement et la créativité.
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Significant advances have been made in understanding mind-brain relationships and the role of biological vulnerabilities in the development of mental disorders. However, we are concerned that the enthusiastic promotion of the brain disease model by NIMH and other prominent sources has far outstripped the available scientific data and may actually be increasing the stigma associated with mental disorders. Dr. Insel's statement that "mental disorders are brain disorders" suggests that problems like anxiety and mood disorders are caused by identifiable brain abnormalities. Insel elaborated on this position at the 2008 annual meeting of the American Psychiatric Association by explaining that mental disorders are not caused by brain lesions as with neurological disorders, but rather from abnormal development of brain circuitry. One reason that mental disorders are described as brain diseases by scientific authorities, despite failing to meet the basic definition of a disease—an abnormality in bodily structure or function—is the reductionist philosophy that abnormal psychological phenomena are the product of a disordered brain. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The course and outcomes of mental illness are hampered by stigma and discrimination. Research on controllability attributions has mapped the relationships between signaling events, mediating stigma, emotional reactions, and discriminating behavior. In this article, I describe how an attribution model advances research questions related to mental health stigma in three areas. (1) Stigma research needs to examine signaling events related to psychiatric stigma including the label of mental illness, behaviors associated with psychiatric symptoms, and physical appearance. (2) Research into mediating knowledge structures needs to bridge information about controllability attributions with public attitudes about dangerousness and self-care. (3) Ways in which these knowledge structures lead to emotional reactions (pity, anger, and fear) as well as behavioral responses (helping and punishing behaviors) need to be examined. The attribution model has significant implications for social change strategies that seek to decrease mental illness stigma and discrimination.
Article
Objective: To evaluate whether a campaign to increase public knowledge about depression (beyondblue: the national depression initiative) has influenced the Australian public's ability to recognize depression and their beliefs about treatments. Method: Data from national surveys of mental health literacy in 1995 and 2003-04 were analysed to see if states and territories which funded beyondblue (the high exposure states) had greater change than those that did not (the low exposure states). In both surveys, participants were asked what was wrong with a person in a depression case vignette and to give opinions about the likely helpfulness for this person of a range of treatments. In the 2003-04 survey participants were also asked questions to assess awareness of beyondblue. Results: Awareness of beyondblue in the states that provided funding was found to be around twice the level of those that did not. Using the low-exposure states as a control, the high-exposure states had greater change in beliefs about some treatments, particularly counselling and medication, and about the benefits of help-seeking in general. Recognition of depression improved greatly at a national level, but slightly more so in the high-exposure states. Conclusions: The data are consistent with beyondblue having had a positive effect on some beliefs about depression treatment.
Article
OBJECTIVE In order to evaluate the effectiveness of the WPA campaign „Open the Doors - against Stigma and Discrimination because of Schizophrenia”, five years upon completion of the campaign, a comparative study was performed to assess the possible changes in the general public's attitudes towards schizophrenia. METHODS Representative population survey, based on a Quota-sampling (n = 988); face-to-face interviews with standardized questionnaires. RESULTS The results of this study were somewhat sobering, with 22.3 % of the population not having any associations with the term „schizophrenia”, 81.3 % not wanting to be further informed about the illness, and 64.1 % agreeing with the statement that patients suffering from schizophrenia are dangerous; compared to the survey in 1998, there was a significant increase within this category. Furthermore, an increase of social distance towards this group of patients has also been noted. CONCLUSION It is to be asked whether a short intervention can change people's profound attitudes.
Article
In the 1950s, the public defined mental illness in much narrower and more extreme terms than did psychiatry, and fearful and rejecting attitudes toward people with mental illnesses were common. Several indicators suggest that definitions of mental illness may have broadened and that rejection and negative stereotypes may have decreased since that time. However, lack of comparable data over time prevents us from drawing firm conclusions on these questions. To address this problem, the Mental Health Module of the 1996 General Social Survey repeated a question regarding the meaning of mental illness that was first asked of a nationally representative sample in 1950. A comparison of 1950 and 1996 results shows that conceptions of mental illness have broadened somewhat over this time period to include a greater proportion of non-psychotic disorders, but that perceptions that mentally ill people are violent are frightening substantially increased, rather than decreased. This increase was limited to respondents who viewed mental illness in terms of psychosis. Among such respondents, the proportion who described a mentally ill person as being violent increased by nearly 2 1/2 times between 1950 and 1996 We discuss the possibility that there has been a real move toward acceptance of many forms of mental illness as something that can happen to one of "us," but that people with psychosis remain a "them" who are more feared than they were half a century ago.
Article
Using General Social Survey data from 1973 to 1998, changing American attitudes toward homosexuality are examined. Two hypotheses are tested: (1) Can changes in attitudes be accounted for by the changing demographics of the population? (2) Are changing attitudes toward homosexuality embedded within larger cultural ideological shifts? The data indicate that Americans distinguish between the morality of homosexuality and the civil liberties of homosexuals. Americans became increasingly negative regarding the morality of homosexuality through 1990, but since then their attitudes have become increasingly liberal. The same 25-year period witnessed a steady decline in Americans' willingness to restrict the civil liberties of homosexuals, Changes in American demographics-particularly increasing educational levels-and changing cultural ideological beliefs can account for only about one-half of the change over time in attitudes toward homosexuality. Several theories are put forth to explain these patterns of change and the distinction made between morality and civil liberties. (PsycINFO Database Record (c) 2012 APA, all rights reserved)