How the Media Cover Mental Illnesses: A Review

Abstract

Purpose
Mental illness has become an important public health issue in society, and media are the most common sources of information about mental illnesses. Thus, it is important to review research on mental illnesses and media. The purpose of this paper is to provide a narrative review of studies on mental illnesses in the media and identifies important research gaps.

Design/methodology/approach
A combination of searching key databases and examining reference lists of selected articles was used to identify relevant articles. In total, 41 empirical studies published in the last 12 years were reviewed.

Findings
The review found that substantial research had been done to investigate media portrayals of mental illnesses and the effects of such portrayals might have on the public. Media still portray mental illnesses negatively in general, which contributes to the ongoing mental illness stigmatization. Nonetheless, discussions of mental illnesses in direct-to-consumer advertisements and social media tend to be more objective and informative. These objective portrayals could help improve mental health literacy and reduce stigma. More importantly, media can also reduce the stigma if used strategically. Research has found that entertainment-education programs and web-based media have strong potential in reducing mental illness stigma. Recommendations for future research are also discussed.

Practical implications
Findings can guide future efforts to use media to educate the public about mental illnesses and reduce mental illness stigma.

Originality/value
This study reviews the most recent research on mental illnesses in the media and provides important references on the media representation of mental illnesses, media effects of such representation, and using media to reduce stigma.

Full text

How the media cover mental
illnesses: a review
Zexin Ma
University of Maryland, College Park, Maryland, USA
Abstract
Purpose –Mental illness has become an important public health issue in society, and media are the most
common sources of information about mental illnesses. Thus, it is important to review research on mental
illnesses and media. The purpose of this paper is to provide a narrative review of studies on mental illnesses
in the media and identifies important research gaps.
Design/methodology/approach –A combination of searching key databases and examining reference
lists of selected articles was used to identify relevant articles. In total, 41 empirical studies published in the
last 12 years were reviewed.
Findings –The review found that substantial research had been done to investigate media portrayals of
mental illnesses and the effects of such portrayals might have on the public. Media still portray mental
illnesses negatively in general, which contributes to the ongoing mental illness stigmatization. Nonetheless,
discussions of mental illnesses in direct-to-consumer advertisements and social media tend to be more
objective and informative. These objective portrayals could help improve mental health literacy and reduce
stigma. More importantly, media can also reduce the stigma if used strategically. Research has found that
entertainment-education programs and web-based media have strong potential in reducing mental illness
stigma. Recommendations for future research are also discussed.
Practical implications –Findings can guide future efforts to use media to educate the public about mental
illnesses and reduce mental illness stigma.
Originality/value –This study reviews the most recent research on mental illnesses in the media and
provides important references on the media representation of mental illnesses, media effects of such
representation, and using media to reduce stigma.
Keywords Media, Mental illness, Health, Stigma, Mental health promotion
Paper type Literature review
Introduction
Mental illnesses are common across the world. According to World Health Organization,
depression affects 350 million people; bipolar affective disorder affects about 60 million people;
and schizophrenia affects about 21 million people worldwide. However, between
76 and 85 percent of people with mental illness in low- and middle-income countries and
between 35 and 50 percent of people with mental illness in high-income countries receive no
treatment (World Health Organization, 2015). It is argued that mental illness stigma is the
major reason to keep people from seeking help (Corrigan and Kleinlein, 2005). Moreover, mental
illness stigma also contributes to robbing important life opportunities from people with mental
illness, such as obtaining and keeping suitable employment and finding housing. At the
societal level, mental illness stigma perpetuates fears about becoming mentally ill, ill-equips
people to interact appropriately and successfully with people with mental illness, and robs the
society of important human resources (Corrigan and Lundin, 2001). A survey supported by the
Robert Wood Johnson Foundation (DYG, Inc., 1990) indicated that mass media are the most
common sources of public information about mental illness. Similarly, Reavley et al. (2010)
found television was the most popular source, followed by brochures and internet. Thus, it is
important to investigate the relationship between the mass media and mental illness.
Muchresearchhasbeendoneinthisarea.Accordingtoasystematicreviewofpublished
research on images of mental illness in the mass media conducted by Stout et al. (2004), existing
Health Education
Vol. 117 No. 1, 2017
pp. 90-109
© Emerald Publishing Limited
0965-4283
DOI 10.1108/HE-01-2016-0004
Received 28 January 2016
Revised 6 June 2016
Accepted 20 June 2016
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/0965-4283.htm
The author thanks Dr Brooke Fisher Liu for the invaluable feedback when preparing for the
manuscript.
90
HE
117,1
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

empirical research in this area can be divided into three categories: media portrayals of mental
illness, media effects of such portrayals, and how media could be used to reduce stigma toward
mental illness. In addition to empirical studies, there is also a large body of research that reviews
studies on mass media images of mental illness, including both systematic reviews (e.g. Stout et al.,
2004) and reviews of portrayals of mental illness in a specific type of media, such as television
(Oostdyk, 2008) or on media targeted at a specific audience, such as children (Wahl, 2003).
Mass media, as important vehicles of information, plays a significant role in contributing
to the stigmatization of mental illness (Stout et al., 2004; Wahl, 1992). Thus, this research
area deserves continued attention to investigate how media portrays people with mental
illness, what effects they have on the public, and how to use media to reduce stigma
effectively. The goal of the current paper is to conduct a narrative review (Green et al., 2006)
of empirical studies published in the past 12 years to answer the above three questions.
Moreover, it also aims to identify the existing research gaps and limitations, and provide
recommendations for the future research. The media types examined in the current review
include non-fiction news media, fictional media, direct-to-consumer (DTC) advertising, and
social media. Before reviewing each empirical study, previous literature reviews on mass
media images of mental illness are summarized.
Previous literature reviews
In Wahl’s (1992) seminal article, he reviewed more than four decades of published studies that
address the frequency, accuracy, and impact of mass media portrayals of mental illness. The
author found that depictions of mental illness were common in the mass media and not confined
to any single medium. Moreover, media portrayals of mental illness were consistently inaccurate
and unfavorable; people with mental illness were labeled as inadequate, unlikable, and
dangerous. There were relatively few studies on the impact of media depictions of mental illness.
However, the published studies indicated that media portrayals of mental illness influenced
people’s knowledge and attitudes toward mental illness and that negative depictions could have
an unfavorable impact on people’s attitudes toward people with mental illness.
More than a decade later, Stout et al. (2004) found similar results. However, the
researchers claimed the nature and scope of the study of mental illness had changed since
Wahl’s (1992) review. They conducted a review of 34 empirical studies examining media,
stigma, and mental illness published between 1990 and 2003. The authors looked at three
aspects: representations of mental illness in the media; evidence of effects of mass media;
and mental illness stigma, and using media as a tool for change. The authors found more
research focusing on images of mental illness in print media, including newspaper and
popular magazines; this differed from Wahl’s (1992) study, where television was claimed as
the most studied medium. Stout et al.’s (2004) review further found that while newspaper
articles covering mental illness more often framed the topic negatively than positively, it is
important to note that the researchers identified a decrease in the number of references
toward the dangerousness of people with mental illness in newspaper coverage of mental
illness. Moreover, magazine articles are fairly accurate whereas television programs and
films still distort the image of mental illness and of mental health professionals.
In line with Wahl’s (1992) study, Stout et al. (2004) claimed that how mental illness is
defined and identified was different across studies, which may result in less meaningful
assessments and comparisons. In addition, Stout et al. (2004) pointed out that little was
known about how mental illness may be represented in media other than newspapers or
televisions, such as the internet or messages through direct-to-audience (DTC) advertising
or public service announcements. Regarding media effects, Stout et al. (2004) found media
could affect public knowledge and attitudes toward mental illness. Consistent with
Wahl’s (1992) findings, Stout et al. (2004) found the media contributed to the perpetuation of
mental illness stigma. Stout et al. (2004) claimed few studies had examined directly how
91
Mental
illnesses
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

media might be used to reduce stigma. The authors recommended that more experimental
research is needed to examine how different media channels (e.g. TV and newspapers) and
genres (e.g. TV news programs, TV drama or televised films) distinctly impact audiences
and under which circumstances, before considering how media might be used to reduce
mental illness stigma.
Moreover, Klin and Lemish (2008) reviewed about 100 books and articles on mental
disorders stigma in the media published between 1985 and 2005. This review has a good
deal of overlap with the previous reviews (Stout et al., 2004; Wahl, 1992), which resulted in
many similar results. Klin and Lemish (2008) found that not only the image of people with
mental disorders was distorted, but also the image of mental health professionals, the
causes, and treatments of mental disorders was distorted. Additionally, these distorted
images could contribute to the perpetuations of mental illness stigma. Consistent with
Stout et al. (2004), Klin and Lemish (2008) argued that more research was needed to examine
new media images of mental disorders. The authors also pointed out that there was a lack of
research examining the media image of mental illness-related policies and drugs.
In sum, the above three reviews examined and analyzed studies of media image of
mental illness mainly in the second half of the twentieth century. Their findings were
consistent in some aspects, though there were some differences due to, for example, the
development of media and prevalence of mental illness. However, these reviews did not
include research published in the past decade, which will be the subject of the current
review. Consistent with the body of research, this paper addresses the following three
questions: how do media portray mental illness? What are the effects of media depictions of
mental illness on the general public? How could the media be used to reduce mental
illness stigma?
Methods
The current paper is a narrative review of literature on how the media cover mental illness.
According to Green et al. (2006), narrative reviews are defined as “comprehensive narrative
syntheses of previously published information”(p. 103). This type of review is suitable for
the scope of the current study because it not only provides a general picture of how the
media cover mental illness, but also identifies the existing research gaps and limitations in
this area.
Because existing reviews do not cover at all or only cover a small number of the most
recently published studies on mental illness and media, this paper summarizes and analyzes
research published in the last 12 years, between 2003 and 2015. The year 2003 was
chosen to start the search is also because Stout et al.’s (2004) review included articles
published between 1990 and 2003. Following Green et al.’s (2006) suggestion, EBSCO and
PsycINFO databases were used to identify relevant studies based on their use in previous
literature reviews (Stout et al., 2004). Keywords included mental illness, mental
disorders, mental health, psychiatric disorders, stigma, media, newspaper, magazines,
television, films, advertising, internet, social media, Facebook, and Twitter. This produced a
research corpus that included reviews, news items or editorials, and empirical studies. Only
empirical research (i.e. content analysis, semiotic analysis, surveys, interviews,
and experiments) examining media and mental illness written in English was selected
and analyzed in this paper. Additionally, reference lists of selected sources were reviewed
and additional empirical research that did not appear in the database was added.
For example, a relevant paper might not have been indexed in the above two databases,
therefore a review of reference lists could help identify potential articles. This study
removed replications of similar studies done by same authors or replications of studies with
identical results due to limited space. This created a final sample of 41 references.
The studies are summarized in Table I.
92
HE
117,1
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

Authors
Publication
year Country Main method Sample size Media type
Mental illness
type Resume of study
Angermeyer
et al.
2005 Germany Survey 5,025 TV and
newspapers
Schizophrenia The more people watched TV, the more they desired
social distance from people with schizophrenia, while no
such evident association emerged between newspaper
consumption and the desire for social distance
An 2008 USA Telephone
interviews
300 DTC
advertisements
Depression People with higher recall for antidepressant DTC
advertisements were more likely to have a higher
estimation of the prevalence of depression than those
with lower recall
An et al. 2009 USA Survey 285 DTC
advertisements
Depression Exposure to antidepressant advertising helped build
viewers’belief that depression was treatable, but it may
also prompt those with mild symptoms to seek a quick
but potentially inadequate medical solution while
ignoring other treatment options
Arney and
Weitz
2012 USA Content
analysis
320 DTC
advertisements
Depression Depression was portrayed as a female disorder
Bie and
Tang
2015 China Content
analysis
795 Newspapers Autism Although autism has received increased media attention,
it is attributed as a family problem. In addition, people
with autism are not given much voice
Boke et al. 2007 Turkey Content
analysis
878 Newspapers Schizophrenia 44.1 percent of the analyzed texts used the word
schizophrenia in a metaphorical way
Carpiniello
et al.
2007 Italia Content
analysis
2,279 Newspapers Mental illness
in general
A significantly higher percentage of stigmatizing
language was used when the violent acts were attributed
to people with mental illness
Cavazos-
Rehg et al.
2016 USA Content
analysis
2,000 Social media Depression The most common theme of depression-related tweets
was being supportive or helpful, closely followed by
disclosing symptoms or feelings of depression
Corrigan
et al.
2005 USA Content
analysis
3,353 Newspapers Mental illness
in general
Recovery about mental illness was beginning to be
discussed in the media and more stories focused on
biological or environmental causes instead of personal or
parental blame
Corrigan
et al.
2013 USA Experiment 151 Newspapers Mental illness
in general
Stories about recovery resulted in reduced stigma and
greater acceptance for people with mental illness;
(continued )
Table I.
Summary of the
reviewed studies
93
Mental
illnesses
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

Authors
Publication
year Country Main method Sample size Media type
Mental illness
type Resume of study
however, stories about dysfunctional public mental
health systems led to increased stigma and decreased
accepting toward people with mental illness
Diefenbach
and West
2007 USA Content
analysis and
telephone
interviews
84 hours of
television programs
and 419 survey
participants
Television
news
Mental illness
in general
The television news image of people with mental illness
was negative and violent. Moreover, people who
watched television news were less willing to live next to
someone with mental illness and that people believed
that television portrayals of mental illness had greater
effects on others than themselves
Duckworth
et al.
2003 USA Content
analysis
1,740 Newspapers Schizophrenia 28 percent of the analyzed newspaper articles that
mentioned schizophrenia used the illness metaphorically
compared to only 1 percent of articles that mentioned
cancer
Fennell and
Boyd
2014 USA Content
analysis
35 Films OCD Although the media image of OCD reinforced some
common negative stereotypes of mental illness, the
media also portrayed people with OCD as relatively
intelligent and functional
Finkelstein
et al.
2008 USA Experiment 193 Web-based
programs
Mental illness
in general
A computer-mediated anti-stigma program was more
effective in changing people’s attitudes toward
psychiatric patients than printed materials
Francis et al. 2005 Australia Content
analysis
1,123 Non-fiction
news media
Depression
and other
mental illness
There was a relatively low level of media coverage of
crimes associated with mental illness in Australia. In
addition, depression was most frequently portrayed in
media
Grow et al. 2006 USA Semiotic
analysis
27 DTC
advertisements
Depression Biochemical framing dominated the framing of
depression. Additionally, depression was portrayed
more common among females
Guidry et al. 2016 USA Content
analysis
783 Social media Depression Depression-related pins had high response levels and
more than half of the pins referred depression as a severe
disorder. Moreover, 10 percent of pins mentioned suicide
or suicidal thoughts and 6.9 percent mentioned self-harm
(continued )
Table I.
94
HE
117,1
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

Authors
Publication
year Country Main method Sample size Media type
Mental illness
type Resume of study
Haverhals
and Lang
2004 USA Experiment 81 DTC
advertisements
Depression Viewers perceived mental illness to be more treatable as
they watched more psychotropic DTC advertisements
Hoffner and
Cohen
2012 USA Survey 142 TV dramas OCD Monk had positive psychological effects on fans that
were dealing with mental illness
Hoffner et al. 2015 USA Survey 198 TV, print, and
online news
Mental illness
in general
People perceived others were more influenced by the
news when they had more prior experience with mental
illness, which was further related with behavioral
outcomes
Holman 2011 USA Content
analysis
202 Mainstream
press and
popular
magazines
PPD Magazines produced more balanced coverage than
newspapers on postpartum depression (PPD)
Holton et al. 2014 USA and
UK
Content
analysis
473 Newspapers Autism More than two-thirds of the newspaper articles about
autism contained stigmatizing cues and more than half
employed loss frames
Joseph et al. 2015 USA Content
analysis
1,838 Twitter Schizophrenia Compared to diabetes, schizophrenia was used more
sarcastic, medically inappropriate, and non-medically in
Twitter. In particular, the tweets were more negative when
they referred schizophrenia as medically inappropriate
and non-medically. Moreover, compared to the noun
“schizophrenia,”the adjective “schizophrenic”was used
more negatively
Kimmerle
and Cress
2013 Germany Survey and
experiment
77 and 39 Films Schizophrenia
and OCD
The more people watched TV, the less knowledge they
had about schizophrenia and OCD. Moreover, people
who watched a fictional film acquired less knowledge
and had more negative emotional reactions toward
schizophrenia than those who watched a documentary
film
Kim and
Stout
2010 USA Experiment 113 Interactive
web-based
media
Schizophrenia Interactive media had a significant positive influence on
processing information related to mental illness and
attitudes toward mental illness
(continued )
Table I.
95
Mental
illnesses
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

Authors
Publication
year Country Main method Sample size Media type
Mental illness
type Resume of study
Lawson and
Fouts
2004 USA Content
analysis
34 Films Mental illness
in general
A high percentage of films referred to mental illness with
stigmatizing words being labeled. Additionally, most of
the characters with mental illness served as the objects
of amusement and mock
McGinty
et al.
2013 USA Experiment 1,797 Newspapers SMI Stories about mass shootings by people with serious
mental illness (SMI) led to more negative attitudes
toward people with SMI and greater support for gun
restrictions for people with SMI
McGinty
et al.
2014 USA Content
analysis
364 Newspapers,
magazines,
and televisions
SMI Gun violence was often related with SMI in mass
shootings. Most coverage was event-focused and
attributed the cause of gun violence as “dangerous
people”rather than “dangerous weapons.”
McKeever 2013 USA Content
analysis
302 Newspapers Autism A large proportion of newspaper articles about autism
quoted medical experts and provided more solutions than
causes
Moreno et al. 2011 USA Content
analysis
200 Facebook Depression College students like to disclose depressive symptoms on
Facebook. In particular, those who received responses to
their posts were more likely to discuss depression on
public profiles
Parrott and
Parrott
2015 USA Content
analysis
983 TV dramas Mental illness
in general
People with mental illness were more likely to commit
crimes and violence, and to be victimized by crimes than
the remaining population
Pavelko and
Myrick
2015 USA Experiment 574 Twitter OCD The use of the hashtag “#OCD”in Twitter did not result
in greater social distance from people with OCD, but did
decrease the liking of the tweets. Female participants
and those with personal experience with OCD and/or
mental illness showed less social distance with people
with OCD
Penn et al. 2003 USA Experiment 163 Films Schizophrenia Documentary films about schizophrenia had an
advantage in reducing stigma than fictional films despite
identical information in both types of films
(continued )
Table I.
96
HE
117,1
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

Authors
Publication
year Country Main method Sample size Media type
Mental illness
type Resume of study
Ray and
Hinnant
2009 USA Content
analysis
234 Magazines ADD and
ADHD
The tone of the magazine articles about ADD and ADHD
was informative and slightly more sympathetic, which
could help normalize the disorder
Ritterfeld
and Jin
2006 USA Experiment 165 Films Schizophrenia Watching an educational movie can increase people’s
knowledge acquisition about schizophrenia. Moreover,
stigma reduction could be achieved by watching both
the movie and a value added component trailer
Siegel 2014 USA Content
analysis
11 Films OCD People with OCD were portrayed more positively in
films, though depictions of violence were still frequently
employed. Moreover, the depictions of how stigma
affects people with OCD were relatively few
Slopen et al. 2007 USA Content
analysis
3,383 Newspapers Mental illness
in general
Newspapers stories focusing on children contained less
stigmatizing terminology than those focusing on adults
Wang and
Liu
2015a China Content
analysis
8,261 Social media Depression Influential users tended to generate more supportive or
helpful posts than stigmatizing posts in Chinese social
media sites
Wang and
Liu
2015b China Content
analysis
8,261 Social media Depression Posts about recovery and treatment of depression
reduced stigmatization and support at the same time.
Moreover, context under which depression was
discussed mattered
Whitley et al. 2015 Canada Content
analysis
1,168 Newspapers Mental illness
in general and
schizophrenia
Articles about men with mental illness were more
stigmatizing than those about women with mental
illness. Moreover, articles focusing on individuals were
more stigmatizing than articles about mental illness in
general
Zhang et al. 2015 China Content
analysis
527 Newspapers Depression Newspaper coverage of depression used more thematic
than episode framing and placed more problem solving
responsibilities to the society
Table I.
97
Mental
illnesses
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

Representations of mental illness in the media
In general, media content of mental illness continues the themes identified in previous
research. Dangerousness is still widely attributed to people with mental illness and there are
many negative depictions reflecting stigma.
Representations of general mental illness in non-fiction news media
Non-fiction news media, such as newspapers, magazines, and television programs are still
the major source of information for the general public. Examining how mental illnesses are
portrayed in news thus continues to be of vital interest.
Consistent with previous findings (Klin and Lemish, 2008; Stout et al., 2004; Wahl, 1992),
mental illnesses are often associated with crimes and violence and still depicted negatively.
A content analysis of articles relating to homicides, suicides, and other violent acts in four
main Italian newspapers found that approximately 40 percent of all deeds were attributed to
people with mental illness. Among these articles, a significantly higher percent of
stigmatizing languages was used when these violent acts were attributed to a person with
mental illness (Carpiniello et al., 2007). Findings from McGinty et al.’s (2014) study on news
coverage of serious mental illness (SMI) and gun violence in the USA further emphasized the
strong association between mental illness and violence. The results indicated that gun
violence was often related with SMI in mass shootings and most stories attributed the cause
of gun violence as “dangerous people”rather than “dangerous weapons.”Similarly,
Corrigan et al.’s (2005) study found almost 40 percent of newspaper stories portrayed mental
illness as dangerous and violent, and the stories often appeared in the front section.
Although negative portrayals of mental illness still account for a large portion of the
research findings, researchers also found the number of such stories is decreasing. Corrigan
et al.’s (2005) study revealed recovery about mental illness and advocacy action was
beginning to be discussed in the media, and more stories focused on biological or
environmental causes instead of personal or parental blame. The researchers claimed that
this finding was good news because previous research suggested people tended to view
people with mental illness as more responsible for their condition than those with other
health disorders (Corrigan et al., 2000). Additionally, Francis et al. (2005) suggested that
there was a relatively low level of media coverage of crime associated with mental illness in
Australia. The authors argued this finding corresponded to the relevant guidelines for
media reporting of mental illness in Australia, which stated that mental illness did not
equate with violence. However, they also found depression was most frequently portrayed
in media, and the coverage of certain types of mental illness did not correlate with the actual
rates of mental illness in the Australian population. Their findings indicate that general
guidelines for media professionals do have some effects on balanced reporting mental health
issues, but they are not influential enough to change the trend of inaccurate and unfavorable
depictions of mental illness.
Age and gender differences in the depiction of mental illness. There is also age and gender
differences in the media image of mental illness. For example, one study content analyzed
US newspaper coverage of mental illness among children and adults and found articles
focusing on children contained less stigmatizing terminology. They also found that articles
featuring stories on children were more likely to provide accurate information about mental
illness than did stories on adults (Slopen et al., 2007). The researchers concluded that articles
about children with mental illness incorporated more elements of responsible journalism,
while articles about adults tended to use a greater degree of stigmatizing terminology.
In another study, Whitley et al. (2015) compared generic and gendered representations
of mental illness in Canadian newspapers. The authors found that articles about men with
mental illness were more stigmatizing than those about women with mental illness.
Moreover, articles focusing on individuals were more stigmatizing than those focusing on
98
HE
117,1
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

mental illness in general. The authors suggested that journalists should be cautious of biases
when reporting on mental illness-related issues.
Portrayals of specific types of mental illness in non-fiction media. Possibly as a response to
Stout et al.’s (2004) call for more precise research, recent studies have started to look at the
image of a specific type of mental illness in non-fiction media. For example, Holton et al.
(2014) found more than two-thirds of the news stories about autism contained stigmatizing
cues; more than half of the sample employed loss frames, which attribute negative outcomes
to having autism. They argued that the presence of stigmatizing cues and the use of loss
frames could create a threatening space for autism. McKeever’s (2013) study found a large
proportion of articles on autism sampled from The New York Times and The Washington
Post provided more solutions for autism than causes and more often used medical experts as
the news sources, which could help normalize this disorder. Similarly, Bie and Tang’s (2015)
study on Chinese newspaper coverage of autism suggested autism received increased media
attention. Their findings indicated that autism was framed as a family problem and people
with autism were not given much voice unless they had special talents. Another content
analysis of Chinese newspaper coverage of depression indicated that the news articles used
more thematic than episode framing and tended to place problem solving responsibilities
society than on individuals (Zhang et al., 2015).
Research on magazines has also focused on specific mental illness. Ray and Hinnant
(2009) conducted a content analysis of articles from popular magazines about attention
deficit disorder and attention deficit hyperactivity disorder, and found the tone of these
articles to be informative and slightly more sympathetic in human-interest stories, which
helped normalize the disorder. In a similar study, Holman (2011) analyzed postpartum
disorders from American mainstream press and popular magazines, and the results
indicated that magazines produced more balanced coverage than newspapers. Holman
(2011) attributed this finding a result of the more flexible and longer time allocated, and
more specialized and focused coverage, compared to newspapers.
Metaphorical use of the term schizophrenia. Researchers found schizophrenia had often
been used metaphorically to reflect journalists’desire to express an opinion more strongly.
For example, Boke et al. (2007) analyzed national newspapers in Turkey to explore
the meaning attributed to the word schizophrenia. The researchers found 44.1 percent of the
analyzed texts used the word schizophrenia in a metaphorical way. The result is consistent
with findings in US newspapers; 28 percent of analyzed articles that mentioned
schizophrenia used the illness metaphorically compared to only 1 percent of articles that
mentioned cancer (Duckworth et al., 2003). The researchers claimed that such inaccurate use
of schizophrenia could contribute to the ongoing stigma.
Representations of mental illness in fictional media
Portrayals of general mental illness in fictional media. As with news media, the image of
mental illness in fictional media is negative. Lawson and Fouts (2004) analyzed Disney
animated films and found a high percentage of films referred to mental illness with
stigmatizing words being labeled. Additionally, most of the characters with mental
illness served as the objects of amusement and mock. The researchers expressed their
concerns that these negative portrayals might influence children’s attitudes and
behaviors toward people with mental illness. Consistent with findings from news
coverage of crime and mental illness, an analysis of crime dramas showed that people
with mental illness were more likely to commit crimes and violence than the remaining
characters. Meanwhile, they were more likely to be victimized by crime than the general
population (Parrott and Parrott, 2015). Similar findings were also reported in
Diefenbach and West’s (2007) study that characters with mental illness were ten
99
Mental
illnesses
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

times more likely to commit violent crimes than characters without mental disorders.
These findings again showed media perpetuated stereotypes and stigmatization of
mental illness.
Portrayals of specific types of mental illness in fictional media. Studies examining
obsessive-compulsive disorder (OCD) in fictional media revealed a rather more positive
picture than for mental illness in general. Fennell and Boyd (2014) content analyzed fictional
media representations of OCD from 1970s to 2000s. The data indicated that though the
media image of OCD reinforced some common negative stereotypes of mental illness, the
media also portrayed people with OCD as relatively intelligent and functional. Siegel (2014)
carried out a similar study by examining films that contain one character with OCD.
The results indicated that people with OCD were often portrayed positively, though depictions
of violence were still frequently employed. The depictions of how stigma affects people with
OCD were relatively few. The authors suggested that understanding of media images of
certain types of mental disorder was needed to better combat mental illness stigma.
Representations of mental illness in DTC advertisements
Besides studies focusing on news reporting, magazine articles or films, a few recent studies
have examined how mental illness, especially depression, is presented in DTC
advertisements. This is a new area of study since Stout et al. (2004) asserted that little
was known about how mental illness might be represented and its effects via messages
delivered through DTC advertising in their review.
Framing depression as an illness that predominantly affects females. Through a semiotic
analysis of print advertisements of antidepressants that appeared in Reader’s Digest and
Time, Grow et al. (2006) argued that gender played a role in framing of depression within
antidepressants DTC advertisements, where depression was presented as more common
among females. Framing depression as a problem that predominately affects women can
perpetuate over-diagnosing female patients while under-diagnosing male patients.
In addition, they also concluded that biochemical framing dominates the framing of
depression, which “marginalizes the psycho-social causes for depression”(p. 178).
Consistent with Grow et al.’s (2006) findings, Arney and Weitz (2012) contended that gender
bias existed in DTC advertisements of antidepressants. A content analysis of magazines
indicated antidepressants DTC advertisements in popular magazines portrayed depression
as a predominantly female disorder and alerted men that they would benefit if their female
partners sought treatment while suggesting women to seek such treatment for the sake of
their loved ones.
Representations of mental illness in social network sites (SNS)
With the rise of social media use, researchers began to examine the discussions of mental
illness in SNS, which also corresponded to Klin and Lemish’s (2008) and Stout et al.’s (2004)
call for more research on the new media.
Providing support for people with depression through SNS. A study on depression-related
tweets found most tweets expressed help or support to people with depression, followed by
tweets about disclosing feelings of depression (Cavazos-Rehg et al., 2016). The similar
finding was also obtained in a study examining Sina Weibo, a popular microblogging
platform in China, where the authors found influential Weibo users tended to generate more
supportive or helpful posts than stigmatizing posts (Wang and Liu, 2015a). Posts that
presented recovery or treatment information were more likely to be supportive.
Revealing depressive symptoms and suicidal thoughts through SNS. People often discuss
stress, depressive symptoms, and self-harm or suicidal thoughts in SNS. Cavazos-Rehg
et al.’s (2016) study revealed that two-thirds of the tweets disclosed one or more symptoms of
100
HE
117,1
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

depression, including tweets mentioning self-harm and/or suicide. A study on Pinterest
found 10 percent of pins mentioned suicide or suicidal thoughts and 6.9 percent mentioned
self-harm (Guidry et al., 2016). College undergraduates often discuss depressive symptoms
on Facebook and those who receive responses to their posts are more likely to discuss
depression on public profiles (Moreno et al., 2011). These findings suggest that mental health
professionals might use SNS to tailor mental health prevention messages strategically and
to identify people at risk for mental illness.
Misuse of the term schizophrenia in SNS. There is one study examining the use and misuse
of the term schizophrenia in Twitter ( Joseph et al., 2015). The results indicated compared to
diabetes, the term schizophrenia was used more sarcastically and inappropriately. The noun
“schizophrenia,”was used negatively less often than the adjective “schizophrenic.”Their
findings were consistent with previous studies on metaphorical use of the term schizophrenia
(Boke et al., 2007; Duckworth et al., 2003), suggesting that the misuse of the term schizophrenia
is quite common across different types of media.
Conclusions
The studies reviewed so far indicate that media still contribute to the mental illness stigma.
There is an age and gender disparity in news stories, where reporting of children/women’s
mental illness is more objective and balanced than reporting of adults/men’s mental illness.
The misuse of the term schizophrenia in the media perpetuates stigma. However, media
professionals are making progress in balancing reporting, especially in magazines. The
representation of presenting a specific type of mental health problem, such as OCD, tends to
be less negative and stigmatizing than the media representation of mental illness in general.
DTC advertising is a new vehicle to present images of mental illness since the Food and
Drug Administration relaxed regulations on broadcast DTC advertising in 1997 in the USA.
DTC advertisements tend to frame depression as more a result of biochemical rather than
psycho-social causes, and represent depression as more common among women.
There is an emerging research area focusing on the representation of mental illness in
SNS since Stout et al.’s (2004) review. Findings from these studies indicate that most online
posts on depression tend to provide helpful or supportive information. People often discuss
the symptoms of depression and some even reveal their self-harm or suicidal intents.
The effects of media representations of mental illness
Media effects literature supports the view that media have strong power in influencing
public’s attitudes and behaviors. Cultivation theory, for example, suggests that the more TV
people watch, the more they perceive the world as it is described in the TV (Gerbner, 1969).
Research suggests that the more TV people watched, the more social distance they wanted
to keep from and less willing to live near with people with mental illness (Angermeyer et al.,
2005; Diefenbach and West, 2007). How the media frame people with mental illness impacts
the way the public think about them. For example, research on SNS found discussing
depression in a crime context increased stigmatizing attitudes, whereas decreased
stigmatization in a health context (Wang and Liu, 2015b).
This section reviews research on the effects of media representations of mental illness
and investigates how media perpetuate mental illness stigma. Over the past 12 years, media
effects studies mainly focused on the impact of depictions of mental illness in newspapers,
televisions, DTC advertisements, and SNS.
Effects of the newspapers and television
Social stigmatizing attitudes and knowledge toward mental illness. Research on effects of
newspapers and televisions mainly focus on social stigma around mental illness.
101
Mental
illnesses
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

Corrigan et al. (2013) found newspaper stories about recovery resulted in reduced stigma
and greater acceptance of people with mental illness; however, stories about dysfunctional
public mental health systems led to increased stigma and decreased acceptance of people
with mental illness. Another study tested the effects of news stories about mass shootings
by people with SMI found that such stories led to more negative attitudes toward people
with SMI and greater support for gun restrictions for people with SMI (McGinty et al., 2013).
The more often people watched TV, the less knowledge they had about schizophrenia and
OCD (Kimmerle and Cress, 2013).
Social distance toward people with mental illness. Angermeyer et al. (2005) found that the
more people watched TV, the more they desired social distance from people with
schizophrenia, while no such evident association emerged between newspaper
consumption and the desire for social distance. Possible reasons include that moving
images might have a stronger effect than the written words and that TV messages are
more strongly targeted at audience’s emotions than newspaper articles. Similarly,
research by Diefenbach and West (2007) indicated that people who watched television
news were less willing to live next to someone with mental illness. Their results also
suggested that the media depictions of people with mental illness as violent criminals
could affect people’s beliefs about their levels of safety if mental health services were
moved into their community.
Perceived media influence on self and others. Diefenbach and West (2007) found people
believed that television portrayals of mental illness had greater effects on others than
themselves. Similar findings were also reported in Hoffner et al.’s (2015) study, which found
that the third-person perception was more salient if people had more prior personal
experience with mental illness.
Effects of DTC advertisements
Perceived prevalence of mental illness. An (2008) found that people with higher recall for DTC
advertisements for antidepressants were more likely to have a higher estimation of
prevalence of depression than those with lower recall. The results indicate that people use
DTC advertisements for antidepressants as a basis to judge the prevalence of depression
when they lack accurate information.
Perceptions of treatment. DTC advertisements for antidepressants can be a positive
vehicle in informing the public that depression is treatable, however, they may also
generate concerns that people might only seek antidepressant while ignoring other
treatment options. Haverhals and Lang’s (2004) study suggested that viewers perceived
mental illness to be more treatable as they watched more DTC advertisements for
psychotropic medication. Women consistently had less stigmatizing attitudes toward
mental illness than males, and also hold more positive attitudes toward DTC
advertisements and treatability of mental illness.
Similar findings were reported in An et al.’s (2009) research on DTC advertisements for
antidepressants and young adults’beliefs about depression. For young people who have no
prior personal experience with depression, the exposure to advertising for antidepressant drugs
may increase their perceived desirability of treating depression with drugs. This helps build
viewers’belief that depression is treatable, but it generates concerns that DTC advertising
exposure could also prompt those with mild symptoms to seek a quick but potentially
inadequate medical solution while ignoring other ways of treatment, such as counseling.
Effects of SNS
Online responses toward depression-related posts. Only limited research has been conducted
to investigate the effects of mental illness discussions in SNS. Using the same data with
102
HE
117,1
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

their previous study on the image of mental illness in SNS (Wang and Liu, 2015a), Wang
and Liu (2015b) further analyzed the impact of depression-related posts on their followers.
The study found that the valence, the attributed causes of depression, and the contexts
used in the original posts could lead to different response posts. More specifically,
negative original posts elicited more negative response posts. Posts that attributed the
cause of depression to the environment or genetics reinforced stigma. Discussing
depression in the context of crime could promote stigma, whereas the use of health context
could increase support among the followers.
Effects of use of disorder hashtag in Twitter. Pavelko and Myrick (2015) investigated the
use of the hashtag “#OCD”in Twitter and found this trivial use of the term OCD did not
result in greater social distance with people with OCD as hypothesized, but did decrease the
liking of the tweets. Women and those with experience with OCD and/or mental illnesses
showed less social distance with people with OCD.
Conclusions
Research on media effects suggests that media images of mental illness can influence the
public’s knowledge and attitudes toward mental illness. Specifically, negative
representations contribute to negative and rejecting attitudes toward people with mental
illness and to mental health services. People believe such portrayals have a greater effect on
others rather than themselves; this is true even for those with high prior experience with
mental illness. However, DTC advertisements for antidepressants can have positive
influence on informing the public that depression is not something scary and it can be
treated. As a personalized media, SNS play a double-edge sword role, which can be used to
either promote or reduce mental illness stigma, depending on the contents and contexts.
Using media to reduce stigma
As suggested by Stout et al. (2004), two aspects should be taken into consideration to
understand how media could be used as a tool to reduce stigma are: the message itself, and
the role played by those who produce media. There are some scholars calling on media
professionals to stop producing inaccurate representations of mental illness and to focus
more on balanced reporting (e.g. Dietrich et al., 2006). However, it is not realistic for media
professionals to merely stop reporting such stories if they meet important news values.
Although the immediate effects of newspaper intervention are positive, resulting more and
longer positive news stories about mental illness, the increase in negative news is still larger
than the increase of positive news after the intervention (Stuart, 2003). Thus, the question is
what strategies health communicators could employ to reduce mental illness stigma.
This section reviews studies on using entertainment educational programs and web-based
media to reduce stigma.
Using entertainment-education (E-E) programs to reduce stigma
An E-E program is “one educational scene, episode, or storyline embedded in an otherwise
purely entertainment program”(Moyer-Gusé and Nabi, 2010, p. 27). Research has shown
that E-E programs have the ability to create awareness and influence behavior across
various health issues, such as promoting safe sex (Collins et al., 2004) and preventing HIV
(Schouten et al., 2014). In the past decade, researchers have investigated how E-E programs
can be used to reduce mental illness stigma.
Hoffner and Cohen (2012) explored the influence of the famous television series, Monk,on
audience’s attitudes toward OCD. Monk tells the story of Adrian Monk, a gifted detective
who has OCD. This series depicted OCD in a positive way and has been awarded for helping
reduce mental illness stigma. An online survey on eight Monk fan message boards
103
Mental
illnesses
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

suggested Monk had positive psychological effects for fans that were dealing with mental
illness. By relating Monk to themselves, they had a higher self-esteem and were more likely
to seek treatment. Moreover, Ritterfeld and Jin (2006) tested E-E strategy and found that
educational movies could have effect on increasing people’s knowledge acquisition about
schizophrenia. When combined with a value added component trailer, which was designed
to provide factual information about schizophrenia, stigma reduction could be achieved.
In addition, participants were more convinced if the trailer was communicated by a
professional expert rather than a person reporting his or her own experience and if the
trailer was viewed after the movie.
Documentary films can also be effective in representing a relatively accurate image of
mental illness. Penn et al.’s (2003) study provided partial support for the hypothesis that
watching a documentary that portrays individuals with schizophrenia could reduce stigma.
Viewers showed more benign attributions about schizophrenia, but did not change their
general attitudes toward schizophrenia or increase the willingness to interact with those
with schizophrenia. Kimmerle and Cress’s (2013) study found similar advantages of
documentaries compared to fictional films. Specifically, the researchers found people who
watched a documentary acquired more knowledge and had less negative emotional
reactions toward schizophrenia than those who watched fictional movies.
Using web-based media to reduce stigma
With the increasing popularity of the internet, research has investigated the role of
web-based media in stigma reduction. Kim and Stout (2010) found that interactive
web-based media had a significant positive influence on processing information related to
mental illness and attitudes toward mental illness. The anti-stigma messages communicated
through interactive media can be more effective than traditional media since the
interactivity motivates users to exert cognitive efforts to process such messages.
In another study, Finkelstein et al. (2008) compared the effects of computer-assisted anti-
stigma interventions and anti-stigma printed materials, and found that a computer-
mediated anti-stigma program was more effective in changing people’s attitudes toward
psychiatric patients. The change in the level of stigma remained significant six months after
the intervention.
Conclusions
This section of reviews suggests that media could be a useful tool to reduce stigma toward
mental illness if used strategically. Calling for media professionals to stop producing
negative portrayals of mental illness is not enough. Media professionals should be asked to
think carefully about the message strategies, for example, they could put a value added
trailer at the end of film that depicts persons with mental illness. Using E-E programs that
portray accurate and likable characters with mental illness could also help reduce mental
illness stigma. Web-based media have strong potential to help reduce mental illness stigma
because interactive media motivate audience to put more cognitive efforts to process
anti-stigma messages. The wide use of social media suggests it is a promising way to reduce
mental illness stigma.
Summary and future research recommendations
Over the past decade, a large body of research has investigated the media representation of
mental illness, media effects of such representation, and using media to reduce stigma.
Consistent with previous reviews (Stout et al., 2004; Wahl, 1992; Klin and Lemish, 2008),
media still tend to depict mental illness negatively. Recent studies in DTC advertisements
and social media found these types of media had a more objective portrayal of mental illness
104
HE
117,1
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

(Grow et al., 2006; Wang and Liu, 2015a). Although negative media portrayals could
promote mental illness stigma, recent researchers have found that DTC advertisements and
social media could have a positive influence on society in improving mental health literacy
and reducing stigma (An, 2008; Wang and Liu, 2015b). Particularly, E-E programs and
web-based media have strong potential in reducing mental illness stigma, if used properly
(Hoffner and Cohen, 2012; Kim and Stout, 2010). Though these studies yield valuable
findings, they are not without limitations.
First, as Wahl’s (1992) and Stout et al.’s (2004) found, the focus of what is meant by mental
illness is not consistent across the literature. This lack of consistency makes it difficult to
compare findings across studies. Therefore, future research should define their focus carefully.
Second, most research focuses on national news media but few studies include local
newspaper and television. However, local news media have important impacts on the
communities. Research has shown that local newspapers’stories are more straightforward
and focus more on the facts of an event while the reporting in the national media is more
interpretative (Pew Project for Excellence in Journalism, 1998). Local journalists are more
likely to elaborate on how something works, but national newspapers tend to look at the big
picture. This difference in reporting style could result in different representations of mental
illness in national vs local papers. Future research could examine and compare the images of
mental illness in both national and local papers.
Third, although some research analyzed in this paper dealt with mental illness in new
media and DTC advertisements, most of the research focuses on depression. Future research
should examine how other types of mental illness, such as autism, are depicted through
these media and what effects they have. Especially social media, which, on the one
hand, afford mental health advocacy groups the opportunity to disseminate more accurate
information about mental illness because they do not relay on journalistic gatekeepers
compared to traditional media; on the other hand, social media can motivate users to exert
more cognitive efforts to process anti-stigma messages due to its interactivity.
Thus, additional research should focus on social media and provide possible guides for
stigma reduction.
Additionally, there is virtually no research examining mental health messages via video
games, although previous studies have shown that well-designed health video games could
lead to positive outcomes, such as knowledge acquisition, attitude, and/or behavior change
(Oakley, 1995; Read et al., 2006). In particular, the interactivity-based feature and a variety of
audience groups, make the video games more promising to promote mental illness
information and stigma reduction. Future research could explore the role of video games in
mental illness stigma reduction context.
Finally, for research that employed experiments, most of them use students as
participants. This is convenient for researchers to conduct the experiments, but the result
cannot be generalized to a larger population. Moreover, the experiments observe only short-
term effects, and are limited to measuring attitudes rather than observing long-term effects
such as behaviors. Thus, future research should expand to a wider range of media, employ
more generalizable samples and examine long-term effects.
Limitations
The goal of this paper is to review studies on mental illness in the media and identify
important research gaps. However, this review is not without limitations. This paper only
reviews articles written in English, excluding books, book chapters, and empirical studies
written in other languages. Moreover, this paper does not include research on examining
how mental health caregivers and services are represented and its effects on the public and
people with mental illness. Additionally, the method employed in this paper is a narrative
review, which could provide a general picture of the media image of mental illness and
105
Mental
illnesses
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

identify the existing research gaps and limitations. Nonetheless, this method can fall short in
being objective and systematic. In order to avoid biases, this paper strictly follows
Green et al.’s (2006) suggestions on how to conduct a narrative review as objective as
possible. By performing preliminary literature search, identifying the scope of the research,
and synthesizing the evidence, the current narrative review can be a valuable contribution
to the literature. Future studies could conduct a systematic review to give a more objective
and quantified summary of this research area.
Conclusions
Collectively, media still contribute to the mental illness stigma, which has serious
consequences for people with mental illness. However, media can also reduce stigma if used
strategically. The current study provides a better understanding of media depictions of
mental illness and its effects, which is needed to understand and analyze the mechanisms
that create, reinforce as well as reduce mental illness stigma. Findings from these studies
can guide future efforts to use media to educate the public about mental illness and reduce
stigma. For example, mental health campaign planners could use SNS to identify people
who might be at risk for mental illness and tailor the messages strategically. They could
also use E-E programs to provide the public with mediated contact with people with
mental illness, which can be a promising tool to influence people’s attitudes and beliefs
about mental illness.
References
References marked with an asterisk (*) indicate studies included in the review.
*An, S. (2008), “Antidepressant direct-to-consumer advertising and social perception of the prevalence
of depression: application of the availability heuristic”,Health Communication, Vol. 23 No. 6,
pp. 499-505.
*An, S., Jin, H.S. and Brown, J.D. (2009), “Direct-to-consumer antidepressant ads and young adults’
beliefs about depression”,Health Marketing Quarterly, Vol. 26 No. 4, pp. 259-278.
*Angermeyer, M.C., Dietrich, S., Pott, D. and Matschinger, H. (2005), “Media consumption and desire
for social distance towards people with schizophrenia”,European Psychiatry, Vol. 20 No. 3,
pp. 246-250.
*Arney, J. and Weitz, R. (2012), “Gendering affective disorders in direct-to-consumer advertisements”,
Research in the Sociology of Health Care, Vol. 30, pp. 161-180.
*Bie, B. and Tang, L. (2015), “Representation of autism in leading newspapers in China: a content
analysis”,Health Communication, Vol. 30 No. 9, pp. 884-893.
*Boke, O., Aker, S., Aker, A.A., Sarisoy, G. and Sahin, A.R. (2007), “Schizophrenia in Turkish
newspapers”,Social Psychiatry and Psychiatric Epidemiology, Vol. 42 No. 6, pp. 457-461.
*Carpiniello, B., Girau, R. and Orrù, M.G. (2007), “Mass-media, violence and mental illness. Evidence
from some Italian newspapers”,Epidemiologia e psichiatria sociale, Vol. 16 No. 3, pp. 251-255.
*Cavazos-Rehg, P.A., Krauss, M.J., Sowles, S., Connolly, S., Rosas, C., Bharadwaj, M. and Bierut, L.J.
(2016), “A content analysis of depression-related tweets”,Computers in Human Behavior,
Vol. 54, pp. 351-357.
Collins, R., Elliott, M., Berry, S., Kanouse, D., Kunkel, D., Hunter, S. and Miu, A. (2004), “Watching sex
on television predicts adolescent initiation of sexual behavior”,Pediatrics, Vol. 114 No. 3,
pp. 280-289.
Corrigan, P.W. and Kleinlein, P. (2005), “The impact of mental illness stigma”, in Corrigan, P.W. (Ed.),
On the Stigma of Mental Illness: Practical Strategies for Research and Social Change, American
Psychological Association, Washington, DC, pp. 11-44.
106
HE
117,1
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

Corrigan, P.W. and Lundin, R.K. (2001), Don't Call Me Nuts: Coping with the Stigma of Mental Illness,
Recovery Press, Tinley Park, IL.
*Corrigan, P.W., Powell, K.J. and Michaels, P.J. (2013), “The effects of news stories on the stigma of
mental illness”,Journal of Nervous and Mental Disease, Vol. 201 No. 3, pp. 179-182.
*Corrigan, P.W., Watson, A.C., Gracia, G., Slopen, N., Rasinski, K. and Hall, L.L. (2005), “Newspaper
stories as measures of structural stigma”,Psychiatric Services, Vol. 56 No. 5, pp. 551-556.
Corrigan, P.W., River, L.P., Lundin, R.K., Wasowski, K.U., Campion, J., Mathisen, J., Goldstein, H.,
Bergman, M., Gagnon, C. and Kubiak, M.A. (2000), “Stigmatizing attributions about mental
illness”,Journal of Community Psychology, Vol. 28 No. 1, pp. 91-102.
*Diefenbach, D.L. and West, M.D. (2007), “Television and attitudes toward mental health issues:
cultivation analysis and the third‐person effect”,Journal of Community Psychology, Vol. 35 No. 2,
pp. 181-195.
Dietrich, S., Heider, D., Matschinger, H. and Angermeyer, M.C. (2006), “Influence of newspaper
reporting on adolescents’attitudes toward people with mental illness”,Social Psychiatry and
Psychiatric Epidemiology, Vol. 41 No. 4, pp. 318-322.
*Duckworth, K., Halpern, J.H., Schutt, R.K. and Gillespie, C. (2003), “Use of schizophrenia as a metaphor
in US newspapers”,Psychiatric Services, Vol. 54 No. 10, pp. 1402-1404.
DYG, Inc. (1990), Public Attitudes Toward People with Chronic Mental Illness, Robert Wood Johnson
Foundation, Boston, MA.
*Fennell, D. and Boyd, M. (2014), “Obsessive-compulsive disorder in the media”,Deviant Behavior,
Vol. 35 No. 9, pp. 669-686.
*Finkelstein, J., Lapshin, O. and Wasserman, E. (2008), “Randomized study of different anti-stigma
media”,Patient Education and Counseling, Vol. 71 No. 2, pp. 204-214.
*Francis, C., Pirkis, J., Blood, R.W., Dunt, D., Burgess, P., Morley, B. and Stewart, A. (2005), “Portrayal
of depression and other mental illnesses in Australian nonfiction media”,Journal of Community
Psychology, Vol. 33 No. 33, pp. 283-297.
Gerbner, G. (1969), “Toward ‘cultural indicators’: the analysis of mass mediated public message
systems”,Educational Technology Research and Development, Vol. 17 No. 2, pp. 137-148.
Green, B.N., Johnson, C.D. and Adams, A. (2006), “Writing narrative literature reviews for peer-reviewed
journals: secrets of the trade”,Journal of Chiropractic Medicine, Vol. 5 No. 3, pp. 101-117.
*Grow, J.M., Park, J.S. and Han, X. (2006), “‘Your life is waiting!’symbolic meanings in direct-to-consumer
antidepressant advertising”,Journal of Communication Inquiry, Vol. 30 No. 2, pp. 163-188.
*Guidry, J., Zhang, Y., Jin, Y. and Parrish, C. (2016), “Portrayals of depression on Pinterest and why
public relations practitioners should care”,Public Relations Review, Vol. 42 No. 1, pp. 232-236.
*Haverhals, L. and Lang, A. (2004), “An empirical examination of the effect of DTC advertising on
stigma towards mental illness”, paper presented at the Annual Meeting of International
Communication Association, New Orleans, LA, May 27-31, available at: http://citation.
allacademic.com/meta/p_mla_apa_research_citation/1/1/2/3/6/p112363_index.html (accessed
September 2, 2014).
*Hoffner, C.A. and Cohen, E.L. (2012), “Responses to obsessive compulsive disorder on Monk among
series fans: parasocial relations, presumed media influence, and behavioral outcomes”,Journal
of Broadcasting & Electronic Media, Vol. 56 No. 4, pp. 650-668.
*Hoffner, C.A., Fujioka, Y., Cohen, E.L. and Atwell Seate, A. (2015), “Perceived media influence, mental
illness, and responses to news coverage of a mass shooting”,Psychology of Popular Media
Culture, Vol. 30 No. 10, pp. 1-15.
*Holman, L. (2011), “Building bias: media portrayal of postpartum disorders and mental illness
stereotypes”,Media Report to Women, Vol. 39 No. 1, pp. 12-19.
*Holton, A.E., Farrell, L.C. and Fudge, J.L. (2014), “A threatening space?: Stigmatization and the
framing of autism in the news”,Communication Studies, Vol. 65 No. 2, pp. 189-207.
107
Mental
illnesses
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

*Joseph, A.J., Tandon, N., Yang, L.H., Duckworth, K., Torous, J., Seidman, L.J. and Keshavan, M.S.
(2015), “#Schizophrenia: use and misuse on Twitter”,Schizophrenia Research, Vol. 165 Nos 2/3,
pp. 111-115.
*Kim, H. and Stout, P.A. (2010), “The effects of interactivity on information processing and attitude
change: implications for mental health stigma”,Health Communication, Vol. 25 No. 2, pp. 142-154.
*Kimmerle, J. and Cress, U. (2013), “The effects of TV and film exposure on knowledge about and
attitudes toward mental disorders”,Journal of Community Psychology, Vol. 41 No. 8, pp. 931-943.
Klin, A. and Lemish, D. (2008), “Mental disorders stigma in the media: review of studies on production,
content, and influences”,Journal of Health Communication, Vol. 13 No. 5, pp. 434-449.
*Lawson, A. and Fouts, G. (2004), “Mental illness in Disney animated films”,Canadian Journal of
Psychiatry, Vol. 49 No. 5, pp. 310-314.
*McGinty, E.E., Webster, D.W. and Barry, C.L. (2013), “Effects of news media messages about mass
shootings on attitudes toward persons with serious mental illness and public support for gun
control policies”,American Journal of Psychiatry, Vol. 170 No. 5, pp. 494-501.
*McGinty, E.E., Webster, D.W., Jarlenski, M. and Barry, C.L. (2014), “News media framing of serious
mental illness and gun violence in the United States, 1997-2012”,American Journal of Public
Health, Vol. 104 No. 3, pp. 406-413.
*McKeever, B.W. (2013), “News framing of autism understanding media advocacy and the combating
autism act”,Science Communication, Vol. 35 No. 2, pp. 213-240.
*Moreno, M.A., Jelenchick, L.A., Egan, K.G., Cox, E., Young, H., Gannon, K.E. and Becker, T. (2011),
“Feeling bad on Facebook: depression disclosures by college students on a social networking
site”,Depression and Anxiety, Vol. 28 No. 6, pp. 447-455.
Moyer-Gusé, E. and Nabi, R.L. (2010), “Explaining the effects of narrative in an entertainment television
program: overcoming resistance to persuasion”,Human Communication Research, Vol. 36 No. 1,
pp. 26-52.
Oakley, C. (1995), “SMACK: a computer driven game for at-risk teens”,Computers in Human Services,
Vol. 11 Nos 1-2, pp. 97-99.
Oostdyk, A.M. (2008), “Portrayal of mental illness on television: a review of the literature”, master’s
thesis, University of Pittsburgh, Pittsburgh, available at: http://d-scholarship.pitt.edu/7009/
(accessed November 10, 2015).
*Parrott, S. and Parrott, C.T. (2015), “Law & disorder: the portrayal of mental illness in US crime
dramas”,Journal of Broadcasting & Electronic Media, Vol. 59 No. 4, pp. 640-657.
*Pavelko, R.L. and Myrick, J.G. (2015), “That’s so OCD: the effects of disease trivialization via social
media on user perceptions and impression formation”,Computers in Human Behavior, Vol. 49,
pp. 251-258.
*Penn, D.L., Chamberlin, C. and Mueser, K.T. (2003), “Effects of a documentary film about
schizophrenia on psychiatric stigma”,Schizophrenia Bulletin, Vol. 29 No. 2, pp. 383-391.
Pew Project for Excellence in Journalism (1998), “Local versus National Papers”, Pew Research Center,
Washington, DC, available at: www.journalism.org/1998/07/13/local-versus-national-papers/
(accessed December 2, 2015).
*Ray, L. and Hinnant, A. (2009), “Media representation of mental disorders: a study of ADD and ADHD
coverage in magazines from 1985 to 2008”,Journal of Magazine & New Media Research, Vol. 11
No. 1, pp. 1-21.
Read, S.J., Miller, L.C., Appleby, P.R., Nwosu, M.E., Reynaldo, S., Lauren, A. and Putcha, A. (2006),
“Socially optimized learning in a virtual environment: reducing risky sexual behavior among
men who have sex with men”,Human Communication Research, Vol. 32 No. 1, pp. 1-34.
Reavley, N.J., Cvetkovski, S. and Jorm, A.F. (2010), “Sources of information about mental health and
links to help seeking: findings from the 2007 Australian National Survey of Mental Health and
Wellbeing”,Social Psychiatry and Psychiatric Epidemiology, Vol. 46 No. 12, pp. 1267-1274.
108
HE
117,1
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)

*Ritterfeld, U. and Jin, S.A. (2006), “Addressing media stigma for people experiencing mental illness using
an entertainment-education strategy”,Journal of Health Psychology, Vol. 11 No. 2, pp. 247-267.
Schouten, B., Vlug-Mahabali, M., Hermanns, S., Spijker, E. and van Weert, J. (2014), “To be involved or
not to be involved? Using entertainment-education in an HIV-prevention program for
youngsters”,Health Communication, Vol. 29 No. 8, pp. 762-772.
*Siegel, D.E. (2014), “The portrayal of characters with obsessive-compulsive disorder in American
films”, dissertation, University of Hartford, West Hartford, available at: http://search.proquest.
com/docview/1534363782 (accessed November 2, 2015).
*Slopen, N.B., Watson, A.C., Gracia, G. and Corrigan, P.W. (2007), “Age analysis of newspaper coverage
of mental illness”,Journal of Health Communication, Vol. 12 No. 1, pp. 3-15.
Stout, P.A., Villegas, J. and Jennings, N.A. (2004), “Images of mental illness in the media: identifying
gaps in the research”,Schizophrenia Bulletin, Vol. 30 No. 3, pp. 543-561.
Stuart, H. (2003), “Stigma and the daily news: evaluation of a newspaper intervention”,Canadian
Journal of Psychiatry, Vol. 48 No. 10, pp. 651-656.
Wahl, O.F. (1992), “Mass media images of mental illness: a review of the literature”,Journal of
Community Psychology, Vol. 20 No. 4, pp. 343-352.
Wahl, O.F. (2003), “Depictions of mental illnesses in children’s media”,Journal of Mental Health, Vol. 12
No. 3, pp. 249-258.
*Wang, W. and Liu, Y. (2015a), “Communication message cues and opinions about people with
depression: an investigation of discussion on Weibo”,Asian Journal of Communication, Vol. 25
No. 1, pp. 33-47.
*Wang, W. and Liu, Y. (2015b), “Discussing mental illness in Chinese social media: the impact of
influential sources on stigmatization and support among their followers”,Health
Communication, Vol. 31 No. 3, pp. 355-363.
*Whitley, R., Adeponle, A. and Miller, A.R. (2015), “Comparing gendered and generic representations of
mental illness in Canadian newspapers: an exploration of the chivalry hypothesis”,
Social Psychiatry and Psychiatric Epidemiology, Vol. 50 No. 2, pp. 325-333.
World Health Organization (2015), “Mental disorders”, available at: www.who.int/mediacentre/
factsheets/fs396/en/ (accessed March 12, 2016).
*Zhang, Y., Jin, Y. and Tang, Y. (2015), “Framing depression cultural and organizational influences on
coverage of a public health threat and attribution of responsibilities in Chinese news media,
2000-2012”,Journalism & Mass Communication Quarterly, Vol. 92 No. 1, pp. 99-120.
Corresponding author
Zexin Ma can be contacted at: marshama@umd.edu
For instructions on how to order reprints of this article, please visit our website:
www.emeraldgrouppublishing.com/licensing/reprints.htm
Or contact us for further details: permissions@emeraldinsight.com
109
Mental
illnesses
Downloaded by Miss Zexin Ma At 12:06 17 January 2017 (PT)