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

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


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

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    • "Claims have been made that medical conceptualizations should reduce stigma towards 'mental illness' by highlighting that 'illnesses' are outside the control and responsibility of the individual (Angermeyer et al., 2011). However, research examining the influence of differential explanations regarding the etiology and maintenance of 'mental illness' on public attitudes towards those deemed to be 'mentally ill' has produced mixed results. "
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    ABSTRACT: Explanations regarding the etiology of mental health difficulties have been found to affect public attitudes towards those who experience such difficulties. Utilizing a large, randomized parallel-groups design (N=1,004), we examined how standardized differential explanations of voice-hearing influence public attitudes, attributions, and behavioral intentions towards voice-hearers. Additionally, we incorporated a behavioral outcome measure to examine whether reported behavioral intentions towards voice-hearers were related to responses towards an individual with a history of voice-hearing. Consistent with attribution theory, mediated pathways between attributions and intentions were identified: broadly, viewing the voice-hearer's behavior as dangerous, within their personal responsibility, and global was associated with more coercive intentions – and these were mediated by feelings of fear, anger, and pity. Reported behavioral intentions demonstrated small-to-moderate associations with our behavioral outcome measure. The findings suggest that explanations regarding the etiology of mental health difficulties that seek to reduce public attributions of dangerousness, personal responsibility, and globality may facilitate more helpful responses towards voice-hearers.
    No preview · Article · Jan 2016
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    • "Most studies, however, analyse the two types of beliefs separately (Angermeyer et al., 2011, 2013; Kvaale et al., 2013; Pilkington et al., 2013; Read et al., 2013a,b; Walker and Read, 2002). An advantage of this approach is illustrated by a study that adopted both approaches (Read and Harre, 2001). "
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    ABSTRACT: Background Public beliefs about the causes of mental health problems are related to desire for distance and pessimism about recovery, and are therefore frequently studied. The beliefs of people receiving treatment are researched less often. Method An online survey on causal beliefs about depression and experiences with antidepressants was completed by 1829 New Zealand adults prescribed anti-depressants in the preceding five years, 97.4% of whom proceeded to take antidepressants. Results The most frequently endorsed of 17 causal beliefs were family stress, relationship problems, loss of loved one, financial problems, isolation, and abuse or neglect in childhood. Factor analysis produced three factors: ‘bio-genetic’, ‘adulthood stress’ and ‘childhood adversity’. The most strongly endorsed explanations for increases in antidepressant prescribing invoked improved identification, reduced stigma and drug company marketing. The least strongly endorsed was ‘Anti-depressants are the best treatment’. Regression analyses revealed that self-reported efficacy of the antidepressants was positively associated with bio-genetic causal beliefs, negatively associated with childhood adversity beliefs and unrelated to adulthood stress beliefs. The belief that ‘People cannot׳ get better by themselves even if they try’ was positively associated with bio-genetic beliefs. Limitations The convenience sample may have been biased towards a favourable view of bio-genetic explanations, since 83% reported that the medication reduced their depression. Conclusions Clinicians׳ should consider exploring patients׳ causal beliefs. The public, even when taking antidepressants, continues to hold a multi-factorial causal model of depression with a primary emphasis on psycho-social causes. A three factor model of those beliefs may lead to more sophisticated understandings of relationships with stigma variables.
    Full-text · Article · Oct 2014 · Journal of Affective Disorders
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    • "With both disorders, there was no statistically significant association between the endorsement of hereditary factors as a cause and social distance. By and large, our results are in line with what had been observed in previous studies (Angermeyer et al. 2011; Schomerus et al. 2014): Biogenetic explanations and social distance either are unrelated or the first are associated with an increase of the latter. This congruence suggests that it matters little whether an unlabelled or a labelled vignette is used when examining the relationship between biogenetic causes and social distance. "
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    ABSTRACT: Aims. Previous population-based studies did not support the view that biological and genetic causal models help increase social acceptance of people with mental illness. However, practically all these studies used un-labelled vignettes depicting symptoms of the disorders of interest. Thus, in these studies the public's reactions to pathological behaviour had been assessed rather than reactions to psychiatric disorders that had explicitly been labelled as such. The question arises as to whether results would have been similar if respondents had been confronted with vignettes with explicit mention of the respective diagnosis. Methods. Analyses are based on data of a telephone survey in two German metropolises conducted in 2011. Case-vignettes with typical symptoms suggestive of depression or schizophrenia were presented to the respondents. After presentation of the vignette respondents were informed about the diagnosis. Results. We found a statistically significant association of the endorsement of brain disease as a cause with greater desire for social distance from persons with schizophrenia. In major depression, this relation was absent. With both disorders, there was no statistically significant association between the endorsement of hereditary factors as a cause and social distance. Conclusions. Irrespective of whether unlabelled or labelled vignettes are employed, the ascription to biological or genetic causes seems not to be associated with a reduction of the public's desire for social distance from people with schizophrenia or depression. Our results corroborate the notion that promulgating biological and genetic causal models may not help decrease the stigma surrounding these illnesses.
    Full-text · Article · Apr 2014 · Epidemiology and Psychiatric Sciences
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