Skip to main content

Advertisement

Log in

A cross-cultural study of employers’ concerns about hiring people with psychotic disorder: implications for recovery

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Introduction

Employment discrimination is considered as a major impediment to community integration for people with serious mental illness, yet little is known about how the problem manifests differently across western and non-western societies. We developed a lay model based on Chinese beliefs and values in terms of Confucianism, Taoism, Buddhism, and folk religions which may be used to explain cross-cultural variation in mental illness stigma, particularly in the arena of employment discrimination. In this study, we tested this lay approach by comparing employers’ concerns about hiring people with psychotic disorder for entry-level jobs in US and China.

Method

One hundred employers (40 from Chicago, 30 from Hong Kong, and 30 from Beijing) were randomly recruited from small size firms and interviewed by certified interviewers using a semi-structured interview guide designed for this study. Content analysis was used to derive themes, which in turn were compared across the three sites using chi-square tests.

Results

Analyses reveal that employers express a range of concerns about hiring an employee with mental illness. Although some concerns were raised with equal frequency across sites, comparisons showed that, relative to US employers, Chinese employers were significantly more likely to perceive that people with mental illness would exhibit a weaker work ethic and less loyalty to the company. Comparison of themes also suggests that employers in China were more people-oriented while employers in US were more task-oriented.

Conclusion

Cultural differences existed among employers which supported the lay theory of mental illness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Andresen R, Oades L, Caputi P (2003) The experience of recovery from schizophrenia: towards an empirically validated stage model. Aust N Z J Psychiatry 37:586–594

    Article  PubMed  Google Scholar 

  2. Anthony W, Blanch AA (1987) Supported employment for persons who are psychiatrically disabled: an historical and conceptual perspective. Psychosoc Rehabil J 11:5–23

    Google Scholar 

  3. Anthony WA, Jansen MA (1984) Predicting the vocational capacity of the chronically mentally ill: research and policy implications. Am Psychol 39:537–544

    Article  PubMed  CAS  Google Scholar 

  4. Baldwin ML, Marcus SC (2006) Perceived and measured stigma among workers with serious mental illness. Psychiatr Serv 57:388–392

    Article  PubMed  Google Scholar 

  5. Baron RC, Salzer MS (2002) Accounting for unemployment among people with mental illness. Behav Sci Law 20:585–599

    Article  PubMed  Google Scholar 

  6. Bordieri JE, Drehmer DE (1986) Hiring decisions for disabled workers: looking at the cause. J Appl Soc Psychol 16:197–208

    Article  Google Scholar 

  7. Brockington IF, Hall P, Levings J, et al. (1993) The community tolerance of the mentally ill. Br J Psychiatry 162:93–99

    PubMed  CAS  Google Scholar 

  8. Chan F, Hedl J, Parker HJ, Chan TN, Yu B (1988) Differential attitudes of Chinese students toward people with disabilities: a cross-cultural perspective. Int J Soc Psychiatry 34:267-273

    Article  PubMed  CAS  Google Scholar 

  9. Chan F, Hua MS, Ju JJ, Lam CS (1984) Factorial structure of the Chinese scale of attitudes towards disabled persons: a cross-cultural validation. Int J Rehabil Res 7:317–337

    Article  Google Scholar 

  10. Chan F, Lam CS, Wong DW, Leung P, Fang XS (1988) Counseling Chinese Americans with disabilities. J Appl Rehabil Couns 19:21–25

    Google Scholar 

  11. Cheung FM (1988) Surveys of community attitudes toward mental health facilities: reflections or provocations. Am J Community Psychol 16:877–882

    Article  PubMed  CAS  Google Scholar 

  12. Cheung FM (1990) People against the mentally ill: community opposition to residential treatment facilities. Community Ment Health J 26:205–212

    Article  PubMed  CAS  Google Scholar 

  13. Chueng LCC, Tsang HWH (2005) Factor structure of essential social skills to be salespersons in retail market: implications for psychiatric rehabilitation. J Behav Ther Exp Psychiatry 36:265–280

    Article  Google Scholar 

  14. Cohen J, Struening EL (1962) Opinions about mental illness in the personnel of two large hospitals. J Abnorm Soc Psychol 64:349–360

    Article  PubMed  CAS  Google Scholar 

  15. Cook JA (2006) Employment barriers for persons with psychiatric disabilities: Updated of a report for the president’s commission. Psychiatr Serv 57:1391–1405

    Article  PubMed  Google Scholar 

  16. Cook JA, Razzano L (2000) Vocational rehabilitation for persons with schizophrenia: recent research and implications for practice. Schizophr Bull 26:87–103

    PubMed  CAS  Google Scholar 

  17. Cook JA, Razzano LA, Straiton DM, Ross Y (1994) Cultivation and maintenance of relationships with employers of people with psychiatric disabilities. Psychosoc Rehabil J 17:103–116

    Google Scholar 

  18. Corrigan P, Markowitz FE, Watson A, Rowan D, Kubiak MA (2003) An attribution model of public discrimination towards persons with mental illness. J Health Soc Behav 44:162–179

    Article  PubMed  Google Scholar 

  19. Corrigan PW, Salzer M, Ralph RO, Sangster Y, Keck L (2004) Examining the factor structure of the recovery assessment scale. Schizophr Bull 30:1035–1041

    PubMed  Google Scholar 

  20. Corrigan PW, Slopen N, Gracia G, Phelan S, Keogh CB, Keck L (2005) Some recovery processes in mutual-help groups for persons with mental illness; II: qualitative analysis of participant interviews. Community Ment Health J 41:1035–1041

    Article  Google Scholar 

  21. Corrigan PW, Watson AC (2002) The paradox of self-stigma and mental illness. Clin Psychol Sci Pract 9:35–53

    Article  Google Scholar 

  22. Diksa E, Rogers ES (1996) Employer concerns about hiring persons with psychiatric disability: results of the employer attitude questionnaire. Rehabil Couns Bull 40:31–44

    Google Scholar 

  23. Farina A, Felner RD (1973) Employment interviewer reactions to former mental patients. J Abnorm Psychol 82:268–272

    Article  PubMed  CAS  Google Scholar 

  24. Feldman D (1988) Employing physically and mentally impaired employees. Personnel 65:14–15

    Google Scholar 

  25. Fogel J, Ford DE (2005) Stigma beliefs of Asian Americans with depression in an internet sample. Can J Psychiatry 50:470–478

    PubMed  Google Scholar 

  26. Fung KMT, Tsang HWH, Corrigan PW, Lam CS (in press) Measuring self-stigma of mental illness in China and its implications for recovery. Int J Soc Psychiatry

  27. Fung MT (2006) Relationship between self-stigma of people with psychotic disorder and their adherence to psychosocial treatment. Unpublished master’s thesis, The Hong Kong Polytechnic University, Hong Kong

  28. Furnham A, Chan E (2004) Lay theories of schizophrenia: a cross-cultural comparison of British and Hong Kong Chinese attitudes, attributions and beliefs. Soc Psychiatry Psychiatr Epidemiol 39:543–552

    Article  PubMed  Google Scholar 

  29. Goffman E (1963) Notes on the management of spoiled identity. NJ: Prentice Hall, Englewood Cliffs

    Google Scholar 

  30. Hand C, Tryssenaar J (2006) Small business employers’ views on hiring individuals with mental illness. Psychiatr Rehabil J 29:166–173

    Article  PubMed  Google Scholar 

  31. Hernandez B, Keys C (2000) Employer attitudes toward workers with disabilities and their ADA employment rights: a literature review. J Rehabil 66:4–16

    Google Scholar 

  32. Johnson-Dalzine P, Dalzine L, Martin-Stanley C (1996) Fear of criminal violence and the African American elderly: assessment of a crime prevention strategy. J Negro Educ 65:462–469

    Article  Google Scholar 

  33. Jorm AF (2000) Mental health literacy–Public knowledge and beliefs about mental disorders. Br J Psychiatry 177:396–401

    Article  PubMed  CAS  Google Scholar 

  34. Jorm AF, Korten AE, Jacomb PA, Christensen H, Rodgers B, Pollitt P (1997) “Mental health literacy”: a survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med J Aust 166:182–186

    PubMed  CAS  Google Scholar 

  35. Killackey EJ, Jackson HJ, Gleeson J, Hickie IB, McGorry PD (2006) Exciting career opportunity beckons! Early intervention and vocational rehabilitation in first-episode psychosis: employing cautious optimism. Aust N Z J Psychiatry 40:951–962

    Article  PubMed  Google Scholar 

  36. King AYC, Bond MH (1985) The Confucian paradigm of man: a sociological view. In: Tseng WS, Wu DYH (eds) Chinese culture and mental health. Academic Press, New York

    Google Scholar 

  37. Kopelowicz A, Aguirre F, Liberman RP, Mintz J, Wallace CJ (2006) Differential performance of job skills in schizophrenia: an experimental analysis. J Rehabil 72:31–39

    Google Scholar 

  38. Lee YT, Jussim L, McCauley C (1995) Stereotype accuracy: toward appreciating group differences. The American Psychological Association, Washington DC

    Google Scholar 

  39. Lin YT (1983) The Wisdom of confucius. Modern library, New York

    Google Scholar 

  40. Link BG (1982) Mental patient status, work, and income: an examination of the effects of a psychiatric label. Am Sociol Rev 47:202–215

    Article  PubMed  CAS  Google Scholar 

  41. Link BG (1987) Understanding labelling effects in the area of mental disorders: an assessment of the effects of expectations of rejection. Am Sociol Rev 52:96–112

    Article  Google Scholar 

  42. Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA (1999) Public conceptions of mental illness: labels, causes, dangerousness, and social distance. Am J Public Health 89:1328–1333

    PubMed  CAS  Google Scholar 

  43. Manning C, White PD (1995) Attitudes of employers to the mentally ill. Psychiatr Bull R Coll Psychiatr 19:541–543

    Article  Google Scholar 

  44. Olshanksy S, Grob S, Ekdahl M (1960) Survey of employment experience of patients discharged from three mental hospitals during the period 1951–1953. Ment Hyg 44:510–521

    Google Scholar 

  45. Pearson V (1995) Mental health care in China: state policies, professional services and family responsibilities. Gaskell, London

    Google Scholar 

  46. Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S (1999) The public’s view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. Am J Public Health 89:1339–1345

    PubMed  CAS  Google Scholar 

  47. Provencher HL, Gregg R, Mead S, Mueser KT (2002) The role of work in the recovery of persons with psychiatric disabilities. Psychiatr Rehabil J 26:132–144

    Article  PubMed  Google Scholar 

  48. Raguram R, Raghu TM, Vounatsou P, Weiss MG (2004) Schizophrenia and the cultural epidemiology of Stigma in Bangalore, India. J Nerv Ment Dis 192:734–744

    Article  PubMed  Google Scholar 

  49. Resnick SG, Fontana A, Lehman AF, Rosenheck RA (2005) An empirical conceptualization of the recovery orientation. Schizophr Res 75:119–128

    Article  PubMed  Google Scholar 

  50. Rochlin J (1987) Rehabilitation: an employer’s perspective. Rehabil Educ, 1:89–94

    Google Scholar 

  51. Scheid TL (2005) Stigma as a barrier to employment: mental disability and the Americans with disabilities act. Int J Law Psychiatry 28:670–690

    Article  PubMed  Google Scholar 

  52. Schiff AC (2004) Recovery and mental illness: analysis and personal reflections. Psychiatr Rehabil J 27:212–218

    Article  PubMed  Google Scholar 

  53. Srinivasan L, Tirupati S (2005) Relationship between cognition and work functioning among patients with schizophrenia in an urban area of India. Psychiatr Serv 56:1423–1428

    Article  PubMed  Google Scholar 

  54. Tan CT, Chee KT, Leung FY (1981) Psychiatric patients who seek traditional healers in Singapore. Singapore Med J 22:643–647

    Google Scholar 

  55. Taylor SM, Dear MJ (1981) Scaling community attitudes toward the mentally-ill. Schizophr Bull 7:225–240

    PubMed  CAS  Google Scholar 

  56. Thomas TD, Thomas G, Joiner JG (1993) Issues in the vocational rehabilitation of persons with serious and persistent mental illness: a national survey of counselor insights. Psychosoc Rehabil J 16:129–134

    Google Scholar 

  57. Tsang HWH, Chen EYH Perceptions on remission and recovery in schizophrenia. Psychopathology (in press)

  58. Tsang H, Lam P, Ng B, Leung O (2000) Predictors of employment outcome of people with psychiatric disabilities: a review of the literature since mid 80s. J Rehabil 66:19–31

    Google Scholar 

  59. Tsang HWH, Ng B, Chiu F (2002) Job profiles of people with schizophrenia: implications for rehabilitation. Int J Rehabil Res 25:189–196

    Article  PubMed  Google Scholar 

  60. Tsang HWH, Tam P, Chan F, Cheung WM (2003) Stigmatizing attitudes towards individuals with mental illness in Hong Kong: implications to their recovery. J Community Psychol 31:383–396

    Article  Google Scholar 

  61. Tsang H, Weng YZ, Tam P (2000) Needs and problems related to mental health services in Beijing. Psychiatr Rehabil Skills 4:1–21

    Google Scholar 

  62. Waghorn G, Lewis S (2002) Disclosure of psychiatric disabilities in vocational rehabilitation. Aust J Rehabil Couns 8:67–80

    Google Scholar 

  63. Waghorn G, Lloyd C (2005) The employment if people with mental illness. AeJAMH 4:1446–1798

    Google Scholar 

  64. Wahl O (1999) Mental health consumers’ experience of stigma. Schizophr Bull 25:467–478

    PubMed  CAS  Google Scholar 

  65. Wansborough N, Cooper P (1980) Open employment after psychotic disorder. Tavistock Publications, London

    Google Scholar 

  66. Webber A, Orcutt J (1984) Employers’ reactions to racial and psychiatric stigma: a field experiment. Deviant Behav 5:327–336

    Article  Google Scholar 

  67. Weiner B (1980) A cognitive (attribution)-emotion-action model of motivated behavior: a analysis of judgments of help giving. J Pers Soc Psychol 39:186–200

    Article  Google Scholar 

  68. Weiner B (1983) Some methodological pitfalls in attributional research. J Educ Psychol 75:530–543

    Article  Google Scholar 

  69. Weiner B (1985) An attributional theory of achievement motivation and emotion. Psychol Rev 92:548–573

    Article  PubMed  CAS  Google Scholar 

  70. Weiner B (1993) On sin versus sickness: a theory of perceived responsibility and social motivation. Am Psychol 48:957–965

    Article  PubMed  CAS  Google Scholar 

  71. Weiner B (1995) Judgments of responsibility: a foundation for a theory of social conduct. Guiford Press, New York

    Google Scholar 

  72. Weiss MG (1997) The explanatory model interview catalogue (EMIC). Framework for comparative study of illness. Transcult Psychiatry 34:235–263

    Article  Google Scholar 

  73. Weiss MG, Sharma SD, Gaur RK, Sharma JS, Desai A, Doongaji DR (1986) Traditional concepts of mental disorder among Indian psychiatric patients: preliminary report of work in progress. Soc Sci Med 23:379–386

    Article  PubMed  CAS  Google Scholar 

  74. Wilgosh L, Skaret D (1987) Employer attitudes toward hiring individuals with disabilities: a review of the recent literature. Can J Rehabil 1:89–98

    Article  Google Scholar 

Download references

Acknowledgments

This study was supported by a grant referenced AA014842-01 from the U.S. National Institute on Alcohol Abuse and Alcoholism, the National Institute of Mental Health, and the Fogarty International Center. We are also grateful to Natalie Slopen, Ellen Chan, Lin Lin, Xioalu Wang, Zhen Wang, Xiaopeng Rui, Bei Liu, Menglei Shi, Yang Ye, and Yi Wang for interviewing the employers.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hector W.H. Tsang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tsang, H.W., Angell, B., Corrigan, P.W. et al. A cross-cultural study of employers’ concerns about hiring people with psychotic disorder: implications for recovery. Soc Psychiat Epidemiol 42, 723–733 (2007). https://doi.org/10.1007/s00127-007-0208-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-007-0208-x

Key words

Navigation