The public stigma of mental illness means a difference between you and me
Introduction
Public stigma has egregious effects on the lives of people with mental illness leading to significant barriers to the individual׳s pursuit of vocational, housing, and healthcare goals (Sartorius and Schulze, 2005, Callard et al., 2012). Many social scientists have described stigma as prejudice and discrimination; stereotypic beliefs that lead power groups – employers, landlords, and healthcare providers – to restrict opportunities of people labeled with mental illness (Link and Phelan, 2001). In addition, stigma might stop people with mental illness from seeking out care. Called label avoidance, people in distress avoid mental health treatment thereby escaping the stigmatizing label that accompanies it (Corrigan et al., 2014a). One model of prejudice and discrimination, based on attribution theory, has been widely tested to describe the stigmatizing experience of people with mental illness (Corrigan, 2000). The model rests on two empirically supported paths (Corrigan et al., 2003, Pingani et al., 2012, Roe et al., 2012): (1) beliefs that people are responsible for their mental illness lead to anger and an unwillingness to help. (2) beliefs that people with mental illness are dangerous lead to fear, desire to stay apart from this group, and calls for coercive treatment and institutionalization. A measure of this model, the Attribution Questionnaire (long and short forms), has been shown to be reliable, valid, and sensitive to the effects of stigma change programs (Corrigan et al., 2002, Brown, 2008, Pinto et al., 2012).
Stigma, however, is more than endorsing disrespectful beliefs; labeled persons are placed into categories different from the majority resulting in separation of “us” from “them” (Link and Phelan, 2001). In some ways, this might be considered the “content-less” belief; there is no substantive attribution for separateness, only the assertion that people with mental illness are different from me. The Opinion about Mental Illness (OMI) scale, used for more than 50 years to document aspects of stigma, included an item on difference: “A heart patient has just one thing wrong with him while a mentally ill person is completely different from other patients” (Cohen and Struening, 1962). A subsequent review of the assessment literature on mental illness stigma uncovered 16 quantitative studies that included some measurement of cognitive separating (social labels imply difference between us and them), but separation was assessed only by one or two items per scale (Link et al., 2004). These studies did not include psychometrics on any assessment of difference per se. We conducted an additional review of the social science literature and only found one paper measuring difference as a social construct; this however, was an assessment of the appreciation of human similarities and difference in general (Miville et al., 1999).
Stigma measurement might be diminished by social desirability (Stier and Hinshaw, 2007, Corrigan and Shapiro, 2010); i.e., people underreport endorsement of stigmatizing beliefs in order to avoid perceptions of being bigoted and lacking open-mindedness. This is problematic when conducting outcome assessments of anti-stigma interventions. Floor effects on stigma measures that result from social desirability restrict the range of possible benefits after participating in anti-stigma programs. Viewing someone as different may be less threatening to personal beliefs of open-mindedness. Hence, in addition to offering another way to understand the prejudice of mental illness, measures of “difference” may provide a more sensitive assessment of anti-stigma interventions. Stigmatizing beliefs and stereotypes have been assessed using varied psychometric strategies including Likert scales and semantic differentials with the object of difference being me, most other people, or people with other kinds of illness (Link et al., 2004, Corrigan and Shapiro, 2010). The purpose of this study is to test the psychometrics of various assessments of difference. We expect to show research participants are more likely to endorse items on these differentness scales than stigmatizing beliefs as measured on the Attribution Questionnaire. We also expect the differentness scales to be significantly associated with other measures of stigma.
Section snippets
Methods
Stigma is often assessed by presenting a vignette of a person with serious mental illness. Our difference measures used a vignette that has been tested and validated in research on the Attribution Questionnaire (Corrigan et al., 2002):
“Harry is a 30 year old single man with schizophrenia. Sometimes he hears voices and becomes upset. He lives alone in an apartment and works as a clerk at a large law firm. He has been hospitalized six times because of his illness.”
Several measures of difference
Results
Using principal component analyses and varimax rotation, the EFA of the Cause of Perceived Difference Scale yielded a two factor solution with Eigenvalues greater than 1.8. The first factor accounted for 47.4% of the variance and represented attribution of difference to illness descriptors (e.g., Harry has schizophrenia or sometimes Harry hears voices). The second factor (18.9% of variance) represented difference attributions based on demographics (Harry is a 30 year old single man). EFA of the
Discussion
Perceived difference is hypothesized to be another way of conceptualizing the stigma of mental illness, which the public is more likely to endorse than measures of other stereotypes. Results supported this hypothesis with all three measures of difference yielding higher endorsements than items of the Attribution Questionnaire. The difference scale scores all had strong internal consistencies. Although participants endorsed stereotypes about Harry at a low level, they were quite willing to view
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