Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-23T06:06:30.862Z Has data issue: false hasContentIssue false
  • English
  • Français

Causal beliefs of the public and social acceptance of persons with mental illness: a comparative analysis of schizophrenia, depression and alcohol dependence

Published online by Cambridge University Press:  11 April 2013

G. Schomerus ,
H. Matschinger  and
M. C. Angermeyer
G. Schomerus*
Affiliation:
Department of Psychiatry, Greifswald University, Germany HELIOS Hanseklinikum Stralsund, Germany
H. Matschinger
Affiliation:
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany
M. C. Angermeyer
Affiliation:
Department of Public Health, University of Cagliari, Italy Center for Public Mental Health, Gösing am Wagram, Austria
*
*Address for correspondence: G. Schomerus, M.D., Department of Psychiatry, University of Greifswald, Rostocker Chaussee 70, 17437 Stralsund, Germany. (Email:georg.schomerus@uni-greifswald.de)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

There is an ongoing debate whether biological illness explanations improve tolerance towards persons with mental illness or not. Several theoretical models have been proposed to predict the relationship between causal beliefs and social acceptance. This study uses path models to compare different theoretical predictions regarding attitudes towards persons with schizophrenia, depression and alcohol dependence.

Method

In a representative population survey in Germany (n = 3642), we elicited agreement with belief in biogenetic causes, current stress and childhood adversities as causes of either disorder as described in an unlabelled case vignette. We further elicited potentially mediating attitudes related to different theories about the consequences of biogenetic causal beliefs (attribution theory: onset responsibility, offset responsibility; genetic essentialism: differentness, dangerousness; genetic optimism: treatability) and social acceptance. For each vignette condition, we calculated a multiple mediator path model containing all variables.

Results

Biogenetic beliefs were associated with lower social acceptance in schizophrenia and depression, and with higher acceptance in alcohol dependence. In schizophrenia and depression, perceived differentness and dangerousness mediated the largest indirect effects, the consequences of biogenetic causal explanations thus being in accordance with the predictions of genetic essentialism. Psychosocial causal beliefs had differential effects: belief in current stress as a cause was associated with higher acceptance in schizophrenia, while belief in childhood adversities resulted in lower acceptance of a person with depression.

Conclusions

Biological causal explanations seem beneficial in alcohol dependence, but harmful in schizophrenia and depression. The negative correlates of believing in childhood adversities as a cause of depression merit further exploration.

Keywords

Attribution theorygenetic essentialismpopulation surveypublic attitudesstigma
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 2 , January 2014 , pp. 303 - 314
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alwin, DF, Hauser, RM (1975). The decomposition of effects in path analysis. American Sociological Review 40, 37–47.CrossRefGoogle Scholar
Angermeyer, MC, Holzinger, A, Carta, MG, Schomerus, G (2011). Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. British Journal of Psychiatry 199, 367–372.CrossRefGoogle ScholarPubMed
Angermeyer, MC, Matschinger, H (1997). Social distance towards the mentally ill: results of representative surveys in the Federal Republic of Germany. Psychological Medicine 27, 131–141.CrossRefGoogle ScholarPubMed
Angermeyer, MC, Matschinger, H (2005). Causal beliefs and attitudes to people with schizophrenia: trend analysis based on data from two population surveys in Germany. British Journal of Psychiatry 186, 331–334.CrossRefGoogle ScholarPubMed
Aroian, LA (1947). The probability function of the product of two normally distributed variables. Annals of Mathematical Statistics 18, 265–271.CrossRefGoogle Scholar
Aroian, LA, Taneja, VS, Cornwell, LW (1978). Mathematical forms of the distribution of the product of two normal variables. Communications in Statistics – Theory and Methods 7, 165–172.CrossRefGoogle Scholar
Bag, B, Yilmaz, S, Kirpinar, I (2006). Factors influencing social distance from people with schizophrenia. International Journal of Clinical Practice 60, 289–294.CrossRefGoogle ScholarPubMed
Bastian, B, Haslam, N (2006). Psychological essentialism and stereotype endorsement. Journal of Experimental Social Psychology 42, 228–235.CrossRefGoogle Scholar
Bennett, L, Thirlaway, K, Murray, AJ (2008). The stigmatising implications of presenting schizophrenia as a genetic disease. Journal of Genetic Counseling 17, 550–559.CrossRefGoogle ScholarPubMed
Boysen, GA (2011). Biological explanations and stigmatizing attitudes: using essentialism and perceived dangerousness to predict antistigma intervention effectiveness. Journal of Social Psychology 151, 274–291.CrossRefGoogle ScholarPubMed
Conrad, P (2001). Genetic optimism: framing genes and mental illness in the news. Culture, Medicine and Psychiatry 25, 225–247.CrossRefGoogle ScholarPubMed
Corrigan, PW (2000). Mental health stigma as social attribution: implications for research methods and attitude change. Clinical Psychology: Science and Practice 7, 48–67.Google Scholar
Corrigan, PW, Watson, AC (2004). At issue: stop the stigma: call mental illness a brain disease. Schizophrenia Bulletin 30, 477–479.CrossRefGoogle ScholarPubMed
Crisp, AH, Gelder, MG, Goddard, E, Meltzer, HI (2005). Stigmatization of people with mental illnesses: a follow-up study within the Changing Minds campaign of the Royal College of Psychiatrists. World Psychiatry 4, 106–113.Google ScholarPubMed
Dar-Nimrod, I, Heine, SJ (2011). Genetic essentialism: on the deceptive determinism of DNA. Psychological Bulletin 137, 800–818.CrossRefGoogle ScholarPubMed
Dietrich, S, Beck, M, Bujantugs, B, Kenzine, D, Matschinger, H, Angermeyer, MC (2004). The relationship between public causal beliefs and social distance toward mentally ill people. Australian and New Zealand Journal of Psychiatry 38, 348–354.CrossRefGoogle ScholarPubMed
Dietrich, S, Matschinger, H, Angermeyer, MC (2006). The relationship between biogenetic causal explanations and social distance toward people with mental disorders: results from a population survey in Germany. International Journal of Social Psychiatry 52, 166–174.CrossRefGoogle ScholarPubMed
Fusar-Poli, P, Broome, M, Cortesi, M (2007). Can neuroimaging reduce social stigma in schizophrenia? Medical Hypotheses 69, 457.CrossRefGoogle ScholarPubMed
Grausgruber, A, Schöny, W, Grausgruber-Berner, R, Koren, G, Apor, BF, Wancata, J, Meise, U (2009). “Schizophrenie hat viele Gesichter” – Evaluierung der österreichischen Anti-Stigma-Kampagne 2000–2002 (“Schizophrenia has many faces” – evaluation of the Austrian Anti-Stigma Campaign 2000–2002). Psychiatrische Praxis 36, 327–333.CrossRefGoogle ScholarPubMed
Hansell, J, Bailin, AP, Franke, KA, Kraft, JM, Wu, HY, Dolsen, MR, Harley, VS, Kazi, NF (2011). Conceptually sound thinking about depression: an Internet survey and its implications. Professional Psychology: Research and Practice 42, 382–390.CrossRefGoogle Scholar
Haslam, N, Rothschild, L, Ernst, D (2000). Essentialist beliefs about social categories. British Journal of Social Psychology 39, 113–127.CrossRefGoogle ScholarPubMed
Insel, TR (2009). Disruptive insights in psychiatry: transforming a clinical discipline. Journal of Clinical Investigation 119, 700–705.CrossRefGoogle ScholarPubMed
Jorm, AF, Griffiths, KM (2008). The public's stigmatizing attitudes towards people with mental disorders: how important are biomedical conceptualizations? Acta Psychiatrica Scandinavica 118, 315–321.CrossRefGoogle ScholarPubMed
Kurtz, E (2002). Alcoholics Anonymous and the disease concept of alcoholism. Alcoholism Treatment Quarterly 20, 5–39.CrossRefGoogle Scholar
Lam, D, Salkovskis, P, Warwick, H (2005). An experimental investigation of the impact of biological versus psychological explanations of the cause of “mental illness”. Journal of Mental Health 14, 453–464.CrossRefGoogle Scholar
Lewison, G, Roe, P, Wentworth, A, Szmukler, G (2012). The reporting of mental disorders research in British media. Psychological Medicine 42, 435–441.CrossRefGoogle ScholarPubMed
Link, BG, Cullen, FT, Frank, J, Wozniak, JF (1987). The social rejection of former mental patients: understanding why labels matter. American Journal of Sociology 92, 1461–1500.CrossRefGoogle Scholar
Link, BG, Phelan, JC, Bresnahan, M, Stueve, A, Pescosolido, BA (1999). Public conceptions of mental illness: labels, causes, dangerousness, and social distance. American Journal of Public Health 89, 1328–1333.CrossRefGoogle ScholarPubMed
MacKinnon, DP, Fairchild, AJ (2009). Current directions in mediation analysis. Current Directions in Psychological Science 18, 16–20.CrossRefGoogle ScholarPubMed
MacKinnon, DP, Fairchild, AJ, Fritz, MS (2007). Mediation analysis. Annual Review of Psychology 58, 593.CrossRefGoogle ScholarPubMed
MacKinnon, DP, Warsi, G, Dwyer, JH (1995). A simulation study of mediated effect measures. Multivariate Behavioral Research 30, 41–62.CrossRefGoogle ScholarPubMed
Martin, JK, Pescosolido, BA, Olafsdottir, S, McLeod, JD (2007). The construction of fear: Americans’ preferences for social distance from children and adolescents with mental health problems. Journal of Health and Social Behavior 48, 50–67.CrossRefGoogle ScholarPubMed
Martin, JK, Pescosolido, BA, Tuch, SA (2000). Of fear and loathing: the role of ‘disturbing behavior,’ labels, and causal attributions in shaping public attitudes toward people with mental illness. Journal of Health and Social Behavior 41, 208–223.CrossRefGoogle Scholar
National Alliance for Mental Illness (2008). Understanding schizophrenia and recovery: what you need to know about this medical illness (http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID6 = 7729). Accessed 23 July 2010.Google Scholar
National Alliance for Mental Iillness (2009). Major depression fact sheet (http://www.nami.org/Template.cfm?Section=Depression&Template=/ContentManagement/ContentDisplay.cfm&ContentID8 = 8956). Accessed 15 July 2010.Google Scholar
Nelkin, D, Lindee, MS (1995). The DNA Mystique: The Gene as a Cultural Icon. Freeman: New York.Google Scholar
Pattyn, E, Verhaeghe, M, Bracke, P (2012). Attitudes toward community mental health care: the contact paradox revisited. Community Mental Health Journal. Published online 20 11 2012 . doi:10.1007/s10597–012-9564-4.CrossRefGoogle Scholar
Pescosolido, BA, Martin, JK, Long, JS, Medina, TR, Phelan, JC, Link, BG (2010). “A disease like any other”? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American Journal of Psychiatry 167, 1321–1330.CrossRefGoogle ScholarPubMed
Phelan, JC (2005). Geneticization of deviant behavior and consequences for stigma: the case of mental illness. Journal of Health and Social Behavior 46, 307–322.CrossRefGoogle ScholarPubMed
Phelan, JC, Yang, LH, Cruz-Rojas, R (2006). Effects of attributing serious mental illnesses to genetic causes on orientations to treatment. Psychiatric Services 57, 382–387.CrossRefGoogle ScholarPubMed
Preacher, KJ, Hayes, AF (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods 40, 879–891.CrossRefGoogle ScholarPubMed
Raykov, T, Mels, G (2007). Lower level mediation effect analysis in two-level studies: a note on a multilevel structural equation modeling approach. Structural Equation Modeling 14, 636–648.CrossRefGoogle Scholar
Schnittker, J (2008). An uncertain revolution: why the rise of a genetic model of mental illness has not increased tolerance. Social Science and Medicine 67, 1370–1381.CrossRefGoogle Scholar
Schomerus, G (2012). Stigmatisierung der Opfer von Kindesmisshandlungen – Traumafolgen im sozialen Kontext (Stigmatization of child abuse victims – the consequences of trauma in a social context). In Kindesmisshandlung. Psychische und körperliche Folgen im Erwachsenenalter (Child Abuse: Mental and Physical Consequences in Adulthood) (ed. Spitzer, C. and Grabe, H. J.), pp. 413–419. Kohlhammer: Stuttgart.Google Scholar
Schomerus, G, Matschinger, H, Angermeyer, MC (2006 a). Alcoholism: illness beliefs and resource allocation preferences of the public. Drug and Alcohol Dependence 82, 204–210.CrossRefGoogle ScholarPubMed
Schomerus, G, Matschinger, H, Angermeyer, MC (2006 b). Preferences of the public regarding cutbacks in expenditure for patient care: are there indications of discrimination against those with mental disorders? Social Psychiatry and Psychiatric Epidemiology 41, 369–377.CrossRefGoogle ScholarPubMed
Schomerus, G, Matschinger, H, Angermeyer, MC (2008). Traces of Freud – the unconscious conflict as a cause of mental disorders in the eyes of the general public. Psychopathology 41, 173–178.CrossRefGoogle ScholarPubMed
Schomerus, G, Matschinger, H, Angermeyer, MC (2013). Continuum beliefs and stigmatizing attitudes towards persons with schizophrenia, depression and alcohol dependence. Psychiatry Research. Published online 2 03 2013 . doi:10.1016/j.psychres.2013.02.006.CrossRefGoogle Scholar
Schomerus, G, Schwahn, C, Holzinger, A, Corrigan, PW, Grabe, HJ, Carta, MG, Angermeyer, MC (2012). Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica 125, 440–452.CrossRefGoogle ScholarPubMed
Sellman, D (2010). The 10 most important things known about addiction. Addiction 105, 6–13.CrossRefGoogle ScholarPubMed
Sobel, ME (1982). Asymptotic confidence intervals for indirect effects in structural equation models. Sociological Methodology 13, 290–312.CrossRefGoogle Scholar
Sobel, ME (1986). Some new results on indirect effects and their standard errors in covariance structure models. Sociological Methodology 16, 159–186.CrossRefGoogle Scholar
van 't Veer, JT, Kraan, HF, Drosseart, SH, Modde, JM (2006). Determinants that shape public attitudes towards the mentally ill: a Dutch public study. Social Psychiatry and Psychiatric Epidemiology 41, 310–317.CrossRefGoogle ScholarPubMed
Walker, I, Read, J (2002). The differential effectiveness of psychosocial and biogenetic causal explanations in reducing negative attitudes toward “mental illness”. Psychiatry 65, 313–325.CrossRefGoogle ScholarPubMed
Weiner, B (1995). Judgments of Responsibility : A Foundation for a Theory of Social Conduct. Guilford Press: New York.Google Scholar
WonPat-Borja, AJ, Yang, LH, Link, BG, Phelan, JC (2012). Eugenics, genetics, and mental illness stigma in Chinese Americans. Social Psychiatry and Psychiatric Epidemiology 47, 145–156.CrossRefGoogle ScholarPubMed
Wu, A, Zumbo, B (2008). Understanding and using mediators and moderators. Social Indicators Research 87, 367–392.CrossRefGoogle Scholar
Zubin, J, Spring, B (1977). Vulnerability: a new view of schizophrenia. Journal of Abnormal Psychology 86, 103–126.CrossRefGoogle ScholarPubMed
Supplementary material: File

Schomerus et al. supplementary material

Supplementary table

Download Schomerus et al. supplementary material(File)
File 75.1 KB
Supplementary material: File

Schomerus et al. supplementary material

Supplementary material

Download Schomerus et al. supplementary material(File)
File 23.6 KB