RESEARCH WEEKLY: Changes in Stigma Toward Serious Mental Illness Over the Past 20 Years
By Elizabeth Sinclair Hancq
(August 3, 2022) The prejudice and discrimination toward people with serious mental illness, often referred to as stigma, changes with public perceptions of people with serious mental illness, individual experiences and societal culture. Whereas schizophrenia was thought to be the result of a broken ego due to an ambivalent mother in much of the early 20th century, today it is much more accepted as an illness affecting the brain.
Research published in JAMA Network Open in December of last year examines how public stigma toward mental illness has changed in the past 20 years. The study authors from Indiana University utilized data from national stigma studies in the United States that included interviews conducted in 1996, 2006 and 2018. In the interviews, respondents were asked to react to different vignettes about people with schizophrenia, major depression or alcohol dependence and responded to questions about their beliefs about the underlying causes, perceptions of violence and their desire for social distance from these individuals with the illnesses.
Changes in stigma over time
There were some significant changes over time in public stigma toward mental illness. According to the study, overall public stigma toward major depression significantly decreased in the 22 years of the study, whereas public stigma for schizophrenia or alcohol dependence remained unchanged. The decrease in stigma of depression was especially pronounced in the more recent period of the study, from 2006 to 2018. For example, approximately one in three individuals expressed an unwillingness to socialize with someone with depression in 2006, but less than one in five individuals expressed the same unwillingness in 2018. While almost 50% of individuals reported an unwillingness to work closely with someone with depression in 2006, only 30% expressed that same unwillingness in 2018. There was no difference in attitudes by different demographic variables, although they did find the well-known conservatizing effect of age: individuals have an increased likelihood of holding more stigmatizing attitudes as they get older.
Over the 22-year period, there was no change in public stigma towards schizophrenia, according to the results. Although not statistically significant, there was a greater belief of dangerousness associated with schizophrenia over the 22 years. The percentage of participants who expressed concerns about the dangerousness to others posed by individuals with schizophrenia increased 13 percentage points from a little more than half in 1996 to almost 70% in 2018.
Despite the limited changes in public stigma toward people with mental illness in the past 20 or so years, the study results indicate a substantial increase in the public acceptance of the biomedical causes of mental illness. The results indicate that participants were more likely to consider mental illness as a chemical imbalance or genetic problem in the most recent interviews, rather than a result of bad character or the way an individual was raised.
Implications of the results
The increase in scientific attribution of mental illness without a subsequent decrease in public stigma has important implications. The results suggest that what the public believes does not necessarily translate into changing their attitudes and behavior toward mental illness. As a result, stigma reduction strategies focused on health literacy or mental health awareness campaigns may not have the desired effect in addressing the “us vs. them” mentality. As Dr. Allen Frances wrote in response to the publication of this research, “the only way to reduce stigma of schizophrenia is to end our shameful neglect” of these individuals. Lack of treatment means that individuals with schizophrenia have more severe symptoms and are more visibly present to society in our nation’s emergency departments, jails and prisons and on our streets. Therefore, ensuring access to treatment for our most vulnerable could be a more effective stigma reduction strategy.
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