November 3, 2010
Researchers in the American Journal of Psychiatry recently evaluated perceptions towards mental illness (schizophrenia and depression) and alcohol dependence, comparing public endorsement of treatment and prejudice from studies performed in 1996 versus 2006. They found that the public perceived mental illness increasingly as a neurobiological disease, increasingly endorsing psychiatric services and medical treatment. However, the stigma of mental illness and community acceptance of people with these problems did not decrease over this time period. It is apparent there is much work to be done to educate the public regarding mental illness and the associated misconceptions.
Am J Psychiatry 2010; 167:1321-1330
(published online September 15, 2010; doi: 10.1176/appi.ajp.2010.09121743)
“A Disease Like Any Other”? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence
Bernice A. Pescosolido, Ph.D., Jack K. Martin, Ph.D., J. Scott Long, Ph.D., Tait R. Medina, M.A., Jo C. Phelan, Ph.D., and Bruce G. Link, Ph.D.
From the Schuessler Institute for Social Research and the Department of Sociology, Indiana University; and the Mailman School of Public Health, Columbia University, New York.
OBJECTIVE: Clinicians, advocates, and policy makers have presented mental illnesses as medical diseases in efforts to overcome low service use, poor adherence rates, and stigma. The authors examined the impact of this approach with a 10-year comparison of public endorsement of treatment and prejudice.
METHOD: The authors analyzed responses to vignettes in the mental health modules of the 1996 and 2006 General Social Survey describing individuals meeting DSM-IV criteria for schizophrenia, major depression, and alcohol dependence to explore whether more of the public 1) embraces neurobiological understandings of mental illness; 2) endorses treatment from providers, including psychiatrists; and 3) reports community acceptance or rejection of people with these disorders. Multivariate analyses examined whether acceptance of neurobiological causes increased treatment support and lessened stigma.
RESULTS: In 2006, 67% of the public attributed major depression to neurobiological causes, compared with 54% in 1996. High proportions of respondents endorsed treatment, with general increases in the proportion endorsing treatment from doctors and specific increases in the proportions endorsing psychiatrists for treatment of alcohol dependence (from 61% in 1996 to 79% in 2006) and major depression (from 75% in 1996 to 85% in 2006). Social distance and perceived danger associated with people with these disorders did not decrease significantly. Holding a neurobiological conception of these disorders increased the likelihood of support for treatment but was generally unrelated to stigma. Where associated, the effect was to increase, not decrease, community rejection.
CONCLUSIONS: More of the public embraces a neurobiological understanding of mental illness. This view translates into support for services but not into a decrease in stigma. Reconfiguring stigma reduction strategies may require providers and advocates to shift to an emphasis on competence and inclusion.