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Angermeyer M.C.,Center for Public Mental Health | Angermeyer M.C.,University of Cagliari | Holzinger A.,Medical University of Vienna | Carta M.G.,University of Cagliari | Schomerus G.,University of Greifswald
British Journal of Psychiatry | Year: 2011

Background: Biological or genetic models of mental illness are commonly expected to increase tolerance towards people with mental illness, by reducing notions of responsibility and blame. Aims: To investigate whether biogenetic causal attributions of mental illness among the general public are associated with more tolerant attitudes, whether such attributions are related to lower perceptions of guilt and responsibility, to what extent notions of responsibility are associated with rejection of people who are mentally ill, and how prevalent notions of responsibility are among the general public with regard to different mental disorders. Method: A systematic review was conducted of representative population studies examining attitudes towards people with mental illness and beliefs about such disorders. Results: We identified 33 studies relevant to this review. Generally, biogenetic causal attributions were not associated with more tolerant attitudes; they were related to stronger rejection in most studies examining schizophrenia. No published study reported on associations of biogenetic causal attributions and perceived responsibility. The stereotype of self-responsibility was unrelated to rejection in most studies. Public images of mental disorder are generally dominated by the stereotypes of unpredictability and dangerousness, whereas responsibility is less relevant. Conclusions: Biogenetic causal models are an inappropriate means of reducing rejection of people with mental illness. Declaration of interest: None.


Schomerus G.,University of Greifswald | Matschinger H.,University of Leipzig | Angermeyer M.C.,University of Cagliari | Angermeyer M.C.,Center for Public Mental Health
Psychological Medicine | Year: 2014

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. Copyright © Cambridge University Press 2013.


Schomerus G.,University of Greifswald | Schwahn C.,University of Greifswald | Holzinger A.,Medical University of Vienna | Corrigan P.W.,Illinois Institute of Technology | And 4 more authors.
Acta Psychiatrica Scandinavica | Year: 2012

Objective: To explore whether the increase in knowledge about the biological correlates of mental disorders over the last decades has translated into improved public understanding of mental illness, increased readiness to seek mental health care and more tolerant attitudes towards mentally ill persons. Method: A systematic review of all studies on mental illness-related beliefs and attitudes in the general population published before 31 March 2011, examining the time trends of attitudes with a follow-up interval of at least 2years and using national representative population samples. A subsample of methodologically homogeneous studies was further included in a meta-regression analysis of time trends. Results: Thirty-three reports on 16 studies on national time trends met our inclusion criteria, six of which were eligible for a meta-regression analysis. Two major trends emerged: there was a coherent trend to greater mental health literacy, in particular towards a biological model of mental illness, and greater acceptance of professional help for mental health problems. In contrast, however, no changes or even changes to the worse were observed regarding the attitudes towards people with mental illness. Conclusion: Increasing public understanding of the biological correlates of mental illness seems not to result in better social acceptance of persons with mental illness. © 2012 John Wiley & Sons A/S.


Speerforck S.,University of Greifswald | Schomerus G.,University of Greifswald | Pruess S.,University of Greifswald | Angermeyer M.C.,University of Cagliari | Angermeyer M.C.,Center for Public Mental Health
Journal of Affective Disorders | Year: 2014

Objective It is unclear whether different biogenetic causal beliefs affect stigmatization of mentally-ill patients differently. It has been argued that in particular believing in a 'chemical imbalance' as a cause of mental disorder might be associated with more tolerant attitudes. Method In a representative population survey in Germany (n=3642), using unlabelled case vignettes of persons with depression, schizophrenia, or alcohol dependence, we elicited agreement with three different biogenetic explanations of the illness: 'Chemical imbalance of the brain', 'brain disease' and 'heredity'. We further investigated emotional reactions as well as the desire for social distance. For each vignette condition we calculated linear regressions with each biogenetic explanation as independent and emotional reactions as well as social distance as dependent variable controlling for socio-demographic variables. Limitations Our cross-sectional study does not allow statements regarding causality and the explanatory power of our statistical models was low. Results 'Chemical imbalance of the brain' and 'brain disease' were both associated with a stronger desire for social distance in schizophrenia and depression, and with more social acceptance in alcohol dependence, whereas 'heredity' was not significantly associated with social distance in any of the investigated illnesses. All three biogenetic causal beliefs were associated with more fear in all three illnesses. Conclusion Our study corroborates findings that biogenetic explanations have different effects in different disorders, and seem to be harmful in depression and schizophrenia. A particular de-stigmatizing potential of the causal belief 'chemical imbalance' could not be found. Implications for useful anti-stigma messages are discussed. © 2014 Elsevier B.V.


Schomerus G.,University of Greifswald | Matschinger H.,University of Leipzig | Matschinger H.,University of Hamburg | Angermeyer M.C.,University of Cagliari | Angermeyer M.C.,Center for Public Mental Health
Psychiatry Research | Year: 2013

Separation is a central step in the process of stigmatizing persons with mental disorders. We examine whether belief in a continuum of symptoms from mental health to mental illness is associated with less stigmatizing attitudes. In a representative population survey in Germany (n=3642), using case-vignettes of persons suffering from schizophrenia, depression or alcohol dependence, we measured belief in a continuity of symptoms, emotional reactions and desire for social distance related to the person described in the vignette. While 42% of respondents agreed in symptom continuity for depression, this percentage was 26% for schizophrenia and 27% for alcohol dependence. Continuum beliefs were associated in general with more positive emotional reactions and less desire for social distance. This relationship was strongest for schizophrenia, followed by alcohol dependence. Continuum beliefs thus seem to be associated with less stigmatizing attitudes, particularly regarding schizophrenia and alcohol dependence. Educational information on the continuous nature of most psychopathological phenomena could usefully be integrated in anti-stigma messages. © 2013 Elsevier Ireland Ltd.


Angermeyer M.C.,Center for Public Mental Health | Angermeyer M.C.,University of Cagliari | Matschinger H.,University of Leipzig | Matschinger H.,University of Hamburg | Schomerus G.,University of Greifswald
British Journal of Psychiatry | Year: 2013

Background: Over the past decades, psychiatry, as a science and a clinical discipline, has witnessed profound changes. Aims: To examine whether these changes are reflected in changes in the public's conceptualisation of mental disorders, the acceptance of mental health treatment and attitudes towards people with mental illness. Method: In 1990 and 2011, population surveys were conducted in Germany on public attitudes about schizophrenia, depression and alcohol dependence. Results: Although the public has become more inclined to endorse a biological causation of schizophrenia, the opposite trend was observed with the other two disorders. The public's readiness to recommend help-seeking from mental health professionals and using psychotherapy and psychotropic medication has increased considerably. Attitudes towards people with schizophrenia worsened, whereas for depression and alcohol dependence no or inconsistent changes were found. Conclusions: The growing divide between attitudes towards schizophrenia and other mental disorders should be of particular concern to future anti-stigma campaigns.


Holzinger A.,Medical University of Vienna | Matschinger H.,University of Leipzig | Angermeyer M.C.,Center for Public Mental Health | Angermeyer M.C.,University of Cagliari
Epidemiology and Psychiatric Sciences | Year: 2011

Aims. Several population studies on beliefs about depression carried out in western countries during the 1990s have shown that the public clearly favors psychotherapy over antidepressant medication. The present study examines whether this phenomenon still exists at the end of the first decade of the twenty-first century.Materials and Methods. In 2009, a telephone survey was conducted among the population of Vienna aged 16 years and older (n=1205). A fully structured interview was administered which began with the presentation of a vignette depicting a case of depression fulfilling the diagnostic criteria of DSM-IV for a moderate depressive episode.Results. Psychotherapists were most frequently endorsed as source of professional help. Antidepressant medication still was more frequently advised against than recommended. Respondents familiar with the treatment of depression tended to be more ready to recommend to seek help from mental health professionals and to endorse various treatment options, particularly medication.Conclusion. At the end of the first decade of this century, there still exists a large gap between the public's beliefs and what mental health professionals consider appropriate for the treatment of depression. Therefore, further effort to improve the public's mental health literacy seems necessary. © 2011 Cambridge University Press.


Bahlmann J.,Universitatsmedizin Greifswald | Angermeyer M.,Center for Public Mental Health | Angermeyer M.,University of Cagliari | Schomerus G.,Universitatsmedizin Greifswald
Psychiatrische Praxis | Year: 2013

Objective: To find out to what extent the German public uses the term "burnouto" to label a depressive episode, and to examine how this label relates to stigmatizing attitudes and treatment recommendations. Methods: Representative population surveys in Germany 2001 (n = 5025) and 2011 (n = 3642), using unlabeled case vignettes of mental disorders. Results: Labeling a depressive episode "burnouto" increased from 0.3 % in 2001 to 10.2 % in 2011. Schizophrenia and alcohol dependence were labeled "burnouto" far less frequently. Compared to the label "depressiono", "burnouto" was associated with less desire for social distance, but also with less recommendation of psychotherapy, medication, and seeing a psychiatrist. Conclusion: While provoking less desire for social distance than "depressiono", using the label "burnout" carries the risk of increasing the proportion of untreated depressive episodes. © Georg Thieme Verlag KG Stuttgart New York.


Angermeyer M.C.,Center for Public Mental Health
Epidemiologia e psichiatria sociale | Year: 2010

AIMS: Based on findings from population surveys, we provide an overview of the public's emotional reactions to people with mental illness. METHODS: A literature search for populations studies using measures of emotional response to people with mental illness was carried out. In addition, data on the public's emotional reactions, originating from representative surveys conducted in Germany in the years 1990, 1993 and 2001, were analysed. RESULTS: Positive emotional reactions to people with mental illness are most prevalent, followed by fear and anger. This pattern appears relatively stable across different cultures. In recent years, the emotional response of the public remained unchanged or even deteriorated. The public seems to react quite differently to people with different mental disorders. Emotional reactions have a substantial effect on the desire for social distance. The association between familiarity with mental disorder and the desire for social distance is to a considerable extent mediated through emotions. CONCLUSIONS: The public's emotional reactions to people with mental disorder are relatively under-researched. More research may help better understand the complexities of the stigma surrounding mental illness. Interventions aimed at reducing the stigma of mental illness may benefit from paying more attention to emotions.


Cechnicki A.,Jagiellonian University | Angermeyer M.C.,Center for Public Mental Health | Bielanska A.,University Hospital
Social Psychiatry and Psychiatric Epidemiology | Year: 2011

Background In recent years, there has been a growing awareness of the stigma experienced by people with mental illnesses and their families. The aim of this study is to assess the amount of stigma anticipated and experienced by schizophrenia patients in one region of Poland and to examine how these figures relate to socio-demographic and clinical correlates. Method Subjective stigmatisation was assessed using the Inventory of Stigma Experiences of Psychiatric Patients. The mental health centres in Malopolska selected for the study were facilities representative of the whole region as regards location and type of treatment. Out of 250 patients contacted, 202 participated in the study, resulting in a response rate of 80.8%. Results The majority of respondents anticipated discrimination in interpersonal contacts (58%) as well as in the area of employment (55%). The most common experiences of discrimination in interpersonal interactions were the feeling of rejection by other people (87%) and having had an interpersonal contact broken off (50%). Participants living in highly urbanised areas more frequently anticipated exclusion of the mentally ill from the labour market, and older participants more often expressed the view that the mentally ill may have difficulties with access to institutions. The experience of structural discrimination was associated with lower education levels, living in a city, unemployment, being female, and being separated or widowed. The experience of rejection in interpersonal interaction was associated with lower education levels and more hospitalisations, and the experience of a negative public image of the mentally ill with unemployment and more hospitalisations. Conclusions (1) In southern Poland, people with schizophrenia both anticipated and experienced the strongest stigma in the domains of interpersonal relationships and employment. (2) Anticipated stigma, contrary to experienced stigma, shows hardly any correlation with patients' specific socio-demographic and clinical characteristics. © Springer-Verlag 2010.

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