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Title: Brief Implicit Association Tests of Stigmatizing Attitudes, Awareness of Mental Distress and Label-Avoidance: A Study in People with Depressive Symptoms

  • Simone FreitagEmail author
  • Susanne Stolzenburg
  • Georg Schomerus
  • Silke Schmidt
Original Paper
  • 35 Downloads

Abstract

This study aims to develop and implement brief implicit association tests (BIATs) assessing stigmatizing attitudes towards mental illness, awareness of mental distress and self-identification as having a mental illness. We recruited 229 people (age range 18–80 years) with currently untreated depressive symptoms. In addition to BIATs, explicit measures assessed depression severity, contact experience and self-identification as having a mental illness. BIATs showed good feasibility. Age and educational differences were observed for each BIAT. Regarding depression severity, people with mild depression severity showed stronger implicit label-avoidance. Novel BIATs proved feasible and future research should investigate the predictive value of implicit measures on help seeking in people with mental illness.

Keywords

Brief implicit association test Mental illness Stigmatizing attitudes Awareness of mental distress Label avoidance Depression 

Notes

Acknowledgements

The study was funded by the German Research Foundation (DFG) with the grant numbers SCHM 2683/4-1 and SCHO 1337/4-1. We would like to thank Dr. Samuel Tomczyk for his time and support revising the manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

10597_2019_372_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 KB)
10597_2019_372_MOESM2_ESM.docx (21 kb)
Supplementary material 2 (DOCX 21 KB)

References

  1. Blankertz, L. (2001). Cognitive components of self esteem for individuals with severe mental illness. American Journal of Orthopsychiatry, 71(4), 457–465.  https://doi.org/10.1037/0002-9432.71.4.457.Google Scholar
  2. Bretschneider, J., Kuhnert, R., & Hapke, U. (2017). Depressive symptomatik bei erwachsenen in deutschland. Journal of Health Monitoring, 2(3), 81–88.  https://doi.org/10.17886/RKI-GBE-2017-058.Google Scholar
  3. Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., … Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27.  https://doi.org/10.1017/S0033291714000129.Google Scholar
  4. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Book: Lawrence Erlbaum.Google Scholar
  5. Corrigan, P. W. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614–625.  https://doi.org/10.1037/0003-066X.59.7.614.Google Scholar
  6. Corrigan, P. W., & Rao, D. (2012). On the self-stigma of mental illness: Stages, disclosure, and strategies for change. The Canadian Journal of Psychiatry, 57(8), 464–469.  https://doi.org/10.1177/070674371205700804.Google Scholar
  7. Corrigan, P. W., River, L. P., Lundin, R. K., Wasowski, K. U., Campion, J., Mathisen, J., … Kubiak, M. A. (2000). Stigmatizing attributions about mental illness. Journal of Community Psychology, 28(1), 91–102.  https://doi.org/10.1002/(SICI)1520-6629(200001)28:1%3C91::AID-JCOP9%3E3.0.CO;2-M Google Scholar
  8. Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 1(1), 16–20. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16946807.
  9. Crisp, A. H., Gelder, M. G., Rix, S., Meltzer, H. I., & Rowlands, O. J. (2000). Stigmatisation of people with mental illnesses. The British Journal of Psychiatry, 177(1), 4–7. Retrieved from http://bjp.rcpsych.org/content/177/1/4.
  10. Downey, R. G., & King, C. V. (1998). Missing data in likert ratings: A comparison of replacement methods. The Journal of General Psychology, 125(2), 175–191.  https://doi.org/10.1080/00221309809595542.Google Scholar
  11. Draine, S. (2014). Inquisit (Version 4) Seattle: Millisecond Software. Seattle, WA: Millisecond Software.Google Scholar
  12. Eisenberg, D., Downs, M. F., Golberstein, E., & Zivin, K. (2009). Stigma and help seeking for mental health among college students. Medical Care Research and Review, 66(5), 522–541.  https://doi.org/10.1177/1077558709335173.Google Scholar
  13. Goguen, K., Britt, T. W., Jennings, K., Sytine, A., Jeffirs, S., Peasley, A., … Palmer, J. (2016). Implicit and explicit attitudes toward mental health treatment. Journal of Social and Clinical Psychology, 35(1), 45–63.  https://doi.org/10.1521/jscp.2016.35.1.45.Google Scholar
  14. Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74(6), 1464–1480.  https://doi.org/10.1037/0022-3514.74.6.1464.Google Scholar
  15. Greenwald, A. G., Nosek, B. A., & Banaji, M. R. (2003). Understanding and using the implicit association test: I. An improved scoring algorithm. Journal of Personality and Social Psychology, 85(2), 197–216.  https://doi.org/10.1037/0022-3514.85.2.197.85)Google Scholar
  16. Greenwald, A. G., Poehlman, T. A., Uhlmann, E. L., & Banaji, M. R. (2009). Understanding and using the implicit association test: III. Meta-analysis of predictive validity. Journal of Personality and Social Psychology, 97(1), 17–41.  https://doi.org/10.1037/a0015575.Google Scholar
  17. Gunn, J. M., Ayton, D. R., Densley, K., Pallant, J. F., Chondros, P., Herrman, H. E., & Dowrick, C. F. (2012). The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort. Social Psychiatry and Psychiatric Epidemiology, 47(2), 175–184.  https://doi.org/10.1007/s00127-010-0330-z.Google Scholar
  18. Hofmann, W., Gawronski, B., Gschwendner, T., Le, H., & Schmitt, M. (2005). A meta-analysis on the correlation between the implicit association test and explicit self-report measures. Personality and Social Psychology Bulletin, 31(10), 1369–1385.  https://doi.org/10.1177/0146167205275613.Google Scholar
  19. Kroenke, K., Spitzer, R. L., Williams, J., & Löwe, B. (2010). The patient health questionnaire somatic, anxiety, and depressive symptom scales: A systematic review. General Hospital Psychiatry, 32(4), 345–359.  https://doi.org/10.1016/j.genhosppsych.2010.03.006.Google Scholar
  20. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606–613.  https://doi.org/10.1046/j.1525-1497.2001.016009606.x.Google Scholar
  21. Lecrubier, Y., Sheehan, D., Weiller, E., Amorim, P., Bonora, I., Sheehan, H., K., … Dunbar, G (1997). The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: Reliability and validity according to the CIDI. European Psychiatry, 12(5), 224–231.  https://doi.org/10.1016/S0924-9338(97)83296-8.Google Scholar
  22. Lincoln, T. M., Arens, E., Berger, C., & Rief, W. (2008). Can antistigma campaigns be improved? a test of the impact of biogenetic vs. psychosocial causal explanations on implicit and explicit attitudes to schizophrenia. Schizophrenia Bulletin, 34(5), 984–994.  https://doi.org/10.1093/schbul/sbm131.Google Scholar
  23. Lindgren, K. P., Neighbors, C., Teachman, B. A., Wiers, R. W., Westgate, E., & Greenwald, A. G. (2013). I drink therefore i am: Validating alcohol-related implicit association tests. Psychology of Addictive Behaviors, 27(1), 1–13.  https://doi.org/10.1037/a0027640.Google Scholar
  24. Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social Science and Medicine, 71(12), 2150–2161.  https://doi.org/10.1016/j.socscimed.2010.09.030.Google Scholar
  25. Meites, T. M., Deveney, C. M., Steele, K. T., Holmes, A. J., & Pizzagalli, D. A. (2008). Implicit depression and hopelessness in remitted depressed individuals. Behaviour Research and Therapy, 46(9), 1078–1084.  https://doi.org/10.1016/j.brat.2008.05.008.Google Scholar
  26. Nosek, B. A., Greenwald, A. G., & Banaji, M. R. (2005). Understanding and using the implicit association test: II. Method variables and construct validity. Personality and Social Psychology Bulletin, 31(2), 166–180.  https://doi.org/10.1177/0146167204271418.Google Scholar
  27. Nosek, B. A., Hawkins, C. B., & Frazier, R. S. (2011). Implicit social cognition: From measures to mechanisms. Trends in Cognitive Sciences, 15(4), 152–159.  https://doi.org/10.1016/J.TICS.2011.01.005.Google Scholar
  28. Pavlovic, M. D., & Zezelj, I. L. (2013). Brief implicit association test: Validity and utility in prediction of voting behavior. Psihologija, 46(3), 261–278.  https://doi.org/10.2298/Psi130606004p.Google Scholar
  29. Peris, T. S., Teachman, B. A., & Nosek, B. A. (2008). Implicit and explicit stigma of mental illness links to clinical care. The Journal of Nervous and Mental Disease, 196(10), 752–760.  https://doi.org/10.1097/NMD.0b013e3181879dfd.Google Scholar
  30. Roth, P. L., Switzer, F. S., & Switzer, D. M. (1999). Missing data in multiple item scales: A Monte Carlo analysis of missing data techniques. Organizational Research Methods, 2(3), 211–232.  https://doi.org/10.1177/109442819923001.Google Scholar
  31. Rüsch, N., Angermeyer, M. C., & Corrigan, P. W. (2005). Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. European Psychiatry.  https://doi.org/10.1016/j.eurpsy.2005.04.004.Google Scholar
  32. Rüsch, N., Corrigan, P. W., Bohus, M., Kuhler, T., Jacob, G. A., & Lieb, K. (2007). The impact of posttraumatic stress disorder on dysfunctional implicit and explicit emotions among women with borderline personality disorder. Journal of Nervous and Mental Disease, 195(6), 537–539.  https://doi.org/10.1097/NMD.0b013e318064e7fc.Google Scholar
  33. Rüsch, N., Corrigan, P. W., Heekeren, K., Theodoridou, A., Dvorsky, D., Metzler, S., … Rössler, W. (2014). Well-being among persons at risk of psychosis: The role of self-labeling, shame, and stigma stress. Psychiatric Services, 65(4), 483–489.  https://doi.org/10.1176/appi.ps.201300169.Google Scholar
  34. Rüsch, N., Corrigan, P. W., Todd, A. R., & Bodenhausen, G. V. (2010). Implicit self-stigma in people with mental illness. Journal of Nervous and Mental Disease, 198(2), 150–153.  https://doi.org/10.1097/NMD.0b013e3181cc43b5.Google Scholar
  35. Rüsch, N., Lieb, K., Gottler, I., Hermann, C., Schramm, E., Richter, H., … Bohus, M. (2007). Shame and implicit self-concept in women with borderline personality disorder. American Journal of Psychiatry, 164(3), 500–508.  https://doi.org/10.1176/appi.ajp.164.3.500.Google Scholar
  36. Rüsch, N., Todd, A. R., Bodenhausen, G. V., & Corrigan, P. W. (2010). Biogenetic models of psychopathology, implicit guilt, and mental illness stigma. Psychiatry Research, 179(3), 328–332.  https://doi.org/10.1016/j.psychres.2009.09.010.Google Scholar
  37. Rüsch, N., Todd, A. R., Bodenhausen, G. V., Weiden, P. J., & Corrigan, P. W. (2009). Implicit versus explicit attitudes toward psychiatric medication: Implications for insight and treatment adherence. Schizophrenia Research, 112(1–3), 119–122.  https://doi.org/10.1016/j.schres.2009.04.011. Journal Article.Google Scholar
  38. Saporito, J. M., Ryan, C., & Teachman, B. A. (2011). Reducing stigma toward seeking mental health treatment among adolescents. Stigma Research and Action, 1(2), 9–21. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24286023.
  39. Schomerus, G., Auer, C., Rhode, D., Luppa, M., Freyberger, H. J., & Schmidt, S. (2012). Personal stigma, problem appraisal and perceived need for professional help in currently untreated depressed persons. Journal of Affective Disorders, 139(1), 94–97.  https://doi.org/10.1016/j.jad.2012.02.022.Google Scholar
  40. Schomerus, G., Matschinger, H., & Angermeyer, M. C. (2013). Continuum beliefs and stigmatizing attitudes towards persons with schizophrenia, depression and alcohol dependence. Psychiatry Research, 209(3), 665–669.  https://doi.org/10.1016/J.PSYCHRES.2013.02.006.Google Scholar
  41. Schomerus, G., Van der Auwera, S., Matschinger, H., Baumeister, S. E., & Angermeyer, M. C. (2015). Do attitudes towards persons with mental illness worsen during the course of life? An age-period-cohort analysis. Acta Psychiatrica Scandinavica, 132(5), 357–364.  https://doi.org/10.1111/acps.12401.Google Scholar
  42. Sekaquaptewa, D., Espinoza, P., Thompson, M., Vargas, P., & von Hippel, W. (2003). Stereotypic explanatory bias: Implicit stereotyping as a predictor of discrimination. Journal of Experimental Social Psychology, 39(1), 75–82.  https://doi.org/10.1016/S0022-1031(02)00512-7.Google Scholar
  43. Sriram, N., & Greenwald, A. G. (2009). The brief implicit association test. Experimental Psychology, 56(4), 283–294.  https://doi.org/10.1027/1618-3169.56.4.283.Google Scholar
  44. Stier, A., & Hinshaw, S. P. (2007). Explicit and implicit stigma against individuals with mental illness. Australian Psychologist, 42(2), 106–117.  https://doi.org/10.1080/00050060701280599.Google Scholar
  45. Stolzenburg, S., Freitag, S., Evans-Lacko, S., Muehlan, H., Schmidt, S., & Schomerus, G. (2017). The stigma of mental illness as a barrier to self labeling as having a mental illness. The Journal of Nervous and Mental Disease, 205(12), 903–909.  https://doi.org/10.1097/NMD.0000000000000756.Google Scholar
  46. Stull, L. G., McGrew, J. H., Salyers, M. P., & Ashburn-Nardo, L. (2013). Implicit and explicit stigma of mental illness: attitudes in an evidence-based practice. The Journal of Nervous and Mental Disease, 201(12), 1072–1079.  https://doi.org/10.1097/NMD.0000000000000056.Google Scholar
  47. Teachman, B. A., Gapinski, K. D., Brownell, K. D., Rawlins, M., & Jeyaram, S. (2003). Demonstrations of implicit anti-fat bias: The impact of providing causal information and evoking empathy. Health Psychology, 22(1), 68–78.  https://doi.org/10.1037/0278-6133.22.1.68.Google Scholar
  48. Teachman, B. A., Wilson, J. G., & Komarovskaya, I. (2006). Implicit and explicit stigma of mental illness in diagnosed and healthy samples. Journal of Social and Clinical Psychology, 25(1), 75–95.  https://doi.org/10.1521/jscp.2006.25.1.75.Google Scholar
  49. Thornicroft, G. (2008). Stigma and discrimination limit access to mental health care. Epidemiologia and Psichiatria Sociale, 17(1), 14–19.  https://doi.org/10.1017/S1121189X00002621.Google Scholar
  50. Tiller, D., Herzog, B., Kluttig, A., & Haerting, J. (2015). Health literacy in an urban elderly East-German population—results from the population-based CARLA study. BMC Public Health, 15(1), 883.  https://doi.org/10.1186/s12889-015-2210-7.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department Health & Prevention, Institute of PsychologyUniversity GreifswaldGreifswaldGermany
  2. 2.Helios Hanseklinikum StralsundStralsundGermany
  3. 3.Department of PsychiatryUniversity Medicine GreifswaldGreifswaldGermany

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