Abstract
Background There is evidence for two different types and/or sources of mental illness stigma, namely the display of psychiatric symptoms and the use of psychiatric service institutions. However, no current study has compared the two. Furthermore, gaps exist in our knowledge of both types of stigma. Little is known about the perceived stigma of specific psychiatric service treatment environments, for instance forensic settings. In addition, systematic research on stigma attached to symptoms of personality disorders in the general population is scarce, and for borderline personality disorder, nonexistent. Methods We conducted a representative survey of the general population (N = 2207) in the canton of Basel-Stadt, Switzerland. Participants were asked to read a vignette depicting either the psychiatric symptoms of a fictitious character or a psychiatric service institution to which the character had been admitted, and indicate desired social distance (an indicator for stigma). Type of symptoms, type of psychiatric service, dangerousness, and gender were systematically varied between vignettes. Findings Desired social distance was significantly lower in relation to psychiatric service use than to psychiatric symptoms. Overall, symptoms of alcohol dependency, behavior endangering others, and the fictitious character’s being male tend to increase stigmatization. Interestingly, the character’s being hospitalized in a psychiatric unit at a general hospital and also respondent familiarity with psychiatric services tend to decrease stigmatization. Interpretation Familiarity of the general population with psychiatric patients should be increased. Furthermore, treatment in psychiatric units located within general hospitals should be promoted, as such treatment is associated with decreased stigma.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
It is important to note that our manipulation of dangerousness does not deal with perceived dangerousness, which is a commonly used construct in stigma research. Instead, we directly manipulated (fictitious) external dangerousness information, within the vignettes. Perceived dangerousness, in contrast, is defined by internal beliefs people have concerning the dangerousness of a person or group of persons. Perceived dangerousness is commonly measured using self-report measures such as the dangerousness scale [12].
References
Hinshaw SP, Stier A (2008) Stigma as related to mental disorders. Ann Rev Clin Psych 4:367–393
Lasalvia A, Zoppei S, Van Bortel T et al (2013) Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet 381:55–62
Wrigley S, Jackson H, Judd F, Komiti A (2005) Role of stigma and attitudes toward help-seeking from a general practitioner for mental health problems in a rural town. Aust N Z J Psychiatry 39:514–521
Sirey JA, Bruce ML, Alexopoulos GS et al (2001) Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression. Am J Psychiatry 158:479–481
Schomerus G, Lucht M, Holzinger A, Matschinger H, Carta MG, Angermeyer MC (2011) The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol Alcohol 46:105–112
Markham D (2003) Attitudes towards patients with a diagnosis of borderline personality disorder: social rejection and dangerousness. J Mental Health 12:595–612
Verhaeghe M, Bracke P, Bruynooghe K (2007) Stigmatization in different mental health services: a comparison of psychiatric and general hospitals. J Behav Health Serv Res 34:186–197
Phillips DL (1963) Rejection: a possible consequence of seeking help for mental disorders. Am Sociol Rev 28:963–972
Corrigan PW, Green A, Lundin R, Kubiak MA, Penn DL (2001) Familiarity with and social distance from people who have serious mental illness. Psychiatr Serv 52:953–958
Angermeyer MC, Matschinger H, Corrigan PW (2004) Familiarity with mental illness and social distance from people with schizophrenia and major depression: testing a model using data from a representative population survey. Schizophr Res 69:175–182
Marie D, Miles B (2008) Social distance and perceived dangerousness across four diagnostic categories of mental disorder. Aust N Z J Psychiatry 42:126–133
Penn DL, Guynan K, Daily T, Spaulding WD, Garbin CP, Sullivan M (1994) Dispelling the stigma of schizophrenia: what sort of information is best? Schizophr Bull 20:567–578
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Author, Arlington
Schomerus G, Matschinger H, Angermeyer MC (2013) Continuum beliefs and stigmatizing attitudes towards persons with schizophrenia, depression and alcohol dependence. Psychiatry Res 209:665–669
Nordt C, Rössler W, Lauber C (2006) Attitudes of mental health professionals toward people with schizophrenia and major depression. Schizophr Bull 32:709–714
Statistisches Amt des Kantons Basel-Stadt (2013) Statistisches Jahrbuch des Kantons Basel-Stadt 2013. Author, Basel
Link BG, Cullen FT, Frank J, Wozniak JF (1987) The social rejection of former mental patients: understanding why labels matter. Am J Sociol 92:1461–1500
Bogardus ES (1925) Measuring social distance. J Appl Sociol 9:299–308
Schomerus G, Angermeyer MC, Matschinger H, Riedel-Heller SG (2008) Public attitudes towards prevention of depression. J Affect Disord 106:257–263
von dem Knesebeck O, Mnich E, Daubmann A et al (2013) Socioeconomic status and beliefs about depression, schizophrenia, and eating disorders. Soc Psychiatry Psychiatr Epidemiol 48:775–782
Cohen J, Cohen P, West SG, Aiken LS (2013) Applied multiple regression/correlation analysis for the behavioral sciences, 3rd edn. Erlbaum Publishers, Mahwah, NJ
Schomerus G, Matschinger H, Angermeyer MC (2013) Do psychiatric units at general hospitals attract less stigmatizing attitudes compared with psychiatric hospitals? Epidemiol Psychiatric Sci 1:1–6
Angermeyer MC, Matschinger H (1996) The effect of violent attacks by schizophrenic persons on the attitude of the public towards the mentally ill. Soc Sci Med 43:1721–1728
Glasman LR, Albarracín D (2006) Forming attitudes that predict future behavior: a meta-analysis of the attitude-behavior relation. Psychol Bull 132:778
Acknowledgments
The authors thank Viola Engemann, Franca Gonet-Wirz, Sarah Königer, Lisa Hochstrasser, and Reka Schweighoffer for their assistance in conducting the study.
Funding
This work was supported by an intramural grant of the University of Basel (DMS2304) to JFS. In addition, CGH received funding from a research grant by the UPK Basel, Switzerland, and from an educational and research grant by Takeda Pharma AG, Pfäffikon, Switzerland.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical standards
The manuscript does not contain clinical studies or patient data.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Sowislo, J.F., Lange, C., Euler, S. et al. Stigmatization of psychiatric symptoms and psychiatric service use: a vignette-based representative population survey. Eur Arch Psychiatry Clin Neurosci 267, 351–357 (2017). https://doi.org/10.1007/s00406-016-0729-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00406-016-0729-y