A Hierarchy of Stigma Associated with Mental Disorders.

Abstract

Background: Numerous studies have produced social distance rankings to identify differences in the intensity of stigma associated with various general medical and mental health conditions. All of these studies, however, treat "mental illness" as a single homogeneous condition, when in reality different diagnoses of mental illness may elicit different levels of stigma.

Aims of the study: Within our samples, we aim to: (i) determine if there are significant differences in the intensity of stigma associated with different mental/behavior disorders; (ii) compare the intensity of stigma associated with mental/behavior disorders vs. physical/sensory disorders; and (iii) analyze the effect of familiarity with a person who has a mental/behavior disorder on the stigma associated with that disorder.

Methods: College students in the U.S. (n=213) and Republic of Korea (n=354) completed a survey of community attitudes toward persons with disabilities. Students were asked to rank 22 health conditions, including 10 mental/behavior disorders, according to the level of acceptance most usually accorded to persons with that condition in their society. Students also indicated, for each condition, whether they had close contact with a person who had that condition.

Results: Students in both countries indicated a lower mean level of acceptance for the group of mental/behavior disorders than for the group of physical or sensory disorders. Nevertheless, there were significant differences in the acceptability of different types of mental/behavior disorders, with schizophrenia and substance use disorders eliciting the most negative attitudes in both samples. Familiarity is correlated with greater acceptance for most, but not all, mental/behavior disorders.

Discussion: Mental illness-related stigma imposes costs on society in the form of productivity losses and increased rates of dependency. Reducing these costs requires an understanding of the negative stereotypes that are the source of stigma, and an appreciation of differences in the nature and intensity of stigma associated with different mental disorders. Limitations of the study include: lack of generalizability of the results; terminology which may have generated negative associations for some survey items; possibility of missing variables or data measured with error.

Implications for health policies: The findings with respect to familiarity underscore the importance of inclusive policies to combat mental illness-related stigma. Anti-stigma policies must, however, account for differences in attitudes toward different diagnoses of mental illness. Strategies that may be effective in reducing stigma for some disorders may be counterproductive for others.

Implications for further research: Many social distance studies rely on non-random samples, limiting generalizability of the results. Future research may be able to exploit web-based survey methods to obtain larger, more representative samples. Studies should include multiple diagnoses of mental/behavior disorders, instead of a single category of mental illness, and explore the ways in which familiarity affects intensity of stigma for different mental disorders.