Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-30T20:34:31.893Z Has data issue: false hasContentIssue false
  • English
  • Français

State of the art of population-based attitude research on mental health: a systematic review

Part of: Special Articles

Published online by Cambridge University Press:  30 August 2016

M. C. Angermeyer  and
G. Schomerus
M. C. Angermeyer*
Affiliation:
Center for Public Mental Health, Gösing am Wagram, Austria
G. Schomerus
Affiliation:
Department of Psychiatry, Universitätsmedizin Greifswald, Greifswald, Germany HELIOS Hanseklinikum Stralsund, Stralsund, Germany
*
*Address for correspondence: M. C. Angermeyer, Untere Zeile 13, A-3482 Gösing am Wagram, Austria. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

Population surveys have become a frequently used method to explore stigma, help-seeking and illness beliefs related to mental illness. Methodological quality however differs greatly between studies, and our current knowledge seems heavily biased towards high-income countries. A critical appraisal of advances and shortcomings of psychiatric attitude research is missing. This review summarises and appraises the state of the art in population-based attitude research on mental health.

Methods.

Systematic review of all peer-reviewed papers reporting representative population studies on beliefs and attitudes about mental disorders published between January 2005 and December 2014 (n = 478).

Results.

Over the decade covered by this review considerably more papers on psychiatric attitude research have been published than over the whole time period before. Most papers originated in Europe (36.3%), North America (23.2%) and Australia (22.6%), only 14.6% of all papers included data from low- or middle income countries. The vast majority of papers (80.1%) used correlational cross-sectional analyses, only 4% used experimental or quasi-experimental designs. Data in 45.9% of all papers were obtained with face-to-face interviews, followed by telephone (34.5%), mail (7.3%) and online surveys (4.0%). In almost half of papers (44.6%) case-vignettes served as stimulus for eliciting responses from interviewees. In 20.7% instruments meeting established psychometric criteria were used. The most frequently studied disorder was depression (44.6% of all paper), followed by schizophrenia (33%). 11.7% of papers reported time trend analyses of attitudes and beliefs, 7.5% cross-cultural comparisons. The most common focus of research was on mental health literacy (in total 63.4% of all papers, followed by various forms of stigma (48.3%).There was a scarcity of papers (12.1%) based on established theoretical frameworks.

Conclusions.

In the current boom of attitude research, an avant-garde of studies uses profound and innovative methodology, but there are still blind spots and a large proportion of conventional studies. We discuss current and future methodological challenges that psychiatric attitude research needs to embrace. More innovative and methodologically sound studies are needed to provide an empirical basis for evidence-based interventions aimed at reducing misconceptions about mental disorders and improve attitudes towards those afflicted.

Keywords

Attitudesmental disordersmental health literacypopulation-based study
Type
Special Article
Information
Epidemiology and Psychiatric Sciences , Volume 26 , Issue 3 , June 2017 , pp. 252 - 264
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ajzen, I (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes 50, 179–211.CrossRefGoogle Scholar
Aldersey, HM, Huynh, DC, Whitley, R (2016). A systematic examination of the nature and content of vignettes in schizophrenia research. Journal of Mental Health 25, 189–196.CrossRefGoogle ScholarPubMed
Alonso, J, Buron, A, Bruffaerts, R, He, Y, Posada-Villa, J, Lepine, J, Angermeyer, M, Levinson, D, de Girolamo, G, Tachimori, H, Mneimneh, Z, Medina-Mora, M, Ormel, J, Scott, K, Gureje, O, Haro, J, Gluzman, S, Lee, S, Vilagut, G, Kessler, R, Von Korff, M (2008). Association of perceived stigma and mood and anxiety disorders: results from the World Mental Health Surveys. Acta Psychiatrica Scandinavica 118, 305–314.CrossRefGoogle ScholarPubMed
Angermeyer, M, Beck, M, Dietrich, S, Holzinger, A (2004). The stigma of mental illness: patients’ anticipations and experiences. International Journal of Social Psychiatry 50, 153–162.Google Scholar
Angermeyer, M, Matschinger, H, Schomerus, G (2013). Attitudes towards psychiatric treatment and people with mental illness: changes over two decades. British Journal of Psychiatry 203, 146–151.CrossRefGoogle ScholarPubMed
Angermeyer, MC, Dietrich, S (2006). Public beliefs about and attitudes towards people with mental illness: a review of population studies. Acta Psychiatrica Scandinavica 113, 163–179.Google Scholar
Angermeyer, MC, Holzinger, A (2005). Erlebt die Psychiatrie zurzeit einen Boom der Stigmaforschung? Eine Analyse wissenschaftlicher Zeitschriften.[Is there currently a boom of stigma research in psychiatry?]. Psychiatrische Praxis 32, 399–407.Google Scholar
Angermeyer, MC, Matschinger, H (1995). Violent attacks on public figures by persons suffering from psychiatric disorders. Their effect on the social distance towards the mentally ill. European Archives of Psychiatry and Clinical Neuroscience 245, 159–164.CrossRefGoogle ScholarPubMed
Angermeyer, MC, Matschinger, H (2003). The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder. Acta Psychiatrica Scandinavica 108, 304–309.Google Scholar
Angermeyer, MC, Holzinger, A, Carta, MG, Schomerus, G (2011). Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. British Journal of Psychiatry 199, 367–372.Google Scholar
Angermeyer, MC, Daubmann, A, Wegscheider, K, Mnich, E, Schomerus, G, Knesebeck, OV (2015). The relationship between biogenetic attributions and desire for social distance from persons with schizophrenia and major depression revisited. Epidemiology and Psychiatric Sciences 24, 335–341.CrossRefGoogle Scholar
Baumann, A, Zäske, H, Decker, P, Klosterkotter, J, Maier, W, Möller, H, Gaebel, W (2007). Veränderungen in der sozialen Distanz der Bevökerung gegenüber schizophren Erkrankten in 6 deutschen Großstädten. Ergebnisse einer repräsentativen Telefonbefragung 2001 und 2004 [Changes in the public's social distance toward individuals with schizophrenia in six German cities. Results of representative pre- and postinterventional telephone surveys from 2001 to 2004]. Nervenarzt 78, 787–795.CrossRefGoogle Scholar
Becker, A, Kleinman, A (2013). Mental health and the global agenda. Reply. New England Journal of Medicine 369, 1380–1381.CrossRefGoogle Scholar
Centre for Reviews and Dissemination (2009). Systematic Reviews. CRD's Guidance for Undertaking Reviews in Health-care. University of York: York.Google Scholar
Conrad, P (2007). The Medicalization of Society. On the Transformation of Human Conditions into Treatable Disorders. The John Hopkins University Press: Baltimore.Google Scholar
Corrigan, P (2000). Mental health stigma as social attribution: implications for research methods and attitude change. Clinical Psychology - Science and Practice 7, 48–67.CrossRefGoogle Scholar
Corrigan, P (2014). The Stigma of Disease and Disability: Understanding Causes and Overcoming Injustices. American Psychological Association: Washington, DC.CrossRefGoogle Scholar
de Leeuw, ED, Hox, JJ (2008). Self-administered questionnaires: mail surveys and other applications. In International Handbook of Survey Methodology (ed. de Leeuw, ED, Hox, JJ and Dillman, DA), pp. 239–263. Psychological Press: New York, London.Google Scholar
Dietrich, S, Mergl, R, Freudenberg, P, Althaus, D, Hegerl, U (2010). Impact of a campaign on the public's attitudes towards depression. Health Education Research 25, 135–150.Google Scholar
Dillman, DA, Christian, LM (2003). Survey Mode as a Source of Instability in Response across Surveys, Stability of Methods for Collecting, Analyzing and Managing Panel Data. American Academy of Arts and Sciences: Cambridge, MA.Google Scholar
Evans-Lacko, S, Brohan, E, Mojtabai, R, Thornicroft, G (2012). Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychological Medicine 42, 1741–1752.Google Scholar
Gaebel, W, Zäske, H, Baumann, A, Klosterkötter, J, Maier, W, Decker, P, Möller, H (2008). Evaluation of the German WPA ‘Program against stigma and discrimination because of schizophrenia – Open the Doors’: Results from representative telephone surveys before and after three years of antistigma interventions. Schizophrenia Research 98, 184–193.CrossRefGoogle ScholarPubMed
Griffiths, K, Nakane, Y, Christensen, H, Yoshioka, K, Jorm, AF, Nakane, H (2006). Stigma in response to mental disorders: a comparison of Australia and Japan. BMC Psychiatry 6, 21.Google Scholar
Griffiths, KM, Christensen, H, Jorm, AF (2008). Predictors of depression stigma. BMC Psychiatry 8, 25.CrossRefGoogle ScholarPubMed
Henderson, C, Evans-Lacko, S, Flach, C, Thornicroft, G (2012). Responses to mental health stigma questions: the importance of social desirability and data collection method. Canadian Journal of Psychiatry 57, 152–160.Google Scholar
Henkel, KE, Brown, K, Kalchman, SC (2008). AIDS-related stigma in individuals with other stigmatized identities in the USA: a review of layered stigmas. Social and Personality Psychology Compass 2, 1586–1599.CrossRefGoogle Scholar
Higgins, J, Green, S (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration. http://handbook.cochrane.org.Google Scholar
Holborn, A, Reavley, N, Jorm, A (2012). Differences between landline and mobile-only respondents in a dual-frame mental health literacy survey. Australian and New Zealand Journal of Public Health 36, 192–193.Google Scholar
Holbrook, A, Green, M, Krosnick, J (2003). Telephone versus face-to-face interviewing of national probability samples with long questionnaires – Comparisons of respondent satisficing and social desirability response bias. Public Opinion Quarterly 67, 79–125.Google Scholar
Holzinger, A, Matschinger, H, Schomerus, G, Carta, MG, Angermeyer, MC (2011). The loss of sadness: the public's view. Acta Psychiatrica Scandinavica 123, 307–313.Google Scholar
Holzinger, A, Floris, F, Schomerus, G, Carta, MG, Angermeyer, MC (2012). Gender differences in public beliefs and attitudes about mental disorder in western countries: a systematic review of population studies. Epidemiology and Psychiatric Sciences 21, 73–85.Google Scholar
Ineland, L, Jacobsson, L, Renberg, E, Sjolander, P (2008). Attitudes towards mental disorders and psychiatric treatment-changes over time in a Swedish population. Nordic Journal of Psychiatry 62, 192–197.CrossRefGoogle Scholar
Jang, H, Lim, JT, Oh, J, Lee, SY, Kim, YI, Lee, JS (2012). Factors affecting public prejudice and social distance on mental illness: analysis of contextual effect by multi-level analysis. Journal of Preventive Medicine and Public Health 45, 90–97.CrossRefGoogle ScholarPubMed
Jorm, A, Griffiths, K, Christensen, H, Korten, A, Parslow, R, Rodgers, B (2003). Providing information about the effectiveness of treatment options to depressed people in the community: a randomized controlled trial of effects on mental health literacy, help-seeking and symptoms. Psychological Medicine 33, 1071–1079.CrossRefGoogle ScholarPubMed
Jorm, A, Christensen, H, Griffiths, K (2005 a). The impact of beyondblue: the national depression initiative on the Australian public's recognition of depression and beliefs about treatments. Australian and New Zealand Journal of Psychiatry 39, 248–254.Google Scholar
Jorm, A, Nakane, Y, Christensen, H, Yoshioka, K, Griffiths, K, Wata, Y (2005 b). Public beliefs about treatment and outcome of mental disorders: a comparison of Australia and Japan. BMC Medicine 3, 12.CrossRefGoogle ScholarPubMed
Jorm, AF, Mackinnon, A, Christensen, H, Griffiths, KM (2005 c). Structure of beliefs about the helpfulness of interventions for depression and schizophrenia. Results from a national survey of the Australian public. Social Psychiatry and Psychiatric Epidemiology 40, 877–883.CrossRefGoogle ScholarPubMed
Jorm, A, Christensen, H, Griffiths, K (2006). Changes in depression awareness and attitudes in Australia: the impact of beyondblue: the national depression initiative. Australian and New Zealand Journal of Psychiatry 40, 42–46.Google Scholar
Jorm, AF, Oh, E (2009). Desire for social distance from people with mental disorders. Australian New Zealand Journal of Psychiatry 43, 183–200.Google Scholar
Jorm, AF, Korten, AE, Rodgers, B, Pollitt, P, Jacomb, PA, Christensen, H, Jiao, Z (1997). Belief systems of the general public concerning the appropriate treatments for mental disorders. Social Psychiatry and Psychiatric Epidemiology 32, 468–473.CrossRefGoogle ScholarPubMed
Jorm, AF, Reavley, NJ, Ross, AM (2012). Belief in the dangerousness of people with mental disorders: a review. Australian New Zealand Journal of Psychiatry 46, 1029–1045.Google Scholar
Kvaale, EP, Gottdiener, WH, Haslam, N (2013). Biogenetic explanations and stigma: a meta-analytic review of associations among laypeople. Social Science and Medicine 96, 95–103.Google Scholar
Link, B, Phelan, J (2001). Conceptualizing stigma. Annual Review of Sociology 27, 363–385.Google Scholar
Link, B, Cullen, F, Frank, J, Wozniak, J (1987). The social rejection of former mental-patients-understanding why labels matter. American Journal of Sociology 92, 1461–1500.Google Scholar
Link, B, Cullen, F, Struenung, E, Shrout, P, Dohrenwend, B (1989). A modified labeling theory approach to mental disorders: an empirical assessment. American Sociological Review 54, 400–423.Google Scholar
Link, B, Angermeyer, MC, Phelan, J (2011). Public attitudes towards people with mental illness. In Oxford Textbook of Community Mental Health (ed. Thornicroft, G, Szmukler, G Mueser, KT and Drake, RE), pp. 253–259. Oxford University Press: Oxford.Google Scholar
Loosveldt, G (2008). Face-to-face interviews. In International Handbook of Survey Methodology (ed. de Leeuw, ED, Hox, JJ and Dillman, DA), pp. 201–220. Psychological Press: New York, London.Google Scholar
McGinty, EE, Webster, DW, Barry, CL (2013). Effects of news media messages about mass shootings on attitudes toward persons with serious mental illness and public support for gun control policies. American Journal of Psychiatry 170, 494–501.Google Scholar
Mojtabai, R (2010). Mental illness stigma and willingness to seek mental health care in the European Union. Social Psychiatry and Psychiatric Epidemiology 45, 705–712.Google Scholar
Moscovici, S (2001). Social Representations: Explorations in Social Psychology. New York University Press: New York.Google Scholar
Nakane, Y, Jorm, A, Yoshioka, K, Christensen, H, Nakane, H, Griffiths, K (2005). Public beliefs about causes and risk factors for mental disorders: a comparison of Japan and Australia. BMC Psychiatry 5, 33.Google Scholar
Nelkin, D, Lindee, M (1995). The DNS Mystique. The Gene as a Cultural Icon. WH Freeman and Company: New York.Google Scholar
Patel, V, Kim, Y (2007). Contribution of low- and middle-income countries to research published in leading general psychiatry journals, 2002–2004. British Journal of Psychiatry 190, 77–78.Google Scholar
Pescosolido, B, Medina, T, Martin, J, Long, J (2013). The ‘backbone’ of stigma: identifying the global core of public prejudice associated with mental illness. American Journal of Public Health 103, 853–860.Google Scholar
Phelan, J (2005). Geneticization of deviant behavior and consequences for stigma: The case of mental illness. Journal of Health and Social Behavior 46, 307–322.CrossRefGoogle ScholarPubMed
Phillips, D (1963). Rejection- a possible consequence of seeking help for mental-disorders. American Sociological Review 28, 963–972.CrossRefGoogle Scholar
Reavley, N, Jorm, A (2012). Public recognition of mental disorders and beliefs about treatment: changes in Australia over 16 years. British Journal of Psychiatry 200, 419–425.Google Scholar
Richardson, J, Morgenstern, H, Crider, R, Gonzalez, O (2013). The influence of state mental health perceptions and spending on an individual's use of mental health services. Social Psychiatry and Psychiatric Epidemiology 48, 673–683.CrossRefGoogle Scholar
Rüsch, N, Todd, A, Bodenhausen, G, Corrigan, P (2010). Do people with mental illness deserve what they get? Links between meritocratic worldviews and implicit versus explicit stigma. European Archives of Psychiatry and Clinical Neuroscience 260, 617–625.CrossRefGoogle ScholarPubMed
Sai, G, Furnham, A (2013). Identifying depression and schizophrenia using vignettes: a methodological note. Psychiatry Research 210, 357–362.Google Scholar
Schlier, B, Schmick, S, Lincoln, T (2014). No matter of etiology: biogenetic, psychosocial and vulnerability-stress causal explanations fail to improve attitudes towards schizophrenia. Psychiatry Research 215, 753–759.Google Scholar
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 and Alcoholism 46, 105–112.CrossRefGoogle ScholarPubMed
Schomerus, G, Schwahn, C, Holzinger, A, Corrigan, PW, Grabe, HJ, Carta, MG, Angermeyer, MC (2012). Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica 125, 440–452.Google Scholar
Schomerus, G, Matschinger, H, Angermeyer, MC (2014). Causal beliefs of the public and social acceptance of persons with mental illness: a comparative analysis of schizophrenia, depression and alcohol dependence. Psychological Medicine 44, 303–314.Google Scholar
Schomerus, G, Van der Auwera, S, Matschinger, H, Baumeister, S, Angermeyer, MC (2015). Do attitudes towards persons with mental illness worsen during the course of life? An age-period-cohort analysis. Acta Psychiatrica Scandinavica 132, 357–364.Google Scholar
Sharan, P, Gallo, C, Gureje, O, Lamberte, E, Mari, J, Mazzotti, G, Patel, V, Swartz, L, Olifson, S, Levav, I, de Francisco, A, Saxena, S, World Health Organization-Global Forum for Health Research – Mental Health Research Mapping Project Group (2009). Mental health research priorities in low- and middle-income countries of Africa, Asia, Latin America and the Caribbean. British Journal of Psychiatry 195, 354–363.Google Scholar
Stadler, S (2010). Einstellungen und soziale Distanz gegenüber psychisch Kranken. Positive Wirkung sozialer Kontakte im Umfeld einer gemeindepsychiatrischen Tagesstätte im Vergleich zu einer Kontrollregion [Community attitudes and social distance towards the mentally ill in the surroundings of a community psychiatry day care-unit: The influence of social contact]. Zeitschrift fur Psychiatrie, Psychologie und Psychotherapie 58, 265–273.Google Scholar
Star, SA (1955). The public's idea about mental illness. In Annual Meeting of the National Association for Mental Health, Indianapolis. Indiana National Opinion Research Center, University of Chicago: Chicago.Google Scholar
Steeh, C (1981). Trends in nonresponse rates, 1952–1979. Public Opinion Quarterly 45, 40–57.Google Scholar
Steeh, C (2008). Telephone surveys. In International Handbook of Survey Methodology (ed. de Leeuw, ED, Hox, JJ and Dillman, DA), pp. 221–238. Psychological Press: New York, London.Google Scholar
Taylor, SM, Dear, MJ (1981). Scaling community attitudes toward the mentally ill. Schizophrenia Bulletin 7, 225–240.CrossRefGoogle ScholarPubMed
Thornicroft, G, Brohan, E, Rose, D, Sartorius, N, Leese, M, Indigo Study Group (2009). Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 373, 408–415.Google Scholar
Veltro, F, Raimondo, A, Porzio, C, Nugnes, T, Ciampone, V (2005). A survey on the prejudice and the stereotypes of mental illness in two communities with or without psychiatric residential facilities. Epidemiologia e Psichiatria Sociale 14, 170–176.Google Scholar
von dem Knesebeck, O, Mnich, E, Daubmann, A, Wegscheider, K, Angermeyer, MC, Lambert, M, Karow, A, Härter, M, Kofahl, C (2013). Socioeconomic status and beliefs about depression, schizophrenia and eating disorders. Social Psychiatry and Psychiatric Epidemiology 48, 775–782.Google Scholar
Weiner, B (1995). Judgements of Responsibility – A Foundation for a Theory of Social Conduct. Guilford Press: New York.Google Scholar
Wright, A, McGorry, P, Harris, M, Jorm, A, Pennell, K (2006). Development and evaluation of a youth mental health community awareness campaign – The Compass Strategy. BMC Public Health 6, 215.Google Scholar
Yang, L, Kleinman, A, Link, B, Phelan, J, Lee, S, Good, B (2007). Culture and stigma: adding moral experience to stigma theory. Social Science and Medicine 64, 1524–1535.Google Scholar
Yang, L, Purdie-Vaughns, V, Kotabe, H, Link, B, Saw, A, Wong, G, Phelan, J (2013). Culture, threat, and mental illness stigma: Identifying culture-specific threat among Chinese-American groups. Social Science and Medicine 88, 56–67.CrossRefGoogle ScholarPubMed
Yang, L, Thornicroft, G, Alvarado, R, Vega, E, Link, B (2014). Recent advances in cross-cultural measurement in psychiatric epidemiology: utilizing ‘what matters most’ to identify culture-specific aspects of stigma. International Journal of Epidemiology 43, 494–510.Google Scholar
Yang, LH, Link, BG, Phelan, JC (2008). Stigma measurement approaches: conceptual origins and current applications. In Understanding the Stigma of Mental Illness: Theory and Interventions (ed. Arboleda-Florez, J and Sartorius, N), pp. 175–192. John Wiley & Sons: Chichester.Google Scholar
Supplementary material: File

Angermeyer and Schomerus supplementary material

Online supplement 3

Download Angermeyer and Schomerus supplementary material(File)
File 112.4 KB
Supplementary material: File

Angermeyer and Schomerus supplementary material

Online supplement 1

Download Angermeyer and Schomerus supplementary material(File)
File 507 KB
Supplementary material: File

Angermeyer and Schomerus supplementary material

Flowchart

Download Angermeyer and Schomerus supplementary material(File)
File 61.8 KB