Jack K. Martin, Bernice A. Pescosolido,

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Continuity and Change in the Impact of
Neuroscientific Attributions on the Stigma of
Mental Illness Evidence From Two National
Surveys of the U.S.

• Jack K. Martin, Bernice A. Pescosolido,
• J. Scott Long, Tait Medina
• Indiana University Bloomington
• Bruce G. Link, Jo Phelan
• Columbia University
• Presented at the Fourth International Stigma
  Conference,
• London, United Kingdom. January 2009

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ACKNOWLEDGEMENTS

• Funding provided by the National Science
  Foundation (to NORC) in 1996 2006, and research
  grants from the National Institute of Alcohol
  Abuse and Alcoholism (RO1-AA-10243) for the 1996
  GSS the National Institute for Mental Health
  (NIMH), KO2-MH42655, R29-MH44780, R24-MH51669
  in 1996 the NIMH RO1-MH074985 in 2006 the
  MacArthur Foundation in 1996 and the Office of
  the Vice President for Research at Indiana
  University, Bloomington in 1996 and 2006.
•  
• We also thank Tom Smith, Director, General Social
  Survey (GSS), National Opinion Research Center
  (NORC), University of Chicago for his assistance.

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RATIONALE

• The last 20 years have seen unprecedented
  increases in national and international media and
  governmental efforts to advance a medical model
  of mental illness, with the expressed hope of
  decreasing the stigma of mental illness.
• Illustrated in Figure 1.
• 1995. Depression What Every Woman Should Know
  (NIMH).
• 1996. In Our Own Voice (NAMI).
• 1999. Change Your Mind (MTV).
• 2000. Open The Doors (World Psychiatric Assn).
• 2001. Conference On Stigma and Global Health
  (NIMH).
• 2002. Campaign For The Mind of Americana
  (NIMH).
• 2003. Real Men, Real Depression (NIH).
• 2004. Stigma and Mental Health Disparities
  (NIH).
• 2005. Voice Awards (SAMSHA).
• 2006. What A Difference a Friend Makes
  (SAMSHA).

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FIGURE 1 LOGGED CUMULATIVE DISTRIBUTION OF
ANTI-STIGMA ORGANIZATION AND CAMPAIGN LAUNCH
DATES WITH KEY EXAMPLES
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RATIONALE (cont.)

• These public relations efforts have also been
  accompanied by a significant increase of
  Americans seeking treatment for mental health
  problems, i.e., 30 increase, since 1990 (over a
  12 month interval), in the number of Americans
  who have received treatment for a mental health
  problem (Kessler, et. al, 2005. New England
  Journal of Medicine).
• Moreover, in the 1990s, Americans overwhelmingly
  endorsed the efficacy of psychiatric medicines
  for the treatment of mental health problems.
  (Martin Pescosolido. 2006. Americans Views of
  Psychiatric Medications in Light of Health and
  Health Care. Indiana Consortium for Mental Health
  Services Research).

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RATIONALE (cont.)

• There have also been a number of
  anecdotally-based statements suggesting that
  the stigma of mental illness has been reduced.
• For example, early-on, Walt Gove suggested that
  the evidence of the 1950s would indicate
  that.(then) the public was ignorant about mental
  illness.(but) since then there has been a
  massive education effortfurthermore,the
  effectiveness of treatment has become fairly
  visible (with the result that) in the majority of
  cases the stigma (experienced by mental health
  patients) appears to be transitory and does not
  pose a serious problem. (Gove 1982 290).
• More recently Maria Kraft Goin, past president
  of the American Psychiatric Association, noted,
  that the burden of stigma has begun to lift
  such that people (now) understand that mental
  illnesses are diagnosable and treatable(Am. J.
  Psychiatry 2004).

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RESEARCH QUESTIONS

• 1. Over the past ten years have Americans become
  more likely to endorse a medical/neuro-science
  model of mental illness that has led them to view
  such problems as a disease or medical malady,
  treatable like any other?
• 2. At the turn of the century, are Americans
  less likely to express a desire to avoid
  interaction/contact with persons experiencing
  mental health problems?

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DATA

• 1996-2006 General Social Surveys.
• Coordinated nationally representative
  cross-sections of adult Americans (18).
• 1996 GSS, n 1,444, face-to-face interview,
  response rate 76.1. 2006 GSS, n 1,523,
  replication, response rate 71.2.
• Within sampling error (/- 3), both samples are
  representative of the adult U.S. population.

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INDEPENDENT VARIABLES

• Year (i.e., 1996 or 2006). 1996 providing the
  baseline.
• Disorder type
• Schizophrenia
• Major depression
• Alcohol dependence

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VIGNETTE STRATEGY

• Three vignettes based on DSM-IV criteria.
• Original (1996) vignettes developed by
  researchers at Columbia University and Indiana
  University.
• Vignettes confirmed for accuracy by psychiatric
  practitioners.

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DEPENDENT VARIABLES

• 114 comparisons of knowledge and stigma-related
  items, including attributions, treatment
  recommendations, stigma, and social distance.
• Concentrate on three today.
• Causal attributions.
• In your opinion, is it very likely, somewhat
  likely, not very likely, or not at all likely
  that names situation might be caused by(1
  very likely or somewhat likely)
• 1. Genetic/inherited condition
• 2. A chemical imbalance in the brain.

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DEPENDENT VARIABLES (cont.)

• Treatment Recommendations.
• Should name do any of the following?(1yes)
• 1. Go to a medical doctor for help?
• 2. Go to a psychiatrist for help?
• Social Distance.
• Would you be definitely willing, probably
  willing, probably unwilling, or definitely
  unwilling to (1definitely unwilling or probably
  unwilling)
• 1. Move next door to name?
• 2. Spend an evening socializing with name?
• 3. Make friends with name?
• 4. Have name work closely with you on the job?
• 5. Have name marry into your family?

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FINDINGS

• Examined changes between 1996 and 2006 in the
  observed probabilities on 38 knowledge and stigma
  items across the three vignettes.
• Modest evidence that in 2006 the public is more
  likely to endorse medical and genetic causes of
  mental health problems, and to recommend medical
  treatment for these problems
• Illustrated in Table 1.

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TABLE 1 OBSERVED PROBABILITIES AND CHANGE ON
ATTRIBUTIONS AND TREATMENT RECOMMENDATIONS, 1996
2006 GSS
Depression Depression Depression Schizophrenia Schizophrenia Schizophrenia Alcohol Alcohol Alcohol
Attributions 1996 2006 ? 1996 2006 ? 1996 2006 ?
Genetic/Inherited .54 .66 .12 .66 .74 .08 .62 .70 .08
Chemical Imbalance .71 .84 .12 .84 .91 .07 .64 .69 .05
Treatment Recommendation
Physician .80 .92 .12 .75 .89 .13 .76 .90 .14
Psychiatrist .80 .88 .09 .92 .94 .02 .66 .81 .15
p lt .05 1 tailed-tests
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FINDINGS (cont.)

• Virtually no differences on the stigma items -
  All remained essentially unchanged.
• Illustrated in Table 2.

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TABLE 2 OBSERVED PROBABILITIES AND CHANGE ON
SOCIAL DISTANCE ITEMS, 1996 2006 GSS
Depression Depression Depression Schizophrenia Schizophrenia Schizophrenia Alcohol Alcohol Alcohol
Social Distance 1996 2006 ? 1996 2006 ? 1996 2006 ?
Neighbor .24 .20 -.04 .36 .47 .11 .46 .39 -.07
Socialize .36 .31 -.05 .47 .53 .07 .56 .55 -.01
Friend .24 .21 -.03 .32 .37 .05 .36 .37 .01
Work .48 .48 .00 .60 .65 .05 .75 .75 .00
Marry .62 .54 -.08 .71 .73 .02 .77 .81 .04
p lt .05 1 tailed-tests
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CONCLUSIONS

• GOOD NEWS
• Modest/nominal increase in the publics
  endorsement of a medical model of mental illness.
• BAD NEWS
• Assumption that increased knowledge will
  translate into the reduction of prejudice is
  mistaken.