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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

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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


Acknowledgements
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.


Rationale
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).


FIGURE 1: LOGGED CUMULATIVE DISTRIBUTION OF ANTI-STIGMA ORGANIZATION AND CAMPAIGN LAUNCH DATES WITH KEY EXAMPLES


Rationale cont
RATIONALE (cont.) ORGANIZATION AND CAMPAIGN LAUNCH DATES WITH KEY EXAMPLES

  • 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).


Rationale cont1
RATIONALE (cont.) ORGANIZATION AND CAMPAIGN LAUNCH DATES WITH KEY EXAMPLES

  • 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 effort…furthermore,…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).


Research questions
RESEARCH QUESTIONS ORGANIZATION AND CAMPAIGN LAUNCH DATES WITH KEY EXAMPLES

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?


DATA ORGANIZATION AND CAMPAIGN LAUNCH DATES WITH KEY EXAMPLES

  • 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.


Independent variables
INDEPENDENT VARIABLES ORGANIZATION AND CAMPAIGN LAUNCH DATES WITH KEY EXAMPLES

  • Year (i.e., 1996 or 2006). 1996 providing the baseline.

  • Disorder type

    • Schizophrenia

    • Major depression

    • Alcohol dependence


Vignette strategy
VIGNETTE STRATEGY ORGANIZATION AND CAMPAIGN LAUNCH DATES WITH KEY EXAMPLES

  • 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.


Dependent variables
DEPENDENT VARIABLES ORGANIZATION AND CAMPAIGN LAUNCH DATES WITH KEY EXAMPLES

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 name’s situation might be caused by”(1 = very likely or somewhat likely):

1. Genetic/inherited condition;

2. A chemical imbalance in the brain.


Dependent variables cont
DEPENDENT VARIABLES (cont.) ORGANIZATION AND CAMPAIGN LAUNCH DATES WITH KEY EXAMPLES

Treatment Recommendations.

“Should [name] do any of the following?”(1=yes):

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” (1=definitely 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?


Findings
FINDINGS ORGANIZATION AND CAMPAIGN LAUNCH DATES WITH KEY EXAMPLES

  • 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.


TABLE 1: OBSERVED PROBABILITIES AND CHANGE ON ATTRIBUTIONS AND TREATMENT RECOMMENDATIONS, 1996 – 2006 GSS

*p < .05; 1 tailed-tests


Findings cont
FINDINGS (cont.) AND TREATMENT RECOMMENDATIONS, 1996 – 2006 GSS

  • Virtually no differences on the stigma items - All remained essentially unchanged.

  • Illustrated in Table 2.


Table 2 observed probabilities and change on social distance items 1996 2006 gss
TABLE 2: OBSERVED PROBABILITIES AND CHANGE ON SOCIAL DISTANCE ITEMS, 1996 – 2006 GSS

*p < .05; 1 tailed-tests


Conclusions
CONCLUSIONS DISTANCE ITEMS, 1996 – 2006 GSS

GOOD NEWS

Modest/nominal increase in the public’s endorsement of a medical model of mental illness.

BAD NEWS

Assumption that increased knowledge will translate into the reduction of prejudice is mistaken.


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