"A disease like any other"? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence

Abstract

Objective: Clinicians, advocates, and policy makers have presented mental illnesses as medical diseases in efforts to overcome low service use, poor adherence rates, and stigma. The authors examined the impact of this approach with a 10-year comparison of public endorsement of treatment and prejudice.

Method: The authors analyzed responses to vignettes in the mental health modules of the 1996 and 2006 General Social Survey describing individuals meeting DSM-IV criteria for schizophrenia, major depression, and alcohol dependence to explore whether more of the public 1) embraces neurobiological understandings of mental illness; 2) endorses treatment from providers, including psychiatrists; and 3) reports community acceptance or rejection of people with these disorders. Multivariate analyses examined whether acceptance of neurobiological causes increased treatment support and lessened stigma.

Results: In 2006, 67% of the public attributed major depression to neurobiological causes, compared with 54% in 1996. High proportions of respondents endorsed treatment, with general increases in the proportion endorsing treatment from doctors and specific increases in the proportions endorsing psychiatrists for treatment of alcohol dependence (from 61% in 1996 to 79% in 2006) and major depression (from 75% in 1996 to 85% in 2006). Social distance and perceived danger associated with people with these disorders did not decrease significantly. Holding a neurobiological conception of these disorders increased the likelihood of support for treatment but was generally unrelated to stigma. Where associated, the effect was to increase, not decrease, community rejection.

Conclusions: More of the public embraces a neurobiological understanding of mental illness. This view translates into support for services but not into a decrease in stigma. Reconfiguring stigma reduction strategies may require providers and advocates to shift to an emphasis on competence and inclusion.

Figure 1

Adjusted Survey Year Differences in Attributions of Mental Illness, by Vignette Condition, 1996 and 2006a ^aGraphs indicate the discrete change coefficient in the predicted probability for a given outcome with respect to year (multiplied by 100) adjusted for respondents’ age, sex, education, and race. Predicted probabilities calculated with controls held at their means for the combined sample. Data are from the mental health modules of the 1996 and 2006 General Social Surveys and are weighted. Tic marks indicate 95% confidence intervals.

Figure 2

Adjusted Survey Year Differences in Treatment Endorsement, by Vignette Condition, 1996 and 2006a ^aGraphs indicate the discrete change coefficient in the predicted probability for a given outcome with respect to year (multiplied by 100) adjusted for respondents’ age, sex, education, and race. Predicted probabilities calculated with controls held at their means for the combined sample. Data are from the mental health modules of the 1996 and 2006 General Social Surveys and are weighted. Tic marks indicate 95% confidence intervals.

Figure 3

Adjusted Survey Year Differences in Stigma, by Vignette Condition, 1996 and 2006a ^aGraphs indicate the discrete change coefficient in the predicted probability for a given outcome with respect to year (multiplied by 100) adjusted for respondents’ age, sex, education, and race. Predicted probabilities are calculated with controls held at their means for the combined sample. Data are from the mental health modules of the 1996 and 2006 General Social Surveys and are weighted. Tic marks indicate 95% confidence intervals.