Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta-analysis of population surveys

Abstract

Public attitudes towards psychiatry are crucial determinants of help-seeking for mental illness. It has been argued that psychiatry as a discipline enjoys low esteem among the public, and a "crisis" of psychiatry has been noted. We conducted a systematic review and meta-analysis of population studies examining public attitudes towards various aspects of psychiatric care. Our search in PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on population surveys conducted since 2000 and published no later than 2015. We found that professional help for mental disorders generally enjoys high esteem. While general practitioners are the preferred source of help for depression, mental health professionals are the most trusted helpers for schizophrenia. If respondents have to rank sources of help, they tend to favor mental health professionals, while open questions yield results more favorable to general practitioners. Psychiatrists and psychologists/psychotherapists are equally recommended for the treatment of schizophrenia, while for depression psychologists/psychotherapists are more recommended, at least in Europe and America. Psychotherapy is consistently preferred over medication. Attitudes towards seeking help from psychiatrists or psychologists/psychotherapists as well as towards medication and psychotherapy have markedly improved over the last twenty-five years. Biological concepts of mental illness are associated with stronger approval of psychiatric help, particularly medication. Self-stigma and negative attitudes towards persons with mental illness decrease the likelihood of personally considering psychiatric help. In conclusion, the public readily recommends psychiatric help for the treatment of mental disorders. Psychotherapy is the most popular method of psychiatric treatment. A useful strategy to further improve the public image of psychiatry could be to stress that listening and understanding are at the core of psychiatric care.

Keywords: Public attitudes; depression; meta-analysis; psychiatry; psychotherapy; psychotropic medication; schizophrenia; systematic review.

Figure 1

PRISMA diagram of the literature search

Figure 2

Forest plots for recommendations of different sources of help for depression (proportion of respondents recommending a particular source of help). Studies 31,71,103,129 and 131 examined the recommendation of a psychotherapist; the other studies of a psychologist. ES − estimated proportion

Figure 3

Forest plots for recommendations of different sources of help for schizophrenia (proportion of respondents recommending a particular source of help). Studies 31,71,129 and 131 examined the recommendation of a psychotherapist; the other studies of a psychologist. ES − estimated proportion

Figure 4

Recommendation of psychotropic medication and psychotherapy for depression (proportion of respondents recommending a particular treatment method). ES − Estimated proportion

Figure 5

Recommendation of psychotropic medication and psychotherapy for schizophrenia (proportion of respondents recommending a particular treatment method). ES – Estimated proportion