Emotional Reactions to People with Mental Illness: Results from Population Studies Matthias C....

Emotional Reactions to People with Mental Illness:

Results from Population Studies

Matthias C. AngermeyerCenter for Public Mental Health

Gösing am WagramAustria

“…Social psychologists have focused upon thoughts (cognition) rather than feelings (affect). … However, the reactions of a host majority acting with prejudice in rejecting a minority group usually involve not just negative thoughts but also emotionally laden attitudes involving anxiety, anger, resentment, hostility, distaste or disgust…In fact, prejudice may more strongly predict discrimination than do stereotypes…Interestingly,…there is almost nothing published about emotional reactions to people with mental illness apart from that which describes a fear of violence …”

(Thornicroft & Kassam 2008, 189ff)

Systematic Review of Population Studies on Public Beliefs About Mental Disorders and Attitudes Towards the Mentally Ill

• Inclusion criteria: - Population studies using random sampling - All languages

• Time period covered: 1948 – 2008

• Countries included: 62

• Number of publications: 369

• Number of studies: 261 (137 national, 124 local/regional)

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10

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30

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110

46-48

49-51

52-54

55-57

58-60

61-63

64-66

67-69

70-72

73-75

76-78

79-81

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97-99

00-02

03-05

06-08

N P

ublic

atio

nsPublications on Population Studies on Public Beliefs About Mental Disorder and Attitudes Towards People With Mental

Illness (N=369)

Years

Studies on Public Beliefs about Mental Disorders and AttitudesTowards the Mentally Ill (n=261)

1-9

10+

Publications on Population Studies Including Measures of Emotional Reactions

N % of all studies (n=261)

Perspective of the Stigmatizer

● Positive feelings 15 5.7

● Anxiety 19 7.3

● Anger 15 5.7

Perspective of the Stigmatized

● Shame 7 2.7

● Embarrassment 18 6.9

Total 45 17.2

Components of Modern Conceptualizations of Stigma

Link & Phelan 2004 Corrigan & Watson 2002 Thornicroft 2006

Labelling

Stereotyping

Separating

Status loss + Discrimination

Dependence of Stigma on Power

Stereotype

Discrimination

Ignorance

Discrimination

Emotional Reactions Prejudice Prejudice

Components of Modern Conceptualizations of Stigma

Link & Phelan 2004 Corrigan & Watson 2002 Thornicroft 2006

Labelling

Stereotyping

Separating

Status loss + Discrimination

Dependence of Stigma on Power

Stereotype

Discrimination

Ignorance

Discrimination

„Prejudice also yields emotional responses (e.g. anger or fear) to stigmatized groups“

„The reactions of a host majority acting with

prejudice… involve not just negative thoughts but also

emotionally laden attitudes…“

Emotional Reactions Prejudice Prejudice

The Role of Emotions Seen From the Vantage Point of the Stigmatizer

• In personal encounters, the way others respond emotionally tells the stigmatised person how he or she is being perceived.

Example: “ A person who feels some combination of pity and anxiety in the presence of a person with mental illness might modulate his or her voice, speaking softly and in an unnaturally calm tone, signalling to the person with mental illness that he or she is being approached from a standpoint of differentness.” (Link et al. 2004)

• Emotional responses may shape subsequent behaviour toward the stigmatised person.

Example: A person who reacts with fear might feel a stronger desire for social distance and avoid contact with people with mental illness.

Example: “ A person who feels some combination of pity and anxiety in the presence of a person with mental illness might modulate his or her voice, speaking softly and in an unnaturally calm tone, signalling to the person with mental illness that he or she is being approached from a standpoint of differentness.” (Link et al. 2004)

Example: A person who reacts with fear might feel a stronger desire for social distance and avoid contact with people with mental illness.

The Role of Emotions Seen From the Vantage Point of the Stigmatized

• In interpersonal interaction, how the stigmatised individual responds emotionally may confirm misconceptions held by others.

Example: In interpersonal encounters, a person ashamed of her mental illness might keep her illness a secret. Preoccupation with his or her undisclosed status as mentally ill person may lead to anxiety, which in turn leads to social awkwardness. This may let others feel uncomfortable and confirm their perception that people with mental illness are strange and hard to talk to.

• Emotional responses may shape subsequent behaviour of the stigmatised person.

Example: Shame and anxiety might let people with mental illness avoid contact with mental health professionals, resulting in delayed help seeking or discontinuation of treatment.

Example: In interpersonal encounters, a person ashamed of her mental illness might keep her illness a secret. Preoccupation with his or her undisclosed status as mentally ill person may lead to anxiety,which in turn leads to social awkwardness. This may let others feel uncomfortable and confirm their perception that people with mental illness are strange and hard to talk to.

Example: Shame and anxiety might let people with mental illness avoid contact with mental health professionals, resulting in delayed help seeking or discontinuation of treatment.

• How prevalent are the various emotional reactions to people with mental disorder?

• Are there differences between mental disorders as concerns the public’s emotional reactions?

• How important are emotional reactions as compared with stereotypes?

• Does familiarity with mental illness work through modification of emotional reactions?


• Are there differences between mental disorders?

• How important are emotional reactions as compared to stereotypes?


0

10

20

30

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50

60

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90

100

Pity

Desire

to h

elp

Uneas

iness

Inse

curit

yFea

r

Empa

thy

Lack

of u

nder

standin

g

Irrita

tion

Anger

Ridicu

le

Emotional Reactions to People With SchizophreniaPopulation Study in Germany, 2001

Positive Emotions Fear Anger

%

0

10

20

30

40

50

60

70

80

90

100

Desire

to h

elp

Pity

Inse

curit

y

Uneas

iness

Empa

thy

Fear

Irrita

tion

Lack

of u

nder

standin

g

Anger

Ridicu

le

Emotional Reactions to People With SchizophreniaPopulation Study in Bratislava, 2003

%


0

10

20

30

40

50

60

70

80

90

100

Pity

Desire

to h

elp

Uneas

iness

Inse

curit

y

Irrita

tion

Lack

of u

nder

standin

gFea

r

Empa

thy

Anger

Ridicu

le

Emotional Reactions to People With SchizophreniaPopulation Study in Novosibirsk, 2002

%


0

10

20

30

40

50

60

70

80

90

100

Pity

Desire

to h

elp

Uneas

iness

Fear

Inse

curit

y

Lack

of u

nder

standin

g

Irrita

tion

Empa

thy

Anger

Ridicu

le

Emotional Reactions to People With SchizophreniaPopulation Study in Ulaanbaatar, 2002

%


0

10

20

30

40

50

60

70

80

90

100

Desire

to h

elp

Pity

Empa

thy

Uneas

iness

Inse

curit

yFea

r

Lack

of u

nder

standin

g

Irrita

tion

Anger

Ridicu

le

Emotional Reactions to People With Major DepressionPopulation Study in Germany, 2001

%


0

10

20

30

40

50

60

70

80

90

100

Desire

to h

elp

Pity

Empa

thy

Inse

curit

y

Uneas

iness

Fear

Irrita

tion

Lack

of u

nder

standin

g

Anger

Ridicu

le

Emotional Reactions to People With Major DepressionPopulation Study in Bratislava, 2003

%


0

10

20

30

40

50

60

70

80

90

100

Pity

Desire

to h

elp

Uneas

iness

Inse

curit

y

Irrita

tion

Lack

of u

nder

standin

g

Empa

thy

Fear

Anger

Ridicu

le

Emotional Reactions to People With Major DepressionPopulation Study in Novosibirsk, 2002

%


0

10

20

30

40

50

60

70

80

90

100

Pity

Desire

to h

elp

Uneas

iness

Inse

curit

yFea

r

Lack

of u

nder

standin

g

Empa

thy

Irrita

tion

Anger

Ridicu

le

Emotional Reactions to People With Major DepressionPopulation Study in Ulaanbaatar, 2002

%


Emotional Reactions to People With SchizophreniaPopulation Studies in the Western Part of Germany, 1990 and 2001

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

Score Score ScoreFear Positive emotions Anger

1990 2001 1990 2001 20011990

Emotional Reactions to People With Major DepressionPopulation Studies in the Western Part of Germany, 1990 and 2001

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3


1990 2001 1990 2001 20011990

Emotional Reactions to People With SchizophreniaPopulation Studies in the Eastern Part of Germany, 1993 and 2001

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3


1993 2001 1993 2001 20011993

Emotional Reactions to People With Major DepressionPopulation Studies in the Eastern Part of Germany, 1993 and 2001

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3


1993 2001 1993 2001 20011993


• Are there differences between mental disorders as concerns the public’s emotional reactions?



Emotional Reactions to People With Schizophrenia, Major Depression and Alcohol Dependence

Population Studies in the Western Part of Germany, 1990

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3


Schizophrenia Major Depression Alcohol Dependence

Emotional Reactions to People With Schizophrenia, Major Depression and Alcoholism


-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3


Schizophrenia Major Depression Alcoholism

Emotional Reactions to People With Schizophrenia, Major Depression and Alcohol Dependence


-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3


Schizophrenia Major Depression Alcohol Dependence

Emotional Reactions to People With Schizophrenia, Major Depression and Alcoholism


-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3

-0,3

-0,2

-0,1

0

0,1

0,2

0,3


Schizophrenia Major Depression Alcoholism

Model 1 Model 2 Model 3 Model 4

B p B p B p B p

Age

Gender

Educational attainment

.021 .007

-.302 .236

-.319 .049

.022 .003

-.253 .279

-.100 .509

.029 .000

-.225 .334

.108 .468

.028 .000

-.181 .420

-.073 .616

Dangerous

Unpredictable

Lack of willpower

1.019 .000

1.403 .000

.394 .699

.680 .000

1.036 .000

.011 .351

Fear

Positive emotions

Anger

1.781 .000

-2.154 .000

.181 .100

1.072 .000

-1.819 .000

.211 .061

Adj. R² .005 .165 .209 .270

Regression of Desire For Social Distance Towards People With Schizophrenia on Socio-Demographic Characteristics, Stereotypes

and Emotional Reactions.Population Study in Germany, 2001.


B p B p B p B p

Age

Gender


.021 .007

-.302 .236

-.319 .049

.022 .003

-.253 .279

-.100 .509

.029 .000

-.225 .334

.108 .468

.028 .000

-.181 .420

-.073 .616

Dangerous

Unpredictable

Lack of willpower

1.019 .000

1.403 .000

.394 .699

.680 .000

1.036 .000

.011 .351

Fear

Positive emotions

Anger

1.781 .000

-2.154 .000

.181 .100

1.072 .000

-1.819 .000

.211 .061

Adj. R² .005 .165 .209 .270

Regression of Desire for Social Distance Towards People With Schizophrenia on Socio-Demographic Characteristics, Stereotypes



B p B p B p B p

Age

Gender


.021 .007

-.302 .236

-.319 .049

.022 .003

-.253 .279

-.100 .509

.029 .000

-.225 .334

.108 .468

.028 .000

-.181 .420

-.073 .616

Dangerous

Unpredictable

Lack of willpower

1.019 .000

1.403 .000

.394 .699

.680 .000

1.036 .000

.011 .351

Fear

Positive emotions

Anger

1.781 .000

-2.154 .000

.181 .100

1.072 .000

-1.819 .000

.211 .061

Adj. R² .005 .165 .209 .270

Regression of Desire for Social Distance Towards People with Schizophrenia on Socio-Demographic Characteristics, Stereotypes


0

10

20

30

Positive associations No associations Negative associations

Num

ber

of s

tudi

esFamiliarity with Mental Illness and Desire for Social Distance

Systematic Review of Population-Based Studies on Public BeliefsAbout Mental Disorders and Attitudes Towards the Mentally Ill

Association Between Familiarity, Emotional Reactions and Social Distance Towards People With Schizophrenia

Population Study in Germany, 2001

1.67

-0.2

0

Familiarity Social distance0.22 -2.09Positive emotions

Fear

-0.18

Anger

-1.60

Sum of indirect effects –1.61

0.22

Association Between Familiarity, Emotional Reactions and Social Distance Towards People With Major Depression

Population Study in Germany, 2001

-1.31

Familiarity Social distance0.25 -1.75Positive emotions

1.35

Fear

Sum of indirect effects –1.22

0.15

-0.23

Anger

0.33

• Positive emotional responses to people with mental illness are most prevalent, followed by fear and anger.

• This pattern appears relatively stable across different cultures.

• There are differences in the public’s emotional reactions to the various types of mental disorder.

• Emotional reactions have a substantial effect on the desire for social distance.

• The association between familiarity with mental disorder and the desire for social distance is to a considerable extent mediated through emotions.

Summary

• As compared to stereotypes and behavioural intentions, the public’s emotional reactions to people with mental disorders are relatively under-researched.• Our findings suggest that more research on the public’s emotional reactions may allow to better understand the complexities of the stigma surrounding mental illness.

• Interventions aimed at reducing the stigma of mental illness may benefit from paying more attention to emotions.

Conclusion

Emotional Reactions to People with Mental Illness: Results from Population Studies Matthias C....

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