Paper presented at

Fourth International Stigma Conference 200921st – 23rd January 2009, London UK

Grausgruber, Alfred*Schöny, W.*/Grausgruber-Berner, R.*/Meise, U.*/Koren, G.*

*Department of Sociology, Johannes Kepler University of LinzA-4040 Linz, Altenbergerstr. 69, Austria

e-mail: alfred.grausgruber@jku.at** pro mente praevention Austria, Linz

A-4020 Linz, Lohnstorferplatz 28, Austria

Determinants of Social Distance towards People suffering from Schizophrenia. Results from a

Trend Analysis of two Population Surveys in Austria.

Background

- Anti-Stigma-Campaigne of the WPA – Austria member

- To get a baseline: First nationwide survey in Austria in 1998

- Many activities to combat stigmatization and discrimination

- Second representative survey in 2007

- Attitude comparison of public in 1998 and 2007

- Impact evaluation of the activities

Aims of the presentation

- To examine the impact of various potential determinants of the desire to avoid contacts with people suffering from schizophrenia

- To observe any substantial changes in the general structure of the impact factors

Method

Representative surveys (16 years +)

Table 1: Method – type of vignettes

Year 1998 2007 Data collection Face to face interviews Sample size N = 1035 N = 998 Vignettes - unlabelled presented

1 vignette randomly allocated Schizophrenia: - woman feels sha-

dowed (n=252) - or man feels shadowed - or woman shows

withdrawal - or man shows withdrawal

2 vignettes 1st vign: all Schizophrenia: - woman feels sha-dowed (n=988) 2nd vignette randomly allocated: Depression, or anxiety, or Alzheimer disease

Method

Table 2: Determinants of social distanceYear 1998 2007 Dependent variable

Social distance (5 items guttman scale)

Independent variables Determinants

4 dimensions causal attribution (sum-scores of 8 items, 4 point Likert scale) Perceived treatment success (2 items) Perceived dangerousness (2 items) Course of disease (2 items) Knowing people suffering from schizophrenia

Socio-demogra-phic variables

Gender, age, education, size of residence, household income

(e.g. Link et al 1999, Martin et al 2000, Stuart et al 2001, Gaebel et al 2002, Lauber 2003, Angermeyer/Matschinger 2005)

Statistical analysis: Factor analysis (causal attribution), Guttman and Mokken analysis (social distance), OLS-Regression

ß p 95% CI

Causal attribtion (often) Stress 0.122 .000 0.058 - 0.185 Genetics -0.065 .020 -0.119- -0.010 Social circumstances 0.002 .944 -0.065 - 0.069 Weak character -0.070 .021 -0.130- -0.010 Perceived treatment success (yes) Schizophrenia in general 0.142 .000 0.083 - 0.201 Schizophrenia vignette 0.165 .000 0.104 - 0.225 Perceived dangerousness (yes) People with mental problems -0.129 .000 -0.197- -0.060 People suffering from schizophrenia -0.143 .000 -0.213- -0.073 Knowing people suffering from schizophrenia (yes)

0.097 .001 0.042 – 0.152

Course of schizophtrenia (disappear) Course without treatment 0.132 .000 0.074 – 0.189 Course with treatment 0.005 .851 -0.051 – 0.061 Year of the survey (1998) -0.035 .222 -0.092 – 0.021 Corr R = 0.416; F = 14.864; p = 0.000; n = 1240 Controlling for size of residence, gender, age, education, household income - increasing distance/decreasing contacts, + decreasing distance/ increasing contacts

Table 3. Regression coefficients (stand. ß) of social distance from people with schizophre-nia on causal attribution, perceived treatment success, perceived dangerousness, knowing people suffering from schizophrenia, course of disease and year of survey (n=1240)

Results

1998 2007 ß 95% CI ß 95% CI t Causal attribtion (often) Stress 0.224** 0.079 - 0.369 0.090** 0.020 - 0.162 1) 2)

Genetics -0.150* -0.274- -0.026 -0.034 -0.096 - 0.027 1)

Social circumstances 0.129 -0.023 - 0.282 -0.021 -0.097 - 0.054 1)

Weak character -0.128 -0.269- -0.012 -0.069* -0.136 - 0.002 Perceived treatment success (yes) Schizophrenia in general 0.123 -0.011 - 0.257 0.154** 0.086 - 0.221 Schizophrenia vignette 0.145 -0.009 - 0.280 0.165** 0.096 - 0.234 Perceived dangerousness (yes) People with mental problems -0.113 -0.269 - 0.042 -0.123** -0.200- -0.045 People suffering from schizo- phrenia

-0.181* -0.338- -0.024 -0.142** -0.221- -0.062

Knowing people suffering from schizophrenia. (yes)

0.096 -0.028 - 0.220 0.098** 0.036 - 0.160

Course of schizophrenia (disapp.) Course without treatment 0.051 -0.073 - 0.176 0.151** 0.090 - 0.211 1)

Course with treatment -0.025 -0.155 - 0.106 0.020 -0.044 - 0.085 Corr R 0.377 0.429 F 3.508 13.400 p 0.000 0.000 1998: n=242; 2007: n=877; *p<0.05, ** p<0.01 Controlling for size of residence, gender, age, education, household income - increasing distance/decreasing contacts, + decreasing distance/ increasing contacts 1) l t l > 2,0 2) interaction: time (year) x stress stand. ß = 0.107, p=0.000.

Table 4. Regression coefficients (stand. ß) of social distance from people with schizo-phrenia on causal attribution, perceived treatment success, perceived dangerousness, knowing people suffering from schizophrenia, course of disease 1998 and 2007

Results

Discussion

- Causal attribution, perceived dangerousness, perceived treatment success, perceived course of schizophrenia and familiarity have an independent impact on the desire to contact people suffering from schizophrenia.

- Causal Attribution:

- Assumed biological factors and personality characteristics (weak character) increase social distance

- Assumed social stress increases contacts

- Perceived success of treatment, course of treatment and knowing people suffering from schizophrenia have a direct independent positive effect on contacts

Discussion

- No independent effect of the year when the survey was conducted

- There are modifications in the structure of the determinants between 1998 and 2007, but they do not differ substancially except perceived stress as cause of schizophrenia

- No increased influence of perceived success of treatment

- Limitations: Not a panel study, social desirability, only one vignette, other factors (e.g. personality, values) not included

Conclusion

- Genetics as important causes of schizophrenia leads to more distance: Unintended consequencies of the favoured medical model

- Education people about treatment options increases contacts

- The most important single impact factor on social contacts is still perceived dangerousness. Perceived dangerousness leads to more distance

- How much is the influence of mass media‘s reporting about mental illness and violence?

Conclusion

Influence of mass media?

On 28th August last year (2007) a 19 year old man confessed, that he had killed another man.

Survey conducted: September/Octo-ber 2007

Acknowledgement

The survey 2007 was funded by the Ministry of Health, Family and Youth.

In 1998 the study was unconditional financially supported by Österreichische Schizophrenie-gesellschaft.

The authors are grateful to Hans Bacher and Joachim Gerich (Linz), and Wolfgang Fleischhacker (Innsbruck) for their advice and helpful comments.