Monday, December 17, 2012

Can antistigma campaigns be improved?

Can Antistigma Campaigns Be Improved? A Test of the Impact of Biogenetic Vs Psychosocial Causal Explanations on Implicit and Explicit Attitudes to Schizophrenia

Tania M. Lincoln1,2, Elisabeth Arens2, Cornelia Berger2 and Winfried Rief2

from The Schizophrenia Bulletin

In the hope to reduce stigma, campaigns have been emphasizing biogenetic (BG) explanations of schizophrenia and have been promoting the concept of “schizophrenia is an illness like others.”1517 For example, the “changing minds” program by the Royal College of Psychiatrists18 lists “changes in the structure of their brains,” “infections before they were born,” “disorder appears to run in families,” and “chemical messengers in the brain … are not working correctly” before mentioning any psychosocial (PS) cause. The National Alliance on Mental Illness19 lists no explicit PS causes of schizophrenia but states that “the brains of people with schizophrenia are different from the brains of people without the illness,” “schizophrenia seems to be caused by a combination of problems including genetic vulnerability and environmental factors that occur during a person's development,” and recent research has “identified certain genes that appear to increase risk for schizophrenia.” Similarly, the World Psychiatric Association antistigma initiative “Open the Doors”20 states that “a predisposition is inherited” but that an “environmental trigger,” such as “complications during the mother's pregnancy or labor,” “prenatal exposure to virus,” or “complications during pregnancy and delivery,” must also be present to bring on the “disease.”

There is reason to assume that antistigma programs might be improved by promoting a diathesis-stress model of schizophrenia.21,22 The diathesis-stress model, which is widely accepted in the scientific field, acknowledges genetic and early biologic developmental risks along with environmental stressors, such as life events, daily stressors, family communication, and trauma as relevant risk factors.2329 Its potential usefulness as a means of reducing stigma seems to be supported not only by the theoretical reflections about the possible effects that varying information is going to have on illness attributions and stigma but also by an array of empirical findings. On the one hand, it seems reasonable to assume that if the causes of mental health problems are attributed to factors outside the control of individuals (eg, biological factors), people's reactions will be less negative and patients and families will experience less blame.3032 So far, however, this assumption has only been supported in one experimental study carried out with male students by Mehta and Farina,33 who found a disease view to be associated with less blame. On the other hand, it has been argued that BG explanations might cause the disorder to be viewed as more fundamental and immutable,33,34 exacerbate the “stickiness” of the mental illness label, and strengthen links to other undesirable characteristics.31 In support of this, a large number of studies have found biological explanations to be associated with higher levels of stigma and social distance, while this has not been shown for PS explanations.7,15,35,36 For example, in representative population surveys carried out in Germany, Russia, and Mongolia, it was found that the more respondents endorsed a brain disease as a cause, the more dangerous they believed a person with schizophrenia to be and the more desire they showed for social distance.7,37 The analysis of data from 601 adult respondents to a US telephone survey revealed genetic attributions to be associated with decreased optimism that a mental health professional could help with the problem.38,39 In their experiment, Mehta and Farina33 found that students who were provided with a disease view were prepared to apply more electric shocks toward fellow students whom they believed to have a history of mental disorder than students provided with a PS view.33 Finally, in a trend analysis of data from 2498 participants in Germany, Angermeyer and Matschinger40 found that as biological causes are being more widely acknowledged by the public, the desire for social distance toward people with schizophrenia has increased.

Read more of this study here.

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