Stigma Surrounding Depression Drops for First Time in Us, but Increases for Other Mental Illnesses

Summary: While the stigma against depression has decreased for the first time, the stigma levels for other mental health disorders have either remained stagnant or increased.

Source: Indiana University

For the first time since national data have been tracked in the United States, stigma toward people with depression has dropped significantly, according to a study by Indiana University researchers. However, stigma levels for other mental illnesses remained stagnant and, in some cases, have increased.

The findings can help shape treatment of those with mental illness and have an impact on anti-stigma programs and policies to help people find support, the researchers said.

“Stigma is broad and pervasive and, up till now, has been notoriously stubborn to change efforts,” said study co-author Bernice Pescosolido, a Distinguished Professor of Sociology in the IU Bloomington College of Arts and Sciences.

“Stigma translates into so many issues, including people’s reluctance to seek care, our shortage of mental health professionals, and the U.S.’ unwillingness to invest resources into the mental health sector. The good news from this study is stigma can change, and the change we document crosses all sectors of society and individuals.”

The study, published in JAMA Network Open, examined how stigma has changed over two decades for mental health disorders such as schizophrenia, major depression and alcohol dependence. IU researchers used data from the U.S. National Stigma Studies, which are part of the General Social Survey, to examine public stigma over a 22-year period at three key points: in 1996, 2006 and 2018.

The team looked at how the public understands the causes underlying individuals’ problems; whether they can identify psychiatric cases from daily problems; their perceptions of what people with different mental illness are like; and their willingness to interact with individuals with mental illnesses in various social contexts.

The study found that from 1996 to 2006, Americans reported increasing beliefs that mental health problems are caused by genetics or disruptions in the brain, rather than moral causes including having a bad character or bad upbringing. While these findings reflected a greater belief in scientific causes, they were not accompanied by any decrease in the public rejection of those with mental illness.

However, data from 2006 to 2018 revealed a statistically significant drop in social rejection for people described as having major depression. Across a number of social contexts, including the workplace, the family and the neighborhood, fewer Americans in the 2018 study compared to the 2006 study expressed an unwillingness to interact with the people described as having major depression.

Other disorders did not see a reduction in the public’s desire to distance themselves socially, however. In fact, public perceptions attributing dangerousness to schizophrenia and lack of morality to alcohol dependence increased.

“It is encouraging to find more progressive attitudes toward mental illness among millennials and to see public stigma around depression significantly decreasing, especially as rates of depression continue to rise in the U.S. among young people,” said Brea Perry, study co-author and a professor of sociology at IU.

“However, the increasing stigmatization of schizophrenia and alcohol dependency is concerning. Taken as a whole, our findings support rethinking stigma and retooling stigma reduction strategies to improve public attitudes surrounding mental illness. There is a lot of work left to be done.”

When it comes to stigma, the study found few differences across subgroups like gender, education or income. The authors documented the well-known conservatizing effect of age, i.e. the increased likelihood of holding more stigmatizing attitudes/conservative values as one gets older, and indications that some birth cohorts, including the “greatest generation” and millennials, hold less stigmatizing attitudes and beliefs. The researchers speculated that different experiences of these groups early in life may be at work.

The researchers recommended several ways to address the importance of mental health, including leveraging the educational system to introduce level-appropriate information on mental health; providing teachers with high-quality materials for health-related courses; and helping philanthropic groups develop interesting and relevant programs.

Additional authors on the paper include Andrew Halpern-Manners of the Department of Sociology at IU and Liying Luo of Pennsylvania State University.

Abstract

Trends in Public Stigma of Mental Illness in the US, 1996-2018

Importance

Stigma, the prejudice and discrimination attached to mental illness, has been persistent, interfering with help-seeking, recovery, treatment resources, workforce development, and societal productivity in individuals with mental illness. However, studies assessing changes in public perceptions of mental illness have been limited.

Objective

To evaluate the nature, direction, and magnitude of population-based changes in US mental illness stigma over 22 years.

Design, Setting, and Participants

This survey study used data collected from the US National Stigma Studies, face-to-face interviews conducted as 1996, 2006, and 2018 General Social Survey modules of community-dwelling adults, based on nationally representative, multistage sampling techniques. Individuals aged 18 years or older, including Spanish-speaking respondents, living in noninstitutionalized settings were interviewed in 1996 (n = 1438), 2006 (n = 1520), and 2018 (n = 1171). The present study was conducted from July 2019 to January 2021.

Main Outcomes and Measures

Respondents reacted to 1 of 3 vignettes (schizophrenia, depression, alcohol dependence) meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria or a control case (daily troubles). Measures included beliefs about underlying causes (attributions), perceptions of likely violence (danger to others), and rejection (desire for social distance).

Results

Of the 4129 individuals interviewed in the surveys, 2255 were women (54.6%); mean (SD) age was 44.6 (16.9) years. In the earlier period (1996-2006), respondents endorsing scientific attributions (eg, genetics) for schizophrenia (11.8%), depression (13.0%), and alcohol dependence (10.9%) increased. In the later period (2006-2018), the desire for social distance decreased for depression in work (18.1%), socializing (16.7%), friendship (9.7%), family marriage (14.3%), and group home (10.4%). Inconsistent, sometimes regressive change was observed, particularly regarding dangerousness for schizophrenia (1996-2018: 15.7% increase, P = .001) and bad character for alcohol dependence (1996-2018: 18.2% increase, P = .001). Subgroup differences, defined by race and ethnicity, sex, and educational level, were few and inconsistent. Change appeared to be consistent with age and generational shifts among 2 birth cohorts (1937-1946 and 1987-2000).

Conclusions and Relevance

To date, this survey study found the first evidence of significant decreases in public stigma toward depression. The findings of this study suggest that individuals’ age was a conservatizing factor whereas being in the pre–World War II or millennial birth cohorts was a progressive factor. However, stagnant stigma levels for other disorders and increasing public perceptions of likely violence among persons with schizophrenia call for rethinking stigma and retooling reduction strategies to increase service use, improve treatment resources, and advance population health.