Author
ANGERMEYER Matthias C.; et al.;
Biogenetic explanations and public acceptance of mental illness: systematic review of population studies.
Journal citation/publication details
British Journal of Psychiatry, 199(5), November 2011, pp.367-372.
Summary
There is little evidence, from the 33 representative population studies included in the review, that biological explanations of mental illness reduce the stereotype of self-responsibility in the general population and social rejection. The notions of dangerousness and unpredictability were found to be much more important in predicting the desire for social distance.
Context
According to attribution theory, a stigmatised condition such as mental illness will provoke a more positive and sympathetic response if it is perceived as being due to a biological cause that is beyond the sufferers’ control. However, evidence from population surveys suggests otherwise. The aim of this systematic review was to assess whether ‘biogenetic causal explanations of mental illness are an appropriate means of attempting to reduce the rejection of people with these disorders’.
Methods
What sources were searched?
Searches were carried out in PubMed, PsycINFO, and theWeb of Science and the reference lists of relevant papers were hand searched for additional studies. Database searches were also carried out on the names of authors of identified papers. Experts in the field were contacted for details of any unpublished reports on the subject.
What search terms/strategies were used?
Search strategies included the following terms: (mental illness OR mental disorder OR schizophrenia OR depression OR alcoholism OR alcohol abuse OR alcohol depend* OR alcoholic OR anxiety disorder OR obsessive compulsive disorder OR dementia OR Alzheimer’s disease) AND (attitudes OR stigma OR mental health literacy OR causal beliefs OR causal attributions OR stereotype OR social distance) AND (representative OR population). No language restrictions were applied.
What criteria were used to decide on which studies to include?
Population-based studies published before 30 June 2010 and examining the following, were included in the review: the association of causal attributions with the desire for social distance from those suffering from mental illness; the relationship between biogenetic attributions and the tendency to blame individuals for their illness; the association between the desire for social distance and stereotypes related to responsibility, dangerousness and unpredictability, and; the prevalence of stereotypes amongst the general population. Studies focusing on subgroups, such as consumers, health professionals, or students, were excluded.
Who decided on their relevance and quality?
Titles, abstracts and, when appropriate, full-text reports, were screened by two named authors. There is no indication that study quality was formally assessed.
How many studies were included and where were they from?
Over six thousand references were obtained from the database searches; after initial screening 503 full reports were assessed. Thirty-nine reports on 32 population studies were included in the review. There were fourteen studies from Europe, eight from North America, seven from Asia, and one each from South America, Africa, and Australia.
How were the study findings combined?
The review is narrative in nature with the results presented under each of the four main inclusion criteria described above.
Findings of the review
There were thirteen reports on the association between causal beliefs and the desire for social distance, seven on stereotypes and social distance, and 25 studies on the prevalence of stereotypes. None of the included studies analysed the association between causal beliefs and blame and responsibility. Most studies focused on mental illness in general, schizophrenia, depression, and alcohol dependence; five of the studies on the prevalence of stereotypes looked at drug misuse and two reported on panic attacks, eating disorders, and dementia.
The association between biogenetic causal beliefs and social difference was reported to be insignificant in most studies. The majority of the studies that reported a significant association focused on schizophrenia. The attribution of responsibility to the individual was not associated with the desire for social distance. However there was a strong association between notions of dangerousness and unpredictability and social distance.
Stereotypes relating to self-responsibility were rarely voiced but perceptions of dangerousness and unpredictability were frequently expressed for general mental illness, schizophrenia, and in some countries for depression.
Authors' conclusions
‘Reducing discrimination against people with mental illness is not among the merits of increasing public knowledge of the biological and genetic basis of mental disorder. Instead there seems to be a danger that biogenetic illness concepts increase rather than decrease public stigma of mental illness.’
Implications for policy or practice
None are discussed.