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Emotional Reactions to People with Mental Illness: Results from Population Studies Matthias C. Angermeyer Center for Public Mental Health Gösing am Wagram.

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Presentation on theme: "Emotional Reactions to People with Mental Illness: Results from Population Studies Matthias C. Angermeyer Center for Public Mental Health Gösing am Wagram."— Presentation transcript:

1 Emotional Reactions to People with Mental Illness: Results from Population Studies Matthias C. Angermeyer Center for Public Mental Health Gösing am Wagram Austria

2 …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)

3 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)

4 N Publications Publications on Population Studies on Public Beliefs About Mental Disorder and Attitudes Towards People With Mental Illness (N=369) Years

5 Studies on Public Beliefs about Mental Disorders and Attitudes Towards the Mentally Ill (n=261) 1-9 10+

6 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

7 Components of Modern Conceptualizations of Stigma Link & Phelan 2004Corrigan & Watson 2002Thornicroft 2006 Labelling Stereotyping Separating Status loss + Discrimination Dependence of Stigma on Power Stereotype Discrimination Ignorance Discrimination Emotional Reactions Prejudice

8 Components of Modern Conceptualizations of Stigma Link & Phelan 2004Corrigan & Watson 2002Thornicroft 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

9 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.

10 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.

11 How prevalent are the various emotional reactions to people with mental disorder? Are there differences between mental disorders as concerns the publics emotional reactions? How important are emotional reactions as compared with stereotypes? Does familiarity with mental illness work through modification of emotional reactions?

12 How prevalent are the various emotional reactions to people with mental disorder? Are there differences between mental disorders? How important are emotional reactions as compared to stereotypes? Does familiarity with mental illness work through modification of emotional reactions?

13 Emotional Reactions to People With Schizophrenia Population Study in Germany, 2001 Positive Emotions FearAnger %

14 Emotional Reactions to People With Schizophrenia Population Study in Bratislava, 2003 % Positive Emotions FearAnger

15 Emotional Reactions to People With Schizophrenia Population Study in Novosibirsk, 2002 % Positive Emotions FearAnger

16 Emotional Reactions to People With Schizophrenia Population Study in Ulaanbaatar, 2002 % Positive Emotions FearAnger

17 Emotional Reactions to People With Major Depression Population Study in Germany, 2001 % Positive Emotions FearAnger

18 Emotional Reactions to People With Major Depression Population Study in Germany, 2001 % Positive Emotions FearAnger

19 Emotional Reactions to People With Major Depression Population Study in Bratislava, 2003 % Positive Emotions FearAnger

20 Emotional Reactions to People With Major Depression Population Study in Novosibirsk, 2002 % Positive Emotions FearAnger

21 Emotional Reactions to People With Major Depression Population Study in Ulaanbaatar, 2002 % Positive Emotions FearAnger

22 Emotional Reactions to People With Schizophrenia Population Studies in the Western Part of Germany, 1990 and 2001 Score Fear Positive emotionsAnger 1990200119902001 1990

23 Emotional Reactions to People With Major Depression Population Studies in the Western Part of Germany, 1990 and 2001 Score Fear Positive emotionsAnger 1990200119902001 1990

24 Emotional Reactions to People With Schizophrenia Population Studies in the Eastern Part of Germany, 1993 and 2001 Score Fear Positive emotionsAnger 1993200119932001 1993

25 Emotional Reactions to People With Major Depression Population Studies in the Eastern Part of Germany, 1993 and 2001 Score Fear Positive emotionsAnger 1993200119932001 1993

26 How prevalent are the various emotional reactions to people with mental disorder? Are there differences between mental disorders as concerns the publics emotional reactions? How important are emotional reactions as compared to stereotypes? Does familiarity with mental illness work through modification of emotional reactions?

27 Emotional Reactions to People With Schizophrenia, Major Depression and Alcohol Dependence Population Studies in the Western Part of Germany, 1990 Score Fear Positive emotionsAnger Schizophrenia Major DepressionAlcohol Dependence

28 Emotional Reactions to People With Schizophrenia, Major Depression and Alcoholism Population Studies in the Western Part of Germany, 1990 Score Fear Positive emotionsAnger Schizophrenia Major DepressionAlcoholism

29 Emotional Reactions to People With Schizophrenia, Major Depression and Alcoholism Population Studies in the Western Part of Germany, 1990 Score Fear Positive emotionsAnger Schizophrenia Major DepressionAlcoholism

30 Emotional Reactions to People With Schizophrenia, Major Depression and Alcohol Dependence Population Studies in the Western Part of Germany, 1990 Score Fear Positive emotionsAnger Schizophrenia Major DepressionAlcohol Dependence

31 Emotional Reactions to People With Schizophrenia, Major Depression and Alcoholism Population Studies in the Western Part of Germany, 1990 Score Fear Positive emotionsAnger Schizophrenia Major DepressionAlcoholism

32 How prevalent are the various emotional reactions to people with mental disorder? Are there differences between mental disorders? How important are emotional reactions as compared to stereotypes? Does familiarity with mental illness work through modification of emotional reactions?

33 Model 1Model 2Model 3Model 4 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.

34 Model 1Model 2Model 3Model 4 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.

35 Model 1Model 2Model 3Model 4 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.

36 Model 1Model 2Model 3Model 4 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.

37 How prevalent are the various emotional reactions to people with mental disorder? Are there differences between mental disorders? How important are emotional reactions as compared to stereotypes? Does familiarity with mental illness work through modification of emotional reactions?

38 Number of studies Familiarity with Mental Illness and Desire for Social Distance Systematic Review of Population-Based Studies on Public Beliefs About Mental Disorders and Attitudes Towards the Mentally Ill

39

40

41 Association Between Familiarity, Emotional Reactions and Social Distance Towards People With Schizophrenia Population Study in Germany, 2001 1.67 -0.20 Familiarity Social distance 0.22-2.09 Positive emotions Fear -0.18 Anger -1.60 Sum of indirect effects –1.61 0.22

42 Association Between Familiarity, Emotional Reactions and Social Distance Towards People With Major Depression Population Study in Germany, 2001 -1.31 Familiarity Social distance 0.25 -1.75 Positive emotions 1.35 Fear Sum of indirect effects –1.22 0.15 -0.23 Anger 0.33

43 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 publics 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

44 As compared to stereotypes and behavioural intentions, the publics emotional reactions to people with mental disorders are relatively under-researched. Our findings suggest that more research on the publics 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


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