The Relationship between Individual-Level and Context-Level Factors and Social Distancing from Patients with Depression in Taiwan: A Multilevel Analysis of National Surveys
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample Design
2.2. Measures
2.2.1. Dependent Variable
2.2.2. Individual-Level Variables
2.2.3. Context-Level Variables
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A
References
- Vos, T.; Allen, C.; Arora, M.; Barber, R.M.; A Bhutta, Z.; Brown, A.; Carter, A.; Casey, D.C.; Charlson, F.J.; Chen, A.Z.; et al. Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 310 Diseases and Injuries, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015. Lancet 2016, 388, 1545–1602. [Google Scholar] [CrossRef] [Green Version]
- Luppa, M.; Sikorski, C.; Motzek, T.; Konnopka, A.; König, H.-H.; Riedel-Heller, S.G. Health Service Utilization and Costs of Depressive Symptoms in Late Life—A Systematic Review. Curr. Pharm. Des. 2012, 18, 5936–5957. [Google Scholar] [CrossRef] [PubMed]
- Bromet, E.J.; Andrade, L.H.; Hwang, I.; Sampson, N.A.; Alonso, J.; De Girolamo, G.; De Graaf, R.; Demyttenaere, K.; Hu, C.; Iwata, N.; et al. Cross-National Epidemiology of DSM-IV Major Depressive Episode. BMC Med. 2011, 9, 90. [Google Scholar] [CrossRef]
- Boonstra, N.; Klaassen, R.; Sytema, S.; Marshall, M.; De Haan, L.; Wunderink, L.; Wiersma, D. Duration of Untreated Psychosis and Negative Symptoms—A Systematic Review and Meta-Analysis of Individual Patient Data. Schizophr. Res. 2012, 142, 12–19. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wang, P.S.; Aguilar-Gaxiola, S.; Alonso, J.; Angermeyer, M.C.; Borges, G.; Bromet, E.J.; Bruffaerts, R.; De Girolamo, G.; De Graaf, R.; Gureje, O.; et al. Use of Mental Health Services for Anxiety, Mood, and Substance Disorders in 17 Countries in the WHO World Mental Health Surveys. Lancet 2007, 370, 841–850. [Google Scholar] [CrossRef] [Green Version]
- Vogel, D.L.; Wade, N.G.; Hackler, A.H. Perceived Public Stigma and the Willingness to Seek Counseling: The Mediating Roles of Self-Stigma and Attitudes toward Counseling. J. Couns. Psychol. 2007, 54, 40–50. [Google Scholar] [CrossRef] [Green Version]
- Angermeyer, M.C.; Holzinger, A.; Carta, M.G.; Schomerus, G. Biogenetic Explanations and Public Acceptance of Mental Illness: Systematic Review of Population Studies. Br. J. Psychiatry 2011, 199, 367–372. [Google Scholar] [CrossRef] [Green Version]
- Larkings, J.S.; Brown, P.M. Do Biogenetic Causal Beliefs Reduce Mental Illness Stigma in People with Mental Illness and in Mental Health Professionals? A Systematic Review. Int. J. Ment. Health Nurs. 2017, 27, 928–941. [Google Scholar] [CrossRef]
- Ng, Q.X.; Lim, D.Y.; Chee, K.T. Reimagining the Spectrum of Affective Disorders. Bipolar Disord. 2020. [Google Scholar] [CrossRef]
- Yeger, B.E.; Muzio, C.; Rinosi, G.; Solano, P.; Geoffroy, P.; Pompili, M.; Amore, M.; Serafini, G.; Information, P.E.K.F.C. Extreme Sensory Processing Patterns and Their Relation with Clinical Conditions Among Individuals with Major Affective Disorders. Psychiatry Res. Neuroimaging 2016, 236, 112–118. [Google Scholar] [CrossRef]
- Kosyluk, K.; Conner, K.O.; Al-Khouja, M.; Bink, A.; Buchholz, B.; Ellefson, S.; Fokuo, J.K.; Goldberg, D.; Kraus, D.; Leon, A.; et al. Factors Predicting Help Seeking for Mental Illness Among College Students. J. Ment. Health 2020, 1–8. [Google Scholar] [CrossRef] [PubMed]
- Link, B.G.; Phelan, J.C. Conceptualizing Stigma. Annu. Rev. Sociol. 2001, 27, 363–385. [Google Scholar] [CrossRef]
- Corrigan, P.W.; Edwards, A.B.; Green, A.; Diwan, S.L.; Penn, D.L. Prejudice, Social Distance, and Familiarity with Mental Illness. Schizophr. Bull. 2001, 27, 219–225. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Zhuang, X.Y.; Wong, D.F.K.; Cheng, C.-W.; Pan, S.-M. Mental Health Literacy, Stigma and Perception of Causation of Mental Illness Among Chinese People in Taiwan. Int. J. Soc. Psychiatry 2017, 63, 498–507. [Google Scholar] [CrossRef]
- Parcesepe, A.M.; Cabassa, L.J. Public Stigma of Mental Illness in the United States: A Systematic Literature Review. Adm. Policy Ment. Health Ment. Health Serv. Res. 2013, 40, 384–399. [Google Scholar] [CrossRef] [Green Version]
- Ewalds-Kvist, B.; Högberg, T.; Lützen, K. Impact of Gender and Age on Attitudes towards Mental Illness in Sweden. Nord. J. Psychiatry 2013, 67, 360–368. [Google Scholar] [CrossRef]
- Barry, M.M.; Doherty, A.; Hope, A.; Sixsmith, J.; Kelleher, C.C. A Community Needs Assessment for Rural Mental Health Promotion. Health Educ. Res. 2000, 15, 293–304. [Google Scholar] [CrossRef] [Green Version]
- Aromaa, E.; Tolvanen, A.; Tuulari, J.; Wahlbeck, K. Personal Stigma and Use of Mental Health Services Among People with Depression in a General Population in Finland. BMC Psychiatry 2011, 11, 52. [Google Scholar] [CrossRef] [Green Version]
- Gaebel, W.; Baumann, A.; Witte, A.M.; Zaeske, H. Public Attitudes towards People with Mental Illness in Six German Cities. Eur. Arch. Psychiatry Clin. Neurosci. 2002, 252, 278–287. [Google Scholar] [CrossRef]
- Knesebeck, O.V.D.; Angermeyer, M.C.; Kofahl, C.; Makowski, A.C.; Mnich, E. Education and the Public’s Desire for Social Distance from People with Depression and Schizophrenia: The Contribution of Emotional Reactions and Causal Attributions. Int. J. Soc. Psychiatry 2014, 60, 468–473. [Google Scholar] [CrossRef]
- Angermeyer, M.C.; Dietrich, S. Public Beliefs About and Attitudes towards People with Mental Illness: A Review of Population Studies. Acta Psychiatr. Scand. 2006, 113, 163–179. [Google Scholar] [CrossRef] [PubMed]
- Anderson, K.N.; Jeon, A.B.; Blenner, J.A.; Wiener, R.L.; Hope, D.A. How People Evaluate Others with Social Anxiety Disorder: A Comparison to Depression and General Mental Illness Stigma. Am. J. Orthopsychiatry 2015, 85, 131–138. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lauber, C.; Nordt, C.; Falcato, L.; Rössler, W. Factors Influencing Social Distance Toward People with Mental Illness. Community Ment. Health J. 2004, 40, 265–274. [Google Scholar] [CrossRef]
- Corrigan, P. How Stigma Interferes with Mental Health Care. Am. Psychol. 2004, 59, 614–625. [Google Scholar] [CrossRef] [Green Version]
- Angermeyer, M.C.; Matschinger, H. The Stigma of Mental Illness: Effects of Labelling on Public Attitudes towards People with Mental Disorder. Acta Psychiatr. Scand. 2003, 108, 304–309. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Grausgruber, A.; Meise, U.; Katschnig, H.; Schöny, W.; Fleischhacker, W.W. Patterns of Social Distance towards People Suffering from Schizophrenia in Austria: A Comparison between the General Public, Relatives and Mental Health Staff. Acta Psychiatr. Scand. 2007, 115, 310–319. [Google Scholar] [CrossRef]
- Liekens, S.; Smits, T.; Laekeman, G.; Foulon, V. Factors Determining Social Distance Toward People with Depression Among Community Pharmacists. Eur. Psychiatry 2012, 27, 528–535. [Google Scholar] [CrossRef]
- Corrigan, P.W.; Green, A.; Lundin, R.; Kubiak, M.A.; Penn, D.L. Familiarity with and Social Distance from People Who Have Serious Mental Illness. Psychiatr. Serv. 2001, 52, 953–958. [Google Scholar] [CrossRef]
- Liu, J.; Yan, F.; Ma, X.; Guo, H.L.; Tang, Y.L.; Rakofsky, J.J.; Wu, X.M.; Li, X.Q.; Zhu, H.; Guo, X.B.; et al. Perceptions of Public Attitudes towards Persons with Mental Illness in Beijing, China: Results from a Representative Survey. Soc. Psychiatry Psychiatr. Epidemiol. 2016, 51, 443–453. [Google Scholar] [CrossRef]
- Yang, L.H.; Purdie-Vaughns, V.; Kotabe, H.P.; Link, B.G.; Saw, A.; Wong, G.; Phelan, J.C. Culture, Threat, and Mental Illness Stigma: Identifying Culture-Specific Threat Among Chinese-American Groups. Soc. Sci. Med. 2013, 88, 56–67. [Google Scholar] [CrossRef] [Green Version]
- Huang, L.-L. Interpersonal Harmony and Conflict for Chinese People: A Yin–Yang Perspective. Front. Psychol. 2016, 7. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Triandis, H.C. The self and social behavior in differing cultural contexts. Psychol. Rev. 1989, 96, 506–520. [Google Scholar] [CrossRef]
- Yang, F.; Yang, B.X.; Stone, T.E.; Wang, X.Q.; Zhou, Y.; Zhang, J.; Jiao, S.F. Stigma towards Depression in a Community-Based Sample in China. Compr. Psychiatry 2020, 97, 152152. [Google Scholar] [CrossRef] [PubMed]
- Luo, A.; He, H.; Mohamed, S.; Rosenheck, R. Medical Student Attitudes towards People with Mental Illness in China: A Qualitative Study. Cult. Med. Psychiatry 2018, 42, 535–551. [Google Scholar] [CrossRef] [PubMed]
- Corrigan, P.W.; Markowitz, F.E.; Watson, A.C. Structural Levels of Mental Illness Stigma and Discrimination. Schizophr. Bull. 2004, 30, 481–491. [Google Scholar] [CrossRef] [Green Version]
- Min, S.-Y.; Wong, Y.-L.I. Association between Community Contextual Factors and Stigma of Mental Illness in South Korea: A Multilevel Analysis. Psychiatr. Q. 2017, 88, 853–864. [Google Scholar] [CrossRef]
- Bhavsar, V.; Schofield, P.; Das-Munshi, J.; Henderson, C. Regional Differences in Mental Health Stigma—Analysis of Nationally Representative Data from the Health Survey for England, 2014. PLoS ONE 2019, 14, e0210834. [Google Scholar] [CrossRef]
- Gonzales, L.; Chan, G.; Yanos, P.T. Individual and Neighborhood Predictors of Mental Illness Stigma in New York State. Stigma Health 2017, 2, 175–181. [Google Scholar] [CrossRef]
- Tsai, I.-L.; Ho, M.S. An Institutionalist Explanation of the Evolution of Taiwan’s Disability Movement: From the Charity Model to the Social Model. J. Curr. Chin. Aff. 2010, 39, 87–123. [Google Scholar] [CrossRef] [Green Version]
- Borell, K.; Westermark, A. Siting of Human Services Facilities and the Not in My Back Yard Phenomenon: A Critical Research Review. Community Dev. J. 2016, 53, 246–262. [Google Scholar] [CrossRef] [Green Version]
- Wu, Y.; Zhai, G.; Li, S.; Ren, C.; Tsuchida, S. Comparative Research on NIMBY Risk Acceptability between Chinese and Japanese College Students. Environ. Monit. Assess. 2014, 186, 6683–6694. [Google Scholar] [CrossRef] [PubMed]
- Angermeyer, M.C.; Matschinger, H.; Holzinger, A.; Carta, M.G.; Schomerus, G. Psychiatric Services in the Community? The German Public′s Opinion in 1990 and 2011. Epidemiol. Psychiatr. Sci. 2013, 22, 339–344. [Google Scholar] [CrossRef] [PubMed]
- Piat, M. The NIMBY Phenomenon: Community Residents′ Concerns About Housing for Deinstitutionalized People. Health Soc. Work 2000, 25, 127–138. [Google Scholar] [CrossRef] [PubMed]
- Huang, N.-C.; Kung, S.-F.; Hu, S.C. The Relationship between Urbanization, the Built Environment, and Physical Activity among Older Adults in Taiwan. Int. J. Environ. Res. Public Health 2018, 15, 836. [Google Scholar] [CrossRef] [Green Version]
- Girma, E.; Möller-Leimkühler, A.M.; Müller, N.; Dehning, S.; Froeschl, G.; Tesfaye, M. Public Stigma Against Family Members of People with Mental Illness: Findings from the Gilgel Gibe Field Research Center (GGFRC), Southwest Ethiopia. BMC Int. Health Hum. Rights 2014, 14, 2. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Jadhav, S.; Littlewood, R.; Ryder, A.G.; Chakraborty, A.; Jain, S.; Barua, M. Stigmatization of Severe Mental Illness in India: Against the Simple Industrialization Hypothesis. Indian J. Psychiatry 2007, 49, 189–194. [Google Scholar] [CrossRef]
- Martin, J.K.; Pescosolido, B.A.; Tuch, S.A. Of Fear and Loathing: The Role of ‘Disturbing Behavior,’ Labels, and Causal Attributions in Shaping Public Attitudes toward People with Mental Illness. J. Health Soc. Behav. 2000, 41, 208. [Google Scholar] [CrossRef]
- Wrigley, S.; Jackson, H.; Judd, F.; Komiti, A. Role of Stigma and Attitudes Toward Help-Seeking from a General Practitioner for Mental Health Problems in a Rural Town. Aust. N. Z. J. Psychiatry 2005, 39, 514–521. [Google Scholar] [CrossRef]
- Lien, Y.-J.; Kao, Y.-C. Public Beliefs and Attitudes Toward Schizophrenia and Depression in Taiwan: A Nationwide Survey. Psychiatry Res. Neuroimaging 2019, 273, 435–442. [Google Scholar] [CrossRef]
- Choi, B.C.K. Computer Assisted Telephone Interviewing (CATI) for Health Surveys in Public Health Surveillance: Methodological Issues and Challenges Ahead. Chronic Dis. Can. 2004, 25, 21. [Google Scholar]
- American Psychiatric Association Press. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV; American Psychiatric Association Press: Washington, DC, USA, 2013; pp. 84–85. [Google Scholar]
- Link, B.G.; Phelan, J.C.; Bresnahan, M.; Stueve, A.; A Pescosolido, B. Public Conceptions of Mental Illness: Labels, Causes, Dangerousness, and Social Distance. Am. J. Public Health 1999, 89, 1328–1333. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Link, B.G.; Yang, L.H.; Phelan, J.C.; Collins, P.Y. Measuring Mental Illness Stigma. Schizophr. Bull. 2004, 30, 511–541. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Penn, D.L.; Guynan, K.; Daily, T.; Spaulding, W.D.; Garbin, C.P.; Sullivan, M. Dispelling the Stigma of Schizophrenia: What Sort of Information Is Best? Schizophr. Bull. 1994, 20, 567–578. [Google Scholar] [CrossRef] [PubMed]
- Angermeyer, M.C.; Buyantugs, L.; Kenzine, D.V.; Matschinger, H. Effects of Labelling on Public Attitudes towards People with Schizophrenia: Are There Cultural Differences? Acta Psychiatr. Scand. 2004, 109, 420–425. [Google Scholar] [CrossRef] [PubMed]
- Ellison, N.; Mason, O.J.; Scior, K. Public Beliefs About and Attitudes towards Bipolar Disorder: Testing Theory Based Models of Stigma. J. Affect. Disord. 2015, 175, 116–123. [Google Scholar] [CrossRef]
- Mukaka, M.M. Statistics Corner: A Guide to Appropriate Use of Correlation Coefficient in Medical Research. Malawi Med. J. 2012, 24, 69–71. [Google Scholar]
- Angermeyer, M.C.; Holzinger, A.; Matschinger, H. Emotional Reactions to People with Mental Illness. Epidemiol. Psichiatr. Soc. 2010, 19, 26–32. [Google Scholar] [CrossRef]
- Ministry of Health and Welfare. Statistics. Available online: https://dep.mohw.gov.tw/DOS/cp-1728-2920-113.html (accessed on 4 July 2019).
- National Statistics, R.O.C. Social Indicators. Available online: https://eng.stat.gov.tw/mp.asp?mp=5 (accessed on 4 July 2019).
- IBM SPSS Statistics for Windows; Version 23.0; IBM Corp.: Armonk, NY, USA, 2015.
- Bulmer, M.G. Principles of Statistics; Dover: New York, NY, USA, 1979; p. 1711. [Google Scholar]
- Joanes, D.N.; Gill, C.A. Comparing Measures of Sample Skewness and Kurtosis. J. R. Stat. Soc. 1998, 47, 183–189. [Google Scholar] [CrossRef]
- Crisp, A.; Gelder, M.; Goddard, E.; Meltzer, H. Stigmatization of People with Mental Illnesses: A Follow-up Study within the Changing Minds Campaign of the Royal College of Psychiatrists. World Psychiatry 2005, 4, 106–113. [Google Scholar]
- Svensson, B.; Hansson, L. How Mental Health Literacy and Experience of Mental Illness Relate to Stigmatizing Attitudes and Social Distance towards People with Depression or Psychosis: A Cross-Sectional Study. Nord. J. Psychiatry 2016, 70, 309–313. [Google Scholar] [CrossRef]
- Peluso, E.T.; Blay, S.L. Public Stigma in Relation to Individuals with Depression. J. Affect. Disord. 2009, 115, 201–206. [Google Scholar] [CrossRef]
- Buizza, C.; Pioli, R.; Ponteri, M.; Vittorielli, M.; Corradi, A.; Minicuci, N.; Rossi, G. Community Attitudes towards Mental Illness and Socio-Demographic Characteristics: An Italian Study. Epidemiol. Psichiatr. Soc. 2005, 14, 154–162. [Google Scholar] [CrossRef] [PubMed]
- Kabir, M.; Iliyasu, Z.; Abubakar, I.S.; Aliyu, M.H. Perception and Beliefs About Mental Illness Among Adults in Karfi Village, Northern Nigeria. BMC Int. Health Hum. Rights 2004, 4, 3. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Leiderman, E.A.; Vazquez, G.; Berizzo, C.; Bonifacio, A.; Bruscoli, N.; Capria, J.I.; Ehrenhaus, B.; Guerrero, M.; Guerrero, M.; Lolich, M.; et al. Public Knowledge, Beliefs and Attitudes towards Patients with Schizophrenia: Buenos Aires. Soc. Psychiatry Psychiatr. Epidemiol. 2011, 46, 281–290. [Google Scholar] [CrossRef] [PubMed]
- Dietrich, S.; Beck, M.; Bujantugs, B.; Kenzine, D.; Matschinger, H.; Angermeyer, M.C. The Relationship between Public Causal Beliefs and Social Distance Toward Mentally Ill People. Aust. N. Z. J. Psychiatry 2004, 38, 348–354. [Google Scholar] [CrossRef] [PubMed]
- Magliano, L.; Fiorillo, A.; De Rosa, C.; Malangone, C.; Maj, M. Beliefs About Schizophrenia in Italy: A Comparative Nationwide Survey of the General Public, Mental Health Professionals, and Patients′ Relatives. Can. J. Psychiatry 2004, 49, 323–331. [Google Scholar] [CrossRef] [Green Version]
- Werner, P.; Segel-Karpas, D. Depression-Related Stigma: Comparing Laypersons′ Stigmatic Attributions towards Younger and Older Persons. Aging Ment. Health 2019, 1–4. [Google Scholar] [CrossRef]
- Knesebeck, O.V.D.; Mnich, E.; Daubmann, A.; Wegscheider, K.; Angermeyer, M.C.; Lambert, M.; Karow, A.; Härter, M.; Kofahl, C. Socioeconomic Status and Beliefs About Depression, Schizophrenia and Eating Disorders. Soc. Psychiatry Psychiatr. Epidemiol. 2013, 48, 775–782. [Google Scholar] [CrossRef]
- Song, L.-Y.; Chang, L.-Y.; Shih, C.-Y.; Lin, C.-Y.; Yang, M.-J. Community Attitudes towards the Mentally Ill: The Results of a National Survey of the Taiwanese Population. Int. J. Soc. Psychiatry 2005, 51, 162–176. [Google Scholar] [CrossRef]
- Mojtabai, R. Mental Illness Stigma and Willingness to Seek Mental Health Care in the European Union. Soc. Psychiatry Psychiatr. Epidemiol. 2010, 45, 705–712. [Google Scholar] [CrossRef]
- Charles, H.; Manoranjitham, S.; Jacob, K. Stigma and Explanatory Models Among People with Schizophrenia and Their Relatives in Vellore, South India. Int. J. Soc. Psychiatry 2007, 53, 325–332. [Google Scholar] [CrossRef] [PubMed]
- Mannarini, S.; Boffo, M. Anxiety, Bulimia, Drug and Alcohol Addiction, Depression, and Schizophrenia: What Do You Think About Their Aetiology, Dangerousness, Social Distance, and Treatment? A Latent Class Analysis Approach. Soc. Psychiatry Psychiatr. Epidemiol. 2015, 50, 27–37. [Google Scholar] [CrossRef] [PubMed]
- Thornicroft, G.; Brohan, E.; Kassam, A.; Lewis-Holmes, E. Reducing Stigma and Discrimination: Candidate Interventions. Int. J. Ment. Health Syst. 2008, 2, 3. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fazel, S.; Wolf, A.; Chang, Z.; Larsson, H.; Goodwin, G.M.; Lichtenstein, P. Depression and Violence: A Swedish Population Study. Lancet Psychiatry 2015, 2, 224–232. [Google Scholar] [CrossRef] [Green Version]
- Ahonen, L.; Loeber, R.; Brent, D.A. The Association between Serious Mental Health Problems and Violence: Some Common Assumptions and Misconceptions. Trauma Violence Abus. 2019, 20, 613–625. [Google Scholar] [CrossRef]
- Yuan, Q.; Abdin, E.; Picco, L.; Vaingankar, J.A.; Shahwan, S.; Jeyagurunathan, A.; Sagayadevan, V.; Shafie, S.; Tay, J.; Chong, S.A.; et al. Attitudes to Mental Illness and Its Demographic Correlates among General Population in Singapore. PLoS ONE 2016, 11, e0167297. [Google Scholar] [CrossRef] [Green Version]
- Lam, C.S.; Tsang, H.W.H.; Corrigan, P.W.; Lee, Y.T.; Angell, B.; Shi, K.; Jin, S.; Larson, J. Chinese Lay Theory and Mental Illness Stigma: Implications for Research and Practices. J. Rehabil. 2010, 76, 35. [Google Scholar]
- Maunder, R.D.; White, F.A. Intergroup Contact and Mental Health Stigma: A Comparative Effectiveness Meta-Analysis. Clin. Psychol. Rev. 2019, 72, 101749. [Google Scholar] [CrossRef]
- Sowislo, J.F.; Gonet-Wirz, F.; Borgwardt, S.; Lang, U.E.; Huber, C.G. Perceived Dangerousness as Related to Psychiatric Symptoms and Psychiatric Service Use—A Vignette Based Representative Population Survey. Sci. Rep. 2017, 7, 45716. [Google Scholar] [CrossRef] [Green Version]
- Schomerus, G.; Matschinger, H.; Angermeyer, M. Do Psychiatric Units at General Hospitals Attract Less Stigmatizing Attitudes Compared with Psychiatric Hospitals? Epidemiol. Psychiatr. Sci. 2013, 22, 163–168. [Google Scholar] [CrossRef]
- Jorm, A.F.; Reavley, N.J.; Ross, A.M. Belief in the Dangerousness of People with Mental Disorders: A Review. Aust. N. Z. J. Psychiatry 2012, 46, 1029–1045. [Google Scholar] [CrossRef] [PubMed]
- Phelan, J.C.; Link, B.G. Fear of People with Mental Illnesses: The Role of Personal and Impersonal Contact and Exposure to Threat or Harm. J. Health Soc. Behav. 2004, 45, 68–80. [Google Scholar] [CrossRef] [PubMed]
- Eisenberg, D.; Downs, M.F.; Golberstein, E. Effects of Contact with Treatment Users on Mental Illness Stigma: Evidence from University Roommate Assignments. Soc. Sci. Med. 2012, 75, 1122–1127. [Google Scholar] [CrossRef] [PubMed]
- Ta, T.M.T.; Zieger, A.; Schomerus, G.; Cao, T.D.; Dettling, M.; Do, X.T.; Mungee, A.; Diefenbacher, A.; Angermeyer, M.C.; Hahn, E. Influence of Urbanity on Perception of Mental Illness Stigma: A Population Based Study in Urban and Rural Hanoi, Vietnam. Int. J. Soc. Psychiatry 2016, 62, 685–695. [Google Scholar] [CrossRef] [PubMed]
- Boschma, R.; Minondo, A.; Navarro, M. Related Variety and Regional Growth in Spain. Pap. Reg. Sci. 2012, 91, 241–256. [Google Scholar] [CrossRef]
Variable | n | % | ||
---|---|---|---|---|
Sex | ||||
Male | 400 | 50.00 | ||
Female | 400 | 50.00 | ||
Age (years) | ||||
20–29 | 152 | 19.00 | ||
30–39 | 192 | 24.00 | ||
40–49 | 181 | 22.63 | ||
50–59 | 182 | 22.75 | ||
60–65 | 93 | 11.63 | ||
Educational attainment | ||||
Primary education or below | 14 | 1.75 | ||
Secondary education | 54 | 6.75 | ||
High school | 242 | 30.25 | ||
University degree or above | 490 | 61.25 | ||
Variable | M | SD | Skewness | Kurtosis |
Perceived dangerousness | 6.00 | 1.53 | 0.52 | −0.62 |
Emotional reaction of fear | 2.62 | 1.09 | 0.55 | −1.09 |
Social distance | 21.06 | 4.30 | 0.56 | 0.28 |
Variable | M | SD | r | p Value |
---|---|---|---|---|
Sex | −0.07 † | 0.04 | ||
Male | 21.36 | 4.52 | ||
Female | 20.76 | 4.06 | ||
Age (years) | 0.23 ‡ | <0.001 | ||
20–29 | 19.01 | 3.70 | ||
30–39 | 20.97 | 4.19 | ||
40–49 | 21.73 | 4.37 | ||
50–59 | 21.36 | 3.95 | ||
60–65 | 22.69 | 4.81 | ||
Educational attainment | −0.03 ‡ | 0.36 | ||
Primary education or below | 21.86 | 3.35 | ||
Secondary education | 20.94 | 4.44 | ||
High school | 21.27 | 4.32 | ||
University degree or above | 20.94 | 4.31 | ||
Perceived dangerousness | – | – | 0.22 § | <0.001 |
Emotional reaction of fear | – | – | 0.20 § | <0.001 |
Variable (Ref.) | Model 1 | Model 2 | Model 3 † | Model 3 ‡ | Model 4 † | Model 4 ‡ |
---|---|---|---|---|---|---|
β (SE) | β (SE) | β (SE) | β (SE) | β (SE) | β (SE) | |
Fixed effect | ||||||
Individual-level | ||||||
Sex (male) | −0.70 * (0.29) | −0.70 * (0.29) | −0.72 * (0.29) | −0.59 (0.66) | −1.00 (1.03) | |
Age | 0.75 *** (0.11) | 0.74 *** (0.11) | 0.72 *** (0.11) | 0.27 (0.26) | 1.26 ** (0.42) | |
Perceived dangerousness | 0.51 *** (0.09) | 0.51 *** (0.09) | 0.50 *** (0.09) | 0.005 (0.22) | 0.25 (0.34) | |
Emotional reaction of fear | 0.67 *** (0.13) | 0.67 *** (0.13) | 0.68 *** (0.13) | 0.97 ** (0.30) | 0.84 (0.48) | |
Context-level | ||||||
The density of psychiatric rehabilitation services | 0.20 (0.30) | −2.85 (1.58) | ||||
The degree of urbanization | 1.40 * (0.67) | 1.18 (3.91) | ||||
Cross-level | ||||||
Sex × the density of psychiatric rehabilitation services | −0.08 (0.54) | |||||
Age × the density of psychiatric rehabilitation services | 0.38 (0.19) | |||||
Perceived dangerousness × the density of psychiatric rehabilitation services | 0.46 * (0.17) | |||||
Emotional reaction of fear × the density of psychiatric rehabilitation services | −0.26 (0.24) | |||||
Sex × the density of urbanization | 0.41 (1.34) | |||||
Age × the density of urbanization | −0.70 (0.53) | |||||
Perceived dangerousness × the density of urbanization | 0.36 (0.44) | |||||
Emotional reaction of fear × the density of urbanization | −0.22 (0.61) | |||||
Random effect | ||||||
Between-group variance | 0.22 * | 0.10 * | 0.11 * | 0.08 * | 0.15 * | 0.13 * |
Within-group variance | 18.31 | 16.10 | 16.10 | 16.12 | 15.92 | 16.15 |
Intraclass correlation (%) | 1.19 | 0.62 | 0.68 | 0.49 | 0.93 | 0.80 |
Deviance | 4603.87 | 4502.32 | 4502.43 | 4497.63 | 4494.55 | 4491.04 |
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Tsai, C.-H.; Kao, Y.-C.; Lien, Y.-J. The Relationship between Individual-Level and Context-Level Factors and Social Distancing from Patients with Depression in Taiwan: A Multilevel Analysis of National Surveys. Int. J. Environ. Res. Public Health 2020, 17, 7109. https://doi.org/10.3390/ijerph17197109
Tsai C-H, Kao Y-C, Lien Y-J. The Relationship between Individual-Level and Context-Level Factors and Social Distancing from Patients with Depression in Taiwan: A Multilevel Analysis of National Surveys. International Journal of Environmental Research and Public Health. 2020; 17(19):7109. https://doi.org/10.3390/ijerph17197109
Chicago/Turabian StyleTsai, Chi-Hsuan, Yu-Chen Kao, and Yin-Ju Lien. 2020. "The Relationship between Individual-Level and Context-Level Factors and Social Distancing from Patients with Depression in Taiwan: A Multilevel Analysis of National Surveys" International Journal of Environmental Research and Public Health 17, no. 19: 7109. https://doi.org/10.3390/ijerph17197109