Skip to main content

Advertisement

SpringerLink
Log in

Treatment recommendations for schizophrenia, major depression and alcohol dependence and stigmatizing attitudes of the public: results from a German population survey

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

In addition to mental health literacy, several potentially conflicting emotions and attitudes among the public are hypothesized to guide their recommendations for specific mental health treatments. It is unclear whether evidence-based treatment strategies are guided by pro-social or stigmatizing attitudes and emotions. In a representative population survey in Germany (n = 3642), we asked respondents to what extent they would recommend psychotropic medication, psychotherapy and relaxation techniques for a person with mental illness described in an unlabelled vignette. For each treatment recommendation, we used multinomial logistic regression analyses to obtain predicted probabilities. Predictors comprised illness recognition, vignette condition, causal beliefs (current stress, childhood adversities, biogenetic), emotions (fear, anger, pro-social reactions), social distance, age, gender and education. Fear predicted greater probability for recommending psychotropic drugs in all investigated illnesses (p < 0.001), whereas associations of fear with recommending psychotherapy were generally lower and no associations with the recommendation for relaxation techniques were found. Anger was related to fewer recommendations for psychotherapy in all illnesses (p < 0.01). Pro-social reactions were predominantly related to the recommendation of relaxation techniques for a person with schizophrenia or major depression (p < 0.001). Higher desire for social distance predicted fewer recommendations for relaxation techniques in all three vignette conditions (p < 0.05). Our study corroborates findings that treatment recommendations are not necessarily linked to pro-social reactions or mental health literacy. The recommendation for a treatment modality like psychotropic medication or psychotherapy can be linked to underlying fear, possibly reflecting a public desire for protection against people with mental illness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Angermeyer MC, Holzinger A, Carta MG et al (2011) Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. Br J Psychiatry 199(5):367–372. doi:10.1192/bjp.bp.110.085563

    Article  PubMed  Google Scholar 

  2. Schomerus G, Matschinger H, Angermeyer MC (2013) Causal beliefs of the public and social acceptance of persons with mental illness: a comparative analysis of schizophrenia, depression and alcohol dependence. Psychol Med. doi:10.1017/S003329171300072X

    PubMed  Google Scholar 

  3. Kvaale EP, Gottdiener WH, Haslam N (2013) Biogenetic explanations and stigma: a meta-analytic review of associations among laypeople. Soc Sci Med 96:95–103. doi:10.1016/j.socscimed.2013.07.017

    Article  PubMed  Google Scholar 

  4. Speerforck S, Schomerus G, Pruess S et al (2014) Different biogenetic causal explanations and attitudes towards persons with major depression, schizophrenia and alcohol dependence: is the concept of a chemical imbalance beneficial? J Affect Disord 168:224–228. doi:10.1016/j.jad.2014.06.013

    Article  PubMed  Google Scholar 

  5. Lebowitz MS, W-k A (2014) Effects of biological explanations for mental disorders on clinicians’ empathy. Proc Natl Acad Sci USA 111(50):17786–17790. doi:10.1073/pnas.1414058111

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Malla A, Joober R, Garcia A (2015) “Mental illness is like any other medical illness”: a critical examination of the statement and its impact on patient care and society. J Psychiatry Neurosci JPN 40(3):147–150

    Article  PubMed  Google Scholar 

  7. Farooq S, Large M, Nielssen O et al (2009) The relationship between the duration of untreated psychosis and outcome in low-and-middle income countries: a systematic review and meta analysis. Schizophr Res 109(1–3):15–23. doi:10.1016/j.schres.2009.01.008

    Article  PubMed  Google Scholar 

  8. Angermeyer MC, Matschinger H, Riedel-Heller SG (1999) Whom to ask for help in case of a mental disorder? Preferences of the lay public. Soc Psychiatry Psychiatr Epidemol 34(4):202–210. doi:10.1007/s001270050134

    Article  CAS  Google Scholar 

  9. Moro MF, Angermeyer MC, Matschinger H et al (2014) Whom to ask for professional help in case of major depression? Help-seeking recommendations of the Sardinian public. Adm Policy Ment Health. doi:10.1007/s10488-014-0604-y

    Google Scholar 

  10. Jagdeo A, Cox BJ, Stein MB et al (2009) Negative attitudes toward help seeking for mental illness in 2 population-based surveys from the United States and Canada. Can J Psychiatry 54(11):757–766

    Article  PubMed  Google Scholar 

  11. Lauber C, Nordt C, Falcato L et al (2001) Lay recommendations on how to treat mental disorders. Soc Psychiatry Psychiatr Epidemiol 36(11):553–556. doi:10.1007/s001270170006

    Article  CAS  PubMed  Google Scholar 

  12. Holzinger A, Matschinger H, Angermeyer MC (2011) What to do about depression? Help-seeking and treatment recommendations of the public. Epidemiol Psychiatr Sci 20(02):163–169. doi:10.1017/S2045796011000266

    Article  CAS  PubMed  Google Scholar 

  13. Riedel-Heller SG, Matschinger H, Angermeyer MC (2005) Mental disorders—who and what might help? Help-seeking and treatment preferences of the lay public. Soc Psychiatry Psychiatr Epidemiol 40(2):167–174. doi:10.1007/s00127-005-0863-8

    Article  PubMed  Google Scholar 

  14. Angermeyer MC, Matschinger H, Schomerus G (2013) Attitudes towards psychiatric treatment and people with mental illness: changes over two decades. Br J Psychiatry 203(2):146–151. doi:10.1192/bjp.bp.112.122978

    Article  PubMed  Google Scholar 

  15. Angermeyer MC, Breier P, Dietrich S et al (2005) Public attitudes toward psychiatric treatment. An international comparison. Soc Psychiatry Psychiatr Epidemiol 40(11):855–864. doi:10.1007/s00127-005-0958-x

    Article  PubMed  Google Scholar 

  16. Lauber C, Nordt C, Rössler W (2005) Recommendations of mental health professionals and the general population on how to treat mental disorders. Soc Psychiatry Psychiatr Epidemiol 40(10):835–843. doi:10.1007/s00127-005-0953-7

    Article  PubMed  Google Scholar 

  17. Pescosolido BA, Martin JK, Long JS et al (2010) “A disease like any other”? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. Am J Psychiatry 167(11):1321–1330. doi:10.1176/appi.ajp.2010.09121743

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pattyn E, Verhaeghe M, Sercu C et al (2013) Medicalizing versus psychologizing mental illness: what are the implications for help seeking and stigma? A general population study. Soc Psychiatry Psychiatr Epidemiol 48(10):1637–1645. doi:10.1007/s00127-013-0671-5

    Article  CAS  PubMed  Google Scholar 

  19. Schomerus G, Schwahn C, Holzinger A et al (2012) Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatr Scand 125(6):440–452. doi:10.1111/j.1600-0447.2012.01826.x

    Article  CAS  PubMed  Google Scholar 

  20. Rüsch N, Evans-Lacko S, Thornicroft G (2012) What is a mental illness? Public views and their effects on attitudes and disclosure. Aust NZ J Psychiatry 46(7):641–650. doi:10.1177/0004867412438873

    Article  Google Scholar 

  21. Xu Z, Muller M, Heekeren K et al (2015) Self-labelling and stigma as predictors of attitudes towards help-seeking among people at risk of psychosis: 1-year follow-up. Eur Arch Psychiatry Clin Neurosci 266(1):79–82. doi:10.1007/s00406-015-0576-2

    Article  PubMed  Google Scholar 

  22. Jorm AF, Morgan AJ, Hetrick SE (2008) Relaxation for depression. Cochrane Database Syst Rev 4:CD007142. doi:10.1002/14651858.CD007142.pub2

    Google Scholar 

  23. Hoffmeyer-Zlotnik JHP (1997) Random-Route-Stichproben nach ADM. In: Gabler S, Hoffmeyer-Zlotnik JHP (eds) Stichproben in der Umfragepraxis. VS Verlag für Sozialwissenschaften, Wiesbaden, pp 33–42

    Chapter  Google Scholar 

  24. Angermeyer MC, Matschinger H (1997) Social distance towards the mentally ill: results of representative surveys in the Federal Republic of Germany. Psychol Med 27(1):131–141

    Article  CAS  PubMed  Google Scholar 

  25. Angermeyer MC, Matschinger H, Holzinger A (1998) Gender and attitudes towards people with Schizophrenia. Results of a representative survey in the Federal Republic of Germany. Int J Soc Psychiatry 44(2):107–116. doi:10.1177/002076409804400203

    Article  CAS  PubMed  Google Scholar 

  26. Angermeyer MC, Matschinger H (2003) The stigma of mental illness: effects of labelling on public attitudes towards people with mental disorder. Acta Psychiatr Scand 108(4):304–309

    Article  CAS  PubMed  Google Scholar 

  27. Schomerus G, Matschinger H, Angermeyer MC (2013) Continuum beliefs and stigmatizing attitudes towards persons with schizophrenia, depression and alcohol dependence. Psychiatry Res 209(3):665–669. doi:10.1016/j.psychres.2013.02.006

    Article  PubMed  Google Scholar 

  28. Link BG, Phelan JC (2001) Conceptualizing stigma. Annu Rev Sociol 27:363–385

    Article  Google Scholar 

  29. Link BG, Yang LH, Phelan JC et al (2004) Measuring mental illness stigma. Schizophr Bull 30(3):511–541

    Article  PubMed  Google Scholar 

  30. Link BG, Cullen FT, Frank J et al (1987) The social rejection of former mental patients: understanding why labels matter. Am J Sociol 92:1461–1500

    Article  Google Scholar 

  31. Jorm AF, Griffiths KM (2008) The public’s stigmatizing attitudes towards people with mental disorders: how important are biomedical conceptualizations? Acta Psychiatr Scand 118(4):315–321. doi:10.1111/j.1600-0447.2008.01251.x

    Article  CAS  PubMed  Google Scholar 

  32. Yap MB, Hui RN, Mackinnon AJ et al (2013) Psychiatric labels and other influences on young people’s stigmatizing attitudes: findings from an Australian national survey. J Affect Disorders 148(2–3):299–309. doi:10.1016/j.jad.2012.12.015

    Article  PubMed  Google Scholar 

  33. Bilger M, Manning WG (2015) Measuring overfitting in nonlinear models: a new method and an application to health expenditures. Health Econ 24(1):75–85. doi:10.1002/hec.3003

    Article  PubMed  Google Scholar 

  34. Long JS, Freese J (2014) Regression models for categorical dependent variables using Stata, 3rd edn. Stata Press, College Station

    Google Scholar 

  35. StataCorp (2013) Stata statistical software: release 13. StataCorp LP, College Station

    Google Scholar 

  36. Mojtabai R (2010) Mental illness stigma and willingness to seek mental health care in the European Union. Soc Psychiatry Psychiatr Epidemiol 45(7):705–712. doi:10.1007/s00127-009-0109-2

    Article  PubMed  Google Scholar 

  37. Yap MBH, Wright A, Jorm AF (2011) The influence of stigma on young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help. Soc Psychiatry Psychiatr Epidemiol 46(12):1257–1265. doi:10.1007/s00127-010-0300-5

    Article  PubMed  Google Scholar 

  38. Yap MB, Hui RNJ, Jorm AF (2013) Associations between stigma and help-seeking intentions and beliefs: findings from an Australian national survey of young people. Psychiatry Res 210(3):1154–1160. doi:10.1016/j.psychres.2013.08.029

    Article  PubMed  Google Scholar 

  39. Angermeyer MC, Matschinger H, Schomerus G (2014) Attitudes of the German public to restrictions on persons with mental illness in 1993 and 2011. Epidemiol Psychiatr Sci 23(3):263–270. doi:10.1017/S2045796014000183

    Article  CAS  PubMed  Google Scholar 

  40. Angermeyer MC, Matschinger H, Schomerus G (2013) Has the public taken notice of psychiatric reform? The image of psychiatric hospitals in Germany 1990–2011. Soc Psychiatry Psychiatr Epidemiol 48(10):1629–1635. doi:10.1007/s00127-013-0670-6

    Article  PubMed  Google Scholar 

  41. Grant BF (1997) Barriers to alcoholism treatment: reasons for not seeking treatment in a general population sample. J Stud Alcohol 58(4):365–371

    Article  CAS  PubMed  Google Scholar 

  42. Schomerus G, Matschinger H, Angermeyer MC (2009) The stigma of psychiatric treatment and help-seeking intentions for depression. Eur Arch Psychiatry Clin Neurosci 259(5):298–306. doi:10.1007/s00406-009-0870-y

    Article  PubMed  Google Scholar 

  43. Schomerus G, Lucht M, Holzinger A et al (2011) The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol Alcohol 46(2):105–112. doi:10.1093/alcalc/agq089

    Article  CAS  PubMed  Google Scholar 

  44. Phelan JC, Yang LH, Cruz-Rojas R (2006) Effects of attributing serious mental illnesses to genetic causes on orientations to treatment. Psychiatr Serv 57(3):382–387. doi:10.1176/appi.ps.57.3.382

    Article  PubMed  Google Scholar 

  45. Heydendorff SC, Dreßing H (2016) Medial Stigmatization of Mentally Ill Persons after the “Germanwings”-Crash. Psychiatr Prax 43(3):134–140. doi:10.1055/s-0042-101009

    Article  Google Scholar 

  46. Henderson C, Evans-Lacko S, Thornicroft G (2013) Mental illness stigma, help seeking, and public health programs. Am J Public Health 103(5):777–780. doi:10.2105/AJPH.2012.301056

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. Nicholas Meyer, Kings College London, for valuable comments on the manuscript.

Funding

This study was funded by the Fritz-Thyssen-Stiftung (Az. 10.11.2.175).

Author information

Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Medicine, Greifswald University, Ellernholzstraße 1-2, 17475, Greifswald, Germany

    Sven Speerforck & Georg Schomerus

  2. Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany

    Herbert Matschinger

  3. Institute of Medical Sociology and Health Economics, University of Hamburg, Hamburg, Germany

    Herbert Matschinger

  4. Department of Public Health, Clinical and Molecular Psychiatry, University of Cagliari, Cagliari, Italy

    Matthias C. Angermeyer

  5. Center for Public Mental Health, Gösing Am Wagram, Austria

    Matthias C. Angermeyer

Authors
  1. Sven Speerforck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georg Schomerus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Herbert Matschinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthias C. Angermeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sven Speerforck.

Ethics declarations

Conflict of interest

All authors report no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 42 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Speerforck, S., Schomerus, G., Matschinger, H. et al. Treatment recommendations for schizophrenia, major depression and alcohol dependence and stigmatizing attitudes of the public: results from a German population survey. Eur Arch Psychiatry Clin Neurosci 267, 341–350 (2017). https://doi.org/10.1007/s00406-016-0755-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-016-0755-9

Keywords

Search

Navigation