Study reveals how stigma has changed over two decades for mental health disorders

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. 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."

Bernice Pescosolido, Study Co-Author, Distinguished Professor of Sociology, IU Bloomington College of Arts and Sciences

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.