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Effects of a Randomized Experiment Portraying Mental Illness and Drug Abuse as Treatable Health Conditions


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Principal Investigator(s):

Emma E. McGinty
Johns Hopkins Bloomberg School of Public Health
Email: emcginty@jhsph.edu
Home page: http://www.jhsph.edu/faculty/directory/profile/5368/McGinty/Emma

Sample size: 4554
Field period: 07/30/2013-12/06/2013


Abstract:

Despite significant advances in treatment, stigma and discrimination toward persons with mental illness and drug addiction have remained constant in past decades. Prior work suggests that portraying other stigmatized health conditions (i.e., HIV/AIDS) as treatable can improve public attitudes toward those affected. Our study compared the effects of vignettes portraying persons with untreated and symptomatic versus successfully treated and asymptomatic mental illness and drug addiction on several dimensions of public attitudes about these conditions. We conducted a survey-embedded randomized experiment using a national sample (N=3940) from an online panel. Respondents were randomly assigned to read one of ten vignettes. Vignette one was a control vignette, vignettes 2-5 portrayed individuals with untreated schizophrenia, depression, prescription pain medication addiction and heroin addiction, and vignettes 6-10 portrayed successfully treated individuals with the same conditions. After reading the randomly assigned vignette, respondents answered questions about their attitudes related to mental illness or drug addiction. Portrayals of untreated and symptomatic schizophrenia, depression, and heroin addiction heightened negative public attitudes toward persons with mental illness and drug addiction. In contrast, portrayals of successfully treated schizophrenia, prescription painkiller addiction, and heroin addiction led to less desire for social distance, greater belief in the effectiveness of treatment, and less willingness to discriminate against persons with these conditions. Portrayal of persons with successfully treated mental illness and drug addiction is a promising strategy for reducing stigma and discrimination toward persons with these conditions and improving public perceptions of treatment effectiveness.

Hypotheses:

1. Portrayals of individuals with untreated, symptomatic mental illness and drug addiction will exacerbate negative public attitudes about and decrease public support for policies that benefit persons with these conditions, compared to a control group.
2. Portrayals of individuals who transition from untreated to successfully treated mental illness and drug addiction will improve public attitudes about and increase public support for policies that benefit persons with these conditions, compared to a control group.
3. Compared to portrayals of untreated and symptomatic individuals who do not recover, portrayals of successfully treated mental illness and drug addiction will elicit more positive public attitudes about and greater public support for policies that benefit persons with these conditions.

Experimental Manipulations:

10 vignettes:
The first vignette served as a control condition and portrayed a person without mental illness or drug addiction. Vignettes 2-5 portrayed persons with untreated and symptomatic schizophrenia, depression, prescription painkiller addiction, and heroin addiction. Vignettes 6-10 portrayed persons with successfully treated schizophrenia without relapse, schizophrenia with relapse, depression, prescription painkiller addiction, and heroin addiction.

Key Dependent Variables:

We examined how vignettes affected outcomes in four domains: desirability of social distance (two items); perceptions about treatment effectiveness (two items); willingness to discriminate (three items); and support for policies that can benefit persons with mental illness/drug addiction (four items). Social distance items were modified versions of measures used in the GSS. Respondents were asked how willing they would be to have a person with mental illness/drug addiction marry into their family or start working closely with them on a job.To measure perceptions of treatment effectiveness, respondents were asked to rate their agreement with two statements, the first of which was developed for this study and the second of which is a modified version of a GSS measure: “the treatment options for persons with mental illness/a drug addiction are effective at controlling symptoms” and “most people with mental illness/a drug addiction can, with treatment, get well and return to productive lives.” The discrimination scale was created for this study and comprised of three items. Respondents were asked to report their agreement with three statements: “discrimination against people with mental illness/a drug addiction is a serious problem”; “employers should be allowed to deny employment to a person with mental illness/a drug addiction”; and “landlords should be able to deny housing to a person with mental illness/a drug addiction.” The policy outcome scale, comprised of four items, was also created for this study. Respondents were asked whether they favor or oppose “requiring insurance companies to offer benefits for the treatment of mental illness/drug addiction that are equivalent to benefits for other medical services;” “increasing government spending on the treatment of mental illness/drug addiction;” “increasing government spending on programs to subsidize housing costs for people with mental illness/drug addiction;” and “increasing government spending on programs that help some people with mental illness/a drug addiction find jobs and provide on-the-job support as needed.”

Summary of Findings:

The results of our study suggest that portrayal of persons with successfully treated mental illness and drug addiction may be a promising strategy for improving public attitudes toward persons with these conditions. As hypothesized, portrayals of untreated, symptomatic mental illness and drug addiction – characterized by abnormal behaviors consistent with the onset of these conditions, including deterioration of personal hygiene and failure to fulfill work and family commitments – heightened Americans’ desire for social distance from persons with mental illness or drug addiction. In contrast, the treated vignettes improved some public attitudes about mental illness and drug addiction compared to the control group. Despite exposure to the same symptomatic individual depiction that elicited negative attitudes among respondents exposed to the untreated vignette, respondents who read additional information portraying the transition to successful treatment reported similar or more positive attitudes about mental illness and drug addiction than control group respondents on all measures. Compared to the control group, respondents who read vignettes portraying persons who transitioned to successfully treated schizophrenia (with and without relapse), prescription pain medication addiction, and heroin addiction reported significantly greater belief in the effectiveness of treatment, and respondents exposed to the treated prescription pain medication and heroin addiction vignettes also reported significantly improved social distance attitudes.

Additional Information:

References

McGinty EE, Goldman HH, Pescosolido B, Barry CL (2014). Portraying mental illness and drug addiction as treatable health conditions: Effects of a Randomized Experiment on Stigma and Discrimination. Social Science and Medicine, In Press.

 

 


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