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A new study published in JAMA Network looked at trends in public stigma of mental illness in the United States.

“The National Stigma Studies are designed to monitor the cultural climate surrounding mental illness and addiction,” study author Bernice A. Pescosolido told us. “This involves not only what people understand, what they can recognize as a problem, what they might do about it (or advise others to do), but also the prejudice and potential discrimination that individuals, families and certain groups face if they have mental health issues.”  

Many theories have been suggested to understand stigma – beliefs about underlying causes (attribution theory), familiarity with people with mental illness (contact theory), for example.  

“Our goal was to try to understand what factors that can be changed do shape stigma so that efforts to end stigma could be more effective,” Pescosolido told us. “On the issue of how American society has changed, we were not initially optimistic because out last study, a decade earlier, showed changes in American’s understanding of mental illness. but no change in prejudice.”

That was disappointing, said Pescosolido because, up until that point, efforts to reduce stigma had bet on the idea that if Americans understood that mental illness was a real disease, they would not be so stigmatizing.  

“But in that earlier study, we found no link between whether American believed that mental illness is real did not translate into lower levels of stigma,” Pescosolido told us. “In the current study, we wanted to look for change and to uncover if there were specific groups of people who were changing (there were not); or whether there were larger, societal shifts that might explain any changes.”  

On that last point, researches believe they do have a strong suggestion that the cultural climate at the time when one was born (one’s cohort) matters. It looks like the Greatest Generation and Millennial Cohorts are more accepting.

 The current study was motivated by three things. First, how people are treated when they have a mental illness matters in treatment, in their workplace, in their family, and in the larger society. People with mental illness have to fight the disease and the stigma that comes with it.  

Second, efforts to fight stigma tended to be thought about and dealt with on the individual level – efforts to help people not accept the message that because they have a mental illness, they are “less than” or efforts to help other people in the community understand that people with mental illness are not “less than” and should not be treated differently.  

“But, as social scientists, we understand that the larger culture matters in shaping stigma and discrimination,” Pescosolido told us. “Without an understanding of what are the erroneous of prejudicial beliefs out there, we have no idea what the targets for change are.”

Third, researchers started these studies because they saw claims in the media and even in medicine that stigma was disappearing. But their other studies, some of which took place in medical centers, did not look that way to them.  

“The only way to see what was the case was to do rigorous investigations of what Americans were thinking and doing in their everyday lives,” Pescosolido told us. “We went to one of the best ongoing research efforts, the General Social Survey, the longest running and highest quality monitor of Americans’ attitudes, beliefs and behaviors.”

The GSS started in the early 1970s and has provided a representative picture of American culture every year or two since then. They do face-to-face interviews of a scientifically selected sample of Americans that allow researchers to generalize to the entire population of Americans. Scientists can propose topics to add each time to the regular topics. Since researchers started these studies, they’ve been able to ask Americans about mental illness and stigma each decade, sing the same questions so they can mark changes in American culture.

“A number of results were important,” Pescosolido told us. “For the first time, we saw stigma drop – this was for the case of depression only, but it was a consistent and pretty decisive signal that American were more accepting and understanding of people with depression.”

And, this was an across-the-board change – the drop occurred for all social groups – men and women, people of different races and ethnicities, people with different levels of education.  

“However, the news was not all good,” Pescosolido told us. “We saw evidence that American continue to see people with mental illness as dangerous, and there was an increase in this for the schizophrenia case. There was also some sliding back on issues of addiction – with significantly more American seeing alcohol dependence as a result of having ‘a bad character’.”  

Researchers were pleasantly surprised to see the needle moving on mental illness but also unpleasantly surprised to see the drift toward higher perceptions that people with mental illness are dangerous – a perception that is not borne out by the extensive research on violent behavior among people with mental illness.

“I hope that anti-stigma efforts  – from the federal government to advocacy groups – use these findings to fine tune their targets for change,” Pescosolido told us. “Not only which mental illness need attention but also what aspects of perceptions and behaviors need new or different strategies to improve the lives of people with mental illness, and also not as well understood, decrease the negative messages that people who want to go into psychiatry, psychology, nursing or social work often receive when they choose to focus their work on children, adolescents or adults who experience mental health problems.”  

The study collected data before the COVID-19 pandemic. Pescosolido said she is curious to see how this may have affected how the public thinks about mental health and mental illness.  

“If there is a silver lining to the tragedies that the pandemic brought, it is that we all came to see how important mental health is and how our connectedness to one another is a fundamental key to our lives.”