Department of Sociology, Indiana University, Bloomington.
Department of Sociology, Pennsylvania State University, University Park.
JAMA Netw Open. 2021 Dec 1;4(12):e2140202. doi: 10.1001/jamanetworkopen.2021.40202.
Stigma, the prejudice and discrimination attached to mental illness, has been persistent, interfering with help-seeking, recovery, treatment resources, workforce development, and societal productivity in individuals with mental illness. However, studies assessing changes in public perceptions of mental illness have been limited.
To evaluate the nature, direction, and magnitude of population-based changes in US mental illness stigma over 22 years.
DESIGN, SETTING, AND PARTICIPANTS: This survey study used data collected from the US National Stigma Studies, face-to-face interviews conducted as 1996, 2006, and 2018 General Social Survey modules of community-dwelling adults, based on nationally representative, multistage sampling techniques. Individuals aged 18 years or older, including Spanish-speaking respondents, living in noninstitutionalized settings were interviewed in 1996 (n = 1438), 2006 (n = 1520), and 2018 (n = 1171). The present study was conducted from July 2019 to January 2021.
Respondents reacted to 1 of 3 vignettes (schizophrenia, depression, alcohol dependence) meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria or a control case (daily troubles). Measures included beliefs about underlying causes (attributions), perceptions of likely violence (danger to others), and rejection (desire for social distance).
Of the 4129 individuals interviewed in the surveys, 2255 were women (54.6%); mean (SD) age was 44.6 (16.9) years. In the earlier period (1996-2006), respondents endorsing scientific attributions (eg, genetics) for schizophrenia (11.8%), depression (13.0%), and alcohol dependence (10.9%) increased. In the later period (2006-2018), the desire for social distance decreased for depression in work (18.1%), socializing (16.7%), friendship (9.7%), family marriage (14.3%), and group home (10.4%). Inconsistent, sometimes regressive change was observed, particularly regarding dangerousness for schizophrenia (1996-2018: 15.7% increase, P = .001) and bad character for alcohol dependence (1996-2018: 18.2% increase, P = .001). Subgroup differences, defined by race and ethnicity, sex, and educational level, were few and inconsistent. Change appeared to be consistent with age and generational shifts among 2 birth cohorts (1937-1946 and 1987-2000).
To date, this survey study found the first evidence of significant decreases in public stigma toward depression. The findings of this study suggest that individuals' age was a conservatizing factor whereas being in the pre-World War II or millennial birth cohorts was a progressive factor. However, stagnant stigma levels for other disorders and increasing public perceptions of likely violence among persons with schizophrenia call for rethinking stigma and retooling reduction strategies to increase service use, improve treatment resources, and advance population health.
污名化，即附加于精神疾病的偏见和歧视，一直以来都很顽固，干扰了寻求帮助、康复、治疗资源、劳动力发展以及精神疾病患者的社会生产力。然而，评估公众对精神疾病看法变化的研究一直有限。
评估美国精神疾病污名化在 22 年期间的性质、方向和程度上的变化。
设计、地点和参与者：这项调查研究使用了美国国家污名研究的数据，这些数据来自 1996 年、2006 年和 2018 年作为社区居住成年人的一般社会调查模块的面对面访谈，采用了全国代表性的多阶段抽样技术。1996 年（n=1438）、2006 年（n=1520）和 2018 年（n=1171），年龄在 18 岁或以上的包括讲西班牙语的受访者，居住在非机构化环境中，接受了采访。本研究于 2019 年 7 月至 2021 年 1 月进行。
受访者对 3 个符合《精神疾病诊断与统计手册》第 4 版标准的案例（精神分裂症、抑郁症、酒精依赖）或对照案例（日常麻烦）之一做出反应。衡量标准包括对潜在原因的信念（归因）、对可能暴力的看法（对他人的危险）和排斥（渴望社会距离）。
在接受调查的 4129 个人中，有 2255 名女性（54.6%）；平均（SD）年龄为 44.6（16.9）岁。在早期（1996-2006 年），对精神分裂症（11.8%）、抑郁症（13.0%）和酒精依赖（10.9%）的科学归因（如遗传学）的认同有所增加。在后期（2006-2018 年），对抑郁症在工作（18.1%）、社交（16.7%）、友谊（9.7%）、家庭婚姻（14.3%）和集体之家（10.4%）中产生的社会距离的渴望有所减少。观察到不一致的、有时是倒退的变化，特别是对精神分裂症的危险性（1996-2018 年：增加 15.7%，P=0.001）和对酒精依赖的不良品格（1996-2018 年：增加 18.2%，P=0.001）。按种族和民族、性别和教育程度定义的亚组差异很少且不一致。变化似乎与 2 个出生队列（1937-1946 年和 1987-2000 年）的年龄和代际转变一致。
到目前为止，这项调查研究发现了第一个有意义的证据，表明公众对抑郁症的污名化程度有所下降。研究结果表明，个体的年龄是一个保守因素，而属于二战前或千禧年出生的人则是一个进步因素。然而，其他疾病的污名化水平停滞不前，以及公众对精神分裂症患者可能暴力的看法增加，这呼吁重新思考污名化问题，并调整减少污名化的策略，以增加服务使用、改善治疗资源和促进人口健康。
