Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-23T00:52:09.017Z Has data issue: false hasContentIssue false
  • English
  • Français

Stigma and discrimination associated with mental illness and other stigmatizing conditions in China using two cultural-sensitive measures of stigma: interpersonal distance and occupational restrictiveness

Published online by Cambridge University Press:  02 June 2020

Wei Xiong ,
Michael R. Phillips Open the ORCID record for Michael R. Phillips [Opens in a new window] ,
Zhizhong Wang ,
Yuhong Zhang ,
Hui G. Cheng  and
Bruce G. Link
Wei Xiong
Affiliation:
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Michael R. Phillips*
Affiliation:
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China Departments of Psychiatry and Epidemiology, Columbia University, NY, USA
Zhizhong Wang
Affiliation:
Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, China
Yuhong Zhang
Affiliation:
Department of Epidemiology and Health Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, China
Hui G. Cheng
Affiliation:
Department of Epidemiology & Biostatistics, Michigan State University, MI, USA
Bruce G. Link
Affiliation:
University of California Riverside, CA, USA
*
Author for correspondence: Michael R. Phillips, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Reducing stigma is a perennial target of mental health advocates, but effectively addressing stigma relies on the ability to correctly understand and accurately measure culture-specific and location-specific components of stigma and discrimination.

Methods

We developed two culture-sensitive measures that assess the core components of stigma. The 40-item Interpersonal Distance Scale (IDS) asks respondents about their willingness to establish four different types of relationships with individuals with 10 target conditions, including five mental health-related conditions and five comparison conditions. The 40-item Occupational Restrictiveness Scale (ORS) asks respondents how suitable it is for individuals with the 10 conditions to assume four different types of occupations. The scales – which take 15 min to complete – were administered as part of a 2013 survey in Ningxia Province, China to a representative sample of 2425 adult community members.

Results

IDS and ORS differentiated the level of stigma between the 10 conditions. Of the total, 81% of respondents were unwilling to have interpersonal relationships with individuals with mental health-related conditions and 91% considered them unsuitable for various occupations. Substantial differences in attitudes about the five mental health-related conditions suggest that there is no community consensus about what constitutes a ‘mental illness’.

Conclusions

Selection of comparison conditions, types of social relationships, and types of occupations considered by the IDS and ORS make it possible to develop culture-sensitive and cohort-specific measures of interpersonal distance and occupational restrictiveness that can be used to compare the level and type of stigma associated with different conditions and to monitor changes in stigma over time.

Keywords

Chinadiscriminationinterpersonal distancemental illnessoccupational restrictivenessstigma
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 16 , December 2021 , pp. 2804 - 2813
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Angermeyer, M.C., Matschinger, H., Link, B.G., & Schomerus, G. (2014). Public attitudes regarding individual and structural discrimination: Two sides of the same coin? Social Science & Medicine, 103, 60–66. doi: https://doi.org/10.1016/j.socscimed.2013.11.014CrossRefGoogle ScholarPubMed
Chen, H., Phillips, M.R., Cheng, H., Chen, Q.Q., Chen, X.D., Fralick, D., … Bueber, M. (trans.) (2012). Mental health law of the People's Republic of China (English translation with annotations). Shanghai Archives of Psychiatry, 24 (6), 305–321.Google Scholar
Chen, H., Wang, Z., & Phillips, M. R. (2018). Assessing knowledge and attitudes about mental illness in Ningxia, China. Transcultural Psychiatry, 55(1), 94–119.CrossRefGoogle ScholarPubMed
Chen, H., Wang, Z., Phillips, M. R., Sun, Y., & Cheng, H. G. (2014). Internal consistency and test-retest reliability of the Chinese version of the 5-item Duke University Religion Index. Shanghai Archives of Psychiatry, 26(5), 300–309. doi: 10.11919/j.issn.1002-0829.214088Google ScholarPubMed
Cheng, H. G., Phillips, M. R., Zhang, Y., & Wang, Z. (2016). Psychometric properties of the Drinking Motives Questionnaire-Revised among community-dwelling current drinkers in the Ningxia autonomous region of China. Drug and Alcohol Review, 35, 433–441.CrossRefGoogle ScholarPubMed
Clement, S., Lassman, F., Barley, E., Evans-Lacko, S., Williams, P., Yamaguchi, S., … Thornicroft, G. (2013). Mass media interventions for reducing mental health-related stigma. Cochrane Database of Systematic Reviews, 7, CD009453. doi: 10.1002/14651858.CD009453.pub2Google Scholar
Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologists, 59(7), 614–625. doi: 10.1037/0003-066X.59.7.614CrossRefGoogle ScholarPubMed
Corrigan, P. W., & Shapiro, J. R. (2010). Measuring the impact of programs that challenge the public stigma of mental illness. Clinical Psychology Review, 30, 907–922.CrossRefGoogle ScholarPubMed
Corrigan, P. W., Watson, A. C., Heyrman, M. L., Warpinski, A., Gracia, G., Slopen, N., & Hall, L. L. (2005). Structural stigma in state legislation. Psychiatric Services, 56, 557–563.CrossRefGoogle ScholarPubMed
Dalky, H. F. (2011). Mental illness stigma reduction interventions: Review of intervention trials. Western Journal of Nursing Research, 34(4), 520–547. doi: https://doi.org/10.1177/0193945911400638CrossRefGoogle ScholarPubMed
Gao, S., Phillips, M. R., Wang, X., Xu, D., Jia, Z., Gao, W., & Xu, D. (2005). Experience of stigma among patients with schizophrenia and their family members and attitudes of different groups about this stigma (in Chinese). Chinese Journal of Mental Health, 19(2), 82–85. doi: 10.3321/j.issn:1000-6729.2005.02.005Google Scholar
Gronholm, P. C., Henderson, C., Deb, T., & Thornicroft, G. (2017). Interventions to reduce discrimination and stigma: The state of the art. Social Psychiatry and Psychiatric Epidemiology, 52(2), 249–258.CrossRefGoogle ScholarPubMed
Hanisch, S. E., Twomey, C. D., Szeto, A. C. H., Birner, U. W., Nowak, D., & Sabariego, C. (2016). The effectiveness of interventions targeting the stigma of mental illness at the workplace: A systematic review. BMC Psychiatry, 16, 1. doi: 10.1186/s12888-015-0706-4CrossRefGoogle ScholarPubMed
Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813–821. doi: 10.2105/AJPH.2012.301069CrossRefGoogle ScholarPubMed
Heather, S. (2006). Mental illness and employment discrimination. Forensic Psychiatry, 19(5), 522–526. doi: 10.1097/01.yco.0000238482.27270.5dGoogle Scholar
Jorm, A. F., & Oh, E. (2009). Desire for interpersonal distance from people with mental disorders: A review. Australia & New Zealand Journal of Psychiatry, 43, 183–200.CrossRefGoogle Scholar
Link, B. G., Cullen, F. T., Frank, J., & Wozniak, J. F. (1987). The social rejection of former mental patients: Understanding why labels matter. American Journal of Sociology, 92, 1461–1500.CrossRefGoogle Scholar
Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385.CrossRefGoogle Scholar
Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A., & Pescosolido, B. A. (1999). Public conceptions of mental illness: Labels, causes, dangerousness, and interpersonal distance. American Journal of Public Health, 89, 1328–1333.CrossRefGoogle Scholar
Link, B. G., Yang, L. H., Phelan, J. C., & Collins, P. Y. (2004). Measuring mental illness stigma. Schizophrenia Bulletin, 30(3), 511–541.CrossRefGoogle ScholarPubMed
McGinty, E. E., Goldman, H. H., Pescosolido, B., & Barry, C. L. (2015). Portraying mental illness and drug addiction as treatable health conditions: Effects of a randomized experiment on stigma and discrimination. Social Science & Medicine, 126, 73–85. doi: https://doi.org/10.1016/j.socscimed.2014.12.010CrossRefGoogle ScholarPubMed
Metha, N., Kassam, A., Leese, M., Butler, G., & Thornicroft, G. (2009). Public attitudes towards people with mental illness in England and Scotland, 1994–2003. British Journal of Psychiatry, 194(3), 278-284. doi: https://doi.org/10.1192/bjp.bp.108.052654Google Scholar
National Bureau of Statistics of the People's Republic of China. (2010). Main findings from the 2010 sixth national population census data for Ningxia autonomous region. Available at: http://www.stats.gov.cn/tjsj/tjgb/rkpcgb/dfrkpcgb/201202/t20120228_30398.html. (in Chinese).Google Scholar
Pescosolido, B. A., Medina, T. R., Martin, J. K., & Long, J. S. (2013). The “backbone” of stigma: Identify the global core of public prejudice associated with mental illness. American Journal of Public Health, 103(5), 853–860. doi: 10.2105/AJPH.2012.301147CrossRefGoogle Scholar
Pettigrew, T. F., & Tropp, L. R. (2006). A meta-analytic test of intergroup contact theory. Journal of Personality and Social Psychology, 90(5), 751–783. doi: https://doi.org/10.1037/0022-3514.90.5.751CrossRefGoogle ScholarPubMed
Phelan, J. C., Link, B. G., Stueve, A., & Pescosolido, B. A. (2000). Public conceptions of mental illness in 1950 and 1996: What is mental illness and is it to be feared? Journal of Health and Social Behavior, 41(2), 188–207. doi: https://doi.org/10.2307/2676305CrossRefGoogle Scholar
Pincus, F. L. (1996). Discrimination comes in many forms: Individual, institutional, and structural. American Behavioral Scientists, 40(2), 186–194.CrossRefGoogle Scholar
Stuart, H. (2016). Reducing the stigma of mental illness. Global Mental Health, 3(e17), 1–14. doi: https://doi.org/10.1017/gmh.2016.11CrossRefGoogle ScholarPubMed
Taylor, S. M., & Dear, M. J. (1981). Scaling community attitudes toward the mentally ill. Schizophrenia Bulletin, 7(2), 225–240.CrossRefGoogle ScholarPubMed
Thornicroft, G., Brohan, E., Rose, D., Sartorius, N., Leese, M., & INDICO study group (2009). Global pattern of experienced and anticipated discrimination against people with schizophrenia: A cross-sectional survey. Lancet, 373(9661), 408–415. doi: https://doi.org/10.1016/S0140-6736(08)61817-6CrossRefGoogle ScholarPubMed
Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., … Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet, 387, 1123–1132.CrossRefGoogle ScholarPubMed
USAID (2006). Can we measure HIV/AIDS-related stigma and discrimination? Current knowledge about quantifying stigma in developing countries. Washington, DC: US Agency for International Development.Google Scholar
Wang, W., Ai, M., Kuang, L., Chen, J.M., Gan, Y., Zeng, Y., …Phillips, M.R. (2011). Prevalence of interpersonal distance and restriction among college students with suicide attempts in Chongqing. Chinese Journal of Epidemiology, 32(4), 341–345. (In Chinese).Google ScholarPubMed
Xiong, W., & Phillips, M.R. (trans) (2016). Translated and annotated version of the 2015–2020 National Mental Health Work Plan of the People's Republic of China. Shanghai Archives of Psychiatry, 28(1), 4–17.Google ScholarPubMed
Yang, L. H., Graciete, L., WonPat-Borja, A. J., Singla, D. R., & Link, B. G. (2012). Effects of labeling and interpersonal contact upon attitudes towards schizophrenia: Implications for reducing mental illness stigma in urban China. Social Psychiatry and Psychiatric Epidemiology, 47(9), 1459–1473.CrossRefGoogle ScholarPubMed
Supplementary material: File

Xiong et al. supplementary material

Tables S1-S2

Download Xiong et al. supplementary material(File)
File 41.5 KB
Supplementary material: File

Xiong et al. supplementary material

Figure S1

Download Xiong et al. supplementary material(File)
File 40.1 KB