Differentiating the potential of continuum beliefs to reduce the public stigma of schizophrenia, depression, and alcohol dependence: associations with illness recognition and treatment recommendations

Abstract

Purpose Promoting continuum beliefs has been discussed as a strategy for stigma reduction. The current study examines associations of continuum beliefs with stigma aspects (stereotypes, emotions, and social distance) and mental health literacy (illness recognition and treatment recommendations). Methods In 2011, a sample of the German population (N = 3,642) completed a vignette-based interview on attitudes regarding schizophrenia, depression, or alcohol dependence. Logistic regression analyses were performed and predicted probabilities were used to calculate prevalence estimates and depict direct effect sizes. Results Increased continuum beliefs were strongly related to a decreased likelihood of social distance and endorsement of some negative stereotypes (e.g., being alien for schizophrenia) and an increased likelihood for endorsement of other negative stereotypes (e.g., lack of willpower for schizophrenia and depression) and emotions (e.g., anger for schizophrenia). Effect sizes indicated a greater reduction in negative stereotypes and desired social distance than increases in negative stereotypes or emotions. Furthermore, continuum beliefs were associated with a decreased probability of illness recognition for schizophrenia and recommending treatment for schizophrenia and depression, but an increased likelihood for illness recognition and recommending treatment for alcohol dependence. Conclusion Potentially harmful associations of continuum beliefs were found for schizophrenia and depression and should be considered by future studies and intervention designs. These potentially harmful associations are likely outweighed by helpful associations based on prevalence estimates and effect sizes. Associations between continuum beliefs and mental health literacy seem to be illness-dependent. Because of the sociocultural context and the time gap between the study and publication, representativeness for current public attitudes is limited.