Attitude of society towards people with mental illness: The result of national survey of the Slovak population

Abstract

Aims:

Our survey has been aimed at identifying the society attitude towards people with mental illness in Slovakia.

Method:

Selected group comprised 1,624 adult respondents with 18 years of age as the bottom limit. We applied reduced 26-item Community Attitudes Toward Mentally Ill Scale (CAMI) to the survey of the society attitude towards people with mental illness.

Results:

Average score reached by the respondents reached 94.0800 points, indicating lower stigmatization rate than presumed. Further investigation revealed prejudice and stigmatizing attitudes at significant part of the population. The survey confirmed statistically significant differences at the attitudes in the terms of gender (t = −6.559, p = .000), age within the categories (χ² = 20.358, p = .000), education (F = 9.137, p = .000), socio-economic status (χ² = 50.487, p = .000) and occupation (χ² = 47.989, p = .000). We also confirmed statistically significant relation between the attitude and age (−.085**, p = .001).

Conclusion:

The survey confirmed rather neutral up to slightly positive attitude of the Slovak population towards people with mental illness. Existence of attitudes burdened with fear was revealed in some cases, indicating the need for continuous education of the society in this subject matter.

Keywords

Mental illness attitudes prejudice stigmatization society

Introduction

Attitude of the society towards mentally ill people has definitely passed certain development. People with mental illness represent social group that had been isolated, discriminated and oppressed within major period of the society development. As late as during the 20th century and at the beginning of 21st century, remarkable set-back of the society from this social group was reported (Alexandrovskij, 1987; Dudeková, 2005; Foucault, 1993, 1997; Hinshaw, 2007; Janík, 1987; Kafka et al., 1992; Vencovský, 1983, 1996). We suppose that the attitude towards people with mental illness was partly influenced by the mankind development, thus the development of medicine and psychiatric care. Psychiatry and psychiatric care has passed through various changes, mostly resulted from the society changes (Ventriglio, Torales, & Bhugra, 2016). Current psychiatry maintains close relations with medicine specializations and humanitarian – social sciences, which positively influences the area of mental ill people treatment and their re-integration in the societal life (Ondriášová, 2005). As stated by Babic (2010), certain positive development can be seen in both development of psychiatry and human awareness. Information on mental illnesses, therapeutic possibilities and early medical intervention is now accessible by the society.

Despite psychiatric progress and subsequent care of mentally ill people, as well as identified progress in the society attitudes towards people with mental illness, we can encounter adverse myths, stereotypes and prejudices even in the 21st century (Práznovská, 2001); with fear and social set-back from people with mental illness (Angermeyer & Matschinger, 2005; Ewalds-Kvist, Högberg, & Lützén, 2013) as well as with stigmatization and discrimination of the social group in question; representing one of the major social effects of mental illness (Letovancová, 2014). In some cases, not only people with mental illness but also their families and psychiatrists face stigmatization (Bhugra, Malik, & Ikkos, 2010). Stigmatization and discrimination resulting from adverse attitude of the society seems one of the hardest to overcome barriers during re-integration of mentally ill people in the life, be it leisure time, societal or professional life (Babic, 2010; Faltus & Janečková, 2008; Guimón, 2010; Leff & Warner, 2006; Mental Health and Social Exclusion, Office of the Deputy Prime Minister, 2004; Thornicroft, 2011). Therefore, we see a huge importance in paying attention to the issue of society attitude towards people with mental illnesses.

Since no representative survey of the whole Slovak society attitudes has been conducted in the Slovak conditions that would examine these attitudes, we conducted the first nation-wide survey of the Slovak society attitudes towards people with mental illnesses on the turn of 2015/2016, aimed at ‘identifying the society attitudes towards people with mental illnesses in Slovakia’. Alongside, we examined the differences at the attitudes depending on socio-demographic factors.

Methods

Sample

Selected group of the survey comprised adult population of the Slovak Republic with 18 years of age as the bottom limit. No top age limit was set up.

Targeted quota selection was applied to the survey group selection, ensuring maintained proportional aspect of our survey aimed at reaching comparability of particular monitored survey specimen sub-categories. Gender, age and self-governing region represented the quota signs of the selection.

Total 1,643 respondents participated on the survey dropped down to final 1,624 respondents (98.84%), caused by a few removed questionnaires that were incorrectly filled in. Table 1 shows detailed information on the respondents’ headcount and their percentage, taking into account the monitored quota signs.

Table 1.

Fundamental quota signs of respondents.

		n	%
Gender	Men	740	45.6
Gender	Women	884	54.4
Age	18−34 years	730	45.0
	35−44 years	279	17.2
	45−64 years	422	26.0
	65+ years	193	11.9
Self-governing regions of Slovakia	Banská Bystrica Region	184	11.3
	Bratislava Region	188	11.6
	Košice Region	204	12.6
	Nitra Region	186	11.5
	Prešov Region	224	13.8
	Trenčín Region	188	11.6
	Trnava Region	263	16.2
	Žilina Region	187	11.5

Measures

To investigate the Slovak population attitudes towards people with mental illness, we decided to use valid research tool called Community Attitudes Toward Mentally Ill Scale (CAMI), or its reduced form consisting of 26 statements examining the majority society attitude towards people with mental illnesses, applied in regular intervals as a reliable and valid tool in England and Scotland during period of years 1994−2003 (Metha, Kassam, Leese, Butler, & Thornicroft, 2009).

A 26-item CAMI range applied by us contains 13 positively and 13 negatively formulated attitude standpoints assessed on 5-point Likert scale. Respondent had opportunity to express whether or not does he or she agree with the statements through the scale ranked from 1 (fully agree) up to 5 (fully disagree). Total score that could be reached varied within 26–130 points; the higher the score reached by a respondent, the lower the stigmatization attitude expressed by him (Winkler et al., 2016).

In order to meet our survey aims, we prepared a questionnaire that contains another series of questions related to demographic and socio-economic data, along with already mentioned 26-item standardized scale.

The CAMI scale represents a time-proved valid and reliable tool capable of measuring the society attitudes towards people with mental illnesses (Metha et al., 2009; Taylor & Dear, 1981). The fact that the CAMI scale has become a basis of many nation-wide surveys of the attitudes towards people with mental illnesses (Barke, Nyarko, & Klecha, 2011; Ewalds-Kvist et al., 2013; Girma et al., 2013; Metha et al., 2009; Ng, Martin, & Romans, 1995; Song, Chang, Shih, Lin, & Yang, 2005; Winkler et al., 2016) supported the reasonability of our decision to choose CAMI as our survey tool.

Procedure

The data had been collected by 78 trained pollers and with online survey during period from December 2015 until April 2016. Of total 1,624 questionnaires that were subject to statistical analysis, printed questionnaires referred to 761 pieces and there were 863 filled-in online questionnaires.

The CAMI scale had passed pilot testing before the data collection in order to determine its reliability through random sample of 46 respondents. Data were collected afterwards and subsequently processed through SW IBM SPSS Statistics v. 22.0.0.

Results

At the beginning, the CAMI scale was subjected to reliability test, which demonstrated very high reliability level (α = .824). Average score reached by the respondents was evaluated through SPSS program and reached 94.0800 points.

Detailed examination of the respondents’ answers, monitoring the average values of each scale item, confirmed that the respondents reached higher score indicating lower stigmatization rate only in case of 11 statements (items 7, 9−13, 19 and 22−25). In further 12 statements, they reached average score indicating neutral attitude (items 1, 3, 4, 6, 8, 14−18, 20 and 26). The lowest average score indicating stigmatizing attitude was reached by the respondents at statements No. 2 (‘There is something about people with mental illness that makes it easy to tell them from normal people’, m = 2.884, SD = 1.117), No. 5 (‘Less emphasis should be placed on protecting the public from people with mental illness’, m = 2.750, SD = 1.050) and No. 21 (‘Most women who were once patients in a mental hospital can be trusted as babysitters’, m = 2.940, SD = 0.997). The standard errors for the items ranged from 0.851 (item 23) to 1.377 (item 4).

In the following survey part, we examined statistically significant differences at attitudes towards people with mental illness in terms of monitored socio-demographic indicators. Statistically significant differences were confirmed at the attitudes according to gender (t = −6.559, p = .000), age in particular categories (χ² = 20.358, p = .000), education (F = 9.137, p = .000), socio-economic status (χ² = 50.487, p = .000) and occupation (χ² = 47.989, p = .000). Statistically significant correlation between attitude and age was confirmed as well (−.085**, p = .001).

Within the survey, women (m = 95.834) demonstrated lower stigmatization rate towards people with mental illness than men (m = 91.983). In terms of age, the higher the survey respondents’ age, the higher the stigmatization rate reached. Within the monitored differences at the attitude among the monitored age categories, respondents in the age category 35−44 years showed least stigmatizing attitude (m = 94.706) versus highest stigmatizing attitude demonstrated by respondents in the age category 65 years and more (m = 90.647). Differences at the attitudes were expressed also in relation to reached education degree. Respondents with accomplished elementary education (m = 89.754) showed the highest stigmatization rate, contrary to the respondents with accomplished third level university degree (m = 97.000) who showed least stigmatization attitude towards people with mental illness. Thus, the extent of prejudices towards people with mental illness proportionally decreased with increasing education degree. Attitudes of our respondents also differ in terms of their socio-economic status. Persons drawing old-age (m = 90.325) and disability pension (m = 90.684) reached the highest stigmatizing rate, followed by unemployed persons (m = 92.758). Women at maternity leave showed least stigmatizing attitude (m = 101.022). Students demonstrated slightly higher stigmatizing rate than women at maternity leave (m = 95,782), so did the employed persons (m = 94.469). In the survey, we also investigated the existence of different attitudes towards people with mental illness depending on the respondents’ occupation. In this case, respondents in worker position showed the highest stigmatization towards people with mental illness (m = 90.005), compared to persons employed in cultural sector (m = 102.500) and those working in healthcare and social care sectors (m = 98.479) who demonstrated least stigmatizing attitude. In this area, we were interested in the differences at the attitude among respondents with secondary sector professions (social workers, physicians, healthcare staff, psychologists and special pedagogues) and persons working in other professions. Statistically significant differences at attitudes towards people with mental illness were confirmed among the monitored respondent groups (t = 3.343, p = .001), where professionals from secondary sector (m = 98,807) demonstrated definitely less stigmatizing attitude than persons working in other sectors (m = 94.076).

Confirmed differences at attitudes towards people with mental illness depending on personal respondents’ contact with such a mentally ill person refer to major findings in our survey (Z = −8.661, p = .000). Respondents who met a person with mental illness demonstrated less stigmatizing attitudes towards such persons (m = 96.546) than persons without such experience (m = 91.338).

Discussion

Evaluation of the CAMI scale resulted in various very interesting findings. The most interesting one refers to identification of the attitudes present in our society towards people with mental illness. Evaluation of the scale indicates lower stigmatization rate than expected.

We managed to confirm stigmatizing attitudes in evaluation of statements No. 2, 5 and 21. We presume that these findings point out the respondents’ fear and lack of trust, as well as confirmation of their prejudicial attitude towards people with mental illnesses. As stated by Godan, Brajković, Fortuna, and Godan (2008), average attitude towards people with mental illness related to fear. Fear is one of the fundamental factors reinforcing stereotypes and prejudices associated with persons with mental illness inherited from generation to generation. We suppose that such identified attitudes could relate to the myth that people with mental illness are dangerous and aggressive. Tendency to attribute higher criminal activity rate than actually reported is present also in current times. A few surveys confirmed that there is a correlation between criminal conduct and symptoms of mental illness eventually they confirmed increased risk of violent criminality of persons with mental illness who abuse additive substances (Fazel, Långström, Hjern, Grann, & Lichtenstein, 2009; Short, Thomas, Mullen, & Ogloff, 2013; Torrey, 2011). However, there are also contradictory results of surveys, to which criminal acts commitment by persons with mental illness represents an exaggerated subject matter (Peterson, Skeem, Kennealy, & Bray, 2014). According to these findings, people with mental illness are rather victims than perpetrators of criminal acts (Stuart, 2003), and their share on criminal acts commitment is very small, compared to total rate of committed criminal acts (Hiday, 2006). Despite these contradictions, it is important that it is conviction of correlation between mental illness and violence in the human minds that could cause discrimination and stigmatization of people with mental illness (Corrigan et al., 2002).

According to our opinion, identification of prejudices in our survey is associated with the NIMBY (not in my back yard) phenomena describing the attitude of a person that is open and tolerating only unless it affects his or her personal life, privacy and interests (Lauber, Anthony, Ajdacic-Gross, & Rössler, 2004, Piat, 2000). Our survey confirmed that in case of statements related to human privacy instead of generally to the entire society, the respondents allocated medium or lower values to the statement, indicating higher stigmatization.

With regard to further results, we came to conclusion, similar to the surveys of authors Evans-Lacko, Corker, Williams, Henderson, and Thornicroft (2014), Ewalds-Kvist et al. (2013), TNS (2013), Song et al. (2005) and Taylor and Dear (1981), that women demonstrated lower stigmatization rate than men. However, some of the surveys confirmed also higher social set-back and fear from people with mental illness at female respondents, while we didn’t confirm it in our survey. Survey of Madianosa et al. (2012) is contradictory to our survey, since the women therein showed more stigmatizing attitude than men. Differing from all surveys mentioned herein, no correlation between the gender and attitudes was observed in South Ghana; however, they identified more stereotypical attitudes at women (Barke et al., 2011).

Attitudes towards people with mental illness vary in our survey also depending on the age. Studies of Evans-Lacko et al. (2014) and Girma et al. (2013) confirmed the increase in stigmatization rate towards people with mental illness with age. We came to similar conclusions as Evans-Lacko et al. (2014) regarding the existing significant differences at the attitudes among the monitored age categories, where persons older than 65 years of age demonstrated most stigmatizing attitudes compared to the younger respondents. Our findings also conform to the outcomes of Taiwan survey of the attitudes, namely, that younger respondents showed most positive attitudes towards people with mental illness (Song et al., 2005). Further surveys conducted in Switzerland (Lauber et al., 2004), in the United States (Pescosolido, Monahan, Link, Stueve, & Kikuzawa, 1999) and in Canada (Stuart & Arboleda-Flórez, 2001) confirmed correlation between the age and attitude towards people with mental illness.

Similar to Taylor and Dear (1981) who came to conclusion that education represents an important variable in relation to attitude of the public towards people with mental illness, our survey results confirmed that there is significant difference at the attitudes towards people with mental illness depending on education, and the stigmatization rate decreases with increasing education degree reached. The importance of education degree in relation to the attitude was confirmed by other surveys conducted worldwide (Angermeyer & Dietrich, 2006; Girma et al., 2013; Song et al., 2005).

Along with education degree reached, socio-economic status and occupation of the respondents influenced their attitude towards people with mental illness. Taylor and Dear found out as early as in 1981 that more positive attitudes result from a respondent’s socio-economic status but only if we consider reached education degree or career status. Our confirmation of significant differences at the attitudes depending on the socio-economic status and occupation partly conform to the findings of Taylor and Dear and marginally also to Evans-Lacko et al. (2014) and Song et al. (2005). Our findings in the area of the attitudes towards people with mental illness in the area of respondents’ socio-economic status indicate correlation with age, while in the area of occupation, our findings correlate with education.

Our unambiguously confirmed findings were associated with personal contact with a person with mental illness. We found out that persons who came in contact with a person with mental illness during their life showed much less stigmatizing attitude towards people with mental illnesses than persons who have never met a person with mental illness.

Conclusion

This was the first representative survey identifying the Slovak population attitudes towards people with mental illness and their possible correlation with socio-demographic and socio-economic indicators. Our findings indicate positive trends in the perception of people with mental illness by the majority public; nevertheless, they identify also stigmatizing attitudes expressed by remarkable part of respondents. It points out the need for continuous education within the society in this subject matter. We consider our survey the basis for further surveys that will allow for comparison and monitoring of the development of particular Slovak population attitudes. Concurrently, we consider meaningful the application of our findings to educational and anti-stigma campaigns fighting against the prejudice to people with mental illness and striving for establishment of supporting climate so much required for assurance of integration of people with mental illness in the society. Positive opinion climate can be helpful at development of services for people with mental illness, and importance of such services is undoubted.

Survey limitations

The fact that we could not compare our findings with other surveys’ results represents limitation to our survey since similar surveys were not conducted in our territory and the quota signs of respondents’ selection referred to only age, gender and self-governing region.

Footnotes

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This article was created with the support of the Grant of Slovak Research and Development Agency APVV N. 0524-12 titled The identity of social work in the context of Slovakia.

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