Political attitudes as predictors of the multiple dimensions of mental health stigma

Abstract

Background:

Mental health (MH) stigma is multidimensional and remains common in the United States and throughout the world. While sociopolitical attitudes such as right-wing authoritarianism (RWA) have emerged as strong predictors of some aspects of MH stigma, no study has assessed the relationship between RWA and multidimensional components of MH stigma, or linked this relationship to a theory of stigma.

Aims:

The association between RWA and multiple stigma outcomes, including stereotypes, attributions/negative affect, social distance, microaggressions and help-seeking self-stigma was assessed controlling for covariates, including education, age, social desirability, race/ethnicity, gender, geographic location and prior contact with mental illness.

Method:

A total of 518 US residents (from all geographic regions; convenience sample) completed an online survey.

Results:

Findings indicated that RWA was significantly associated with all MH stigma dimensions analyzed, even after controlling for covariates. A hypothesized mediator for this relationship, dangerous world beliefs, was not supported as a theoretical explanation.

Conclusion:

Right-wing authoritarianism predicts various dimensions of mental health stigma, but more research is needed to determine the theoretical underpinnings. These current findings may guide research in this area and be used to target a variety of conservative audiences for stigma reduction.

Keywords

Mental health stigma political attitudes right-wing authoritarianism conservatism dangerous world beliefs

Introduction

Stigma has been defined as a process that includes the endorsement of negative stereotypes, prejudiced affect and discriminatory behavior toward labeled individuals in a social, economic or political context (Link & Phelan, 2001). Research supports that mental health (MH) stigma, or stigma concerning people diagnosed with mental disorders, remains common in the United States and throughout the world (Pescosolido et al., 2010; Pescosolido, Medina, Martin, & Long, 2013). Researchers have noted that stigma is multidimensional, and the degree to which stigma is endorsed is likely to be influenced by a variety of factors, including the specific disorder being assessed (McGinty, Goldman, Pescosolido, & Barry, 2015; Pescosolido et al., 2010), the specific dimension being studied (Link, Yang, Phelan, & Collins, 2004; Pescosolido & Martin, 2015), and community factors (Pescosolido, Martin, Lang, & Olafsdottir, 2008). These findings suggest that research into MH stigma needs to assess multiple components of the construct while considering covariates.

Concurrent with an interest in the multidimensionality of MH stigma has been an interest in the various individual-level factors that predict it. Conservative political attitudes, including measures of right-wing authoritarianism (RWA; Altemeyer, 2006), have recently emerged as consistent predictors of at least two facets of MH stigma, negative stereotypes and intended social distancing (DeLuca & Yanos, 2016; Gonzales, Chan, & Yanos, 2017), and it is plausible that conservatism is related to other aspects of MH stigma. Identifying predictors of MH stigma is important, because it can lead to more targeted and effective anti-stigma messages and interventions (Stuart, Arboleda-Florez, & Sartorius, 2012). Moreover, an understanding of stigmatizers’ dynamics can elucidate stigma mechanisms (both toward the public and the self) and stigma theory and guide broader research in the area of political attitudes and stigma.

The stigma complex

In a recent undertaking to connect conceptual and theoretical work on stigma, Pescosolido and Martin (2015) posited that the inherent complexity of stigma naturally calls for multidimensional understandings of the stigma process – in what they term the stigma complex. The stigma complex is defined as ‘the set of interrelated, heterogeneous system structures, from the individual to the society, and processes, from the molecular to the geographic and historical, that constructs, labels, and translates difference into marks’ (Pescosolido & Martin, 2015, p. 101). Pescosolido and colleagues’ (2008) Framework Integrating Normative Influences on Stigma (FINIS) is one example of this systems approach to understanding stigma. FINIS is grounded in evidence that demonstrates stigma emanates from many societal and individual systems whose interconnections cannot be easily separated; this dynamic includes an interplay of the media, the community and the individual. Under this transdisciplinary model, for example, actions such as social distancing and help-seeking are seen as socially constructed patterns of decisions, rather than solely individual choices (Pescosolido, 1992). Finally, it should be noted that Pescosolido and Martin (2015) even posit multidimensionality within dimensions of stigma, such as public stigma. Public MH stigma, thus, can be understood via traditional prejudice (‘preconceived unfavorable judgments …’), social distance (‘desire to maintain an interactional detachment …’), treatment carryover (‘belief that public knowledge that an individual has received medical or psychological treatment for a stigmatized condition and/or status reduces the status of that individual in the larger community’), negative affect (‘… unpleasant emotional reactions’) and perceptions of dangerousness (Pescosolido & Martin, 2015, p. 97).

Measuring stigma

No single dimension of stigma is uniformly accepted as the best way to capture this construct, and most researchers have relied on one dimension or on a global scale designed to capture stigma dimensions (Pescosolido & Martin, 2015). Although various stigma measures do tend to significantly correlate, there are unique ramifications and nuances between various forms of stigma (e.g. negative stereotypes, social distancing, self-stigma for seeking personal help). Similar to Pescosolido and Martin’s (2015) stance on stigma research, we contend that studying stigma in a multidimensional way best advances continuing inquiry surrounding stigma.

A simple way to assess MH stigma is to directly assess endorsement of negative stereotypes (e.g. beliefs that persons with mental illness are dangerous). A shortcoming of the direct assessment of attitudes, however, is that such attitudes are most likely to be affected by social desirability bias (Link et al., 2004). Closely related to attitudes, but less likely to be affected by social desirability (Pescosolido et al., 2010), are attributions about and affect toward mental illness, which concern how people attach meaning to behaviors and make sense of unusual circumstances (Weiner, 1995). Measures of social distance tap the behavioral component of stigma by assessing the degree to which respondents would socially interact or associate with a member of a target group (Link et al., 2004). In addition to more direct measures of intention to interact with persons with mental illness, more recent research has demonstrated that ‘microaggressions’, or subtle discriminatory behaviors, also occur in relation to people with mental illness (Gonzales, Davidoff, DeLuca, & Yanos, 2015a; Gonzales, Davidoff, Nadal, & Yanos, 2015b). Finally, help-seeking self-stigma comprises attitudes related to receiving personal psychological services, including perceptions that people who seek psychological treatment are undesirable or socially unacceptable (Vogel, Wade, & Haake, 2006). Persons who perceive public stigma toward MH, which is ostensibly heightened in stigmatizing communities, are also less likely to seek help (Vogel, Wade, & Hackler, 2007).

Predictors of stigma

Evidence demonstrates that, in the United States, stigma tends to be inversely associated with female gender (Corrigan & Watson, 2007), European-American ethnicity (WonPat-Borja, Yang, Link, & Phelan, 2012), previous contact with mental illness (Corrigan, Edwards, Green, Diwan, & Penn, 2001; Couture & Penn, 2003), degree of formal education (Phelan & Link, 2004) and liberal political identification (DeLuca & Yanos, 2016). Despite evidence for a relationship between political conservatism and stigma, it is difficult to interpret the reasons for this relationship since most prior studies have relied on self-reported political affiliation, which can include a range of political views and be an invalid predictor of one’s true political views (Zell & Bernstein, 2014).

In regard to other less consistent covariates, the relationship between age and MH stigma appears to differ by stigma dimension studied, whereby younger age has predicted more intended social distance (DeLuca, 2014) and older age has been related to less willingness to seek MH treatment (Conner et al., 2010). Additionally, living in the Midwest significantly predicted MH stigma in a recent study (Barry & McGinty, 2014), though regional relationships have not been consistently found across studies and stigma measurements (Kobau, DiIorio, Chapman, & Delvecchio, 2010). In regard to specific stigma toward MH diagnoses, research consistently demonstrates that the public endorses more stigma toward persons living with schizophrenia (vs depression, for example; Pescosolido et al., 2010).

Conservatism and stigma

Conservative political attitudes are associated with a host of characteristics, including adherence to tradition and resistance to change, justification of inequality and heightened feelings of fear and perceptions of threat (Hibbing, Smith, & Alford, 2014; Jost, Kruglanski, Glaser, & Sulloway, 2003). Given the aforementioned limitations of self-reported political attitudes, the RWA scale is one commonly used alternative method for tapping into nuanced and meaningful clusters of sociopolitical attitudes (Altemeyer, 2006). The RWA scale measures ideological commitment to tradition, authority, religion and social convention against threats of change and political rebellion (Jost et al., 2003). People demonstrating high RWA are likely to perceive the world as a more dangerous place than others (Altemeyer, 1988), and this worldview includes fears of lawlessness, political uncertainty and perceived threats to the in-group and self (Altemeyer, 1988, 2006; Shaffer & Duckitt, 2013). For context, one current example of a right-wing authoritarian may be the President-elect in the United States, Donald Trump, as evidenced by his campaign messages and supporters’ ideologies (MacWilliams, 2016). In fact, a recent survey of American adults by Choma and Hanoch (2017) showed that endorsement of RWA predicted greater support for Donald Trump, which was attributed to his campaign messages around law and order, aggressiveness toward outgroups and general fear of threats; conversely, lower endorsement of RWA uniquely led to intentions to vote for Hillary Clinton. Given that 20%–25% of the American public endorse high RWA values (Altemeyer, 2006) and many more individuals have moderately high RWA leanings, this is a potentially significant group to target for anti-stigma initiatives.

In regard to MH stigma, self-reported conservatism has been linked to attributing mental illness with ‘bad character’ (Watson, Corrigan, & Angell, 2005) and supporting less government funding for MH services (Barry & McGinty, 2014). RWA has been linked to harsher sentencing toward a hypothetical person with mental illness (Fodor, Wick, Hartsen, & Preve, 2008), lower evaluations toward a hypothetical job candidate with schizophrenia (Fodor, 2006) and negative attitudes toward MH services (Furr, Usui, & Hines-Martin, 2003). Recent studies have demonstrated that RWA is a consistent predictor of the endorsement of negative stereotypes and intended social distance toward people with mental illness, even when controlling for other consistent individual-level predictors (e.g. DeLuca & Yanos, 2016).

RWA has been studied intensively over the last several decades and has been subsequently linked to broader ideological theories. According to the dual-process model of ideology and prejudice proneness (DPM; Duckitt & Sibley, 2010), perceived threats to collective security (i.e. RWA) is one of the major sociopolitical motivational bases for stigma in society. To this end, research has identified mediators in relationships involving RWA and stigma, including dangerous world beliefs and perceived threat (Crowson, 2009; Duckitt, 2006). However, such mediators have not been explicitly tested in the relationship between RWA and multiple dimensions of MH stigma.

Current study

Despite the relationship between political conservatism and MH stigma, gaps in the knowledgebase remain, as research to date has (1) not addressed the relationship between RWA and the multiple dimensions of stigma, including negative affect, and only one study (Furr et al., 2003) has assessed conservatives’ attitudes toward treatment carryover and help-seeking. In addition, (2) studies infrequently control for sociodemographic covariates and no study has assessed the comparative impact of different mental disorder presentations (e.g. schizophrenia vs depression). Based on the FINIS model, it is plausible that other individual, social and community-level variables, including geographic region, can contribute variance to MH stigma explanations. Furthermore, (3) theoretical explanations for these relationships have seldom been examined. Previous research posits that Terror Management Theory (TMT) provides one explanation for stigma among conservatives (DeLuca & Yanos, 2016; Greenberg, Landau, Kosloff, Soenke, & Solomon, 2015; Jost et al., 2003). TMT holds that when individuals are confronted with thoughts of their own mortality, they shun and denigrate outsiders who activate such anxiety (Jost et al., 2003). A survey assessment of dangerous world beliefs (used as a mediator) may provide one proxy for examining this theory. While fear is at the root of stigma for most people, such fear appears to be particularly salient among political conservatives. Thoughts about, or encounters with, people with mental illness may trigger fears of the unknown – or even fears of losing one’s own sanity – and activate stigma responses across multiple dimensions.

In sum, while several studies have linked political attitudes to dimensions of MH stigma, this study aimed to (1) extend these findings to understudied dimensions, (2) control for other predictors of stigma within dimensions and (3) verify these findings using a larger (convenience) sample of individuals living in the United States. It was further hypothesized that RWA would be significantly related to multiple dimensions of stigma, including traditional prejudice, negative affect, perceptions of dangerousness, social distance, microaggressions and help-seeking self-stigma, even when controlling for covariates. In regard to theory, it was also expected that RWA would be related to dangerous world beliefs and that such beliefs would partially mediate the relationship between RWA and dimensions of MH stigma.

Methods

Sample

Participants were recruited from and compensated via the Qualtrics Panel, a national online survey agency. Qualtrics is an online surveying mechanism that partners with numerous other surveying panels; partners then randomly select respondents for surveys, specifically where respondents are highly likely to meet the requested criteria. This allows Qualtrics to proportion a variety of demographic attributes into a single sample. Qualtrics participants were compensated through independent partners (e.g. via partner-specific rewards, points and gift cards) and not directly by the investigators. Qualtrics Panel samples have been successfully used to conduct stigma survey research on targeted groups (e.g. Cheng, 2014). A priori exclusion criteria for this study included finishing the survey in under 5 minutes (average completion M = 30.5 minutes), failing any of the three attention check questions (e.g. ‘Have you ever had a fatal heart attack while watching TV?’ – correct response: ‘never’), having an identical IP address to another participant, or any obvious responding patterns (e.g. determined by illogical patterns of responses on the majority of one’s responses, such as consistently answering the same number on several reverse-coded scales). Only one participant was excluded based on these criteria (for an obvious response pattern), resulting in a total N of 518.

The Qualtrics Panel was stratified based on demographic attributes such that there would be relatively equal numbers of four age groupings and regions, in addition to approximately the same number of males and females included in the final sample. To make the convenience sample more nationally representative, four US regions were targeted (see Table 1): Northeast, West, South and Midwest (US Census Bureau, US Department of Commerce and Statistics Administration, 2010). Overall, the sample was middle-aged (M = 46.4, standard deviation (SD) = 15.5, range: 18–82), predominantly White and politically moderate, and well-educated (nearly half of the sample had at least an associate’s degree). The same survey was completed online by all samples and was approved by the appropriate institutional review board. This study was part of a large survey that contained measures and questions for other studies examining stigma in marginalized populations. Questions used in the other studies were asked after the current study’s items, minimizing their impact on the current results. After completing informed consent, participants were forwarded to the survey by the platform they were recruited from. This research complies with human subjects’ ethics and was reviewed and approved by the Institutional Review Board at the City University of New York. There are no known conflicts of interest.

Table 1.

Demographic characteristics of the sample (N = 518).

	N	%
Gender
Male	255	49.2
Female	262	50.6
Transgender	1	0.2
Race/ethnicity
Black or African American	44	8.7
White or European American	406	80.1
Asian or Pacific Islander	23	4.5
Hispanic/Latino(a)	20	3.9
Bi- or multi-racial	5	1.0
Native American/American Indian	7	1.4
Other	2	0.4
Education level
Some high school or less	16	3.1
High school diploma/GED	93	18.2
Some college or vocational training	159	31.1
Associate’s degree	55	10.7
Bachelor’s degree	138	27
Master’s degree	42	8.2
Professional/doctorate degree	9	1.8
Political attitudes
Liberal	114	22.1
Moderate	255	49.3
Conservative	148	28.6
Region
Midwest	127	24.5
Northeast	129	24.9
Northeast	156	30.1
South	106	20.5
West
Contact with mental illness
Personally diagnosed	96	18.5
Family member diagnosed	192	37.1
Close friend diagnosed	169	32.6

Ns may not equal 518 due to unanswered questions.

Measures

Political attitudes

Participants self-reported political affiliation on a 3-point scale (1 = Liberal, 2 = Moderate, 3 = Conservative). Participants also completed the RWA scale (Altemeyer, 2006), a 20-item measure in which participants rate sociopolitical statements on a 9-point scale (−4 = very strongly disagree, 4 = very strongly agree), such as ‘What our country really needs is a strong, determined leader who will crush evil, and take us back to our true path’. For some reported statistics below, interquartile split was used (as used in Altemeyer, 1996; see also Fodor et al., 2008) to categorize individuals into ‘Low RWA’ (bottom 25th percentile of scorers) and ‘High RWA’ (top 25th percentile) groupings. Consistent with previous research, RWA had excellent internal consistency (α = .93).

Dangerous world beliefs

The 12-item Belief in a Dangerous World Scale (Altemeyer, 1988) (DWS; α = .86) was used to assess social worldviews associated with threat, danger and unpredictability, with items such as ‘Any day now, chaos and anarchy could erupt around us. All the signs are pointing to it’. DWS items were rated on a 5-point scale (1 = strongly disagree, 5 = strongly agree). The DWS was hypothesized to be a mediator in this study, consistent with TMT.

Negative stereotypes and traditional prejudice

The Attitudes about Mental Illness and Its Treatment Scale (AMIS) was used to assess negative stereotypes and prejudice (including perceptions of dangerousness) generally toward persons with MH problems (Kobau et al., 2010).¹ AMIS comprises a total scale (seven items; α = .73) and two subscales: AMIS 1 (three items about negative stereotypes; α = .82) and AMIS 2 (four items regarding recovery; α = .72), which include items such as ‘I believe a person with mental illness is a danger to others’ and ‘I believe a person with mental illness can eventually recover’, respectively. The 9-item Depression Stigma Scale (DSS; α = .86) assessed negative stereotypes and prejudice specifically toward persons diagnosed with depression (Griffiths, Christensen, Jorm, Evans, & Groves, 2004), such as ‘Depression is a sign of personal weakness’. However, the DSS should not be considered solely a scale of stereotypes, as it includes items related to social distance, knowledge and discrimination. Therefore, a 5-item subscale of DSS items indicating stereotypes was also used for this study (α = .81). Items for all scales were rated on a 5-point scale based on agreement with statements (1 = strongly disagree, 5 = strongly agree).

Attributions/negative affect

The Attribution Questionnaire (AQ-9; α = .83) consists of nine items reflecting attributions and negative emotions toward a brief vignette about Harry, a man described as having symptoms of schizophrenia (Corrigan, Watson, Warpinski, & Gracia, 2004). One item reads, ‘I would feel pity for Harry’. For this study, we adapted this measure to also include a separate vignette about Walter, a man with symptoms of depression (α = .84). Items were rated on a 9-point scale (e.g. 1 = not at all, 9 = very much). The symptoms of depression used to describe Walter (i.e. feeling sad and hopeless; experiencing anhedonia) were consistent with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnosis of major depressive disorder (American Psychiatric Association, 2013).

Social distance

The Reported and Intended Behavior Scale (RIBS; α = .88) includes questions related to future interactions with persons who have MH problems (Evans-Lacko et al., 2011), such as ‘In the future, I would be willing to work with someone with a MH problem’. This 4-item measure is rated on a 5-point scale (1 = agree strongly, 5 = disagree strongly). The Depression Social Distance Scale (DSDS; α = .91) was used to specifically assess social distance toward someone with depression (Link, Phelan, Bresnahan, Stueve, & Pescosolido, 1999). A vignette was presented to participants about John, a man with symptoms of major depressive disorder, and five questions were posed on a 4-point scale (1 = definitely willing, 4 = definitely unwilling) regarding participants’ willingness to move next door to John, spend an evening socializing with John, make friends with John, work closely on a job with John and have John marry into your family.

Microaggressions

The 14-item Mental Illness Microaggressions Scale–Perpetrator Version (MIMS-P; α = .88) measures subtle stigma toward persons with mental illness, in contrast to more traditional measures of overt discrimination (Gonzales et al., 2015a). In addition to the total scale (14 items), MIMS-P comprises three subscales: Assumption of inability (five items, α = .81), for example, ‘If someone I’m close to told me that they had a mental illness diagnosis, I would try to talk more slowly so that they wouldn’t get confused’; Patronization (five items, α = .81), for example, ‘If someone I’m close to told me that they had a mental illness diagnosis, I would frequently remind them that they need to take their medication’; and Fear of Mental Illness (four items, α = .74), for example, ‘If I saw a person who I thought had a mental illness in public, I would be careful in case they “snap”’. Items were rated on a 4-point scale (1 = strongly disagree, 4 = strongly agree).

Help-seeking stigma/treatment carryover

The Self-Stigma of Seeking Help Scale (SSOSH; α = .87) is a 10-item scale consisting of items related to feelings of inadequacy and inferiority for seeking MH treatment (Vogel et al., 2006). Overall, SSOSH assesses threats to one’s self-evaluation for seeking help, such as ‘I would feel inadequate if I went to a therapist for psychological help’. The Perceptions of Stigmatization by Others for Seeking Help Scale (PSOSH; α = .95) assesses the perceived stigma persons anticipate from those they interact with (Vogel, Wade, & Ascheman, 2009). PSOSH items ask respondents whether others in their life (e.g. peers, friends, family) would react negatively or ‘think bad things’ about them if they sought counseling. Both scales predict attitudes toward seeking help (Vogel et al., 2009) and actual service utilization (Vogel et al., 2006). Both measures used a similar 5-point Likert scale.

Covariates

We controlled for sociodemographic correlates of stigma that could account for differences in stigmatizing, in addition to political attitudes. These were assessed after the stigma measures were presented. These variables included age, in years (continuous variable); gender (0 = female, 1 = male); formal education (1 = no schooling completed to 11 = doctoral degree); previous MH contact² (close friend, family member, or self: variable dichotomized as 0 = no contact, 1 = any form of contact) (see Penn, Kommana, Mansfield, & Link, 1999); race/ethnicity (0 = all other races/ethnicities and 1 = White); and US geographic region (reference: Midwest = 1). The 11-item Social Desirability Scale (SDS; α = .70) was also employed to gauge the level at which participants put themselves in an overly positive light (Crowne & Marlowe, 1960), for example, ‘I am always courteous, even to people who are disagreeable’. Higher SDS mean scores were indicative of higher social desirability.

Data analyses

So as not to exclude participants for missing scale items, mean imputation was used. The highest percentage of mean imputed respondents for any scale was 3.8% (MIMS-P), while the average percentage was 1.9% (range: 1.1%–3.8%). An alpha level of 0.05 was used for all statistical tests. Analysis of variance (ANOVA) with Tukey post hoc testing was used to provide an overview of political differences in dangerous world beliefs. Simultaneous regression was then utilized with the stigma measures as dependent variables and political attitudes as the primary predictor along with covariates. Finally, additional regressions were computed including dangerous world beliefs to assess whether these beliefs mediated the relationship between political attitudes and stigma. All analyses were completed using IBM SPSS Statistics v24.

Results

Differences in stigma dimensions

Correlational analyses were first conducted which confirmed that conservative political attitudes were related to dangerous world beliefs (DWS), with RWA (mean scale) being more strongly related (r = .60, n = 517, p < .001) than self-reported conservative affiliation (r = .28, n = 516, p < .001). RWA and self-reported conservative affiliation were also significantly related (r = .45, n = 517, p < .001). In analyses using quartile RWA measurement, self-reported political conservatives made up 57.4% (n = 70) of the high RWA quartile. Consistent with the theory proposed in this study, the high RWA group endorsed significantly more dangerous world beliefs (M = 3.88, SD = 0.643) than every other RWA quartile (ps all <.001). This score means that high RWA participants, on average, trended toward responding to DWS items with agreement (4 = ‘agree’ on the DWB scale). A similar pattern emerged for self-reported conservatives (M = 3.57, SD = 0.658, ps all <.001 vs liberals and moderates). DWS was significantly, modestly correlated with four stigma variables: AMIS (r = .15, n = 517, p = .001), AMIS 1 (r = .14, n = 517, p = .002), AMIS 2 (r = .10, n = 517, p = .029) and MIMS-P Inability subscale (r = .10, n = 517, p = .029).

Regression

Overall, bivariate analyses indicated that RWA (mean scale) was a better predictor of stigma than self-reported political affiliation, as expected (not seen in tables). To elucidate the impact of RWA on stigma dimensions, regressions were computed controlling for covariates (Table 2). While certain variables are known to predict aspects of MH stigma (e.g. RWA, contact, gender, race/ethnicity), less is known about the relative impact of these variables and other covariates on other stigma dimensions. Thus, simultaneous regression was used to test the hypotheses of this study. After controlling for covariates, RWA still remained a significant and robust predictor of every stigma dimension. RWA models explained more variance in these dimensions (22% at most, M = 14.1%) than self-reported political attitudes (14% at most, M = 9% (not shown in tables)). While RWA was the strongest predictor of stigma, having more contact, identifying as White, being female, being older, having more socially desirable responding and living outside of the Midwest were significant predictors of less stigma across several dimensions. In regard to geographic region, post hoc analyses revealed that participants living in the South tended to endorse more stigma across dimensions, which is consistent with patterns in at least one study (Kobau et al., 2010); contrary to other research (Barry & McGinty, 2014), participants living in the Midwest tended to endorse less stigma across dimensions in this study. Younger age predicted more stigma across several dimensions.

Table 2.

Regression of right-wing authoritarianism (RWA) on stigma dimensions, controlling for covariates.

Stigma dimension	RWA	Contact	Race/ethnicity	Gender	Education	Region	Age	SDS	R ²
Stigma dimension	B (SE)	B (SE)	B (SE)	B (SE)	B (SE)	B (SE)	B (SE)	B (SE)	R ²
AMIS total	0.310 (0.016)**	−0.170 (0.049)**	−0.097 (0.062)*	0.119 (0.048)*	0.008 (0.013)	−0.067 (0.055)	−0.084 (0.002)*	0.094 (0.103)*	.18
AMIS 1	0.284 (0.024)**	−0.141 (0.075)**	−0.152 (0.095)**	0.111 (0.074)*	0.065 (0.020)	−0.091 (0.085)*	−0.037 (0.002)	0.124 (0.159)*	.17
AMIS 2	0.197 (0.018)**	−0.124 (0.057)*	0.001 (0.073)	0.072 (0.057)	−0.056 (0.015)	−0.014 (0.065)	−0.091 (0.002)*	0.022 (0.121)	.07
DSS total	0.318 (0.021)**	−0.139 (0.066)**	−0.126 (0.085)*	0.179 (0.066)**	0.055 (0.017)	−0.055 (0.076)	−0.110 (0.002)*	0.064 (0.141)	.20
DSS stereotypes	0.311 (0.023)**	−0.090 (0.071)*	−0.167 (0.090)**	0.178 (0.070)**	0.031 (0.019)	−0.053 (0.081)	−0.189 (0.002)**	0.027 (0.150)	.22
AQ-9 schizophrenia	0.299 (0.037)**	−0.120 (0.115)*	−0.119 (0.146)*	0.111 (0.114)*	0.066 (0.030)	−0.021 (0.131)	−0.161 (0.004)**	0.107 (0.244)*	.18
AQ-9 depression	0.238 (0.039)**	−0.063 (0.122)	−0.140 (0.156)**	0.135 (0.121)**	0.104 (0.032)*	−0.042 (0.139)	−0.152 (0.004)**	0.078 (0.259)	.14
RIBS (general social distance)	0.191 (0.024)**	−0.299 (0.076)**	−0.122 (0.097)*	−0.002 (0.075)	−0.015 (0.020)	−0.080 (0.086)	0.012 (0.002)	0.092 (0.161)*	.16
DSDS (depression social distance)	0.124 (0.023)*	−0.197 (0.070)**	−0.062 (.090)	0.119 (0.070)*	0.114 (0.019)*	0.019 (0.080)	0.012 (0.002)	0.019 (0.150)	.08
MIMS-P total	0.265 (0.015)**	−0.026 (0.045)	−0.122 (0.058)*	0.162 (0.045)**	0.005 (0.012)	−0.126 (0.052)*	−0.102 (0.001)*	0.066 (0.096)	.14
MIMS-P Inability	0.279 (0.018)**	−0.038 (0.055)	−0.150 (0.070)**	0.139 (0.054)**	0.010 (0.014)	−0.116 (0.062)*	−0.052 (0.002)	0.053 (0.116)	.14
MIMS-P Patronization	0.164 (0.018)**	0.063 (0.057)	−0.058 (0.073)	0.139 (0.056)*	−0.058 (0.015)	−0.103 (0.065)*	−0.150 (0.002)**	−0.014 (0.121)	.08
MIMS-P Fear	0.224 (0.017)**	−0.110 (0.053)*	−0.100 (0.068)*	0.127 (0.052)*	0.081 (0.014)	−0.094 (0.060)*	−0.041 (0.002)	0.149 (0.112)**	.12
Help-seeking self-stigma (SSOSH)	0.255 (0.021)**	−0.099 (0.064)*	−0.029 (0.082)	0.126 (0.064)*	0.036 (0.017)	−0.058 (0.073)	−0.122 (0.002)*	0.130 (0.136)*	.12
Help-seeking perceptions (PSOSH)	0.207 (0.028)**	0.034 (0.087)	−0.046 (0.111)	0.096 (0.086)*	0.062 (0.023)	−0.083 (0.100)	−0.165 (0.003)**	0.211 (0.185)**	.12

SE: standard error; AMIS: Attitudes about Mental Illness and Its Treatment Scale; DSS: Depression Stigma Scale; AQ-9: Attribution Questionnaire; RIBS: Reported and Intended Behavior Scale; DSDS: Depression Social Distance Scale; MIMS-P: Mental Illness Microaggressions Scale–Perpetrator Version; SSOSH: Self-Stigma of Seeking Help Scale; SDS: Social Desirability total scale; PSOSH: Perceptions of Stigmatization by Others for Seeking Help Scale.

Standardized coefficients (B) and standard errors are reported. Standard errors are in parentheses. RWA refers to the total computed scale. R2 refers to adjusted R2 as per output in IBM SPSS Statistics v24.

p < .05, **p ≤ .001.

Mediation

Next, we utilized Hayes’ (2013) PROCESS macro for IBM SPSS v24 in order to investigate whether the relationship between RWA and stigma was mediated by dangerous world beliefs. Specifically, we tested whether there was a significant indirect effect of RWA on stigma dimensions through dangerous world beliefs; variables that were significantly correlated with DWS (AMIS, AMIS 1, AMIS 2, and MIMS-P Inability) were tested in these models. The addition of the dangerous world variable had modest effects on the magnitude of RWA in our models; the standardized beta of RWA increased slightly in all of the models, though the total variance in each model did not change significantly. Overall, there was no evidence of DWS partially mediating the relationship between RWA (and other covariates) and specific stigma dimensions, contrary to hypotheses.

Discussion

Consistent with hypotheses, findings indicated that people who endorse higher RWA demonstrated greater MH stigma across a wide range of dimensions, including social distancing and stereotyping toward people with both schizophrenia and depression; negative attributions and negative affect; subtle forms of stigma, exclusionary statements; perceptions of dangerousness; and personal help-seeking/treatment carryover (Pescosolido & Martin, 2015). These relationships remained robust even when controlling for other individual and social-level covariates. Results therefore extend previous findings to understudied stigma dimensions and to a larger sample.

Findings related to depression and schizophrenia stigma show that individuals who endorse high RWA follow a similar pattern to the general public (Pescosolido et al., 2010); that is, conditions such as schizophrenia are more stigmatized than depression, albeit RWAs’ stigma begins at a higher baseline. To this end, persons high on RWA in this study endorsed higher than average negative attributions and affect toward vignette characters living with depression and schizophrenia. Given that the vignettes stated that the individual had been hospitalized multiple times, this may have raised fear in persons high on RWA and activated cognitive structures related to social order (Altemeyer, 2006).

In addition to explicit MH stigma endorsement, persons high on RWA in this study also endorsed more subtle forms of stigma through agreement with microaggression statements. This indicates a tendency to assume low ability in and act paternalistically toward persons with mental illness among persons higher in RWA. Finally, findings related to self-stigma for seeking help and perceptions of help-seeking stigma show that conservative individuals are more likely to feel inadequate, inferior and stigmatized if they were to seek psychological help. This finding could be related to conservative attitudes of individualism and personal responsibility – internalizing a strong individualistic orientation is likely at odds with submitting oneself to MH treatment and may create cognitive barriers to giving in to and accepting the therapy process (Furr et al., 2003). This finding may also be related to conservatives’ perception of their environment as stigmatizing and non-inclusive of persons with MH concerns. Moreover, in line with Pescosolido and colleagues’ (2008) FINIS model, social and community factors (including geographic region) may also influence such decisions.

Overall, based on TMT, the designation of people with mental illness as ‘others’ may be one way that people who are high in RWA cope with concern that the world is a dangerous place (e.g. by helping to distinguish ‘good people’ from ‘bad people’; Greenberg et al., 2015; Lilienfeld & Latzman, 2014). That this threat may also extend broadly to psychological threats (e.g. concern that one might develop psychological problems oneself) was also suggested by the finding that people who were high in RWA also showed more stigma toward seeking psychological help. However, our analyses did not support the hypothesis that dangerous world beliefs would partially mediate connections between RWA and MH stigma. One explanation for this lack of mediation could be the nature of the DWS measure; threat is also a multidimensional construct (Cohrs, 2013) and DWS may not have tapped into all facets underlying TMT. Other common TMT measures, such as experimental tests of mortality salience and standardized measures of death anxiety or death thought accessibility, may elucidate this relationship in future studies. An alternative explanation could be that other factors related to conservatism better explain MH stigma.

An important limitation of this study is the role of social desirability. Consistent with previous work (Link et al., 2004), attitude scales were most susceptible to this bias, as evidenced by the significant contribution of the social desirability scale in our regression models. Another limitation may be the characteristics of the vignette characters in three of our measures – all were male, two were presented as working full time and living independently and none provided details about current treatment. Recent research demonstrates that vignettes portraying persons with particular characteristics, such as successfully treated symptoms, can reduce stigma (McGinty et al., 2015). Furthermore, the study sample, though drawn from all regions of the United States, was not randomly selected and is therefore not representative of the US population. Finally, the direction of the relationships observed cannot be determined from study findings (e.g. stigma might lead to RWA rather than the reverse), although this interpretation is less plausible, since political attitudes tend to be a more central aspect of one’s worldview and develop early in life (e.g. Block & Block, 2006). Longitudinal research exploring the development of both political attitudes and stigma would clarify this issue.

In sum, we believe that our findings have important implications for stigma reduction activities, MH outreach/treatment and broader stigma theory. A recent review by Pescosolido and Martin (2015) highlighted the importance of understanding stigma dimensionality to ‘narrow the targets of social change’ (p. 99). Given the connection of both self-reported attitudes and measured right-wing attitudes to various MH stigma dimensions, these findings may be used to target a variety of conservative audiences for stigma reduction. Data such as these can guide the framing of political messages (Lilienfeld & Latzman, 2014) – conservatives, for example, may be most persuaded by communications that reduce the perceived ‘otherness’ of people with mental illness, as well as communication that discusses MH in relation to other conservative ideals, such as responsibility, adherence to tradition and social order. Moreover, practitioners should be aware of the connection between RWA and attitudes toward MH services, including self-stigma, and how this may present a barrier to treatment. Individuals high in RWA or otherwise described as ‘ideologically intolerant’ can also benefit from contact interventions (Hodson, 2011), but more research is needed in this area. As research and theory grows in this area, more specific and tailored programs can be created to reduce MH stigma and facilitate more accepting communities.

Footnotes

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was partially supported by a Qualtrics Behavioral Research Grant:

Notes

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