Personality and attitudes towards people with mental disorders: Preliminary studies results

Abstract

Background:

The subject of psychological research all over the world is to understand the factors conditioning relationships between healthy people and people with mental disorders. Authors analysing attitudes towards people with mental disorders emphasize the importance of two types of determinants: personality factors and demographic and social variables.

Aim:

The aim of the research was to determine the interdependencies between personality traits and attitudes towards people with mental disorders, taking into account the moderating role of social distance and demographic and environmental variables.

Method:

Polish version of Community Attitudes towards Mental Illness (CAMI) – Kwestionariusz Postaw (KP) was used to measure attitudes towards people with mental disorders. Personality traits were measured using the NEO-Five-Factor Inventory (FFI) Personality Inventory by Costa and McCrae–Polish Adaptation, and the polish version of the Social Distance Scale was used to measure the declared social distance. In all, 204 people participated in the research: 133 women and 71 men, aged 18–65 years, living in the Kuyavian-Pomeranian and Greater Poland voivodeships.

Results:

The results showed that there is a relationship between personality traits: neuroticism, extraversion, openness to experience and agreeableness and an attitude towards people with mental disorders. Social distance, as the proposed moderator, did not significantly change the relationship between the variables.

Conclusion:

The results of the research have confirmed the important role of personality factors for attitudes, what should be remembered to exploration of presented phenomenon.

Keywords

Mental disorders personality traits social distance attitudes

Introduction

The observation of social life and the governmental attempt to implement an environmental model of psychiatric care became a good reason to undertake research in this area. The aim of the governmental programme is to change the philosophy of care for patients with mental disorders – resigning from hospitalization for the so-called mental health centres in which patients receive help within the clinic. People with mental disorders would also be able to depend on the help of mobile environmental teams, day care team and in the most severe cases 24-hour care of the hospital team. The aim of the programme is also professional activation of people with mental disorders. The programme assumes providing comprehensive mental health care to people with mental disorders in the patient’s natural environment. These activities are inscribed in the global trend of leaving from institutionalized treatment of mental disorders; however, they do not bring the desired effects yet. On one hand, there are visible procedures which follow the worldwide current of abandoning institutionalized treatment of psychic illnesses. On the other hand, they do not bring the desired effects. According to epidemiological data, 27% of adult Europeans and 23.4% of adult Poles declare that they experience at least one of the bad mental health symptoms yearly (World Health Organization (WHO), n.d.). The European Union imposed an obligation on its member states to accede the EU Joint Action on Mental Health and Wellbeing. Its main goal is to promote mental health and prevent mental disorders by shaping favourable attitudes and increasing social integration. Studies published in Poland have demonstrated the effectiveness of environmental impacts of support systems located in local communities in the process of recovering from mental disorders (Bronowski, 2012; Załuska et al., 2007). Unfortunately, the data collected by the Centre for Public Opinion Research (CBOS, 2012) indicated that the attitude of the society towards people with mental disorders is still unfavourable. This seemed to be one of the reasons why the attempt to realize the first edition of this programme proved unsuccessful. Therefore, the successful implementation of the environmental model of psychiatric care requires not only a better coordination of governmental units’ activities but also an investigation into the psychological factors which shape the unfavourable social attitudes towards people with mental disorders. Polish and global research confirm that it is the right direction for the development of psychiatric care (Bednar, 2006; Beresford, 2002; Bronowski & Chotkowska, 2016).

The understanding of the factors conditioning the relationships between healthy people and people with mental disorders is the area of psychological research worldwide. The precursors of the environmental psychiatric care current are Americans who have run numerous studies into this area since 1970. The American approach to studies into the relationships with people with mental disorders uses the term attitude. This notion connotates with behaviour, beliefs and the accompanying emotions and spreads throughout a continuum from a negative to positive appraisal of people with mental disorders (Abelson, 1982; Dear & Taylor, 1982; Eagly & Chaiken, 1993).

It is also worthwhile to explain the legitimacy of using the term mental disorder which starts to play a superior role with regard to all medical conditions dealt with by a psychiatrist and clinical psychology (Pużyński, 2007). The authors of International Classification of Diseases (10th Revision; ICD-10, 2009) and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-V, 2016) explain that the term ‘disorder’ aims to indicate the existence of a system of clinically identifiable symptoms or behaviour, most frequently, combined with suffering and pathology of individual functioning. The use of this term in scientific publications is also wider with regard to other expressions (Pużyński, 2007).

The subject literature provides a lot of reports about attitudes towards people with mental disorders. The majority of them prove to be more negative than attitudes towards people with any other dysfunctions (Dziwota, 2014; Ministry of Health, 2018; Świtaj, 2008; Świtaj et al., 2010). The attitudes of rejection are characterized by a lack of positive emotions or empathy. The most common consequence of disposure towards a person with mental disorder is depriving them of the possibility to undertake family and professional roles, depriving of social contacts, that is, social exclusion. They are opposite to the presumptions of the environmental model of psychiatric care (Reavley & Jorm, 2011). The motives contemporary world health institutions, including Poland, are driven by are partly economical. The reduction of costs related to providing care to people with mental disorders is significant within the model of environmental psychiatric care. Moreover, the model of environmental treatment is therapeutic itself. Based on the presumptions of this trend, the very inclusion in ecosystem exerts a beneficial therapeutic influence on people with mental disorders. The inhabitants of districts and neighbours are supposed to play an accepting role towards people who have typically been excluded from social life. The potentially therapeutic value of being a part of the society may be weakened when the citizens demonstrate a negative attitude (Rabkin, 1977).

Therefore, it seems worthwhile to determine the variables which play an important role in the process of forming attitudes towards people with mental disorders. The subject literature analysis revealed (Ewalds-Kvist et al., 2013; Klimasiński, 1976; Sękowski, 1991; Waugh et al., 2017; Witkowska, 2001) that the authors involved in studying attitudes towards disabled people and people with mental disorders accentuate the importance of two types of factors. As mentioned before, these are personality factors and demographic–social variables.

Personality, as an internal system that regulates intrapersonal and interpersonal relations of a unit, is characterized by a relative time stability. This structure enables human to adapt and internally integrate thoughts, feelings and behaviour in a given environment over time. It is an inventory of relatively stable features or psychic dispositions of a unit, differentiating it from others (C. S. Hall et al., 2010). The personality factors which have been studied worldwide as prone to be significant for developing negative attitudes towards people with mental disorders are authoritarianism (Canter & Shoemaker, 1966; Corrigan et al., 2001), preference for economical values (Sękowski, 1994; Witkowska, 2001), low level of creativity (Peterson, 1973; Sękowski, 1994; van 't Veer et al., 2006; Witkowska, 2001), the external localization of the feeling of control (Beckman, 1972) and a high level of fear as a trait (Emrich et al., 2003; Martin et al., 2000; Szeto et al., 2015; Walsh, 1971). The relationship between personality traits and attitudes towards disabled people in Poland was studied by Sękowski (1991). Beyond that, merely one study has been published. Its author is interested in the profile of personality variables, which influence the attitudes towards people with mental disorders revealed by residential homes workers (Witkowska, 2001). In her studies, she included such personality variables as cognitive skills, preferences for values, the level of fear as a state and feature, as well as the level of self-esteem. The suggested variables, however, are not part of any system of personality structure; hence, they may rather be regarded as a set of various aspects named personality variables. The subject literature review shows that factors which are indicators of personality traits may be significant for the process of developing attitudes towards people with mental disorders. Nevertheless, no previous study on personality factors has been connected with any particular theory, which is the reason for suggesting the use of a systematic model of research into the importance of personality traits for the process of forming attitudes towards people with mental disorders.

Another type of conditionings determined by authors interested in studying the attitudes towards people with mental disorders are demographic–environmental variables (Klimasiński, 1976; Sękowski, 1991; Witkowska, 2001). The literature worldwide contains numerous publications concerning such aspects like

Age (Clark & Binks, 1966; Ewalds-Kvist et al., 2013; Murray, 1969);

Gender (Fox et al., 2015; Stromwall et al., 2012; Taylor et al., 1979; Witkowska, 2001);

Knowledge about mental disorders (Corrigan et al., 2013; Pitre et al., 2007);

Experience with people with mental disorders (Ewalds-Kvist et al., 2013; Kennedy & Belgamwar, 2014; Kolodziej & Johnson, 1966);

The kind of disorder (Westbrook et al., 1993);

The level and kind of education (Vijayalakshmi et al., 2013);

Studies concerning the general diagnosis of attitudes towards people with mental disorders (Gonzales et al., 2017; Ross & Goldner, 2009).

Sources provide interesting information about the role of social distance in the process of forming attitudes towards people with mental disorders. The experience of close contact with people with mental disorders modifies the attitudes of the respondents from negative to positive (Lebowitz & Ahn, 2016; Waugh et al., 2017). Following Park’s (1924) concept, distance is defined as a nearness or intimacy of a human in a social relationship. It accounts for a circumstance for indicating a direction of individual’s categorization of reality on a continuum from ‘a stranger’ to ‘a fellow’. The research reports, however, reveal a scarce amount of data concerning the significance of factors which moderate the attitudes towards people with mental disorders.

The aim of the study

The main aim of the presented study is to determine the interrelationships between personality traits and attitudes towards people with mental disorders regarding the moderating role of social distance and demographic–environmental variables. Concerning the formulated aim, the research may be assumed as both cognitive and practical. The cognitive aim is to obtain empirically confirmed knowledge and explore the new area of interrelationships between personality factors, according to the trait theory paradigm, and the attitudes towards people with mental disorders with particular regard to the moderating role of social distance and sociodemographic variables. Another cognitive aim of the presented study is to adapt a new research method – Community Attitudes towards Mental Illness (CAMI) Scale questionnaire – Community Attitudes Towards the Mentally Ill by Dear and Taylor (1982) to Polish conditions. The questionnaire is used to study the social attitudes towards people with mental disorders. Its secondary aim is to describe the strength of interrelationships between the attitudes and social distance. Moreover, the obtained results may allow to realize a practical aim which could extend the range of possible activities in this area. It corresponds with the currently disseminated environmental model of psychiatric care.

Materials and methods

The main research problem concerns attitudes towards people with mental disorders. Particular attention was paid to the role of personality factors in the process of shaping these attitudes. Based on the analysis of the literature, the theory of personality and personality factors resulting from it were selected. The following research questions were formulated: Is there a relationship between personality variables and attitudes towards people with mental disorders and are such variables as personality traits significant predicates of attitudes towards people with mental disorders? Is the social distance variable a significant moderator of the relationship between personality traits and the attitude towards people with mental disorders?

The explained variable in the presented study is the attitude towards people with mental disorders, that is, relatively stable, positive, or negative appraisal of people, objects and ideas (Eagly & Chaiken, 1993). An operational definition of attitude adopted from American research in relation to people with mental disorders connotes behaviours, beliefs and emotions associated with them. Attitudes towards people with mental disorders are described in content as a set of statements referring to beliefs, potential experiences and emotional states related to people with mental disorders (Wolska et al., 2017). The explained variable was measured with Attitudes Questionnaire (KP). It was created on the basis of an American tool for measuring attitudes towards people with mental disorders CAMI (Taylor et al., 1979). The Polish tool KP is a Likert-type scale that contains 30 items describing an attitude towards people with mental disorders in three dimensions (emotional, cognitive and behavioural). The respondents mark whether they agree or not with every item using a 6° rank scale. The tool was used with the consent of the authors of the original version. Its psychometric properties and the Cronbach alpha reliability coefficient are satisfactory.

The exogenous variable in the presented project is personality traits according to Costa and McCrae (1991; Zawadzki et al., 1998). Personality is currently defined as an internal system which regulates intrapersonal and interpersonal relationships which are constant in time (C. S. Hall et al., 2010). The exogenous variable was measured with NEO-Five-Factor Inventory (FFI) Personality Inventory by Costa and McCrae – Polish adaptation (Zawadzki et al., 1998). The NEO-FFI questionnaire consists of 60 items – 12 for each of the 5 scales – and requires the majority of respondents to devote 10–15 minutes to work on it. NEO-FFI questionnaire includes five main dimensions: neuroticism, extraversion, openness to experiences, agreeableness and conscientiousness (Costa & McCrae, 1991). Each of the factors contains six components, which allow for their classification. Each item is a statement which requires a respondent to take a stance by a positive answer on the scale from ‘I definitely agree’ to ‘I definitely disagree’. The reliability coefficients for each factor of NEO-FFI Questionnaire are satisfactory. The structure of the tool has also been confirmed on the Polish sample (Zawadzki et al., 1998).

The moderating variable is the social distance understood as a degree of intensity of preferred distance declared by respondents towards people with mental disorders in five areas: intimate, private, microsocial, macrosocial and public, according to E. T. Hall (2001). The concept of social distance assumes the existence of ‘measures and degrees of understanding closeness which are usually used to describe personal and social relationships’ (Bogardus, 1925; Park, 1924).

The study used the ‘Social Distance – DS’ questionnaire based on the original social distance scale by Bogardus (1925) consisting of five statements aiming to describe the desired social distance. It was significant for this study to find out the degree of intensity of social distance towards people with mental disorders declared by the respondents. For each of the five statements, the respondent was expected to circle an answer that best reflected their opinion. The answers took the form of a rank scale from 1 to 6, where 1 determined statement definitely adequate to my beliefs and 6 definitely inadequate to my beliefs (neutral answer was impossible). The mean value of social distance towards people with mental disorders revealed by respondents was an arithmetic mean value of all the given answers. Therefore, the higher result was obtained by a respondent, the bigger social distance towards people with mental disorders.

The study used a modified measurement of distance according to the classification by E. T. Hall (2001), divided into five areas: intimate distance – the admissibility of close emotional relationship; private distance – the admissibility of friendly relationships; microsocial distance – the admissibility of living in close neighbourhood; macrosocial distance – the admissibility of contact in public sphere; public distance – the admissibility of indirect contacts with a person with mental disorder. Cronbach alpha reliability coefficient of the scale = .82.

In addition, the authors used a self-constructed personal questionnaire. It was created in order to obtain such data from the respondents as gender, age, marital status, education and having children.

The study was carried out between December 2017 and March 2018 in Kuyavian-Pomeranian and Greater Poland Voivodeships. The sample group consisted of 204 people: 133 (65%) women and 71 (35%) men aged 18–65 years (M = 38.05 years; SD = 12.50 years); 58 respondents (28%) declared their education at the secondary level and 113 subjects declared higher education (55%). Education basic or professional was declared by 33 people, which constituted 16% of the total sample; 42 respondents (21%) declared that they had received psychiatric or psychological consultations in the past year, and 162 respondents declared that they had not received psychiatric and psychological consultations (79%). In addition, 125 respondents (61%) declared having a child and 79 respondents (39%) were childless.

The group was chosen according to the following criteria: the age of the respondents was between 18 and 65 years, consent to participate in the study. The individuals who agreed to take part had been given a set of questionnaires to complete. The study took approximately 40 minutes.

The respondents had been informed about the aim and procedure prior to the beginning of the study. Moreover, the participants had been informed about anonymity and the fact that the study is conducted for purely scientific reasons. They had the right to withdraw at any point of the study.

Results

The Statistica 12 software package was used to carry out statistical analyses to answer the formulated research questions. First, the distribution of the examined variables was verified with Shapiro–Wilk test (Brzeziński, 2003). Pearson linear correlation was carried out to verify the hypotheses concerning the relationship between personality traits and attitudes towards people with mental disorders. Table 1 presents the results of the analysis.

Table 1.

The values of Pearson correlation coefficients for the variable personality against attitude.

N = 202	Attitude	p value
Neuroticism	.29	.02
Extraversion	−.12	.09
Openness to experiences	−.31	.001
Agreeableness	−.32	.001

The analysis of the presented data indicates the existence of statistically significant, positive low correlation (Brzeziński, 2003) between neuroticism and attitude (r = .29; p = .02). Openness to experiences reveals a statistically significant negative correlation with attitude (r = −.31; p = .001). Agreeableness and attitude show statistically significant, negative correlation (r = −.32; p = .001).

The verification of the hypothesis concerning the predictive character of personality traits for the attitude towards people with mental disorders variable was verified with multiple regression (Table 2).

Table 2.

Linear regression: predictor: personality traits.

N = 202	b *	Standard error with b*	B	Standard error with b*	t (195)	p value
Intercept parameter			109.11	11.15	9.79	.001
NEU	.21	.07	0.25	0.18	1.36	.035
EXT	−.02	.08	−0.04	0.21	−0.24	.081
OPE	−.21	.07	−0.56	0.19	−2.72	.007
AGR	−.31	.07	−0.66	0.19	−3.45	.001
CON	.06	.07	0.16	0.19	0.87	.385

The summary of regression of the dependent variable: attitudes R = .37, R² = .15 Correct. R² = .12, F(5, 196) = 6.41; *p < .001, estimation of standard error: 15.66.

Based on the regression coefficient, it has been stated that personality traits such as neuroticism (beta = .21; p = .03), openness to experiences (beta = −.21; p = .007) and agreeableness (beta = −.31; p = .001) are significant predictors of attitudes. The variance analysis confirms the matching of the model (F(5, 196) = 6.41, p < .001). The suggested model explains 12% of the dependent variable variance (R² corrected = .12) (Table 3).

Table 3.

Moderation results matrix for personality traits – predictor; social distance – moderator; independent variable – attitude towards people with mental disorders.

N = 202	b *	Standard error with b*	B	Standard error with b	t(198)	p value
Intercept parameter			85.52	1.05	81.11	.001
Moderator distance	.44	.06	7.32	1.05	6.93	.001
Predictor (NEU)	.18	.07	3.06	1.1	2.79	.005
InteractionModerator × predicator	.08	.07	1.39	1.1	1.26	.208
Intercept parameter			85.55	1.06	80.38	.001
Moderator distance	.44	.06	7.41	1.06	6.95	.001
Predictor (EXT)	−.13	.07	−2.22	−1.11	−1.99	.04
InteractionModerator × predicator	−.02	.07	−0.17	−0.11	−0.16	.88
Intercept parameter			85.57	1.05	81.34	.001
Moderator distance	.42	.06	7.02	1.05	6.67	.001
Predictor (OPE)	−.21	.07	−3.24	1.17	−2.76	.006
InteractionModerator × predicator	.05	.07	0.78	1.17	0.67	.502
Intercept parameter			85.59	1.03	82.66	.001
Moderator × distance	.41	.06	6.87	1.04	6.63	.001
Predictor (AGR)	−.27	.05	−4.17	1.04	−4.02	.001
InteractionModerator × predicator	.06	.06	1.04	1.04	1.01	.317
Intercept parameter			85.58	1.07	79.71	.001
Moderator distance	.43	.06	7.36	1.07	6.86	.001
Predictor (CON)	−.04	.07	−0.63	1.13	−0.55	.581
InteractionModerator × predicator	.04	.07	0.67	1.13	0.59	.551

p < .001.

The regression analysis with an interaction component was carried out to determine the relationship between particular personality traits and social distance and their interaction with the dependent variable attitudes towards people with mental disorders. The social distance moderating variable was aligned; however, in case of the personality trait variables, the aligning method was based on standardization of the results. The conducted regression analysis with an interaction component revealed the existence of relationships between personality traits (NEU) beta = .18; p = .001, (EXT) beta = −.13; p = .001, (OPE) beta = −.21; p = .001, (AGR) beta = −.27; p = .001 and attitudes towards people with mental disorders variable. Conversely, no significant interaction effect occurred with regard to any of the independent variables suggested in the model considering social distance as a moderator and attitudes towards people with mental disorders (NEU) beta = .08; p = .208, (EXT) beta = −.02; p = .88, (OPE) beta = −.05; p = .502 and (AGR) beta = −.06; p = .317. The analysis of the regression with an interaction component did not reveal a relationship between personality trait (CON) beta = −.04; p = .55 and attitudes towards people with mental disorders.

Discussion and conclusion

The conducted research indicates the existence of a relationship between neuroticism and attitude towards people with mental disorders. The higher the level of neuroticism, the less positive attitude of the respondents towards people with mental disorders. The study also revealed a relationship between openness to experiences and agreeableness with the attitude towards people with mental disorders. The higher the level of these variables, the more positive attitude of the respondents towards people with mental disorders. The listed personality traits such as openness to experiences, agreeableness and neuroticism are also predictors of an attitude towards people with mental disorders. No relationship between conscientiousness and extraversion and attitudes towards people with mental disorders was observed. Social distance as a suggested moderator for the relationship between personality traits and attitudes towards people with mental disorders did not prove to significantly alter the primary relationship between these variables.

The results obtained with regard to the relationship between personality traits and attitudes towards people with mental disorders partially confirm the research hypotheses. Neuroticism (NEU), which reflects the emotional adaptation versus emotional imbalance, may be related to experiencing negative emotions, such as fear, anger, dissatisfaction and sensitivity to psychological stress. Providing that negative emotions affect an individual’s adaptation to the environment, neurotic people have a limited ability to control their drives. However, people with low neuroticism are calm, relaxed and satisfied with themselves. They have a clearly shaped personality and are objective which may contribute to a greater acceptance for people with mental disorders (Costa & McCrae, 2005; Zawadzki et al., 1998).

Extraversion (EXT), as a second personality trait which revealed a statistically significant relationship, describes the willingness to undertake social interactions as well as an individual’s high level of activity, energy and the ability to experience positive emotions. Extravert people are friendly and talkative. They seek social stimulation, present life optimism and are characterized by a positive mood. A low level of this feature is typical for emotionally plain people who avoid close relationships, overly control impulses and are submissive (Costa & McCrae, 2005). Such relationships may explain the obtained results concerning the connection between extraversion and the attitudes towards people with mental disorders.

Openness to experiences (OPE) is typical for people who rebel against patterns, nonconformists seeking alternative solutions and are introspective. On the other extreme are individuals who support conservative values, judge by conventional categories and uncertain facing difficulties and moralizing (McCrae et al., 1986). The characteristics of people with a high level of openness to experiences may indicate its relationship with a positive attitude towards people with mental disorders.

The public beliefs concerning people with mental disorders or physical disability are closely related to the social history of psychiatric asylum. Rabkin (1977) emphasizes that, despite general acceptance for the medical approach and the tendency to regard it as proper, people tend to avoid contacting a person who is or has been psychiatrically treated. More and more studies confirm that the experience of stigmatization is significantly more frequent in people with mental disorders than with somatic disorders (Corrigan et al., 2005; Crisp et al., 2000; Rabkin, 1977; Świtaj et al., 2010). A particular role in the process of integrating people with mental disorders is played by social distance. The very experience of contacting a person with mental disorder modifies the attitudes towards approving (Kennedy & Belgamwar, 2014). Social distance as a declarative inference indicator may play a significant role as a moderator of relationships in the process of forming attitudes towards people with mental disorders which failed to be proved in the presented study.

It is possible that the study group was too small to detect the actual moderation. The reason may also be the method of data collection and the imperfection of the distance measuring tool. However, it cannot be ruled out that the experience of social distance is a regulator for attitudes towards people with mental disorders. Perhaps direct experience, in one of the spheres presented in this study, referred to as social distance, and not an artificial questionnaire study situation, may constitute a better, significantly modifying relationship of personality traits and attitudes towards people with mental disorders factor. As confirmed by studies, the attitudes of healthy people towards people with mental disorders are a significant variable which conditions the successful implementation of an environmental model of psychiatric care. However, the realities prove that we still face numerous challenges. Determining significant factors which correlate with the social attitudes towards people with mental disorders may contribute to a better understanding of these attitudes and their more effective modification.

The obtained research results are interesting from theoretical and practical perspectives. They provide data concerning a significant relationship between the chosen personality traits: neuroticism, openness to experiences and agreeableness with the dependent variable, that is, the attitude towards people with mental disorders. Data based on empirical studies indicate that the personality variables and their configurations are predispository for revealing positive or negative attitudes towards people with mental disorders.

The results of the study may lead to a reflection on the process of personnel selection for Mental Health Centres. Empowering people with mental disorders and strengthening their functioning is the basis of a modern system of rehabilitation. The obtained research results can contribute to better implementation of the environmental model of psychiatric care and may be used in the process of implementing the environmental model of psychiatric care through the creation of programmes with the participation of experts aimed at changing attitudes towards people with mental disorders to more positive. It is also worth, based on the acquired knowledge, to deliver psychoeducational programmes, which could be based on the experience of contact with people with mental disorders addressed to students of schools or workplaces. This could increase the social acceptance of people with mental disorders.

Therefore, it may be used in the process of implementing the environmental model of psychiatric care in the broad sense.

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) received no financial support for the research, authorship and/or publication of this article.

ORCID iD

Alicja Malina

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