An empirical examination of the biogenetic approach in schizophrenia stigma reduction through an attribution lens

Abstract

Background:

The biogenetic approach in mental health stigmatization reduction has received increased attention. Taking the perspective of Weiner’s attribution theory, the biogenetic explanations can be helpful in reducing the perceptions of controllability of mental illnesses (e.g., schizophrenia). However, recent studies reveal that biogenetic explanations may increase social stigma and discrimination against people with schizophrenia.

Aims:

The current research, using Weiner’s attribution theory, empirically examined the effects of biogenetic beliefs on the desire for social distance via perceptions of controllability and stability of schizophrenia using a Chinese sample.

Methods:

A cross-sectional study (n = 156) and an experiment (n = 124) were carried out. Participants were recruited from an urban city in China. In the experiment, participants were randomly assigned to receive a biogenetic/control lecture and filled out a survey.

Results:

Biogenetic beliefs had indirect effects on the desire for social distance via decreased perceived controllability and increased perceived stability, which resulted in little to no change on the desire for social distance.

Conclusion:

The biogenetic approach could decrease the perceptions of controllability of schizophrenia which may reduce the desire for social distance; however, it could also increase the perceptions of stability which may increase the desire for social distance, especially among close others. Cautions are warranted when using and disseminating the biogenetic causes of schizophrenia amongin the general public.

Keywords

Schizophrenia biogenetic approach attribution China

The biogenetic approach, an intervention strategy that emphasizes biological or genetic causes of schizophrenia with the expectation to reduce negative attitudes towards individuals with schizophrenia, has received increased attention in recent years (Clement et al., 2010). The core assumption of the biogenetic approach is that ascribing causes of schizophrenia to biogenetic factors would reduce the perceptions of responsibility among the individuals with schizophrenia, which could consequently reduce blame and rejection by their social environment (Angermeyer et al., 2011). The attempt to reduce mental health stigma through reducing perceived responsibility (usually operationalized as ‘controllability’) corresponds to a series of studies (e.g., Muschetto & Siegel, 2019; Ruybal & Siegel, 2017, 2018; Siegel et al., 2012; Yao & Siegel, 2020) that used and expanded on Weiner’s attribution theory (Weiner, 1980a, 1980b). For instance, Ruybal and Siegel experimentally manipulated participants’ perception of controllability of their loved ones’ postpartum depression and found that reduced perceived controllability led to higher sympathy and lower anger, which increased their willingness to provide social support.

However, findings reveal that the biogenetic approach has consistently been shown to result in a number of negative outcomes, such as increased prejudice and stigmatization, fear, and desire for social distance (e.g., Angermeyer et al., 2011, 2013; Angermeyer & Dietrich, 2006; Angermeyer & Matschinger, 2005; Kvaale et al., 2013; Longden & Read, 2017; Read, 2020; Read et al., 2006, 2013; Read & Harper, 2020; Read & Harre, 2001; Yao et al., 2020). For instance, Yao and colleagues found that increased biogenetic beliefs were related to an increase in close others’ desire for social distance through increased perceptions of affiliate stigma, the fear of being associated with those with schizophrenia, among a sample of Chinese community residents.

From an attributional perspective, the negative effects of biogenetic stigma on close others’ desire for greater social distance could also be explained by the potential increase of perceptions of stability, another critical dimension in Weiner’s attribution theory (Weiner, 1985). Higher perception of stability was found to be related to lower willingness to provide social support for those with depression and increased desired social distance among close others through lowered sympathy (Muschetto & Siegel, 2019; Yao & Siegel, 2020). However, the adverse effects of perceived stability on helping were not observed when the target was an acquaintance. It was reasoned that the discrepancies in reactions to perceived stability based on interpersonal relationships could be because mental illnesses are far more impactful on close others than acquaintances. As such, the perception of stability may be particularly concerning to close others who are likely to be primary help providers to individuals with schizophrenia. Another possible explanation related to perceived stability could be psychological essentialism, the belief that there are immutable and natural essences beneath the observed properties (Haslam & Whelan, 2008). When schizophrenia is viewed as immutable or stable, and that it reflects inherently negative traits of the person with schizophrenia, it is not surprising that fear and discrimination may rise (Kvaale et al., 2013).

As discussed, although the biogenetic approach may reduce the perceptions of controllability of schizophrenia, it may increase the perceptions of stability. Research showed that close others are particularly sensitive to the perceptions of stability (e.g., Yao & Siegel, 2020). To our knowledge, the links between biogenetic beliefs, perceptions of controllability and stability, and desire for social distance have not yet been explicitly examined, at least in the close other and cross-culture context. Although emotional reactions to attributions are important in Weiner’s (1985) attribution theory, we did not explicitly measure emotions because the role of emotions was studied among a similar population in depression (Yao & Siegel, 2020). The current studies looked to provide preliminary results to understand whether the biogenetic approach, a well-intended stigmatization reduction strategy, could produce negative outcomes through the lens of attributional elements (i.e., controllability and stability).

Study 1

Participants and procedure

Participants were recruited from three local communities in Qingdao China. A total of 170 participants were recruited. After removing missing cases (n = 12) and outliers (n = 4), the final sample consisted of 156 participants. The majority of the sample was female (55.50%) with an average age of 42.41 (SD = 9.23) years. A simulation technique was used, similar to previous studies (e.g., Yao et al., 2020). Specifically, participants read an overview of symptoms of schizophrenia and treatments, imagined one of their close others was diagnosed with schizophrenia, and filled out a brief survey. Incentives were provided (worth approximately $1) upon completion of the survey.

Measures

Biogenetic belief of schizophrenia

Participants expressed the extent to which they believed in biogenetic causes of schizophrenia (e.g., ‘brain disease’) on a 7-point Likert-type (strongly disagree to strongly agree) scale (ɑ = .84). These items were adapted from a previous study (Speerforck et al., 2014) and were translated and tested in a similar Chinese population (Yao et al., 2020). However, one revision in translation was made for the item heredity – the original translation (see Yao et al., 2020) had a focus on the genetic aspect and the revised item emphasized the hereditary aspect.

Perceived controllability

The three-item subscale from the Attribution Questionnaire (Corrigan et al., 2004), translated and used by Yao and Siegel (2020), was administrated to measure the extent to which participants felt their close others’ schizophrenia is controllable. Participants responded on a 7-point Likert-type scale from 1 (not at all) to 7 (completely). This scale (ɑ = .79) was negatively associated with willingness to provide social support and positively correlated with desire for social distance (Yao & Siegel, 2020).

Perceived stability

Similar to previous research (e.g., Yao & Siegel, 2020), the perceived stability subscale from the Causal Dimension Scale-II (CDS-II; McAuley et al., 1992) was used to measure the extent to which participants’ perceptions of the longitude of schizophrenia. Participants responded to three items (e.g., ‘temporary/permanent’) on a 7-point semantic differential scale (ɑ = .81).

Desire for social distance

Following Link et al.’s (1999) measurement of desire for social distance, participants rated their willingness to engage in five social activities (e.g., ‘have this person move to the next door’) with this person as if they did not know this person on a 7-point Likert-type scale (not at all to definitely). This scale was related to attitudes towards helping, sympathy, and willingness to provide social support in previous studies (Grausgruber et al., 2007; Lauber et al., 2004; Muschetto & Siegel, 2019).

Results

Cross-sectional results showed that, as predicted, stronger biogenetic beliefs were associated with lower perceived controllability (r = −.36, p < .01) and higher perceived stability (r = .29, p < .01), and weakly negatively correlated with desire for social distance (r = −.11, p < .05). Stronger desire for social distance was related to lower perceived controllability (r = −.27, p < .01) and higher perceived stability (r = .21, p < .01).

These correlational results qualified for a mediation analysis. SPSS PROCESS macro (Version 3.1; Model 4; Hayes, 2018) was used. Results showed that biogenetic beliefs had indirect effects on desire for social distance via perceived controllability, b = −0.08 (0.03), 95% confidence interval (CI) = [−0.14, −0.02], and perceived stability, b = 0.06 (0.04), 95% CI = [0.01, 0.12]. Although these results aligned with our predictions, the cross-sectional design was a limitation because was it unable to infer causality.

Study 2

Participants, Procedure, and Measures

Researchers distributed flyers and asked community residents to sign up for a ‘10 minute lecture about the newest findings in schizophrenia’. Six sessions (n = 25 per session, total n = 150) were filled, although 20 participants had no-show when the lectures were conducted. Participants were randomly assigned to receive the biogenetic lecture or the control lecture. The second author (male, 39-year-old, Chinese-native) delivered all the lectures. Identical to Yao and colleagues’ (2020) study, the biogenetic lecture discussed the role of brain and heredity in the development of schizophrenia and the control lecture balanced the information with the a discussion of psychosocial influences. After the lectures, participants filled out an identical survey to Study 1. After removing missing cases (n = 2) and outliers (n = 4), the final sample included of 124 participants (biogenetic, n = 66; control, n = 58). Over half of the sample was female (60.48%), with an average age of 40.28 (SD = 7.21) years.

Results

A one-way multivariate analysis of variance (MANOVA) revealed a statistically significant difference between the experimental condition and control condition in perceptions of controllability and stability of schizophrenia, F(2, 121) = 14.64, p < .01, Wilks’s λ = 0.81, partial $η^{2}$ = .20, but not desire for social distance. Subsequent univariate analysis showed that the biogenetic lecture had statistically significant effect on both perceived controllability, F(1, 122) = 5.27, p < .05, partial $η^{2}$ = .06, and perceived stability, F(1, 122) = 29.45, p < .01, partial $η^{2}$ = .19. The biogenetic lecture significantly decreased participants’ perceptions of controllability of schizophrenia but increased perceptions of stability, compared with the control group (see Table 1 for mean level differences).

Table 1.

Means and standard deviations.

	Variable	M	SD
Study 1
Cross-sectional study	1. Biogenetic belief	5.31	1.23
	2. Controllability	4.03	1.37
	3. Stability	4.52	1.28
	4. DSD	4.13	1.19
Study 2
Control	1. Controllability	3.89	1.16
	2. Stability	4.37	1.39
	3. DSD	4.11	1.03
Biogenetic	1. Controllability	3.31	1.43
	2. Stability	4.82	.95
	3. DSD	3.96	1.34

Note. DSD = desire for social distance.

Mediation analysis indicated that biogenetic beliefs had indirect effects on desire for social distance via perceived controllability, b = −0.22 (0.12), 95% CI = [−.46, −.03]; however, the indirect effect of perceived stability was marginally significant, b = 0.17 (0.14), 95% CI = [−0.01, 0.34]. Patterns of mediational results are similar to Study 1.

Discussion

A cross-sectional study and an experiment were conducted using Chinese community samples. Results showed that biogenetic beliefs decreased participants’ perceived controllability of schizophrenia but increased perceived stability. In turn, biogenetic beliefs had little to no effect on participants’ desire for social distance among their close others. Specifically, stronger biogenetic beliefs were related to lower desire for social distance via lower perceived controllability; however, stronger biogenetic beliefs were associated with more desire for social distance through heighted perceived stability. Although experimental results provided partial support for mediational effects of perceived stability, potentially due to the small sample size, these findings nevertheless offered preliminary support for explanations of why biogenetic approach could yield negative outcomes in the literature (e.g., Angermeyer et al., 2015) from an attribution perspective (Weiner, 1985).

As discussed earlier, although the reduction of perceived controllability can be useful for increasing help provision (e.g., Muschetto & Siegel, 2019), perceived stability can be negative for people’s willingness to provide social support for close others, compared with acquaintances (e.g., Muschetto & Siegel, 2019; Yao & Siegel, 2020). Because biogenetic beliefs impact help provision via reduced controllability and increased stability, these indirect effects may neutralize the overall effect of the biogenetic approach. However, depending on the target of help provision (e.g., close other vs. acquaintance; see Yao & Siegel, 2020) and the type of measures (e.g., willingness to provide social support, desire for social distance, public stigma), biogenetic beliefs may result in differentiated outcomes.

Cautions are warranted prior to the implementation of anti-stigma campaigns using the biogenetic approach. One reason is that biogenetic beliefs may result in increased levels of perceived affiliate stigma (Yao et al., 2020) among close others who are likely to be primary caretakers of individuals with schizophrenia. Also, the potentially strengthened belief of the immutable and natural causes of schizophrenia derived from the biogenetic explanations may be paired with perceptions of dangerousness and fear, and consequently increase prejudice and stigmatization (Haslam & Whelan, 2008). Future studies may investigate other underlying psychological processes to explain the impacts of biogenetic beliefs on mental health stigma and help provision and to increase the awareness of situations in which the biogenetic approach could be effective.

Limitations

Despite the contributions of the current research, there were limitations. Most importantly, the sample sizes were relatively small and not representative of the Chinese population. Therefore, results from this research may not be generalizable to other populations. Another notable limitation is that some threats to internal validity may introduce noises into the results. For instance, no-pretest was in place to ensure the effectiveness of randomization. In addition, the control group in the experiment also received biogenetic information which, although balanced with psychosocial influences, may reduce the capability of the experiment to detect differences among the two groups. Future research could include more participants from a diverse sample, use different types of manipulations and introduce more complex experimental designs to investigate the impacts of biogenetic beliefs. Moreover, future studies should consider introducing a truly neutral condition to compare with the biogenetic condition.

Conclusion

Two studies were carried out to test the effects of biogenetic beliefs on desire for social distance from an attribution perspective. Results demonstrated that biogenetic beliefs had negative indirect effect on desire for social distance via lowered perceived controllability, but positive indirect effect through higher perceived stability. As such, the biogenetic approach resulted in little to no difference on the desire for social distance. Future research should investigate the underlying psychological factors and situational factors that contribute to the outcomes of the biogenetic approach, and aim to develop intervention strategies to boost the reduction of perceived controllability and decrease the perceptions of stability when using the biogenetic approach.

Footnotes

Funding

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

ORCID iD

Chunhui Wang

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