Mental disorders in the media: A retrospective study of newspaper coverage in the Chilean Press

Abstract

Background:

The mass media are relevant in shaping the population’s attitudes towards mental disorders. In low- and middle-income countries there is little information about the portrayal of people with mental disorders in the mass media.

Aim:

The general objective of the study was to assess the tone and content of Chilean newspaper articles about mental disorder from 2000 to 2019.

Method:

The digital editions of four national circulation Chilean newspapers were intentionally selected. The search engine Google News was used to identify and retrieve the news. To evaluate the news, a standardised codebook was administered. A total of 385 news were evaluated.

Results:

The results show that a large proportion of the news items has an overall positive/optimistic tone 43.5% and 57.5% does not stigmatise; however, only 18.4% emphasises recovery as part of the content. The highest percentages of news stigmatising in tone and content are observed for bipolar disorder and schizophrenia. Furthermore, the experts are quoted much more frequently than people diagnosed with mental disorders or their families and/or friends. When comparing by years there is a trend towards general decrease in stigmatisation, moving towards a more positive or optimistic view of mental health,

Conclusions:

In general, low stigmatisation towards mental disorders was found in the news and this was reduced steadily over time. Although there are aspects to improve in some particular areas, suggesting that manifest stigma has diminished, but more subtle forms still remain.

Keywords

Stigma mass media mental disorder

Introduction

People with a mental disorder (MD) diagnosis are stigmatised (Henderson et al., 2014; Holder et al., 2019). Stigma has important consequences for those affected: it is a serious threat to full and active citizenship and wider social inclusion (Corrigan, 2016; Stuart, 2006).

One of the ways in which structural stigma occurs is through the media (Corrigan et al., 2005). These have a great influence on public attitudes towards people with MD (Babić et al., 2017; Pratiwi et al., 2018). Various studies show how the way in which information about people with MD is delivered encourages positive attitudes or, on the contrary, contributes to the formation of prejudices (Alyousef et al., 2019; Corrigan et al., 2013; Ross et al., 2019). The media often present distorted and negative images of MDs, associating them with aggressiveness, lack of control and criminality; people with MD are seen as a danger to others and to themselves (Aci et al., 2020; Bowen et al., 2019; Klin & Lemish, 2008; Nawková et al., 2012; Subramanian, 2018). Further research indicates that these lead to public perceptions that people with MD are violent and characterised by outbursts of anger, childlike behaviours and severe symptoms (Quintero Johnson & Riles, 2016; Reavley et al., 2016).This media coverage models the public’s reactions towards people with MD, generating fear, rejection and, in general, the feeling that they are a threat to the societal order, which maintains and feeds back into the stigma circle (Ma, 2017; Murphy et al., 2013; Stuart, 2006).

The media present a negative image of different diagnoses (Bowen, 2016; Koike et al., 2016; MacLean et al., 2015); however, some such as schizophrenia generate greater prejudices (Guarniero et al., 2017; Reavley et al., 2016).Differences have also been found by sex and age group, the news about adult men with MD is usually more negative, than those of children and women (Slopen et al., 2007; Whitley et al., 2015).Moreover, it has been found that not only the image of people with psychiatric diagnoses is distorted but also other aspects such as the causes of the disorders and their treatments (Klin & Lemish, 2008; Subramanian, 2018).Finally, another way to perpetuate stigma is to not include the perspective of those affected in the press. This generates the vision, on the one hand, that they are unable to express their point of view and, on the other one, that the professionals are the only experts in what happens to them (Guarniero et al., 2017; Ohlsson, 2018; Subramanian, 2018).

Over the last decade, different interventions have been developed and implemented to reduce the stigmatisation exercised by the press (Maiorano et al., 2017), meaning that research that carries out a longitudinal evaluation of the occurrence of stigma should show some modification of the negative image broadcast by the media. However, the results are contradictory. Some studies show that the way in which mental health issues and mental disorders are treated has improved (Economou et al., 2015; Hildersley et al., 2020; Whitley & Wang, 2017); others indicate that information that encourages prejudices and stereotypes is maintained (McGinty et al., 2016; Murphy et al., 2013); and, finally, it has also been found that stereotypes linked to dangerousness have decreased, but others associated with disability have increased (Rhydderch et al., 2016). Given that the above-described studies were conducted in a variety of locales, the lack of consistency in the findings indicate the importance of local context and the delivery of interventions tailored to the local setting.

Research evaluating the occurrence of stigma towards MD in the media has been carried out mainly in English-speaking countries. In the two most recent systematic reviews on the subject, no study in Spanish is found (Ma, 2017; Ross et al., 2019), despite being one of the most widely spoken languages in the world.

Over the last decade, only two studies on the subject have been published in Spain and two in Latin America. One Spanish study by Aragonès et al. (2014) found high levels of stigmatisation in the press while another, in the research by Cano-Orón et al. (2020), 26% of the studied media refers to MDs negatively and 18% metaphorically, which can also contribute to stigmatisation. Regarding Latin America, it was found that in Brazil the press reinforces the relationship between schizophrenia and violence, and rarely includes the opinion of those affected by this diagnosis (Guarniero et al., 2017). In Colombia, research that aimed to determine the relevance given to mental health and the quality of the information provided by journalists found that they inadequately address mental health problems, evidencing a lack of information on the subject (Gutiérrez-Coba et al., 2017). There is no research in Latin America that studies the way the media refer to a wide range of mental disorders and which consider different variables such as age group, the chances of recovery of those affected and the causes, among others, but the aforementioned studies from Brazil and Colombia suggest that there may be high-levels of stigmatisation in the Latin American media, but this needs further investigation.

Considering the relevance that the media have in shaping the population’s attitudes towards mental disorders, the consequences of stigma for those affected, the scarce information on how the media stigmatise in Latin American countries, and the possible differences with Anglophone media, it is necessary to investigate this phenomenon in Latin America. This information would also allow generating a baseline that will facilitate the evaluation of future interventions aiming to reduce stigma in the media.

Although most people in Chile get information through television and digital media, figures indicate that around 40% of the adult population regularly read newspapers, meaning almost one in two adults are frequently exposed to print media content (Newman et al., 2018).Within digital media, social networks have been the most important source of information with more than 70% of the preferences (Newman et al., 2018). However, this trend seems to be changing as a result of the COVID-19 pandemic. In the last two studies carried out in the country on the subject, it was found that the use of social networks for information has decreased and the use of digital and printed press has increased (CADEM, 2020a, 2020b). This phenomenon is due to the fact that the trust and credibility of traditional media has increased reaching 63% compared to social networks that only have 33% (CADEM, 2020b).

Given this situation, the primary objective of this study was to assess the tone and content of Chilean newspaper articles about mental disorder from 2000 to 2019. A secondary objective is to investigate variations in coverage according to diagnosis and demographic group. A tertiary objective is to examine change over time.

Method

Design

Standard procedures for the analysis of news content in the media (Krippendorff, 2004; Riffe et al., 2019)were followed, which involved systematically collecting the news and administering a standardised codebook adapted from the previous work of other authors described in detail elsewhere (Whitley & Berry, 2013a, 2013b; Whitley & Wang, 2017).

The digital editions of four national circulation Chilean newspapers in Spanish were intentionally selected: El Mostrador, El Mercurio (EMOL), La Cuarta y La Tercera. The search engine Google News was used to identify and retrieve the news. The time range defined for the search was from January 1, 2000 to December 31, 2019. The news items that included any of the following keywords in the title, subtitle and/or body of the publication were selected:bipolaridad; depresión; desorden mental; desorden psiquiátrico; enfermedad mental; enfermedad psiquiátrica; esquizofrenia; patología mental; patología psiquiátrica; trastorno bipolar; trastorno mental y trastorno psiquiátrico (bipolarity, depression, mental disorder, psychiatric disorder, mental illness, psychiatric illness, schizophrenia, mental pathology, psychiatric pathology and bipolar disorder, mental disorder).The words Alzheimer, drug addiction and dementia were excluded, as well as news related to opinion columns, letters to the editor, editorials, obituaries, advertisements, book and movie reviews, classified advertisements and metaphorical use of keywords (e.g. schizophrenic music). In addition, news items that mentioned some of the key words in passing were excluded, without constituting a main or secondary topic of the article.

Procedure

Taking into account the 12 selected keywords, a total of 1,945 news items were retrieved, 1,284 were duplicated and 276 were excluded according to the criteria already defined. The remaining 385 news items were successfully coded.

Two researchers performed the coding process for which they received intensive training and supervision from the first author of the study, as well as from another author (RW) during their visit to Chile in August 2018. The researchers also received remote training and advice from the latter author during the study execution. As part of the training, articles on stigma were consulted in the media, the codebook used was discussed and 30 news items were coded as a pilot test to clarify doubts about the procedure. Likewise, supervision meetings were held on a regular basis.

An inter-rater reliability analysis was also carried out with the answers to the 10 key questions (Table 1). For this purpose, the Krippendorf’s alpha coefficient (De Swert, 2012; Krippendorff, 1970). For the first 30 pilot-coded news items, an average value of .83 was obtained, indicating a high level of agreement. With news items that had values below .80, discussion sessions were held with the first author of the study to clarify concepts and solve discrepancies between the two coders and thus increase the level of agreement (De Swert, 2012). Krippendorf’s alpha value for the total news items (n = 385) was .96, reflecting a high level of agreement.

Table 1.

Codebook.

General descriptive information
Criteria	Code
Date of the news	Eight-digit format (e.g. 01012000)
Newspaper title	Literal name
Length of the news	Number of words
Disorder or ‘disease’	Referred in the story
What the news is due to	1. The situation of a person with a mental disorder who affected himself/herself
	2. The situation of a person with a mental disorder that affected others without the presence of violence
	3. The situation of a person with a mental disorder that affected others with the presence of violence
	4. Dissemination article about the disorder or mental health
	5. Article about a specific scientific breakthrough in relation to the disorder or mental health
	6. Article about a scientific event related to the disorder or mental health
	7. Article revealing psychiatric diagnosis
Who the news is focused on	1. Children
	2. Adolescents
	3. Young adults
	4. Adults
	5. Older adults
	6. No age group defined
Who are the protagonists of the news?	1. Women
	2. Men
	3. Homosexuals/lesbians
	4. Bisexuals
	5. Transsexuals
	6. Men and women
	7. Unspecified
Key questions
Question	Code
I. Is the general tone on mental health optimistic/positive?	1. Yes
	2. No
	3. Neutral
II. Is recovery/rehabilitation a significant issue?	1. Yes
	2. No
	3. Neutral
III. Does the story stigmatise in tone and/or content?	1. Yes
	2. No
	3. Neutral
IV. Is danger, violence or crime negatively linked to mental disorder?	1. Yes
	2. No
	3. Neutral
V. Is the scarcity of resources or the poor quality of care an issue?	1. Yes
	2. No
	3. Neutral
VI. Are mental health experts directly/indirectly cited in the text (paraphrased)?	1. Not quoted
	2. Positively quoted
	3. Negatively quoted
	4. Mix quoted (positively-negatively)
VII. Are people with mental disorders directly/indirectly quoted in the text (paraphrased)?	1. Not quoted
	2. Positively quoted
	3. Negatively quoted
	4. Mix quoted (positively-negatively)
VIII. Are the relationships (family, friends, etc.) of the person with a mental disorder directly/indirectly quoted in the text (paraphrased)?	1. Not quoted
	2. Positively quoted
	3. Negatively quoted
	4. Mix quoted (positively-negatively)
IX. Are mental health interventions discussed in the story?	1. Not discussed
	2. Positively discussed
	3. Negatively discussed
	4. Positively and negatively discussed
X. Is there a biological or psychosocial approach to the aetiology and/or treatment?	1. Not discussed
	2. Biological approach
	3. Psychological approach
	4. Biological and psychological approach

In the coding procedure, each researcher independently read each news item and recorded the code in a database created from the content of the codebook, supported by SPSS software version 26.0 (IBM Corp, 2019) to facilitate the analysis. Table 1 shows the codebook used.

Analysis

After encoding the news, a descriptive analysis was performed from the calculation of the frequencies and percentages for each of the variables in the codebook. Because the study is longitudinal in type, a trend analysis was also performed using the technique called moving average, appropriate for measurements that are performed repeatedly over time (Streiner, 1997). Firstly, the values of each answer option were counted for each month for each key question in the codebook, namely whether the published news presented an optimistic/positive overall tone on mental health, whether the story stigmatised in tone and/or content, and whether recovery/rehabilitation was a significant topic in the news. Later the averages of four consecutive periods were calculated to obtain the moving averages throughout time. Finally, the values of each period were plotted in the range of 19 years considered in the study in order to identify whether there were positive changes in the content of the news published in the media.

The data used in the analysis are available to any researcher, upon request via mail to the first author, to replicate the study.

Results

A total of 385 news items published during the period 2000 to 2019 was analysed in four Chilean newspapers in digital version. All the news items analysed were published in Spanish, with a national scope, covering all the regions of the country.

A large proportion of the news items has an overall positive/optimistic tone (43.5%) 57.5% does not stigmatise; however, only 18.4% emphasises recovery as part of the content. As for public stigma, in the majority of the news items no link was found between mental disorder and categories of violence, danger or criminality (n = 344; 89.4%); nonetheless, the scarcity of resources or poor quality of care, which are aspects of structural stigma, are only discussed in 11.7% of the news items (n = 45) (Table 2).

Table 2.

Distribution of frequencies and percentages for general categories on stigmatisation.

	Yes		No		Neutral		Total
	f	%	f	%	f	%	f	%
Is the general tone on mental health optimistic/positive?	168	43.5	115	29.7	102	26.6	385	100.0
Is recovery/rehabilitation a significant issue?	71	18.4	298	77.4	16	4.2	385	100.0
Does the story stigmatise in tone and/or content?	52	13.5	221	57.5	112	29.0	385	100.0
Is danger, violence or criminality negatively linked?	39	10.0	344	89.4	2	0.5	385	100.0
Is the scarcity of resources or the poor quality of care an issue?	45	11.7	333	86.5	6	1.6	385	100.0

Regarding the distribution of disorders, a predominance of mood disorders was observed, particularly depressive disorder (n = 123; 31.9%), followed by bipolar disorder (n = 50; 12.9%), anxiety disorders (n = 30; 7.8%), schizophrenia (n = 26; 6.9%) and others (n = 98; 25.7%). A significant share of news items did not record any diagnostic category, making a general reference to mental health (n = 58; 15.1%).Subsequently, the affirmative coding of the key questions in each type of disorder was analysed (Figure 1).

Figure 1.

Distribution of percentages according to type of disorders and variables associated with stigma.

Figure 1 highlights that the most positive tone in the news items is found in anxiety disorders (66.7%) and schizophrenia has the lowest percentage (34.6%), along with unspecified mental disorders (29.3%). The same difference is observed with respect to recovery or rehabilitation as a significant issue, being considerably higher in anxiety disorders (38.3%) and lower in schizophrenia (11.5%). On the other hand, the highest percentages of news stigmatising in tone and content are observed for bipolar disorder (27.7%) and schizophrenia (30.8%). Finally, schizophrenia appears to be the most linked to danger, violence and/or criminality (28.8%); while depression is most associated with resource scarcity in care (18.0%).

Regarding the opinion of experts, people with a psychiatric diagnosis, their families or friends, a predominance of positive over negative quotes, both direct and indirect, was found in all categories. However, the aforementioned experts are quoted much more frequently than people diagnosed with mental disorders or their families and/or friends. Table 3 summarises the distributions observed.

Table 3.

Distribution of frequencies and percentages for key players quotes in the news.

	Experts				People diagnosed				Family or friends
	Direct		Indirect		Direct		Indirect		Direct		Indirect
	f	%	f	%	f	%	f	%	f	%	f	%
Not quoted	167	43.4	213	55.5	256	66.6	298	77.5	324	84.2	352	91.4
Positively quoted	137	35.5	114	29.5	28	7.3	31	8.1	28	7.4	18	4.8
Negatively quoted	14	3.6	9	2.3	21	5.5	25	6.6	7	1.8	4	1.0
Mixed quoted	67	17.5	49	12.7	80	20.6	30	7.7	26	6.6	10	2.6
Total	385	100.0	385	100.0	385	100.0	384	99.9	385	100.0	384	99.9

Considering only the news items containing positive and negative quotes, the proportion between these varies by player. While, in relation to experts, for every ten positively cited news items there is one cited negatively; in people diagnosed with mental disorder, the difference is narrower, with three news items cited negatively for every four news items with positive quotes (Table 3).

Example of a negative quote

(. . .) The doctors, seeing that her disorders were ‘incurable’, considered that the woman was ‘totally competent’ and that depression and her other disorders ‘did not affect’ her mental faculties, so they requested euthanasia, which in Holland is legal since 2002 (El Mercurio, 10/05/2016).

Example of a positive quote

As explained by its director, Mariane Krause, ‘our purpose is to extend the effectiveness of interventions by identifying various agents, whether social, cultural, genetic, among others and mechanisms of change involved in prevention, treatment and rehabilitation’ (El Mostrador, 10/11/2015).

Mental health interventions are not discussed in the majority of the news items (n = 238; 61.8%). Within the news items that do consider them, 97.5% (n = 118) did so positively and only 2.5% (n = 3) negatively.

The majority of the news items do not refer to the aetiology of the disorder or its treatment (n = 257; 68.7%). However, among those that do, the presence of a mixed approach (n = 62; 16.2%) predominates over the biological and psychosocial approaches (7.1% and 7.7% respectively).

As for the motive for the news, it was observed that most items correspond to popular scientific dissemination articles (n = 289; 75.2%), while the rest correspond to situations relative to individuals diagnosed with some mental health disorder (n = 75; 24.8%).

The majority of the news items analysed do not specify any age group, (n = 222; 57.7%), but among those that do, those centred on adults predominate (n = 68; 17.8%), followed by young adults (n = 52; 13.4%), girls, boys or adolescents (n = 31; 8.1%) and older adults (n = 12; 3.1%).

When comparing these distributions according to the variables relative to stigmatisation (Figure 2), the difference regarding the positive or optimistic vision of mental health among children and adolescents (54.8%) stands out compared to older adults (16.7%). In the last group, in addition, the highest percentages occur for the stigmatisation of the story in tone and content (25%), the variables scarcity of resources or poor quality of care (20.8%) and the link with the danger, violence or criminality (25%).Regarding recovery and/or rehabilitation as a significant issue, the group of young adults shows the highest percentage (39.8%), followed by adults (29.9%), the lowest being observed in the news about children and adolescents (19.4%).

Figure 2.

Distribution of percentages according to age group and variables associated with stigma.

As for the description of the protagonists of the story regarding their sex, it was observed that the majority of the news items analysed does not specify it (n = 173; 44.8%). Among those who do specify it, there is an emphasis on news centred on women (n = 112; 29.2%) or men (n = 89; 23.1%), rather than both (n = 8; 2.1%).

Finally, a longitudinal 5-year comparison was made covering the periods 2000 to 2005, 2006 to 2010, 2011 to 2015 and 2016 to 2019. These results show a trend towards general decrease in stigmatisation, moving towards a more positive or optimistic view of mental health, which is supported by the reduction of news items that are neither classified as positive nor optimistic (Figure 3). Stigmatisation in news tends to decrease, in general. This is seen both between the first and second 5-year periods, and between the fourth and fifth. Similarly, the percentage of news stories whose stories are not stigmatising has risen since the first 5-year period (29.3%) (63.1%), as shown in Figure 4.

Figure 3.

Evolution of the assessment on the overall tone of mental health (2000–2019).

Figure 4.

Evolution of the assessment on the content or stigmatising tone (2000–2019).

Finally, reference to recovery and/or rehabilitation as a significant topic in news items rises by almost ten percentage points, while news items that do not include these topics decrease by almost fifteen percent (Figure 5).

Figure 5.

Evolution of assessment on recovery and/or rehabilitation.

Discussion

This is one of the few studies examining newspaper coverage of mental disorder in a Latin American country.

It emphasises that, broadly speaking, the majority of the news items were positive and consequently only a lower percentage stigmatises people with psychiatric diagnoses and links them to violence and danger. In addition, a sustained decrease in stigmatisation over the past two decades was found. The positive tone of the news increases, the association with violence and danger decreases and reference to rehabilitation and recovery increases. These results differ from those found in other low- and middle-income countries, where there are higher levels of stigma in the press (Aci et al., 2020; Guarniero et al., 2017; Nawková et al., 2012). Indeed, the decrease in stigmatisation in the news in recent decades is consistent with what has been found in other research in Anglophone countries where anti-stigma interventions have been carried out in the mass media. In the study by Whitley and Wang, over a period of 11 years, the positive tone in the news, the opinion of those affected and experts, references to scarce resources and interventions increased (Whitley & Wang, 2017). Similar results were found in the UK, where there was a significant increase in anti-stigma news in the press over the last 12 years (Li et al., 2021); the allusion to recovery and successful treatment increased, and those with stigmatising content were reduced, specifically seeing people with mental disorders as dangerous, victims and with strange behaviours (Hildersley et al., 2020).

In Chile, there have been no mass campaigns for the reduction of stigma or interventions towards the mass media, and the press media only have very general protocols of action based on the law on freedom of opinion and information (Ley 19733, 2001); however, stigma has diminished. Despite these positive results, there was also little reference to rehabilitation and recovery of mental disorders and the scarcity of resources or the quality of care in the health system. In addition, it is the experts who appear as the main voices on the subject, the vision of users and family members being relegated to the background. These aspects suggest that, although manifest stigma has decreased, as shown by other research (Cano-Orón et al., 2020; Ma, 2017), there still remain subtler aspects of discrimination that need attention.

Respect for human rights and, in this case in particular, the rights of those of people with psychiatric diagnoses, is regarded as a fundamental aspect of health policies in the world (Organización Mundial de la Salud [OMS], 2006) and in Chile (Ministerio de Salud del Gobierno de Chile [MINSAL], 2017). Stigma transgresses these rights and creates multiple negative consequences and is therefore the subject of attention. In this context, there would be a greater awareness of stigma and the inconvenience of expressing negative opinions towards people with MD. Stigma has transformed and become more subtle; the idea that people with mental disorders need others to speak for them and have difficulties recovering still is passed on. In addition, health system deficits to meet the mental health needs of the population, which in the case of Chile are significant (MINSAL, 2014), are rendered invisible. If so, it would be necessary to include ways of evaluating stigma that look for these and other aspects. Reavley et al. (2016), found that the association of MDs with danger had decreased, but that their association with disability had increased, that is stigmatising beliefs had changed. However, this hypothesis requires exploration.

In this study, news items about depression and anxiety, which are less stigmatised diagnostic categories, were almost twice as many (39.7%) as those relative to more stigmatised ones such as schizophrenia and bipolar disorder (19.8%), which is consistent with other studies and could also help explain the low stigmatisation found (Li et al., 2021).

Though in general, stigmatisation was low, 30.8% of news items about schizophrenia stigmatises and 28.8% associates it with violence, which is in line with what is found in other research showing schizophrenia as one of the most stigmatised disorders (Bowen et al., 2019; Guarniero et al., 2017; Reavley et al., 2016).

It stands out that when experts are cited, it is done in a fundamentally positive way (10/1), while when commenting on specific people with diagnoses, there is a much higher proportion of negative news items (4/3). It seems that when mental health issues are raised in an abstract way, the character of the news is more positive than when done in a concrete and therefore personalised way. It would be desirable for interventions aimed at changing press coverage of mental disorders and mental health to consider how news is addressed in a differentiated way according to its general or particular nature.

Moreover, the majority of the news items did not provide information on causes and forms of mental health intervention, even though they were primarily classified as scientific dissemination. This gap in the delivery of information should be seen as an aspect to be improved in Chile’s press. Information allows to educate the population and thus reduce public stigma (Brown, 2020).

Older adults were the most stigmatised age group. Socially, there is a negative view of aging (Li et al., 2020; Scazufca et al., 2016), to which suffering from a mental disorder is added, which shows the intersectionality of stigma. Different identities subject to stigma converge in a person or social group, affecting their well-being (Turan et al., 2019).Special attention should be placed in the news on these groups, and in this particular case on the elderly.

The highest percentage of news items was focused on women which is coincidental with the fact that mood and anxiety disorders are diagnostic categories referred to and are most prevalent in this group (Steel et al., 2014).

This research has some limitations that are important to consider. Only press articles that could be obtained through the Google News search engine were accessed, which leaves out part of what was published during time range considered in this study. Having considered newspapers from 2000 onwards, we may not have had access to articles that were only published in the print edition of these.

Only four newspapers were accessed, although they are the most recognised in the country, there is a significant number left out, especially the digital ones that have emerged in recent years. Besides, we only considered the press, and excluded television and radio. Moreover, we did not consider social networks such as Facebook or Instagram, which are currently a key source of people’s expression on the most diverse topics.

Our results have some implications that need to be mentioned. Although stigmatisation towards mental disorders is generally low, there is still much room for improvement. It would be important to educate journalists to increase the amount of news that considers the recovery and rehabilitation of those affected, especially in disorders such as bipolar and schizophrenia. In addition, it is necessary to provide a less stigmatising vision of these disorders, and in the case of schizophrenia, reduce its association with violence. Finally, it is essential to consider the point of view of those affected and their families and reduce the negative view of mental disorders in older adults. The next step would be to establish simple guidelines and trainings for journalists that emphasise these aspects, which should be evaluated in further investigations.

Conclusion

In general, low stigmatisation towards of MDs was found in the news and this was reduced steadily over time, even without large-scale interventions. Although there are aspects to improve in some particular areas, suggesting that manifest stigma has diminished, but more subtle forms still remain, the results show that the stereotype of low- and middle-income countries having worse stigma than rich Anglophone countries is not always correct.

Footnotes

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Funding

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

ORCID iDs

Pamela Grandón

Dany Fernández Vega

Loreto Villagrán Valenzuela

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