Public Stigma of Mental Illness in the United States: A Systematic Literature Review

“…eleven examined the public’s stigmatizing beliefs of adults with mental illness (Anglin et al. 2006; Boyd et al. 2010; Corrigan and Watson 2007; Corrigan et al. 2009; Link et al. 1999; Martin et al. 2000; Pescosolido et al. 1999, 2010; Phelan et al. 2000; Whaley 1997; Wirth and Bodenhausen 2009).”

“However, more studies are needed that examine reports of respondents’ past behaviors, especially as differences may exist between reports of past behavior and reports of one’s response to hypothetical situations (Link et al. 2004).”

“…eleven examined the public’s stigmatizing beliefs of adults with mental illness (Anglin et al. 2006; Boyd et al. 2010; Corrigan and Watson 2007; Corrigan et al. 2009; Link et al. 1999; Martin et al. 2000; Pescosolido et al. 1999, 2010; Phelan et al. 2000; Whaley 1997; Wirth and Bodenhausen 2009).”

“Fewer explored respondents’ stigmatizing actions which limit opportunities for people with mental illness, especially in relation to employment and housing (Corrigan and Shapiro 2010; Hogan 2003; Link et al. 1997).”

“Keywords Public stigma; Mental illness; Systematic literature review Introduction Public stigma refers to a set of negative attitudes and beliefs that motivate individuals to fear, reject, avoid, and discriminate against people with mental illness (Corrigan and Penn 1999).”

“Among adults who associated mental illness with psychosis, the odds of describing a person with mental illness as violent in 1996 were 2.3 times the odds of describing a person with mental illness as violent in 1950 (Phelan et al. 2000).”

“…eleven examined the public’s stigmatizing beliefs of adults with mental illness (Anglin et al. 2006; Boyd et al. 2010; Corrigan and Watson 2007; Corrigan et al. 2009; Link et al. 1999; Martin et al. 2000; Pescosolido et al. 1999, 2010; Phelan et al. 2000; Whaley 1997; Wirth and Bodenhausen 2009).”

“…eleven examined the public’s stigmatizing beliefs of adults with mental illness (Anglin et al. 2006; Boyd et al. 2010; Corrigan and Watson 2007; Corrigan et al. 2009; Link et al. 1999; Martin et al. 2000; Pescosolido et al. 1999, 2010; Phelan et al. 2000; Whaley 1997; Wirth and Bodenhausen 2009).”

“…stigmatizing beliefs about the competency of individuals with mental illness compromise individuals’ financial autonomy, restrict opportunities, and may lead to coercive treatment and reduced independence (e.g., through institutionalization; Corrigan and Shapiro 2010; Pescosolido et al. 2007a).”

“Fewer explored respondents’ stigmatizing actions which limit opportunities for people with mental illness, especially in relation to employment and housing (Corrigan and Shapiro 2010; Hogan 2003; Link et al. 1997).”

“illness or a person addicted to drugs as dangerous, as compared to a person in a wheelchair (Corrigan et al. 2009).”

“newspapers found that dangerousness was the most common theme of mental health-related articles, with 39 % of articles about mental health focused on dangerousness and violence (Corrigan et al. 2005).”

“2008) and six examined stigmatizing actions towards adults with mental illness (Boyd et al. 2010; Corrigan and Watson 2007; Corrigan et al. 2009; Link et al. 1999; Martin et al. 2000; Pescosolido et al. 2010).”

“2000; Whaley 1997; Wirth and Bodenhausen 2009) surveyed adults about perceptions of mental illness among adults, seven (Martin et al. 2007; McLeod et al. 2004, 2007; Mukolo and Heflinger 2011; Pescosolido et al. 2007a, b, 2008) surveyed adults about perceptions of mental illness among children, two (Coleman et al.”

“, those who experienced a major depressive episode) these positive attitudes seemed to turn negative once they were exposed to mental health services (Diala et al. 2000).”

“In both years, the public estimated that more than half of people with an emotional problem who see a professional are helped and that less than half of those who do not obtain professional help recover (Mojtabai 2007).”

“The most popular sources of help for ADHD were teachers, doctors, and mental health professionals (e.g., psychologists), followed by family/friends, psychiatrists, and taking the child to a hospital (Pescosolido et al. 2008).”

“Given these consistent findings, anti-stigma interventions should focus on increasing positive personal contact with people living with mental illness (Thornicroft et al. 2008), target key groups in positions of power (e.”

“…people with schizophrenia and major depression, and feeling less embarrassed if friends knew they were seeking professional help compared to non-Hispanic whites, after adjusting for socioeconomic variables (Anglin et al. 2008; Diala et al. 2000, 2001; Gonzalez et al. 2005, 2009; Shim et al. 2009).”

“, gender, age) influenced respondents’ stigmatizing beliefs and actions, anti-stigma interventions should consider tailoring to the sociodemographics of the intended audience to increase audience involvement and engagement, two important pre-requisites for attitudinal and behavioral changes (Sood 2002).”

“…Carpiano 2006; Leaf et al. 1987; Link et al. 1999; Martin et al. 2000; Mojtabai 2007, 2009; Pescosolido et al. 1999, 2010; Phelan et al. 2000, 2006; Schnittker et al. 2000; Shim et al. 2009; Swindle et al. 2000; Whaley 1997; Wirth and Bodenhausen 2009) surveyed adults about perceptions of mental…”

“N IH -PA Author M anuscript N IH -PA Author M anuscript N IH -PA Author M anuscript blamed or punished for violent behavior (Anglin et al. 2006).”

“For example, internetbased interventions to increase mental health literacy have shown some impact (Jorm and Griffiths 2008).”

“In fact, longitudinal studies that track changes in the public’s attitudes toward mental health care have found that the public has become more receptive towards more formal, biological-based treatments over time, particularly for more serious mental illnesses (Blumner and Marcus 2009; Pescosolido et al. 2010; Swindle…”

“…of common mental disorders (e.g., depression, schizophrenia) significantly increased the odds of endorsing biological-based treatments, particularly more extreme forms, such as use of prescription medications and hospitalization (Pescosolido et al. 2010; Phelan et al. 2006; Schnittker et al. 2000).”

“However, increased mental health literacy has been associated with unchanged or even increased levels of stigma (Angermeyer et al. 2009).”

“…people with schizophrenia and major depression, and feeling less embarrassed if friends knew they were seeking professional help compared to non-Hispanic whites, after adjusting for socioeconomic variables (Anglin et al. 2008; Diala et al. 2000, 2001; Gonzalez et al. 2005, 2009; Shim et al. 2009).”

“For example, levels of acculturation have been found to be associated with individuals’ assessment of and treatment preferences for depression (Cabassa et al. 2007; Kumar and Nevid 2010; Wong et al. 2010).”

“Children with mental illness were more likely to be viewed as lazy than children with asthma, with children with depression viewed as lazier than child with ADHD (Walker et al. 2008).”

“…al. 2006, 2008; Blumner and Marcus 2009; Boyd et al. 2010; Corrigan and Watson 2007; Corrigan et al. 2009; Croghan et al. 2003; Diala et al. 2000; Diala et al. 2001; Gonzalez et al. 2005, 2009; Kuppin and Carpiano 2006; Leaf et al. 1987; Link et al. 1999; Martin et al. 2000; Mojtabai 2007, 2009;…”

“stigma and discrimination impede life goals and opportunities (Corrigan 2011).”

“The two studies (Croghan et al. 2003; Mojtabai 2009) that examined the public’s attitudes towards psychiatric medications for adults present a complex picture.”

“…eleven examined the public’s stigmatizing beliefs of adults with mental illness (Anglin et al. 2006; Boyd et al. 2010; Corrigan and Watson 2007; Corrigan et al. 2009; Link et al. 1999; Martin et al. 2000; Pescosolido et al. 1999, 2010; Phelan et al. 2000; Whaley 1997; Wirth and Bodenhausen 2009).”

“For example, African Americans were more likely than whites to prefer counseling or a combination of counseling and medication over no treatment for treating ADHD in children (McLeod et al. 2007), but also reported being less willing than whites to seek advice for depression and ADHD from teachers and parents and less…”

“…people with schizophrenia and major depression, and feeling less embarrassed if friends knew they were seeking professional help compared to non-Hispanic whites, after adjusting for socioeconomic variables (Anglin et al. 2008; Diala et al. 2000, 2001; Gonzalez et al. 2005, 2009; Shim et al. 2009).”

“…eleven examined the public’s stigmatizing beliefs of adults with mental illness (Anglin et al. 2006; Boyd et al. 2010; Corrigan and Watson 2007; Corrigan et al. 2009; Link et al. 1999; Martin et al. 2000; Pescosolido et al. 1999, 2010; Phelan et al. 2000; Whaley 1997; Wirth and Bodenhausen 2009).”

“For instance, individuals with mental illness are more likely to experience housing and employment discrimination and homelessness compared to people without mental illness (Corbiere et al. 2011; Corrigan et al. 2006; Corrigan and Shapiro 2010).”

“…information to different audiences and provide a promising approach to increase knowledge of mental illness, model appropriate help-seeking behaviors, and reduce mental health stigma (see Cabassa et al. 2010; Ritterfeld and Jin 2006; Unger et al. 2012 for examples of using EE to reduce stigma).”

“Social distance is a measure of exclusion of individuals in a variety of social situations (e.g., unwilling to work closely with someone, to have someone as a neighbor, to have someone marry into your family) because of their mental illness (Boyd et al. 2010).”

“…et al. 1999, 2010; Phelan et al. 2006; Schnittker et al. 2000; Swindle et al. 2000), three examined the public’s treatment recommendations for children (McLeod et al. 2007; Pescosolido et al. 2007a, b, 2008), and one compared treatment recommendations for adults and children (Perry et al. 2007).”

“…information to different audiences and provide a promising approach to increase knowledge of mental illness, model appropriate help-seeking behaviors, and reduce mental health stigma (see Cabassa et al. 2010; Ritterfeld and Jin 2006; Unger et al. 2012 for examples of using EE to reduce stigma).”

“…people with schizophrenia and major depression, and feeling less embarrassed if friends knew they were seeking professional help compared to non-Hispanic whites, after adjusting for socioeconomic variables (Anglin et al. 2008; Diala et al. 2000, 2001; Gonzalez et al. 2005, 2009; Shim et al. 2009).”

“For example, levels of acculturation have been found to be associated with individuals’ assessment of and treatment preferences for depression (Cabassa et al. 2007; Kumar and Nevid 2010; Wong et al. 2010).”

“…information to different audiences and provide a promising approach to increase knowledge of mental illness, model appropriate help-seeking behaviors, and reduce mental health stigma (see Cabassa et al. 2010; Ritterfeld and Jin 2006; Unger et al. 2012 for examples of using EE to reduce stigma).”

“The two studies (McLeod et al. 2004; Pescosolido et al. 2007b) that examined the public’s attitudes and use of psychiatric medications for children showed that there still exists substantial stigma associated with the use of these medications for children.”

“hypothetical situation rather than reports of past or present behaviors and facilitates the examination of the public’s understanding, evaluation, attitudes, and beliefs related to a specific scenario without having to wait for that situation to arise (Gilner et al. 1999; Lau and Takeuchi 2001).”

“The two studies (Croghan et al. 2003; Mojtabai 2009) that examined the public’s attitudes towards psychiatric medications for adults present a complex picture.”

“For example, levels of acculturation have been found to be associated with individuals’ assessment of and treatment preferences for depression (Cabassa et al. 2007; Kumar and Nevid 2010; Wong et al. 2010).”

“…et al. 2010; Corrigan and Watson 2007; Corrigan et al. 2009; Croghan et al. 2003; Diala et al. 2000; Diala et al. 2001; Gonzalez et al. 2005, 2009; Kuppin and Carpiano 2006; Leaf et al. 1987; Link et al. 1999; Martin et al. 2000; Mojtabai 2007, 2009; Pescosolido et al. 1999, 2010; Phelan et al.…”

“2000; Whaley 1997; Wirth and Bodenhausen 2009) surveyed adults about perceptions of mental illness among adults, seven (Martin et al. 2007; McLeod et al. 2004, 2007; Mukolo and Heflinger 2011; Pescosolido et al. 2007a, b, 2008) surveyed adults about perceptions of mental illness among children, two (Coleman et al.”

“For instance, individuals with mental illness are more likely to experience housing and employment discrimination and homelessness compared to people without mental illness (Corbiere et al. 2011; Corrigan et al. 2006; Corrigan and Shapiro 2010).”

“hypothetical situation rather than reports of past or present behaviors and facilitates the examination of the public’s understanding, evaluation, attitudes, and beliefs related to a specific scenario without having to wait for that situation to arise (Gilner et al. 1999; Lau and Takeuchi 2001).”

“Blumner and Marcus (2009) also found that during the same ten-year period the public’s endorsement of biological-based treatments (e.g., visiting a psychiatrist, taking prescription medications) increased significantly for depression, particularly among respondents that were White, had a high…”

“2007a, b, 2008) surveyed adults about perceptions of mental illness among children, two (Coleman et al. 2009; Walker et al. 2008) surveyed children about perceptions of mental illness among children, and one (Perry et al.”

“[77] and generally low levels of health literacy in racial and ethnic minority com-”

“Similar conclusions have been reported by other authors who conducted reviews of stigma associated with mental illness among Arab and non-Arab populations (Ciftci, 2013; Dardas & Simmons, 2015; Parcesepe & Cabassa, 2013; Pescosolido et al., 2007; Sewilam et al., 2015).”

“…distance towards individuals with substance abuse in private life (socializing, relationships) and work life, and greater willingness to discriminate against them in terms of employment, housing, and governmental policy (Pescosolido et al., 1999; Parcesepe and Cabassa, 2013; Barry et al., 2014).”

“Stigma research in the United States, Greece, and Japan [20–22] identifies social distance and discriminatory beliefs related to mental health problems and a systematic review found stigma of mental disorders associated with violence, unpredictability and disability in Latin America and the Caribbean [23].”

“The markedly greater stigmatization of individuals with more severe conditions, such as schizophrenia (8), and the impacts of these types of illness have important and unique implications for treatment.”

“Chronic illness stigmatization, most notably characterized in mental health 43–45 and HIV/AIDS 46–48 research, is a common and global social issue.”

“Furthermore, despite MHS being widely prevalent within the general population (Parcesepe and Cabassa, 2013), few studies have assessed MHS and its consequences within the general population.”

“The patients are considered to harm other people and their environment and cause unwanted problems [46,50].”

“Relatedly, these studies generally focus on reducing public stigma (P. W. Corrigan et al., 2012; Couture & Penn, 2003; Morgan et al., 2018; Parcesepe & Cabassa, 2013) and, to a lesser extent, self-stigma (Birtel et al., 2017; Yanos et al., 2015), but they focus only to a limited extent on…”

“With increasing effort being made to promote public awareness of mental illness, the general public in the US and Europe have shown increased understanding and acceptance of mental illness and its treatment in the last decade (Parcesepe and Cabassa 2012; Schomerus et al. 2012).”

“Research has identified that public stigma is associated with lack of engagement, poor adherence and utilization of mental health services and treatment outcomes (Al-Krenawi et al. 2004; Parcesepe and Cabassa 2013; Rüsch et al. 2005).”

“Many illnesses are associated with significant stigma including mental illness, HIV, cancer, and others [4, 5].”

“The aforesaid has great relevance in the global context, where research has shown the presence of high levels of discrimination, stigma, and prejudice toward those impacted by mental health problems, especially schizophrenia and bipolar disorder [6,7].”

“High levels of perceived stigma and discrimination toward people who are homeless and living with mental illness have also been previously reported in studies with cross-sectional design [15,17,47,48].”

“Public stigma against mental illness remains widespread in the workplace in the USA [113, 114].”

“Recent research suggests that women and older users are particularly vulnerable to dropout when using digital lifestyle interventions and that dropout risk is highest in early sessions (Pedersen et al., 2019).”

“Despite becoming more sophisticated in understanding MI, a near public majority expresses animosity and endorses exclusion.(6) The battle over parity in insurance, research funding, and services continues.”

“While stigma is a part of life for persons with a wide range of mental disorders, studies show that the stigma associated with SUD is particularly severe [14, 23].”

“In addition, there may be other potential confounders for mental-health-related stigma; for example, race, socioeconomic status, and educational qualifications may be relevant factors.(44) While a randomized controlled trial creates strong evidence and theoretically prevents potential confounding effects, it seems to…”

“Stigma is prevalent, both among the general public and those with mental health training (Kingdon, Sharma, & Hart, 2004; Lyons & Ziviani, 1995; Parcesepe & Cabassa, 2013), is often perpetuated through the media (Chopra & Doody, 2007), and has persisted over the past several decades at a consistent…”

“Therefore, they are more likely to experience severe social isolation in personal life or workplace and be treated differently in national policies [22, 26].”

“…negative attitudes, beliefs, and behaviours that members of the public have and direct towards persons with disabilities, mental illnesses, and physical illnesses, such as HIV, often motivating individuals to fear, reject, avoid, and discriminate against these groups (Parcesepe and Cabassa 2013).”

“As one of the first countries to establish a mental health policy in 1996, the United States has seen its residents hold increasingly positive attitudes toward seeking professional help for mental health problems over time [15].”

“…negative stereotypes (e.g. believing people with mental illness are dangerous) and discriminatory behaviors (e.g. avoiding living near people with mental illness), the behavioral component of stigma toward individuals with mental illness has been relatively understudied (Parcesepe & Cabassa, 2013).”

“For example, similar typologies, such as intentional care fragmentation, and similar drivers, such as stigma concerns, are likely to be seen in the mental healthcare field, where longstanding prejudicial attitudes about mental illness may lead some individuals to segregate psychiatric or psychological services from ot…”

“Perceived public stigma is a recognized barrier that affects individuals from engaging in mental healthcare (Parcesepe & Cabassa, 2013).”

“28,29 33 The worries of prejudices may influence the patient’s efforts to find adequate treatment.”

“The unaffected majority feels more anxious, less empathic, more socially distant towards affected persons, and is less supportive of policies that benefit people with mental disorders [19,28].”

“Second, many Americans hold stigmatizing attitudes towards people with mental illness (Parcesepe and Cabassa 2013; Stuber et al. 2014); and these attitudes are inversely correlated with public support for mental health legislation (Barry and McGinty 2014; Corrigan and Watson 2003; Corrigan et al.…”

“While there is an increasing acceptance of the chronic disease model for substance use disorders, there remains more stigmatization when compared to other health conditions.(11,12) While stigma may originate in an effort to discourage unhealthy behaviors, it carries negative consequences.”

“Information-seeking trends align with trends of mental health beliefs, diagnostic prevalence and service utilization (Danielson et al., 2018; Parcesepe & Cabassa, 2013; Piper et al., 2018; Visser et al., 2014; Xu et al., 2018).”

“…disorders including depression, bipolar disorder, and schizophrenia has remained essentially unchanged and substantially negative over the past two decades, and for some conditions, such as substance use disorders, attitudes have worsened over time (Parcesepe & Cabassa, 2013; Pescosolido, 2013).”

“Chronic illness stigmatization has been explored across numerous health conditions, most notably in HIV/AIDS [14] mental health [15, 16], but has also been explored in cancers such as breast [17, 18], colorectal, skin [19] and lung cancer [20–22] as well as other chronic conditions such as obesity [23].”

“For instance, there is a deep literature on mental health stigma (Parcesepe and Cabassa 2013; Sickel, Seacat, and Nabors 2014), its serious consequences (Sharac et al. 2010), and efforts to reduce it (Yanos et al. 2015).”

“adherence) and their willingness to seek help (5,6).”

“Even fewer studies of acculturation factors and cultural variations that influence mental health stigma are available [6, 14].”

“Older age, male gender, non-White race, and fewer years of education have been associated with endorsing stigmatizing beliefs (Corrigan & Watson, 2007; Parcesepe & Cabassa, 2013), perceived public stigma, selfstigma, and decreased initiation of mental health services (Wu et al., 2017).”

“Numerous studies have documented that negative stereotypes were commonly endorsed by the general public in both Western and nonWestern countries (Corrigan et al., 2015; Parcesepe & Cabassa, 2013; Pescosolido, 2013; Xu et al., 2017).”

“In general, there are perceptions that individuals with mental health problems are dangerous or that children’s mental health problems are attributed to lack of appropriate parenting (Parcesepe & Cabassa, 2013).”

“22 Widespread stigma and negative stereotypes include the ideas that having mental health problems such as depression is being weak, inferior, incompetent, or vulnerable, and that the condition is shameful, embarrassing, or socially unacceptable.”

“It is conveyed by the widespread perception among the general public that individuals with mental illnesses are dangerous (Jorm, Reavley, & Ross, 2012; Mestdagh & Hansen, 2014; Parcesepe & Cabassa, 2013; Pescosolido, 2013; Schomerus et al., 2012).”

“, in terms of the targeted age group)–stem from the particular mental disorders that were considered in the included studies, since different mental health conditions are stigmatized to different extents [9, 10, 12, 13].”

“…HIV/AIDS (Monteiro, Villela, & Soares, 2013), tuberculosis (Juniarti & Evans, 2011), Hepatitis C (Treloar, Rance, & Backmund, 2013), substance use (van Boekel, Brouwers, van Weeghel, & Garretsen, 2013), and mental health (Ando, Yamaguchi, Aoki, & Thornicroft, 2013; Parcesepe & Cabassa, 2013).”

“In accordance with widespread prejudices, the patient may think that he is somehow inferior, weak, unwanted, or unreliable because of his mental issues.(3) As these interpretations tend to be rigidly held, and as they are unrealistically negative and unbalanced (“I am weak, inferior, different, .”