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Emotional Reactions to People with Mental
Illness Results from Population Studies
Matthias C. Angermeyer Center for Public Mental
Health Gösing am Wagram Austria
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Social psychologists have focused upon thoughts
(cognition) rather than feelings (affect).
However, the reactions of a host majority acting
with prejudice in rejecting a minority group
usually involve not just negative thoughts but
also emotionally laden attitudes involving
anxiety, anger, resentment, hostility, distaste
or disgustIn fact, prejudice may more strongly
predict discrimination than do stereotypesInteres
tingly,there is almost nothing published about
emotional reactions to people with mental illness
apart from that which describes a fear of
violence (Thornicroft Kassam 2008, 189ff)
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Systematic Review of Population Studies on
Public Beliefs About Mental Disorders and
Attitudes Towards the Mentally Ill
Inclusion criteria - Population studies using
random sampling -
All languages Time period covered 1948
2008 Countries included 62 Number of
publications 369 Number of studies 261 (137
national, 124 local/regional)
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Publications on Population Studies on Public
Beliefs About Mental Disorder and Attitudes
Towards People With Mental Illness (N369)
N Publications
Years
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Studies on Public Beliefs about Mental Disorders
and Attitudes Towards the Mentally Ill (n261)
1-9
10
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Publications on Population Studies Including
Measures of Emotional Reactions
N of all studies (n261)
Perspective of the Stigmatizer ? Positive feelings 15 5.7 ? Anxiety 19 7.3 ? Anger 15 5.7 Perspective of the Stigmatized ? Shame 7 2.7 ? Embarrassment 18 6.9 Total 45 17.2
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Components of Modern Conceptualizations of Stigma
Link Phelan 2004 Corrigan Watson 2002 Thornicroft 2006
Labelling Stereotyping Separating Status loss Discrimination Dependence of Stigma on Power Stereotype Discrimination Ignorance Discrimination
Prejudice
Emotional Reactions
Prejudice
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Components of Modern Conceptualizations of Stigma
Link Phelan 2004 Corrigan Watson 2002 Thornicroft 2006
Labelling Stereotyping Separating Status loss Discrimination Dependence of Stigma on Power Stereotype Discrimination Ignorance Discrimination
Prejudice also yields emotional responses (e.g.
anger or fear) to stigmatized groups
The reactions of a host majority acting with
prejudice involve not just negative thoughts but
also emotionally laden attitudes
Prejudice
Emotional Reactions
Prejudice
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The Role of Emotions Seen From the Vantage
Point of the Stigmatizer
In personal encounters, the way others respond
emotionally tells the stigmatised person how
he or she is being perceived. Example A
person who feels some combination of pity and
anxiety in the presence of a person with mental
illness might modulate his or her voice,
speaking softly and in an unnaturally calm tone,
signalling to the person with mental illness
that he or she is being approached from a
standpoint of differentness. (Link et al.
2004) Emotional responses may shape subsequent
behaviour toward the stigmatised person.
Example A person who reacts with fear might feel
a stronger desire for social distance and
avoid contact with people with mental illness.
Example A person who feels some combination of
pity and anxiety in the presence of a person with
mental illness might modulate his or her voice,
speaking softly and in an unnaturally calm tone,
signalling to the person with mental illness that
he or she is being approached from a standpoint
of differentness. (Link et al. 2004)
Example A person who reacts with fear might feel
a stronger desire for social distance and avoid
contact with people with mental illness.
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The Role of Emotions Seen From the Vantage
Point of the Stigmatized
In interpersonal interaction, how the
stigmatised individual responds emotionally
may confirm misconceptions held by others.
Example In interpersonal encounters, a person
ashamed of her mental illness might keep her
illness a secret. Preoccupation with his or
her undisclosed status as mentally ill person may
lead to anxiety, which in turn leads to social
awkwardness. This may let others feel
uncomfortable and confirm their perception that
people with mental illness are strange and
hard to talk to. Emotional responses may shape
subsequent behaviour of the stigmatised
person. Example Shame and anxiety might let
people with mental illness avoid contact with
mental health professionals, resulting in delayed
help seeking or discontinuation of treatment.
Example In interpersonal encounters, a person
ashamed of her mental illness might keep her
illness a secret. Preoccupation with his or her
undisclosed status as mentally ill person may
lead to anxiety, which in turn leads to social
awkwardness. This may let others feel
uncomfortable and confirm their perception that
people with mental illness are strange and hard
to talk to.
Example Shame and anxiety might let people with
mental illness avoid contact with mental health
professionals, resulting in delayed help seeking
or discontinuation of treatment.
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How prevalent are the various emotional
reactions to people with mental disorder?
Are there differences between mental disorders as
concerns the publics emotional reactions?
How important are emotional reactions as compared
with stereotypes? Does familiarity with
mental illness work through modification of
emotional reactions?
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How prevalent are the various emotional
reactions to people with mental disorder?
Are there differences between mental
disorders? How important are emotional
reactions as compared to stereotypes? Does
familiarity with mental illness work through
modification of emotional reactions?
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Emotional Reactions to People With
Schizophrenia Population Study in Germany, 2001

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Emotional Reactions to People With
Schizophrenia Population Study in Bratislava, 2003

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Emotional Reactions to People With
Schizophrenia Population Study in Novosibirsk,
2002

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Emotional Reactions to People With
Schizophrenia Population Study in Ulaanbaatar,
2002

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Emotional Reactions to People With Major
Depression Population Study in Germany, 2001

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Emotional Reactions to People With Major
Depression Population Study in Germany, 2001

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Emotional Reactions to People With Major
Depression Population Study in Bratislava, 2003

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Emotional Reactions to People With Major
Depression Population Study in Novosibirsk, 2002

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Emotional Reactions to People With Major
Depression Population Study in Ulaanbaatar, 2002

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Emotional Reactions to People With
Schizophrenia Population Studies in the Western
Part of Germany, 1990 and 2001
Positive emotions
Anger
Fear
Score
Score
Score
1990
2001
1990
2001
2001
1990
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Emotional Reactions to People With Major
Depression Population Studies in the Western Part
of Germany, 1990 and 2001
Positive emotions
Anger
Fear
Score
Score
Score
1990
2001
1990
2001
2001
1990
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Emotional Reactions to People With
Schizophrenia Population Studies in the Eastern
Part of Germany, 1993 and 2001
Positive emotions
Anger
Fear
Score
Score
Score
1993
2001
1993
2001
2001
1993
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Emotional Reactions to People With Major
Depression Population Studies in the Eastern Part
of Germany, 1993 and 2001
Positive emotions
Anger
Fear
Score
Score
Score
1993
2001
1993
2001
2001
1993
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How prevalent are the various emotional
reactions to people with mental disorder?
Are there differences between mental disorders
as concerns the publics emotional
reactions? How important are emotional
reactions as compared to stereotypes? Does
familiarity with mental illness work through
modification of emotional reactions?
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Emotional Reactions to People With Schizophrenia,
Major Depression and Alcohol Dependence Populatio
n Studies in the Western Part of Germany, 1990
Positive emotions
Anger
Fear
Score
Score
Score
Major Depression
Alcohol Dependence
Schizophrenia
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Emotional Reactions to People With Schizophrenia,
Major Depression and Alcoholism Population
Studies in the Western Part of Germany, 1990
Positive emotions
Anger
Fear
Score
Score
Score
Major Depression
Alcoholism
Schizophrenia
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Emotional Reactions to People With Schizophrenia,
Major Depression and Alcoholism Population
Studies in the Western Part of Germany, 1990
Positive emotions
Anger
Fear
Score
Score
Score
Major Depression
Alcoholism
Schizophrenia
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Emotional Reactions to People With Schizophrenia,
Major Depression and Alcohol Dependence Populatio
n Studies in the Western Part of Germany, 1990
Positive emotions
Anger
Fear
Score
Score
Score
Major Depression
Alcohol Dependence
Schizophrenia
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Emotional Reactions to People With Schizophrenia,
Major Depression and Alcoholism Population
Studies in the Western Part of Germany, 1990
Positive emotions
Anger
Fear
Score
Score
Score
Major Depression
Alcoholism
Schizophrenia
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How prevalent are the various emotional
reactions to people with mental disorder?
Are there differences between mental
disorders? How important are emotional
reactions as compared to stereotypes? Does
familiarity with mental illness work through
modification of emotional reactions?
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Regression of Desire For Social Distance Towards
People With Schizophrenia on Socio-Demographic
Characteristics, Stereotypes and Emotional
Reactions. Population Study in Germany, 2001.
Model 1 Model 2 Model 3 Model 4
B p B p B p B p
Age Gender Educational attainment .021 .007 -.302 .236 -.319 .049 .022 .003 -.253 .279 -.100 .509 .029 .000 -.225 .334 .108 .468 .028 .000 -.181 .420 -.073 .616
Dangerous Unpredictable Lack of willpower 1.019 .000 1.403 .000 .394 .699 .680 .000 1.036 .000 .011 .351
Fear Positive emotions Anger 1.781 .000 -2.154 .000 .181 .100 1.072 .000 -1.819 .000 .211 .061
Adj. R² .005 .165 .209 .270
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Regression of Desire For Social Distance Towards
People With Schizophrenia on Socio-Demographic
Characteristics, Stereotypes and Emotional
Reactions. Population Study in Germany, 2001.
Model 1 Model 2 Model 3 Model 4
B p B p B p B p
Age Gender Educational attainment .021 .007 -.302 .236 -.319 .049 .022 .003 -.253 .279 -.100 .509 .029 .000 -.225 .334 .108 .468 .028 .000 -.181 .420 -.073 .616
Dangerous Unpredictable Lack of willpower 1.019 .000 1.403 .000 .394 .699 .680 .000 1.036 .000 .011 .351
Fear Positive emotions Anger 1.781 .000 -2.154 .000 .181 .100 1.072 .000 -1.819 .000 .211 .061
Adj. R² .005 .165 .209 .270
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Regression of Desire for Social Distance Towards
People With Schizophrenia on Socio-Demographic
Characteristics, Stereotypes and Emotional
Reactions. Population Study in Germany, 2001.
Model 1 Model 2 Model 3 Model 4
B p B p B p B p
Age Gender Educational attainment .021 .007 -.302 .236 -.319 .049 .022 .003 -.253 .279 -.100 .509 .029 .000 -.225 .334 .108 .468 .028 .000 -.181 .420 -.073 .616
Dangerous Unpredictable Lack of willpower 1.019 .000 1.403 .000 .394 .699 .680 .000 1.036 .000 .011 .351
Fear Positive emotions Anger 1.781 .000 -2.154 .000 .181 .100 1.072 .000 -1.819 .000 .211 .061
Adj. R² .005 .165 .209 .270
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Regression of Desire for Social Distance Towards
People with Schizophrenia on Socio-Demographic
Characteristics, Stereotypes and Emotional
Reactions. Population Study in Germany, 2001.
Model 1 Model 2 Model 3 Model 4
B p B p B p B p
Age Gender Educational attainment .021 .007 -.302 .236 -.319 .049 .022 .003 -.253 .279 -.100 .509 .029 .000 -.225 .334 .108 .468 .028 .000 -.181 .420 -.073 .616
Dangerous Unpredictable Lack of willpower 1.019 .000 1.403 .000 .394 .699 .680 .000 1.036 .000 .011 .351
Fear Positive emotions Anger 1.781 .000 -2.154 .000 .181 .100 1.072 .000 -1.819 .000 .211 .061
Adj. R² .005 .165 .209 .270
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How prevalent are the various emotional
reactions to people with mental disorder?
Are there differences between mental
disorders? How important are emotional
reactions as compared to stereotypes? Does
familiarity with mental illness work through
modification of emotional reactions?
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Familiarity with Mental Illness and Desire for
Social Distance Systematic Review of
Population-Based Studies on Public Beliefs About
Mental Disorders and Attitudes Towards the
Mentally Ill
Number of studies
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Association Between Familiarity, Emotional
Reactions and Social Distance Towards People
With Schizophrenia Population Study in Germany,
2001
Fear
1.67
0.22
-0.20
Familiarity
Social distance
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Association Between Familiarity, Emotional
Reactions and Social Distance Towards People
With Major Depression Population Study in
Germany, 2001
0.15
Familiarity
Social distance
-1.31
Sum of indirect effects 1.22
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Summary

• Positive emotional responses to people with
  mental illness are most
• prevalent, followed by fear and anger.
• This pattern appears relatively stable across
  different cultures.
• There are differences in the publics emotional
  reactions to the
• various types of mental disorder.
• Emotional reactions have a substantial effect
  on the desire for social
• distance.
• The association between familiarity with mental
  disorder and the
• desire for social distance is to a considerable
  extent mediated through
• emotions.

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Conclusion

• As compared to stereotypes and behavioural
  intentions, the publics
• emotional reactions to people with mental
  disorders are relatively
• under-researched.
• Our findings suggest that more research on the
  publics emotional
• reactions may allow to better understand the
  complexities of the
• stigma surrounding mental illness.
• Interventions aimed at reducing the stigma of
  mental illness may
• benefit from paying more attention to emotions.