Telephone Survey of Missourians Regarding Attitudes toward People with Mental Illness, Substance Use and Developmental Disabilities

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1 Telephone Survey of Missourians Regarding Attitudes toward People with Mental Illness, Substance Use and Developmental Disabilities Prepared for: Missouri Mental Health Foundation June 2013 Prepared by: The Missouri Institute of Mental Health at the University of Missouri-St. Louis Missouri Institute of Mental Health and Health and Behavioral Risk Research Center at the University of Missouri-Columbia

2 EXECUTIVE SUMMARY In spring, 2013, 2,360 Missouri adults (age 18+) were randomly selected to participant in a telephone survey to examine attitudes and stigma towards mental illness, substance use disorders, and developmental disabilities. The 114-item survey utilized a vignette strategy; the respondents were randomly assigned to one of the following 12 vignettes describing a mental illness, a substance use disorder, or a developmental disability: 1. Major depressive disorder in a young adult 2. Major depressive disorder in an older adult 3. Schizophrenia 4. Bipolar disorder 5. Post-traumatic stress disorder 6. Alcohol dependence 7. Marijuana dependence 8. Prescription drug abuse 9. Hard drug abuse 10. Autism 11. Mild developmental delay 12. Severe developmental delay The respondents were asked questions about the vignette that explored a variety of issues, such as attitudes and stigma, perceived causes of the disorder, knowledge of diagnoses, treatment options and effectiveness, personal experiences with the disorder, and perceived dangerousness of the vignette character. Interviews were conducted by professionally trained interviewers at the Health and Behavioral Risk Research Center at the University of Missouri-Columbia, a unit specializing in survey research. Survey design, data management and analysis, and report writing were conducted by the Missouri Institute of Mental Health. PERSONAL EXPERIENCE WITH MENTAL ILLNESSES, SUBSTANCE USE DISORDERS, AND DEVELOPMENTAL DISABILITIES Respondents were asked about their personal experiences with mental illness, substance abuse, and developmental disabilities: whether they lived near or worked with someone with the diagnosis described in the vignette, whether they ever had a mental health or substance abuse problem of their own, if they ever sought help and, if so, from whom. Generally, around half of respondents either lived near or worked with someone with either a mental illness or a substance use disorder; a majority reported knowing someone with a substance use problem (6) or a developmental disability (67%) Respondents most commonly worked with or lived near someone with alcohol dependence (68%) and least commonly worked with/lived near someone with autism (29%) 2

3 Around one fifth of respondents reported ever having a mental health problem and 8% reported ever having a substance abuse problem Respondents were more likely to get help for a mental health problem (84%) than a substance use problem (61%) Almost all respondents (92%) who sought help for mental illness or substance abuse problems said that the treatment or intervention was helpful Respondents with a mental disorder most commonly sought help from a psychiatrist (48%) or psychologist (38%), whereas the majority (6) of those with a substance use problem sought help from other forms of treatment such as self-help groups or drug and alcohol treatment centers Respondents most common reason for not getting help was because they felt they could handle it on their own Figure 1. Percent who Lived Near/Worked with a Person with the Vignette Disorder Percent % 66% 65% 64% 52% 51% 48% 46% 44% 33% 29% CAUSES OF MENTAL ILLNESSES, SUBSTANCE USE DISORDERS, AND DEVELOPMENTAL DISABILITIES All respondents were asked a series of questions related to their beliefs about causes of the vignette character s disorder. Respondents were asked how likely they felt that the disorders described in the vignettes were the result of either bad character, chemical imbalance, how they were raised, stressful circumstances, genetics, aging or a higher power. 3

4 Genetics and chemical imbalance were among the top three causes for persons in the mental illness, substance use disorder, and developmental disability vignettes For developmental disability vignettes, the top perceived cause was genetics; for mental illness vignettes, it was stressful circumstances; and for substance abuse vignettes, it was bad character Whereas bad character was most commonly identified as a likely cause for persons in substance abuse vignettes, especially the hard drug abuse vignette (87% thought bad character was the likely cause), it was among the least likely endorsed cause for mental illness and developmental disability vignettes Figure 2. Percent Believing the Cause was "Very" or "Somewhat" Likely Mental Illness Substance Abuse Developmental Disability % 78% 78% 82% 78% 83% 6 53% 49% 66% 62% 52% 44% 32% 34% 32% 33% 19% 21% 15% Bad character Chemical imbalance The way s/he was raised Stressful cicumstances Genetic or inherited Higher power Aging Respondents were generally more likely to endorse bad character as a cause if they were male, aged or older than 65, had less formal education, lower income, or lived in urban areas A majority (83%) of respondents attributed major depressive disorder in an older adult to aging, compared to only 44% who responded to the major depressive disorder in a young adult A majority of respondents thought the way the person was raised was a likely cause for persons in the autism (71%), hard drug abuse (64%), and alcohol dependence (59%) vignettes 4

5 Figure 3. Percent Believing Bad Character is a "Very" or "Somewhat" Likely Cause % 83% 76% 6 66% 52% 45% 31% 31% 26% 12% More than half of respondents (52%) thought bad character was a cause for the person in the autism vignette Nine out of 10 respondents thought genetics was a likely cause for persons in the mild and severe developmental delay vignettes, and more than a third thought a higher power was a likely cause Genetics was seen as a more likely cause of alcohol dependence (67%) than substance abuse, especially marijuana dependence (39%) RECOGNIZING MENTAL ILLNESSES, SUBSTANCE USE DISORDERS, AND DEVELOPMENTAL DISABILITIES Respondents were asked what diagnosis was being described in the vignette, as well as whether the vignette was describing a person experiencing the normal ups and downs of life, a nervous breakdown, a mental illness, and/or a physical illness. In general, the majority of respondents recognized the disorder described in the vignette 5

6 Respondents were least successful at recognizing the disorder described in the developmental disability vignettes, especially the autism vignette (only 68% thought the disorder described in the vignette was likely autism) Respondents were more likely to believe persons in the substance abuse vignettes were experiencing the normal ups and downs of life than those in the mental illness or developmental disability vignettes, and less likely to believe they were experiencing a mental illness Respondents were more likely to believe persons in the mental illness vignettes were experiencing a nervous breakdown than those in the substance abuse or a developmental disability vignettes More respondents thought the persons in the developmental disability vignettes were experiencing mental illness (81%) than the persons in the mental illness vignettes (71%) Figure 4. Likelihood the Vignette Character was Experiencing... Mental Illness Substance Use Disorder Developmental Disability Percent Very or Somewhat Likely % 56% 54% Normal up and downs of life? 59% 49% 42% A nervous breakdown? 81% 71% 54% 56% 54% 57% A mental illness? A physical illness? Respondents with less formal education, lower incomes, or from urban or rural areas were more likely to believe the person described in the vignette was experiencing the normal ups and downs of life or a nervous breakdown Fewer than half thought mental illness was being experienced by the person in the posttraumatic stress disorder vignette, versus almost all (92%) for the schizophrenia vignette Of all the mental illness vignettes, the symptoms experienced by the older adult in the major depressive disorder vignette were most likely to be considered part of the normal ups and downs of life, and about three-fourths of respondents believe the person in the vignette had both a mental and a physical illness Respondents over 50 were more likely than younger respondents to believe the person described in the vignette was experiencing a physical illness 6

7 STIGMA FOR MENTAL ILLNESSES, SUBSTANCE USE DISORDERS, AND DEVELOPMENTAL DISABILITIES To assess stigma, respondents were asked a number of questions about their willingness to interact with the vignette character in a variety of situations, which varied in their level of intimacy. Respondents were asked if they would be willing to: 1. Have a group home for the vignette character in their neighborhood 2. Make friends with the vignette character 3. Move next door to the vignette character 4. Spend an evening socializing with the vignette character 5. Work closely with the vignette character 6. Have the vignette character marry into their family 7. Have the vignette character as their boss 8. Have the vignette character teach their children 9. Share an apartment with the vignette character 10. Have the vignette character babysit their children Overall Stigma Of all 12 disorders surveyed in 2013, respondents were least willing to interact with persons in the substance use disorder vignettes; in almost all situations the majority of respondents were unwilling to interact with the person in the vignette Fewer than 1 out of every 10 respondents were willing to have the persons in the substance use disorder vignettes teach their children, be their boss, share an apartment with them, or babysit their children Stigma for developmental disabilities and mental illnesses were comparable, but respondents were slightly more willing to work closely or make friends with persons in the developmental disability vignettes, or have a group home for people with developmental disabilities in their neighborhood. Compared to the developmental disability vignettes, respondents to the mental illness vignettes were slightly more willing to share an apartment with the person described in the vignette or have them as a boss 7

8 Figure 5. Willingness to Interact with the Vignette Character Percent "Very" or "Somewhat" Willing % 59% 87% Mental Illness Substance Use Disorder Developmental Disabilities 83% 79% 77% 52% 77% 74% 75% 57% 53% 45% 43% 45% 47% 24% 22% 23% 16% 21% 21% 17% 15% 11% 11% 9% 5% 3% 6% In general, older respondents (aged 65+) were less willing to interact with persons described in the vignettes than younger respondents Males were more willing to socialize with a person with a substance use disorder than females Respondents with incomes above $100,000 a year were much less willing than those making less to have a group home for persons with a substance use disorder in their neighborhood Those with lower household incomes (below $35,000) were more willing to have a person with a developmental disability as a boss than those with higher incomes Stigma by Vignette Six of the questions asked of respondents comprised the Social Distance Scale used in nationally representative surveys of stigma; the questions were summed to get a total social distance score used to compare individual vignettes. Questions included in the scale asked about respondents willingness to: 1) Have a group home for the vignette character in their neighborhood, 2) Make friends with the vignette character, 3) Move next door to the vignette character, 4) Spend an evening socializing with the vignette character, 5) Work closely with the vignette character, and 6) Have the vignette character marry into their family. 8

9 Respondents desired the most social distance from the person in the hard drug abuse vignette, and desired the least social distance from the person in the post-traumatic stress disorder vignette Of all the mental illnesses, schizophrenia was the most stigmatized, with social distance scores falling right below those of substance use disorders Of the developmental disabilities, severe developmental delay was the most stigmatized, though social distance scores fell below that of all substance use disorders, schizophrenia, and bipolar disorder Figure 6. Social Distance Scores by Vignette Hard Drug Abuse Marijuana Dependence Alcohol Abuse Prescription Drug Abuse Schizophrenia Bipolar Disorder Severe Developmental Delay Autism Major Depressive Disorder in a Younger Adult Major Depressive Disorder in an Older Adult Mild Developmental Delay PTSD Desire for Social Distance Note: Social Distance Scores range from 6-24, with higher scores representing more desire for social distance among respondents Change in Stigma after Treatment For a subset of the stigma questions, respondents were also asked how willing they were to interact with the person described in the vignette after they were treated, stabilized, and able to function. Respondents were asked how willing they were to allow the person to marry into their family, be their boss, teach or babysit their children, and share an apartment with them after treatment. Generally, the majority of respondents were willing to have the person in vignette as a boss, and allow him or her to marry into their family or teach their children after treatment; but more 9

10 than half were still unwilling to share an apartment with the persons described in the vignettes, or allow them to babysit their children However, there were exceptions to the above: after treatment, the majority of respondents were willing to allow persons with post-traumatic stress disorder or major depressive disorder to share an apartment with them or babysit their children Even after treatment, most respondents were still unwilling to allow the person in the hard drug abuse vignette to marry into their family, teach their children, share an apartment with them, or babysit their children, though most (77%) were willing to have the person as a boss Beliefs about People with Addiction or in Recovery For substance use disorders, respondents were also asked their beliefs about recovery and addiction. Whereas almost half of respondents would think less of their friend or relative who was addicted to drugs, only one fifth would think less of someone who was addicted to alcohol Only 15% would think less of a friend or relative in recovery for drugs or alcohol The majority of respondents agreed that a person addicted to drugs could stop using if they had enough willpower, whereas less than half felt the same for alcohol Change in Stigma from 2006 to 2013 Finally, the change in levels of mental illness stigma among Missourians from 2006 to 2013 was assessed for mental illness using the questions from the social distance scale, which were collected in both survey years. Overall, the desire for social distance (i.e., stigma) did not increase significantly from 2006 to 2013 (there was a slight 2.1% increase) Compared to 2006 data, respondents in 2013 were generally less willing to allow persons in the schizophrenia or bipolar disorder vignettes to marry into their family, work closely with them, or move next door to them Stigma for major depressive disorder in a younger adult decreased from 2006 to Respondents were more willing to make friends with, socialize with, or move next to door to a the young person in the major depressive disorder vignette In 2013, slightly fewer respondents were willing to allow persons in the mental illness vignettes to marry into their family, work closely with them, or move next door to them. For instance, in 2006, 61% of respondents were definitely or probably willing to work closely with persons in the mental illness vignettes compared to 53% in PERCEIVED DANGEROUSNESS OF PEOPLE WITH MENTAL ILLNESSES, SUBSTANCE USE DISORDERS, AND DEVELOPMENTAL DISABILITIES Respondents were asked how likely it was that the person in the vignette would be violent towards himor herself and others. 10

11 In general, respondents were more likely to believe a person would be violent towards himself or herself than towards others Respondents were most likely to believe persons in the alcohol dependence, hard drug abuse, or prescription drug abuse vignettes would be violent towards others The person in the hard drug abuse vignette was considered most likely to be violent towards both him- or herself and others Among the mental illness vignettes, the person in the schizophrenia vignette was considered most violent towards self and others Perceived likelihood of violence for developmental disabilities was generally low, though more than half felt it likely that a person in the severe developmental delay vignette would be violent towards him- or herself In general, those with less formal education were more likely to believe the persons described in the vignettes would be violent towards others Figure 7. Perceived Likelihood of Violence towards Self and Others Violent towards self Violent Towards others Percent "Very" or "Somewhat" LIkely % 46% 49% 36% 66% 64% 52% 29% 23% 23% 72% 56% 68% 54% 52% 54% 48% 48% 44% 45% 34% 33% 36% 35% TREATMENT Respondents were asked about the vignette character s ability to make treatment or money decisions, 11

12 whether the person s condition was likely to improve on its own or with treatment, and the effectiveness of psychotherapy or medication. Respondents with the substance use disorder vignettes were also asked questions regarding whether recovery from addiction was possible and about the effectiveness of treatment programs. Likely Improvement with or without Treatment In general, respondents felt improvement was much more likely with treatment than without Post-traumatic stress disorder was considered most likely to improve, both on its own and with treatment, and the person in the severe developmental delay vignette was considered least likely to improve Although the person in the alcohol abuse vignette was considered highly unlikely to improve on their own (only 8% thought it would improve), more than 9 out of 10 respondents thought they would improve with treatment For developmental disabilities, males were more likely than females to believe the condition would improve on its own Younger respondents were more likely than older respondents to believe substance use disorders would improve on their own The belief mental illness would improve with treatment was highest among females, more educated respondents (with at least a high school diploma or GED), and middle aged respondents (aged 34-64) Figure 8. Likely Improvement of Vignette Character's Condition on Its Own vs. With Treatment On its Own With Treatment Percent "Very" or "Somewhat" Likely % 95% 93% 94% 23% 23% 17% 85% 41% 96% 11% 92% 87% 8% 93% 92% 18% 13% 84% 18% 93% 6% 55% 12

13 Effectiveness of Medication and Psychotherapy Psychotherapy was considered a more effective treatment than medication for persons in the substance use disorders, developmental delay, and post-traumatic stress disorder vignettes Medication was considered more effective than psychotherapy for persons in the schizophrenia, bipolar disorder, and autism vignettes For persons in the major depressive disorder vignettes, medication and psychotherapy were considered similarly effective Those with more formal education were more likely to believe that psychotherapy is an effective treatment for substance use disorders For mental illness vignettes, those under 50 thought psychotherapy was more effective than medication while those over 50 thought medication was more effective than psychotherapy For mental illness vignettes, females were more likely than males to believe that therapies are effective (whether psychotherapy or medication) For developmental disability vignettes, younger respondents (under age 65), females, and more educated respondents (with at least a high school diploma or GED) were more likely to believe psychotherapy is an effective treatment Figure 9. Perceived Effectiveness of Psychotherapy and Medication Psychotherapy Medication Percent "Very" or "Somewhat" Effective % 89% 92% 82% 92% 89% 96% 87% 91% 88% 88% 86% 78% 72% 71% 62% 93% 89% 89% 88% 84% 84% 13

14 Treatment and Money Decisions The majority of respondents (6) felt persons in the mental illness vignettes were able to make their own treatment decisions, whereas fewer than half felt individuals in the substance use disorder or developmental disability vignettes could make their own decisions Persons in the mental illness vignettes were deemed equally capable of making money and treatment decisions, whereas persons in the substance use disorder or developmental disability vignettes were considered better able to make treatment decisions than money decisions In general, younger respondents (those under age 65) were more likely to believe persons in the vignettes could make their own treatment and money decisions The person in the post-traumatic stress disorder vignette was considered most capable of making their own treatment and money decisions, and the person in the severe developmental delay vignette was considered least capable Figure 10. Perceived Ability of Vignette Character to Make Treatment and Money Decisions Treatment Decisions Money Decisions Percent "Very" or "Somewhat" Able % 27% 68% 57% 65% 64% 63% 63% 83% 73% 32% 13% 58% 54% 45% 32% 58% 44% 38% 58% 56% 19% 8% 14

15 Recovery from Addiction and Effectiveness of Treatment Programs A majority (68%) of respondents believed full recovery from addiction was possible Full recovery was seen least likely for hard drug abusers (51% agreed full recovery is possible) and most likely for alcohol abusers (8 agreed full recovery is possible) Respondents were more likely to believe full recovery from addiction is possible if they were younger (under age 65), had more formal education, or lived in urban areas A large majority (8) agreed that treatment programs can help people with addiction Those abusing alcohol were considered most likely to be helped by a treatment program, whereas those abusing hard drugs were considered least likely (even so, 69% still agreed treatment programs would help those with hard drug addiction) Older adults (aged 65+) were less likely than other age groups to believe that treatment programs help people with addictions other than alcohol and middle-aged adults (aged 50-64) were more likely to believe that treatment programs are effective for marijuana addiction Those with more formal education were more likely to believe that treatment programs help those with addiction Figure 11. "A Person Can Fully Recover from Addiction" Strongly disagree Disagree Undecided Agree Strongly agree Percent 45% 35% 25% 15% 5% 44% 42% 36% 35% 31% 23% 23% 18% 17% 16% 2% 9% 9% 3% 8% 4% Alcohol Marijuana Hard Drugs Prescription Drugs 15

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