543312
research-article2014
ISP0010.1177/0020764014543312International Journal of Social PsychiatryAngermeyer et al.
E CAMDEN SCHIZOPH
Article
Continuum beliefs and attitudes towards people with mental illness: Results from a national survey in France
International Journal of Social Psychiatry 1–7 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0020764014543312 isp.sagepub.com
Matthias C Angermeyer1,2, Aurélie Millier3, Cécile Rémuzat3, Tarek Refaï3, Georg Schomerus4,5 and Mondher Toumi6
Abstract Background: Whether mental disorders should be considered as categorical or dimensional has found increasing attention among mental health professionals. Only little is known about what the public thinks about this issue. Aims: First, to assess how prevalent the belief in a continuum of symptoms from mental health to mental illness is among the general public. Second, to examine how continuum beliefs are associated with attitudes towards people with mental disorder. Methods: In 2012, an on-line survey was conducted in France (N = 1,600). After the presentation of a case-vignette depicting a person with either schizophrenia or depression, belief in a continuum of symptoms, emotional reactions and desire for social distance related to the person in the vignette were assessed. Results: While 58.2% of respondents agreed in a symptom continuum for depression, this percentage was only 28.5% for schizophrenia. In both disorders, continuum beliefs were associated with more pro-social reactions and less desire for social distance. Only in schizophrenia, there was an inverse relationship with the expression of anger. Conclusions: There is increasing evidence of an association between continuum beliefs and positive attitudes towards people with mental illness. Information on the continuous nature of psychopathological phenomena may usefully be included in anti-stigma messages. Keywords Symptom continuum, attitudes, schizophrenia, major depression, population survey
Introduction An increasing number of epidemiological studies on the prevalence of psychiatric symptoms among the general population support the view that mental health and mental illness are two points on a continuum of symptom severity rather than dichotomous entities. For instance, numerous studies provide evidence for a continuum of psychosis ranging from self-reported infrequent psychotic symptoms in the general population to full-blown psychosis resulting in a diagnosable primary psychotic disorder (Esterberg & Compton, 2009; Loch et al., 2011; Stip & Letourneau, 2009; Van Os, Linscott, Myin-Germeys, Delespaul, & Krabbendam, 2010). Similarly, in 68 countries participating in the World Health Organization’s World Health Survey, it was found that sub-threshold depressive disorders occur commonly all across the world which do not qualitatively differ from full-blown episodes and lie on a continuum with more severe forms of depressive episodes (Ayuso-Mateos, Nuevo, Verdes, Naidoo, & Chatterji, 2010).Thus, many persons who do not fulfill criteria for a
mental disorder nevertheless experience various psychiatric symptoms to different degrees. These research findings did not remain without impact on theoretical considerations on the nature of mental disorders and the structure of psychiatric diagnoses. During the development of Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM)-5, there was a 1Center
for Public Mental Health, Gösing am Wagram, Austria of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy 3Creativ-Ceutical, Paris, France 4Department of Psychiatry, University of Greifswald, Greifswald, Germany 5HELIOS Hanseklinikum Stralsund, Stralsund, Germany 6University of Lyon I, Lyon, France 2Department
Corresponding author: Matthias C Angermeyer, Center for Public Mental Health, Untere Zeile 13, A-3482 Gösing am Wagram, Austria. Email: [email protected]
Downloaded from isp.sagepub.com at FLORIDA INTERNATIONAL UNIV on May 28, 2015
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International Journal of Social Psychiatry
debate about whether certain mental disorders should be considered categorical or dimensional, for instance, with regard to affective disorders (Andrews et al., 2007; Henry & Etain, 2010), schizophrenia (Linscott & Van Os, 2010), substance use disorders (Helzer, Van den Brink, & Guth, 2006) and personality disorders (Trull, Tragesser, Solhan, & Schwartz-Mette, 2007). While questions of the scientific foundation of psychiatric diagnoses found increasing attention, revolving mainly around issues of validity and reliability, there was little interest in what common sense tells us about the boundaries between the ‘normal’ and the pathological. Hardly anything is known about what the public thinks on the notion of a continuum of symptoms from mental health to mental illness. To our knowledge, a single study from Germany has so far addressed this question, coming up with the result that 42% of the German public agreed in a symptom continuum for depression while this percentage was 26% for schizophrenia and 27% for alcohol dependence (Schomerus, Matschinger, & Angermeyer, 2013). Apart from psychiatric diagnosis, the continuum issue is also of interest in the context of stigma which has been conceptualized as a process of several distinct, but interrelated steps (Link & Phelan, 2001). Central to this process is a separation between ‘us’ and ‘them’, leading to negative emotional reactions and resulting in discrimination and devaluation of the person. While the hypothetical first steps of the stigma process, labeling and stereotyping, and their relation to discrimination and devaluation have been examined in much detail (e.g. Angermeyer & Matschinger, 2003, 2005; Link, Cullen, Frank, & Wozniak, 1987), there is a surprising scarcity of studies focusing on perceived differentness and separation. This is deplorable, since, theoretically, perceived differentness is a promising target for anti-stigma messages. An attitude opposed to it would be the perception that a person with mental illness is someone like us, and that to a certain degree his or her experiences resemble experiences of myself. In view of the theoretical implications and possible conclusions to be drawn concerning de-stigmatization strategies, we set out, using data from a survey conducted in France, to address the following questions: •• How prevalent is the continuum notion among the public and what are its correlates? •• How are continuum beliefs associated with public attitudes towards persons with schizophrenia and depression?
Methods
on-line survey between January and March 2012. If a person did not respond to the initial contact, he or she was contacted again 3 days later. Recruitment continued until 1,600 interviews were obtained. To ensure that the sample was representative of the general adult population of France, sampling was stratified for place of residence, gender, age and family status. In total, 1,600 persons were interviewed. The socio-demographic characteristics of the sample reflect well the socio-demographic composition of the general population in France: 50% were men (France: 50.6%); 17.5% of respondents were 16 to 24 years, 20.2% 25 to 34 years, 22.1% 35 to 44 years, 21.3% 45 to 54 years and 18.9% 55 to 65 years old (France: 17.1%, 19.1%, 20.9%, 21.1%, 21.7%, respectively). In all, 43.1% of respondents were single (France: 45.8%). Informed consent was considered to have been given when individuals agreed to complete the interview.
Interview The fully structured interview had originally been developed in Germany, and had been successfully employed in several surveys (Angermeyer & Matschinger, 2003, 2005). For use in this study, it had been translated into French following the guidelines of the World Health Organization (Sartorius & Kuyken, 1994). At the beginning of the interview, respondents were presented with a vignette of a diagnostically unlabeled psychiatric case history, depicting a case of either schizophrenia or major depressive disorder. The symptoms described in the vignettes fulfilled the criteria of Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV) (American Psychiatric Association, 1994) for the respective disorder. Vignettes had undergone validation by blinded experts in psychopathology (Angermeyer & Matschinger, 1997). The sex of the individual presented in the vignettes was randomly varied. A total of 800 respondents each were allocated to receive either the vignette depicting schizophrenia or the vignette depicting major depressive disorder.
Measures Identification as mental illness. Following the presentation of the case-vignette, respondents were asked whether they considered the person described as suffering from a mental illness in a medical sense. Answers were coded 1 = yes, 2 = no and 3 = don’t know.
Belief in a continuum of symptom experience
Survey Persons aged 16 to 65 years, of French nationality, were drawn from an established market research panel. They were contacted by email and invited to participate in an
Respondents were then asked to indicate their agreement with the following statement: ‘Basically we are all sometimes like this person. It’s just a question how pronounced this state is.’ Answers had to be given using a 5-point
Downloaded from isp.sagepub.com at FLORIDA INTERNATIONAL UNIV on May 28, 2015
3
Angermeyer et al. Table 1. Rotated factor loadings, emotional reactions to a person with schizophrenia or depression (n = 1,600). Item I feel uncomfortable I feel insecure The person provokes fear The person provokes my incomprehension I feel sympathy I feel pity I feel the need to help I feel annoyed I react angrily I am amused Eigenvalue Cumulative explained variance (%)
Factor 1 ‘Fear’
Factor 2 ‘Pro-social reactions’
Factor 3 ‘Anger’
0.87 0.79 0.77 0.51
−0.06 0.11 −0.07 −0.15
0.09 0.15 0.08 0.41
−0.13 0.09 −0.06 0.24 0.20 −0.04 2.36 23.57
0.84 0.82 0.77 −0.05 −0.02 −0.20 2.04 44.01
−0.01 −0.10 −0.17 0.77 0.75 0.73 1.93 63.32
Likert-type scale, ranging from ‘1’ indicating strong agreement to ‘5’ indicating strong disagreement with the statement. We reversed this score for our analysis, a higher score thus indicating stronger belief in a continuum of symptom experience.
Familiarity with mental illness Familiarity with mental illness was assessed by asking respondents whether they had themselves received mental health care previously or whether they knew someone who had been treated for mental illness. Answers were coded 0 = unfamiliar with mental illness and 1 = familiar with mental illness.
Emotional reactions According to previous research, three types of emotional reactions to people with mental illness can be distinguished: fear, anger, and pro-social reactions (Angermeyer, Holzinger, & Matschinger, 2010). A list of 10 items, representing these three ways of responding to individuals with mental illness, was used to assess respondents’ emotional reactions to the person described in the vignette. These items were coded from 1 (‘applies completely’) to 5 (‘does not apply at all’). The Kaiser–Meyer–Olkin measure of sampling adequacy was 0.76 (greater than 0.5), indicating that a factor analysis is appropriate for the scale. A Principal Component Analysis (PCA) with varimax rotation was carried out yielding three factors with an eigenvalue > 1. Table 1 shows items, rotated factor loadings and eigenvalues of the three factors plus the cumulative explained variances (63% in total). We termed the first factor ‘fear’, the second ‘pro-social reactions’ and the third ‘anger’. The same three factors have been found in previous studies (Angermeyer et al., 2010). Scores were reversed for our analyses, higher scores indicating stronger emotional reactions.
Desire for social distance Respondents’ desire for social distance was assessed by means of a scale developed by Link et al. (1987), a modified version of the Bogardus Social Distance Scale. The scale includes seven items representing the following social relationships: rent a room, work together, have as neighbor, let take care of a little child, have marry into family, introduce to friends, recommend for a job. With the help of 5-point Likert-type scales, respondents could indicate to what extent they were willing or unwilling to engage in the proposed relationships. For our analyses, we used a sum score of all seven items, ranging from a minimum of 7 to a maximum of 35, with higher scores indicating stronger desire for social distance.
Statistical analysis For the examination of potential correlates of continuum beliefs, we conducted a logistic regression analysis with type of disorder depicted in the vignette, identification as mental disorder, familiarity with mental illness and sociodemographic characteristics of respondents as independent variables. Then, separately for both vignettes, we regressed the factor scores for ‘fear’, ‘pro-social reactions’ and ‘anger’ as well as desire for social distance on continuum beliefs. Since previous studies had shown an association of attitudes toward people with mental illness with identification as mental illness (Link et al., 1987) and with familiarity with mental illness (Angermeyer & Dietrich, 2006), these two variables were introduced into the regression equation. In addition, socio-demographic characteristics of respondents were included as control variables (Knesebeck et al., 2013a). Wald tests were performed to test whether the effect of continuum beliefs on emotional reactions and desire for social distance differed between schizophrenia and depression. All statistical analyses were performed using SAS, release 9.3.
Downloaded from isp.sagepub.com at FLORIDA INTERNATIONAL UNIV on May 28, 2015
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International Journal of Social Psychiatry
Table 2. Belief in a continuum of symptoms regarding an unlabeled case vignette of schizophrenia and depression: ‘Basically, we are all sometimes like this person. It’s just a question as to how pronounced this state is’.
Agree Undecided Disagree
Schizophrenia (n = 800) %
Depression (n = 800) %
28.5 29.5 42.0
58.2 26.9 14.9
Answers on either side of the midpoint of the 5-point Likert-type scales are collapsed into ‘agree’ and ‘disagree’, respectively.
Table 3. Correlates of continuum beliefsa (logistic regression analysis).
(schizophrenia)b
Disorder Identification as mental illnessc Familiarity with mental illnessd Gender (male)e Age Educationf
OR
0.46 0.93 1.41 0.98 1.00 1.07
*** ***
OR: odds ratio. Pseudo R2 = 0.03. ***p
research-article2014
ISP0010.1177/0020764014543312International Journal of Social PsychiatryAngermeyer et al.
E CAMDEN SCHIZOPH
Article
Continuum beliefs and attitudes towards people with mental illness: Results from a national survey in France
International Journal of Social Psychiatry 1–7 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0020764014543312 isp.sagepub.com
Matthias C Angermeyer1,2, Aurélie Millier3, Cécile Rémuzat3, Tarek Refaï3, Georg Schomerus4,5 and Mondher Toumi6
Abstract Background: Whether mental disorders should be considered as categorical or dimensional has found increasing attention among mental health professionals. Only little is known about what the public thinks about this issue. Aims: First, to assess how prevalent the belief in a continuum of symptoms from mental health to mental illness is among the general public. Second, to examine how continuum beliefs are associated with attitudes towards people with mental disorder. Methods: In 2012, an on-line survey was conducted in France (N = 1,600). After the presentation of a case-vignette depicting a person with either schizophrenia or depression, belief in a continuum of symptoms, emotional reactions and desire for social distance related to the person in the vignette were assessed. Results: While 58.2% of respondents agreed in a symptom continuum for depression, this percentage was only 28.5% for schizophrenia. In both disorders, continuum beliefs were associated with more pro-social reactions and less desire for social distance. Only in schizophrenia, there was an inverse relationship with the expression of anger. Conclusions: There is increasing evidence of an association between continuum beliefs and positive attitudes towards people with mental illness. Information on the continuous nature of psychopathological phenomena may usefully be included in anti-stigma messages. Keywords Symptom continuum, attitudes, schizophrenia, major depression, population survey
Introduction An increasing number of epidemiological studies on the prevalence of psychiatric symptoms among the general population support the view that mental health and mental illness are two points on a continuum of symptom severity rather than dichotomous entities. For instance, numerous studies provide evidence for a continuum of psychosis ranging from self-reported infrequent psychotic symptoms in the general population to full-blown psychosis resulting in a diagnosable primary psychotic disorder (Esterberg & Compton, 2009; Loch et al., 2011; Stip & Letourneau, 2009; Van Os, Linscott, Myin-Germeys, Delespaul, & Krabbendam, 2010). Similarly, in 68 countries participating in the World Health Organization’s World Health Survey, it was found that sub-threshold depressive disorders occur commonly all across the world which do not qualitatively differ from full-blown episodes and lie on a continuum with more severe forms of depressive episodes (Ayuso-Mateos, Nuevo, Verdes, Naidoo, & Chatterji, 2010).Thus, many persons who do not fulfill criteria for a
mental disorder nevertheless experience various psychiatric symptoms to different degrees. These research findings did not remain without impact on theoretical considerations on the nature of mental disorders and the structure of psychiatric diagnoses. During the development of Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM)-5, there was a 1Center
for Public Mental Health, Gösing am Wagram, Austria of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy 3Creativ-Ceutical, Paris, France 4Department of Psychiatry, University of Greifswald, Greifswald, Germany 5HELIOS Hanseklinikum Stralsund, Stralsund, Germany 6University of Lyon I, Lyon, France 2Department
Corresponding author: Matthias C Angermeyer, Center for Public Mental Health, Untere Zeile 13, A-3482 Gösing am Wagram, Austria. Email: [email protected]
Downloaded from isp.sagepub.com at FLORIDA INTERNATIONAL UNIV on May 28, 2015
2
International Journal of Social Psychiatry
debate about whether certain mental disorders should be considered categorical or dimensional, for instance, with regard to affective disorders (Andrews et al., 2007; Henry & Etain, 2010), schizophrenia (Linscott & Van Os, 2010), substance use disorders (Helzer, Van den Brink, & Guth, 2006) and personality disorders (Trull, Tragesser, Solhan, & Schwartz-Mette, 2007). While questions of the scientific foundation of psychiatric diagnoses found increasing attention, revolving mainly around issues of validity and reliability, there was little interest in what common sense tells us about the boundaries between the ‘normal’ and the pathological. Hardly anything is known about what the public thinks on the notion of a continuum of symptoms from mental health to mental illness. To our knowledge, a single study from Germany has so far addressed this question, coming up with the result that 42% of the German public agreed in a symptom continuum for depression while this percentage was 26% for schizophrenia and 27% for alcohol dependence (Schomerus, Matschinger, & Angermeyer, 2013). Apart from psychiatric diagnosis, the continuum issue is also of interest in the context of stigma which has been conceptualized as a process of several distinct, but interrelated steps (Link & Phelan, 2001). Central to this process is a separation between ‘us’ and ‘them’, leading to negative emotional reactions and resulting in discrimination and devaluation of the person. While the hypothetical first steps of the stigma process, labeling and stereotyping, and their relation to discrimination and devaluation have been examined in much detail (e.g. Angermeyer & Matschinger, 2003, 2005; Link, Cullen, Frank, & Wozniak, 1987), there is a surprising scarcity of studies focusing on perceived differentness and separation. This is deplorable, since, theoretically, perceived differentness is a promising target for anti-stigma messages. An attitude opposed to it would be the perception that a person with mental illness is someone like us, and that to a certain degree his or her experiences resemble experiences of myself. In view of the theoretical implications and possible conclusions to be drawn concerning de-stigmatization strategies, we set out, using data from a survey conducted in France, to address the following questions: •• How prevalent is the continuum notion among the public and what are its correlates? •• How are continuum beliefs associated with public attitudes towards persons with schizophrenia and depression?
Methods
on-line survey between January and March 2012. If a person did not respond to the initial contact, he or she was contacted again 3 days later. Recruitment continued until 1,600 interviews were obtained. To ensure that the sample was representative of the general adult population of France, sampling was stratified for place of residence, gender, age and family status. In total, 1,600 persons were interviewed. The socio-demographic characteristics of the sample reflect well the socio-demographic composition of the general population in France: 50% were men (France: 50.6%); 17.5% of respondents were 16 to 24 years, 20.2% 25 to 34 years, 22.1% 35 to 44 years, 21.3% 45 to 54 years and 18.9% 55 to 65 years old (France: 17.1%, 19.1%, 20.9%, 21.1%, 21.7%, respectively). In all, 43.1% of respondents were single (France: 45.8%). Informed consent was considered to have been given when individuals agreed to complete the interview.
Interview The fully structured interview had originally been developed in Germany, and had been successfully employed in several surveys (Angermeyer & Matschinger, 2003, 2005). For use in this study, it had been translated into French following the guidelines of the World Health Organization (Sartorius & Kuyken, 1994). At the beginning of the interview, respondents were presented with a vignette of a diagnostically unlabeled psychiatric case history, depicting a case of either schizophrenia or major depressive disorder. The symptoms described in the vignettes fulfilled the criteria of Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV) (American Psychiatric Association, 1994) for the respective disorder. Vignettes had undergone validation by blinded experts in psychopathology (Angermeyer & Matschinger, 1997). The sex of the individual presented in the vignettes was randomly varied. A total of 800 respondents each were allocated to receive either the vignette depicting schizophrenia or the vignette depicting major depressive disorder.
Measures Identification as mental illness. Following the presentation of the case-vignette, respondents were asked whether they considered the person described as suffering from a mental illness in a medical sense. Answers were coded 1 = yes, 2 = no and 3 = don’t know.
Belief in a continuum of symptom experience
Survey Persons aged 16 to 65 years, of French nationality, were drawn from an established market research panel. They were contacted by email and invited to participate in an
Respondents were then asked to indicate their agreement with the following statement: ‘Basically we are all sometimes like this person. It’s just a question how pronounced this state is.’ Answers had to be given using a 5-point
Downloaded from isp.sagepub.com at FLORIDA INTERNATIONAL UNIV on May 28, 2015
3
Angermeyer et al. Table 1. Rotated factor loadings, emotional reactions to a person with schizophrenia or depression (n = 1,600). Item I feel uncomfortable I feel insecure The person provokes fear The person provokes my incomprehension I feel sympathy I feel pity I feel the need to help I feel annoyed I react angrily I am amused Eigenvalue Cumulative explained variance (%)
Factor 1 ‘Fear’
Factor 2 ‘Pro-social reactions’
Factor 3 ‘Anger’
0.87 0.79 0.77 0.51
−0.06 0.11 −0.07 −0.15
0.09 0.15 0.08 0.41
−0.13 0.09 −0.06 0.24 0.20 −0.04 2.36 23.57
0.84 0.82 0.77 −0.05 −0.02 −0.20 2.04 44.01
−0.01 −0.10 −0.17 0.77 0.75 0.73 1.93 63.32
Likert-type scale, ranging from ‘1’ indicating strong agreement to ‘5’ indicating strong disagreement with the statement. We reversed this score for our analysis, a higher score thus indicating stronger belief in a continuum of symptom experience.
Familiarity with mental illness Familiarity with mental illness was assessed by asking respondents whether they had themselves received mental health care previously or whether they knew someone who had been treated for mental illness. Answers were coded 0 = unfamiliar with mental illness and 1 = familiar with mental illness.
Emotional reactions According to previous research, three types of emotional reactions to people with mental illness can be distinguished: fear, anger, and pro-social reactions (Angermeyer, Holzinger, & Matschinger, 2010). A list of 10 items, representing these three ways of responding to individuals with mental illness, was used to assess respondents’ emotional reactions to the person described in the vignette. These items were coded from 1 (‘applies completely’) to 5 (‘does not apply at all’). The Kaiser–Meyer–Olkin measure of sampling adequacy was 0.76 (greater than 0.5), indicating that a factor analysis is appropriate for the scale. A Principal Component Analysis (PCA) with varimax rotation was carried out yielding three factors with an eigenvalue > 1. Table 1 shows items, rotated factor loadings and eigenvalues of the three factors plus the cumulative explained variances (63% in total). We termed the first factor ‘fear’, the second ‘pro-social reactions’ and the third ‘anger’. The same three factors have been found in previous studies (Angermeyer et al., 2010). Scores were reversed for our analyses, higher scores indicating stronger emotional reactions.
Desire for social distance Respondents’ desire for social distance was assessed by means of a scale developed by Link et al. (1987), a modified version of the Bogardus Social Distance Scale. The scale includes seven items representing the following social relationships: rent a room, work together, have as neighbor, let take care of a little child, have marry into family, introduce to friends, recommend for a job. With the help of 5-point Likert-type scales, respondents could indicate to what extent they were willing or unwilling to engage in the proposed relationships. For our analyses, we used a sum score of all seven items, ranging from a minimum of 7 to a maximum of 35, with higher scores indicating stronger desire for social distance.
Statistical analysis For the examination of potential correlates of continuum beliefs, we conducted a logistic regression analysis with type of disorder depicted in the vignette, identification as mental disorder, familiarity with mental illness and sociodemographic characteristics of respondents as independent variables. Then, separately for both vignettes, we regressed the factor scores for ‘fear’, ‘pro-social reactions’ and ‘anger’ as well as desire for social distance on continuum beliefs. Since previous studies had shown an association of attitudes toward people with mental illness with identification as mental illness (Link et al., 1987) and with familiarity with mental illness (Angermeyer & Dietrich, 2006), these two variables were introduced into the regression equation. In addition, socio-demographic characteristics of respondents were included as control variables (Knesebeck et al., 2013a). Wald tests were performed to test whether the effect of continuum beliefs on emotional reactions and desire for social distance differed between schizophrenia and depression. All statistical analyses were performed using SAS, release 9.3.
Downloaded from isp.sagepub.com at FLORIDA INTERNATIONAL UNIV on May 28, 2015
4
International Journal of Social Psychiatry
Table 2. Belief in a continuum of symptoms regarding an unlabeled case vignette of schizophrenia and depression: ‘Basically, we are all sometimes like this person. It’s just a question as to how pronounced this state is’.
Agree Undecided Disagree
Schizophrenia (n = 800) %
Depression (n = 800) %
28.5 29.5 42.0
58.2 26.9 14.9
Answers on either side of the midpoint of the 5-point Likert-type scales are collapsed into ‘agree’ and ‘disagree’, respectively.
Table 3. Correlates of continuum beliefsa (logistic regression analysis).
(schizophrenia)b
Disorder Identification as mental illnessc Familiarity with mental illnessd Gender (male)e Age Educationf
OR
0.46 0.93 1.41 0.98 1.00 1.07
*** ***
OR: odds ratio. Pseudo R2 = 0.03. ***p
