Stigma of Mental Illness: Social Distancing Attitudes among Registered Nurses in Australia

Background: Stigma of mental illness is often examined in social psychology and psychiatric rehabilitation using attitude studies. Participants of these studies are among health professionals and general public members. A common measure of stigma is using validated scale which measures the opinion on mental illness. Method: A cross-sectional survey was presented to 208 registered nurses. Principal component analyses (with oblique rotation) were used to identify underlying dimensionality in the correlations of items for social distancing. Subscale score variations were analysed across nurse type and ethnicity to examine the discriminant validity of the subscale. Results: Principal component analysis (PCA) revealed one dimension accounting for 43.5% of the variations within items for social distancing. Developed as scale, termed Stigma towards Psychiatric Patients (STPP), reliability analysis indicated high internal consistency with respective alpha coefficient of 0.8. Chinese general nurses scored highest on social distancing than the other three groups: Chinese psychiatric nurses, Anglo general and Anglo psychiatric nurses. Conclusion: Psychometric evaluation of the Stigma Scale (STPP) suggests it is a reliable instrument for measuring social distancing attitudes towards mental illness. The effect of ethnicity on stigmatising attitudes is not entirely accounted for by exposure to people with mental illness.

• Stigma
• Mental Illness
• Social Distancing

1. Introduction

The word “stigma” has its origin in Greek and is defined in the dictionary as a mark of disgrace or dishonour; a reproach or slur (New Webster’s Dictionary and Thesaurus and Medical Dictionary, 1992) [1]. An illustration of the word “stigma” is its application to the wounds (stigmata in pleural) inflicted on the Lord Jesus when He was crucified. The wounded sores signify that the bearer is a criminal, a slave, a betrayer or a notorious person. “Stigma” is used often in relation to attitudes of shame, guilt, disgrace or disapproval, and fear of identification with self and others (Goffman, 1970) [2]. Stigma is a word that stirs up negative emotion and reaction. Stigmatised individuals are likely to be disliked, rejected and discriminated against.

Stigma of mental illness is associated with people who are often perceived by the general public as untrustworthy and incompetent (Angermeyer & Schulze, 2001) [3] and in severe cases, the stigmatised person is “locked away” and hidden from society (Rabkin, 1974) [4]. A person with mental illness is regarded as dangerous, unpredictable and this in part “justifies” their discrimination by society. The term also implies inner perception of inferiority regarding the self especially after hospitalization and labeling (Link et al., 1991) [5] and leads the individual to behave in such a way that causes others to respond negatively to such self-perception and perpetuate feelings of exclusion and inadequacy. The degree of stigma is particularly strong when the mentally ill person exhibits unusual or extraordinary behaviours, such as episodes of psychosis in Chinese society (Lin, 1983) [6].

2. Methods

2.1. Subjects

Two hundred and eight nurses (208) participated in this study. They were selected for the purpose of a larger study on the influence of cultural values in nursing practice within psychiatric and general settings. Consequently, the sample was comprised of 49 Chinese-Australian and 83 Anglo-Australian psychiatric nurses, and 35 Chinese-Australian and 41 Anglo-Australian general nurses. One hundred and forty eight (148) were females and 60 were males. The mean age of the sample was 44.8 years (s.d. = 9.6), ranging from 21 to 65 years of age. For the overall sample the mean number of years working in general setting was 11.2 (s.d. = 12.0) and in psychiatric setting was 9.8 (s.d. = 11.0) respectively. Table 1 shows the sample demographics.

With regards to whether or not the nurses had received psychiatric training, the results indicated that a large number (over 90%) of psychiatric nurses in the sample had psychiatric training. As indicated in Table 1, a smaller number of general nurses than psychiatric nurses, and a smaller number of Chinese General nurses than Anglo nurses, had psychiatric training. This difference was statistically significant. Though the majority of nurses underwent nursing training through a course of study ranging between 80% and 100%, there were no significant differences in relation to training course, in-service training or other forms of experience when the sources of training were compared.

2.2. Item Development of General Stigma Scale (STPP)

A reduced version (consisting of 10 questions) of the Opinion on Mental Illness (OMI) Scale developed by Cohen & Struening (1962) [7] was used to measure social distancing and alienation of those with mental illness,

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