Attitudes Toward Mental Illness --- 35 States, District of Columbia, and Puerto Rico, 2007

Attitudes Toward Mental Illness --- 35 States, District of Columbia, and Puerto Rico, 2007
Weekly
May 28, 2010 / 59(20);619-625


Negative attitudes about mental illness often underlie stigma, which can cause affected persons to deny symptoms; delay treatment; be excluded from employment, housing, or relationships; and interfere with recovery (1). Understanding attitudes toward mental illness at the state level could help target initiatives to reduce stigma, but state-level data are scant. To study such attitudes, CDC analyzed data from the District of Columbia (DC), Puerto Rico, and the 35 states participating in the 2007 Behavioral Risk Factor Surveillance System (BRFSS) (the most recent data available), which included two questions on attitudes toward mental illness. Most adults (88.6%) agreed with a statement that treatment can help persons with mental illness lead normal lives, but fewer (57.3%) agreed with a statement that people are generally caring and sympathetic to persons with mental illness. Responses to these questions differed by age, sex, race/ethnicity, and education level. Although most adults with mental health symptoms (77.6%) agreed that treatment can help persons with mental illness lead normal lives, fewer persons with symptoms (24.6%) believed that people are caring and sympathetic to persons with mental illness. This report provides the first state-specific estimates of these attitudes and provides a baseline for monitoring trends. Initiatives that can educate the public about how to support persons with mental illness and local programs and media support to decrease negative stereotypes of mental illness can reduce barriers for those seeking or receiving treatment for mental illness (2,3).

To measure attitudes about mental illness through BRFSS and other surveys, the Substance Abuse and Mental Health Services Administration (SAMHSA) and CDC collaborated in 2005 to develop brief questions suitable for surveillance (4). BRFSS is an ongoing, state-based, random-digit--dialed telephone survey of the noninstitutionalized civilian population aged ≥18 years.* With SAMHSA and CDC support, 35 states, DC, and Puerto Rico questioned survey respondents to the 2007 BRFSS about mental illness. Questions included the Kessler-6 scale of serious psychological distress (5), frequent mental distress, one question about current treatment for an emotional problem, and two attitudinal questions.

The Kessler 6-scale asks respondents how often in the past 30 days they felt six symptoms of mental illness (i.e., feeling nervous, depressed, hopeless, restless, like a failure, like everything was an effort). Each item is scored on a 5-point scale indicating frequency, ranging from 0 (none of the time) to 4 (all of the time), and summed (score range: 0--24). Respondents scoring 13 or more on this scale were classified as having serious psychological distress (5). Frequent mental distress was measured with the question, "For how many days in the past 30 days was your mental health (due to stress, depression, or problems with emotions) not good?" Respondents reporting 14 or more poor mental health days were identified as having frequent mental distress. To determine current treatment for an emotional problem, survey participants were asked, "Are you now taking medicine or receiving treatment from a doctor or other health professional for any type of mental health condition or emotional problem?"

Attitudes were assessed by asking respondents to indicate their level of agreement with two statements. The first statement assessed attitude on the effectiveness of treatment: "Treatment can help people with mental illness lead normal lives." The second statement assessed the respondent's perception of others' attitudes toward persons with mental illness: "People are generally caring and sympathetic to people with mental illness."† Before inclusion in BRFSS, cognitive testing in a sample of the general population confirmed that adults understood these questions as intended. For example, respondents suggested that "normal lives" meant "being able to do everyday things, like going to the grocery store, paying bills, things that you have to do to live." The question about attitudes toward treatment also demonstrated acceptable construct validity with expectations regarding mental illness recovery.

Data were weighted to estimate population parameters. CDC used statistical software to calculate unadjusted and adjusted proportions (adjusted for sex, age group, racial/ethnic group, education, and household income) of agreement by state and by serious psychological distress, frequent mental distress, and mental health treatment, and to account for the complex BRFSS survey design. After adjustment, CDC examined differences in proportions across agreement categories for both questions by serious psychological distress, frequent mental distress, and mental health treatment status. The analyses excluded persons who responded "did not know" or "refused" to answer the questions.§ The sample size included 202,065 adults. Among the 35 states, DC, and Puerto Rico, the median Council of American Survey Research Organization (CASRO) response rate was 51% and the CASRO cooperation rate was 71.4%.¶

Most adults agreed, either strongly (62.8%) or slightly (25.8%), that treatment could help persons with mental illness lead normal lives, but responses varied by states (Table 1). The highest percentages of strongly agreeing with this statement were in Connecticut, DC, Louisiana, Oregon, Vermont, Virginia, and Washington; the lowest was in Puerto Rico (Figure). Proportions for neither agree nor disagree ranged from 0.6% (Iowa) to 9.2% (Puerto Rico). Younger adults, men, persons other than white non-Hispanics, and persons at lower education levels were less likely to agree strongly with this statement (Table 2).

In contrast with the statement about treatment, a lower proportion of adults agreed, either strongly (22.3%) or slightly (35.0%), with the statement that people are caring and sympathetic to persons with mental illness (Table 3). The highest percentages of strongly agreeing with this statement occurred in Hawaii, Louisiana, Mississippi, Oklahoma, Nevada, and New Mexico. The lowest was in Puerto Rico. Adults aged 25--54 years, women, white non-Hispanics and black non-Hispanics, and college graduates were less likely to agree with this statement (Table 2).

Approximately 4.0% of adults were classified with serious psychological distress, 10.0% were classified with frequent mental distress, and 10.8% reported receiving treatment for an emotional problem. Although most adults with mental health symptoms (77.6%) agreed strongly or slightly that treatment can help persons with mental illness lead normal lives, about 17.8% disagreed (Table 2). Fewer respondents with mental health symptoms (24.6%) agreed strongly or slightly that people are generally caring and sympathetic to persons with mental illness than those without such distress or treatment (Table 2).

Reported by
R Manderscheid, PhD, National Assoc of County Behavioral Health and Developmental Disability Directors. P Delvecchio, MSW, C Marshall, Center for Mental Health Svcs, Substance Abuse and Mental Health Svcs Admin. RG Palpant, MS, J Bigham, TH Bornemann, EdD, Carter Center Mental Health Program. R Kobau, MPH, MAPP, M Zack, MD, G Langmaid, W Thompson, PhD, D Lubar, MSW, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

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Attitudes Toward Mental Illness --- 35 States, District of Columbia, and Puerto Rico, 2007