Public Perceptions of the Social Determinants of Mental Illnesses

Research has shown that public beliefs about the causes of mental illness are linked to stigma attitudes, with biological attributions linked to greater stigmatising attitudes overall than social attributions. The present thesis draws on attribution theory and essentialism theory to investigate whether different types of social attributions have distinct relationships with stigma, with the goal of identifying the types of social explanations associated with the least stigmatising attitudes towards people with mental illness. Study 1 conducted a rapid umbrella literature review of the social determinants of mental illness, identifying empirical evidence for a wide range of social determinants, spanning conflict, violence and maltreatment, life events and experiences, racism and discrimination, culture and migration, social interaction and support, structural policies and inequality, financial factors, employment factors, housing and living conditions, and demographic factors. Study 2 examined how causal attributions for mental illnesses are represented in popular Irish news media, finding that one in four articles that mentioned one of the included mental illnesses contained a causal explanation for that mental illness. Attributions to life events/experiences, the cultural/societal environment, interpersonal relations, and health and lifestyle factors occurred more frequently than attributions to biological or psychological determinants, suggesting that members of the public are frequently exposed to a wide range of social explanations for mental illness. Study 3 developed and validated a novel psychometric tool to measure public social attributions for mental illnesses. The Social Attributions for Mental Illness scale (SAMI) was developed and validated in three phases: item generation, item evaluation and survey development, and psychometric assessment. The resulting scale demonstrated good reliability and validity, and is viable tool for measuring four types of social attributions for mental illness: life circumstances, relational challenges, violence/abuse, and sociopolitical turmoil. Study 4 used the SAMI to explore how each of the resulting constructs, and biological attributions, relate to stigma, in a liner mixed model analysis of cross-sectional survey data. The study found that attributions to sociopolitical turmoil were associated with lower desire for social distance from someone with mental illness, while biological attributions were associated with greater desire for social distance. Attributions to life circumstances, relational challenges, and violence/abuse were unrelated to social distance. Study 5 presented each of the five aforementioned types of causal explanations to members of the public in the form of a fabricated news article, for depression (5a) and schizophrenia (5b). While the articles had limited impact on participants’ causal beliefs, those exposed to explanations for depression that centred around violence/abuse were significantly more likely to rate the person presented in the article as more dangerous. The articles otherwise did not significantly impact participants’ desire for social distance or perceptions of dangerousness. This thesis presents the first investigation of the differential implications of specific social attributions for mental illness, presenting a novel contribution to the empirical and theoretical literature. The findings offer guidance surrounding how causal explanations for mental illnesses may be communicated to the public in a socially responsible manner, with applications for anti-stigma campaigns, news outlets, public health informational resources, and other campaigns and initiatives. Despite potentially limited applicability of the findings to non-western populations, this thesis presents a novel contribution to knowledge, with numerous implications and future directions for public communications, clinical practice, policy, empirical research, and theory.