(PS13-A6) Association Between Mental Illness Stigma and Controllability of Everyday Mental States

Background: Stigmatized attitudes towards those with mental disorders is a widespread, persistent, and harmful public health problem. Stigma is associated with a host of negative social and economic consequences for those with mental illness (Thornicroft et al., 2016). One hypothesized driver of stigma is the belief that mental illness is the result of poor choices that are within the individuals’ control and therefore their condition is their fault (Corrigan, 2000).

An unaddressed question is why people believe that mental illness is controllable. Since mental health disorders involve disordered emotional reactions, thoughts, and behaviors, one unexplored possibility is that people generalize from beliefs about the controllability of everyday mental states and behaviors to reason about the controllability of mental disorders. Given that prior research suggests that people believe humans have control over mental states (Cusimano & Goodwin, 2019), they may assume those with mental disorders possess similar levels of control. Furthermore, beliefs about control are strongly and positively associated with judgments of fault and responsibility. Thus, beliefs about the controllability and responsibility (i.e., “fault’) of everyday mental states may partially underlie with mental illness stigma.

Method: Participants were 100 adults (ages 12-19) recruited on the internet. Participants provided ratings of control and responsibility (i.e., fault) for uncontrollable events, such as having an itch, emotions, thoughts and behaviors for different vignettes describing everyday events, such as job stress or ending a relationship. Each participants received one of four possible endings for each vignette so that we could account for any differences in the vignettes. Participants also completed the Endorsed and Anticipated Stigma Inventory (EASI).

Results: After averaging control and fault ratings over different mental states and over participants, results of a linear regression replicated the effect showing that participants’ attributions of control predicted attributions of fault over all mental states and behaviors (β = .67, p < .001). We also found that both attributions of control and fault were independently associated with stigmatizing attitudes toward mental illness (control: β = .23, p < .05; fault: β = .38, p < .001). However, in a multiple regression with control and fault predicting stigma, only fault predicted stigma (control: β = -.05, p > .7; fault: β = .42, p < .001).

Conclusion: First, we replicated findings showing that beliefs about control over their everyday mental states and behaviors predicts attributions of fault for such states. Second, we found that attributions of control and fault for everyday mental states and behaviors were independently related to stigmatizing attitudes about mental illness but that when put together in a model, only fault was related to stigma. These results suggest that people may generalize beliefs about the controllability of everyday mental states to beliefs about control over mental illness and that attributions of fault for everyday mental states may mediate the relationship between attributions of control and mental illness stigma.