Impact of positive images of a person with intellectual disability on attitudes: randomised controlled trial

Sabu John Varughese,Jason Luty,Vania Mendes

doi:10.1192/pb.bp.110.032425

Abstract

Aims and methodTackling discrimination, stigma and inequalities in mental health is a major UK government objective yet people with intellectual disability (also known as learning disability in UK health services) continue to suffer serious stigma and discrimination. We examine the effect of viewing pictures of a person with intellectual disability on stigmatised attitudes. The 20-point Attitude to Mental Illness Questionnaire (AMIQ) was used to assess stigmatised attitudes. Members of the general public were randomised to complete the questionnaire having looked at a good (attractive) or bad (unattractive) photograph of a person with intellectual disability.ResultsQuestionnaires were received from 187 participants (response rate 74%). The mean AMIQ stigma score for the bad photo group was 1.3 (s.e. = 0.3, median 1, interquartile range (IQR) = 0–3,n= 82). The mean AMIQ score for the good photo group was 2.8 (s.e. = 0.3, median 3, IQR = 1–5,n= 105). The difference in AMIQ stigma score was highly significant (two-sidedP= 0.0001, median difference 2, Mann–WhitneyU-test).Clinical implicationsLooking at a good (attractive) picture of a person with intellectual disability significantly reduces reported stigmatised attitudes, whereas a bad (unattractive) picture has no effect.

Highlights

The ‘bad photo’ group were asked to look at a photograph of a man with intellectual disability from the cover of the Learning Disability Coalition leaflet entitled Tell it Like it is.[31]
This study shows that an attractive photograph of a person with intellectual disability significantly reduces stigmatised attitudes when compared with an unattractive photograph
In another study we found that a good photo produced a mean Attitude to Mental Illness Questionnaire (AMIQ) score of 2.43 (s.e. = 0.12, n = 174).[32]

Summary

Results

Service user group transcripts revealed four prominent themes: ‘loss of value’, ‘loss of adulthood and autonomy’, ‘loss of subjectivity’ and ‘shaming or blaming of others’. Staff group transcripts revealed two themes one of which overlapped with service users (‘shaming or blaming of others’) and one of which was distinct (‘entrapment’). As a result shame can correlate with a wide range of psychopathology and self-esteem measures.[3,4,5] In 1987 Lazare noted that people receiving treatment and healthcare sometimes fail to adhere to treatment or else neglect consultations because of shame.[6] Compared with other in-patient settings, psychiatric in-patients may not receive comparable levels of support from relatives.[7] Individuals may enter hospital vulnerable to feeling shame, influencing subsequent treatment and care processes.[6] To date, there are no published reports addressing the global in-patient experience of shame comparing service users’ and professionals’ perspectives.[8] The aim of this qualitative research was to understand ways in which shame experiences are brought into, elicited by and dealt with in in-patient psychiatric care.

Participants

Procedure

Discussion

Strengths and limitations