Vignette Conditions Research Articles

Examining the relationship between public stigma, models of addiction, and addictive disorders

Background The stigmatization of addiction has been identified as a barrier to treatment-seeking among individuals with substance use concerns. Although some evidence exists that beliefs in different models of addiction (MOAs) are associated with stigma, the research is limited in several ways. The aim of the current study is to understand the relationship between different MOAs and public stigma toward substance use disorders and behavioral addictions. Method Participants were 755 adults who completed an online survey on MTurk (Mage = 36.2, SD = 10.1, 40.3% women, 59.4% men) and were randomized to one of four vignette conditions describing an individual with alcohol use disorder, opioid use disorder, problem gambling disorder, or diabetes. Participants completed measures assessing perceived stigma toward the vignette character and beliefs related to five MOAs (disease, moral, psychological, sociological, nature). Results Stigma ratings were significantly higher in the alcohol and opioid use disorder conditions compared to the problem gambling and diabetes conditions. Greater beliefs in the disease MOA were associated with greater stigma in the problem gambling condition, whereas greater beliefs in the moral MOA were associated with greater stigma in all addiction conditions. Greater beliefs in the psychological MOA were associated with lower stigma in the opioid use disorder and problem gambling conditions. Conclusions The current study provides further support that addictive disorders are more stigmatized than other health disorders and suggests that beliefs in specific MOAs are differentially associated with stigma. Interventions addressing addiction stigma may consider incorporating information emphasizing MOAs that are less stigmatizing.

Nature and/or Nurture: Causal Attributions of Mental Illness and Stigma

Most medical researchers and social scientists concur that mental illness is caused by “nature” and “nurture,” yet efforts to reduce stigma tend to focus on biomedical causes. This study analyzed original survey data collected from 1,849 respondents in 2021–2022 who were randomly assigned to 16 experimental vignette conditions. Each vignette portrayed a man and varied according to which psychiatric diagnosis his situation resembled (alcohol dependence, depression, or schizophrenia) and what caused it: genetics (nature), environmental stress (nurture), or both. Control conditions included subclinical distress and no explanation. Exposure to the environmental explanation (vs. no explanation) predicted identifying mental illness, reduced expectation of violence toward others, increased willingness to socially interact, and optimism for recovery with treatment. Exposure to the nature and nurture explanation (vs. no explanation) predicted reduced desire for social distance. Implications of these findings for future research and for contact-based anti-stigma efforts are presented.

Understanding community attitudes toward miscarriages of justice: the role of social characteristics on perceptions of wrongfully convicted exonerees

ABSTRACT Objective: Not all exonerees are perceived equally. Attitudes toward exonerees are negatively impacted by social characteristics, such as race and criminal history; providing significant challenges for exonerees attempting to reintegrate into the community. The present study examined whether exoneree race, gender and criminal history influenced ratings of desired social distance. Method: A community sample of 1043 females and males completed an online survey. Participants were asked to read a vignette of a mock news article that described a wrongful conviction, then complete a desired social distance scale. Exoneree gender, race and criminal history were manipulated in the news article, with a minimum of 120 participants randomised to eight vignette conditions. Results: Exoneree race and the presence of a prior criminal history had significant main effects on participant attitudes regarding desired social distance. There were no interactions between exoneree gender, race and priors, but differences did emerge suggesting differential views of desired social distance for females and older participants when the exoneree had a prior offence. Conclusion: Social characteristics, demographics and individual differences may be particularly important in forming community attitudes toward wrongful conviction. This holds important implications for exoneree reintegration and community attitudes toward the Australian criminal justice system.

An examination of college student helping intentions: depression, suicidal, and homicidal presentations

ABSTRACT Depression is common in college students. Little research has examined peer helping intentions when a student is posed with a peer disclosing depression. Moreover, little research has examined how helping intentions may change with presentation severity (e.g. if suicidal or homicidal ideation is present). We addressed these questions by collecting data from a large sample of college students. Participants were randomly assigned through an online survey into one-of-three experimental vignette conditions to a hypothetical peer with depression (n =198), depression with suicidal ideation (Depression-SI; n = 194), and depression with homicidal ideation (Depression-HI; n = 175). Participants then responded to a measure of helping intentions. Respondents across conditions indicated they generally intended to help their peer. Referrals to a mental health professional and family members were the most frequently chosen, with referrals to a hotline or website being the least frequently chosen. Participants in the Depression-HI condition reported the greatest helping intentions, followed by participants in the Depression-SI condition. Participants in the Depression condition reported the lowest helping intentions. College students likely intend to help their peers with mental health concerns, particularly if the peer is presenting with risk factors that may indicate a threat of violence.

STIs and Stigma: Effects of STI Diagnoses and Sexual/Gender Minority Identity on Perceptions of Potential Partners

This study tested how an STI diagnosis influences perceptions of hypothetical romantic/sexual partners. In an online experiment, participants (n = 189) were randomly assigned to one of five vignette conditions, which varied in how a potential partner’s STI status was described. HSV or HIV-positive status (with treatment) decreased the likelihood that participants would have sex or a relationship with the target. However, LGBTQ participants were less likely to consider an STI diagnosis a deal-breaker relative to cisgender, heterosexual participants. Results highlight a need for accurate sex education content about living with treatable but incurable STIs.

Adults apply different criteria for virginity loss depending on the context of the judged behavior

ABSTRACT Introduction Health care practitioners may rely on abstract concepts such as “virginity loss” when assessing emerging adults’ sexual history. Additionally, virginity loss can be an important life event or “a turning point” in a person's sexual life. Sometimes, virginity loss has social implications and can be associated with potential social status changes. Therefore, it is important to understand emerging adults’ definitions of “virginity loss”. Objective The current study analyzed whether emerging adults apply different criteria for virginity loss depending on the context of the judged behavior. Methods The online study included 987 persons (75% women/25% men; M age = 23.7, SD = 3.8) from German-speaking countries. Each participant was assigned one of 16 vignette conditions. Each vignette described a situation in which two persons engage in intimate partnered behavior. The main character's gender, sexual orientation, the partner's gender and the commitment of the two persons to each other were manipulated. Participants had to indicate whether 13 intimate partnered behaviors qualified as virginity loss in the given context. Multinomial logistic regression models were calculated for the analysis. Results Almost all participants agreed that penile-vaginal intercourse constituted loss of virginity. However, other intimate partnered behaviors were more likely judged to constitute loss of virginity only when the two partners had the same gender. For instance, penile-anal intercourse was often perceived as virginity loss only when two men engaged in this intimate partnered behavior. Conclusion Emerging adults do not agree on whether intimate partnered behaviors other than penile-vaginal and penile-anal intercourse between two men constitute virginity loss. Even though participants seem to apply different standards for virginity loss definitions depending on the gender of the involved partners, they mostly judge close physical partnered behaviors as virginity loss when the behavior is or resembles penile-vaginal intercourse. Thus, participants seem to base their virginity loss definitions on heteronormative beliefs. The devaluation and non-acceptance of close physical partnered behaviors that do not resemble penile-vaginal intercourse as constituting virginity loss may lead some emerging adults to feel pressured to engage in non-preferred close physical partnered behaviors in order to not be denied social implications or social status changes that may result from virginity loss. For health care practitioners it is recommended to use descriptions of concrete behavior and not rely on abstract concepts such as “virginity” when taking a patient's sexual history. Disclosure Work supported by industry: no.

The negative implications of relative deprivation: an experiment of vicarious police contact and Muslims’ perceptions of police bias

ABSTRACT For decades, Muslims living in Western countries have experienced disproportionate scrutiny from police. Such scrutiny can result in relative deprivation; the feeling that they or their group is unfairly disenfranchised compared to others. Scholars have theorised that relatively deprived individuals may assess police-citizen interactions as more biased than non-relatively deprived individuals. Yet, limited research tests this relationship. The current study utilises survey data collected from 502 Muslims in Australia. The survey contained an embedded vignette experiment depicting a male Muslim driver being pulled over by a police officer. The officer’s behaviour was manipulated between participants in the vignette (as procedurally just versus procedurally unjust). Participants were asked if the officer in the vignette acted in a biased manner. Findings showed that officer behaviour significantly impacted perceptions of bias but was moderated by the degree of relative deprivation felt by the participant prior to reading the vignette. Compared to those scoring low on relative deprivation, those scoring high on relative deprivation showed less variation in police bias ratings between the procedurally just and unjust vignette conditions. Implications for the utility of relative deprivation theory in policing, particularly against the backdrop of a renewed focus on police bias, are discussed.

A Vignette Study Analyzing Contextual Factors that Influence Emerging Adults’ Definitions of Virginity Loss in German-Speaking Countries

ABSTRACT Past research on virginity loss definitions revealed that emerging adults’ definitions of virginity loss are associated with emerging adults’ own sociodemographic characteristics. However, previous research has not systematically studied whether emerging adults applied different criteria for virginity loss depending on the context of the judged behavior. The current study used vignettes to explore which contextual factors of an intimate partnered behavior influence emerging adults’ definition of virginity loss. Each of the 987 participants (75% women/25% men; M age = 23.7, SD = 3.8) was assigned to one of 16 vignette conditions. The main character’s gender, sexual orientation, and commitment to the partner were manipulated in the vignettes, describing the main character engaging in intimate partnered behavior with either a woman or a man. Participants had to indicate whether 13 intimate partnered behaviors qualified as virginity loss in the given context. Emerging adults applied different standards for virginity loss definitions depending on the involved partners’ gender. They counted more behaviors as virginity loss in conditions where two people of the same gender engaged in intimate partnered behavior. Healthcare practitioners concerned with emerging adults’ sexual health should be aware of these double standards for virginity loss definitions.

Moral Framing and Mechanisms Influence Public Willingness to Optimize Cognition

Scientists, clinicians, and the public aim to optimize cognition using numerous techniques. While drugs and education have become mainstays in the public and professional practice, brain stimulation is rapidly emerging. The public reports some concerns about brain stimulation used to optimize cognition. In our prior work using hypothetical vignettes involving brain stimulation, the moral acceptability of specific uses was only somewhat related to the public’s willingness to administer brain stimulation to influence a given cognitive function. Notably, whether the moral framing influences willingness to optimize cognition with various mechanisms is unknown. Here, we randomly assigned subjects to one of four mechanism vignette conditions: education, drugs, invasive brain stimulation, and noninvasive brain stimulation. Within each mechanism, subjects were assigned to think morally either before or after reporting their willingness to optimize specific cognitive functions in others. Across 1328 subjects, we found that thinking morally reduced the public’s willingness to optimize cognition overall. Moreover, willingness decreased the most in invasive and noninvasive brain stimulation. Encouraging moral reasoning uniquely reduces openness to using brain stimulation among other ways to optimize cognition. Studying how specific moral concerns drive public hesitancy about brain stimulation could suggest avenues for education and ethical discourse.

Assessing attitudes toward juveniles and adults adjudicated for sexual offenses in Canada: does offender age matter?

ABSTRACT Over the past several decades, societal responses to juvenile crime has evolved from harsh sentences (including death) to more lenient punishments in congruence with our greater understanding of adolescent development. However, some groups of young offenders, such as those convicted of sexual offenses, appear to have fallen victim to a more punitive zeitgeist, where the mitigating effect of age may be diminished. In a 3 × (2) design, participants were randomly assigned to one of three vignette conditions and completed several measures regarding both juveniles and adults adjudicated for sexual offenses, including attitudes, moral outrage, and recommendations for sentence length and registration. Results indicated that adjudicated juveniles are viewed more favourably than their adult counterparts, although both received relatively long sentences. Further, over 90% of participants endorsed some form of registration for juvenile offenders. Implications for offender reintegration and public policy are discussed below.

Severity of Coercive Sexual Harassment in Professor–Student Interaction and Peer Bystander Responses

The risk for female students in academia of sexual harassment by male faculty and staff remains a national crisis. This study examined effects of severity of coercive sexual harassment (CSH) by a male professor of a female student on peer bystander intervention responses. A total of 180 undergraduate and graduate college students who volunteered for an online survey were randomly assigned to one of three vignette conditions that varied severity of CSH. Following Bowes-Sperry’s ethical model of bystander behaviors, it was predicted that severity of CSH would affect cognitive appraisals and emotional reactions, which would further predict intentions for intervention behaviors. Predictions generally were supported. Logistic regression analyses indicated that severity of CSH, fears of consequences, and negative emotions toward the professor were significant predictors of direct confrontation of the professor by the student observer, whereas only severity and negative emotions toward the professor were predictors of the indirect intervention (finding an excuse to remove the victim) or delegation (going to get help) while the incident was occurring. Fears of personal consequences suppressed direct intervention in the moderate condition. Findings suggest ongoing need within academia for clarification of behaviors that constitute CSH, as well as safety for bystanders who intervene.

Psychosis risk stigma and help‐seeking: Attitudes of Chinese and Taiwanese residing in the United States

Intervention during the clinical high-risk phase for psychosis (CHR) can reduce duration of untreated psychosis and associated negative outcomes. Early treatment access and sustained engagement are important to understand for effective intervention. Understanding stigma and help-seeking processes is particularly important for groups that experience mental healthcare disparities such as those of Chinese heritage living in the United States. Chinese and Taiwanese participants (N = 215) residing in the United States were randomly assigned to one of three CHR vignette conditions based on the "what matters most" stigma framework for Chinese groups, which identifies capacities that define "personhood" and thereby shapes stigma for members of a particular cultural group. Participants completed measures of help-seeking attitudes, family stigma and individual stigma. More stigma towards the CHR vignette character's family was associated with positive CHR help-seeking attitudes. Participants who read the vignette describing CHR affecting family obligations, "what matters most" and participants who read the vignette describing CHR symptomology only had more positive CHR help-seeking attitudes compared to participants who read the vignette describing CHR affecting individual aspirations. Chinese and Taiwanese residing in the United States may perceive professional mental healthcare to be especially relevant for persons with CHR when symptoms are particularly stigmatizing for the person's family and when symptoms threaten the person's ability to fulfil family obligations (ie, "what matters most"). Clinical implications of findings include the importance of emphasizing positive treatment outcomes that increase an individual's ability to engage in valued life domains.

Public perceptions toward mental illness in Japan.

The purpose was to characterize public perceptions in Japan of mental illness and how they related to stigma-related attitudes for the same. Data were obtained using a vignette survey conducted as a part of the Stigma in Global Context - Mental Health Study and contained a nationally representative sample (n = 994). The survey was conducted using a multi-mode approach (face-to-face interviews, the drop-off-and-pick-up, postal collection) from September to December 2006, with a multi-stage probability sample of Japanese residents aged 18-64 years. Respondents were randomly assigned one of four vignette conditions that described psychiatric disorders meeting the diagnostic criteria for schizophrenia and major depressive disorder (one vignette for each gender exhibiting each diagnosis). We compared respondents' stigma-related attitudes and perceptions toward mental illness between vignettes. Over 80% of Japanese participants believed that depressive disorder or schizophrenia could be cured via treatment. However, Japanese people still had relatively strong vigilance and denial of competency toward schizophrenia. Participants expressed the belief that mental illnesses are curable, but stigma toward people with schizophrenia was still relatively strong.

The Mild Traumatic Brain Injury Rest and Activity Questionnaire (MTBI-RAQ): A Pilot Study

Objective: To develop a tool for assessing intentions to continue or change activities for recovery following mild traumatic brain injury (mTBI) and determine if they are dependent on injury context or activity type. Method: Adult volunteers with no (or no recent) history of mTBI were randomly allocated to one of two vignette conditions, each with a different injury context. The vignette described an mTBI due to a motor vehicle accident (MVA, n = 76) or sport (SPORT, n = 89). Volunteers reported their rest or activity plans for 39 behaviours comprising three behaviour types (cognitive, physical, and restful). Results: Compared to a cut-score representing no change, on average there was a significant (p <= .001) planned decrease in physical and cognitive behaviours (MVAphysicalt(53) = 7.373; SPORTphysicalt(41) = 9.281; MVAcognitivet(41) = 9.367; SPORTcognitivet(51) = −3.521) and a significant planned increase in restful behaviours, such as sleep (MVArestfult(72) = 10.006; SPORTrestfult(86) = 9.566). An overall within-group effect for behaviour-type was not identified and there was no effect of condition (MVA vs. SPORT). Conclusion: The acute rest and activity plans for a simulated mTBI are behaviour specific and not dependent on context. An expectation for blanket-rest was not was observed but rest was planned for specific behaviours. This tool could be used to guide discussions with mTBI patients about their recovery so that their plans align with advice, and it could aid further research into the relation between intended and actual rest and activity and the effect on eventual outcomes.

A case-controlled field study evaluating ICD-11 proposals for relational problems and intimate partner violence

Background/Objective: Intimate partner relationship problems and intimate partner abuse and neglect — referred to in this paper as “relational problems and maltreatment” — have substantial and well-documented impact on both physical and mental health. However, classification guidelines, such as those found in the International Classification of Diseases (ICD-10), are vague and unlikely to support consistent application. Revised guidelines proposed for ICD-11 are much more operationalized. We used standardized clinical vignette conditions with an international panel of clinicians to test if ICD-11 changes resulted in improved classification accuracy. Method: English-speaking mental health professionals (N = 738) from 65 nations applied ICD-10 or ICD-11 (proposed) guidelines with experimentally manipulated case presentations of presence or absence of (a) individual mental health diagnoses and (b) relational problems or maltreatment. Results: ICD-11, compared with ICD-10, guidelines resulted in significantly better classification accuracy, although only in the presence of co-morbid mental health problems. Clinician factors (e. g., gender, language, world region) largely did not impact classification performance. Conclusions: Despite being considerably more explicated, raters’ performance with ICD-11 guidelines reveals training issues that should be addressed prior to the release of ICD-11 in 2018 (e. g., overriding the guidelines with pre-existing archetypes for relationship problems and physical and psychological abuse).

T214. STIGMA ABOUT SCHIZOPHRENIA: THE EFFECTS OF DIAGNOSTIC LABELS, SYMPTOMS, AND ILLNESS PHASE

BackgroundSchizophrenia is possibly the most stigmatised of all mental disorders. It has been argued that the label of schizophrenia itself has become stigmatically charged through over a century of association with misleading and sensationalist representations in news media and pop-culture. There has, therefore, been considerable recent debate on the topic of changing the label of schizophrenia. Label change advocates argue that public stigma about schizophrenia would be reduced should the label be replaced with either an eponymous or descriptive alternative. However, few empirical studies to date have directly investigated this possibility. Moreover, no known single study has investigated the effects of descriptive and eponymous relabelling of schizophrenia on public stigma as a function of symptomatology and illness phase. The current study aimed to fill this gap in the literature.MethodsAustralian university students (m = 181, f = 176, other/unspecified = 4, Mage = 19.58 years, age range 17–60 years) participated in the study by reading a brief vignette depicting a protagonist with schizophrenia, and by subsequently completing a number of stigma measures. Participants were randomly allocated to vignette conditions that varied systematically by disorder label (schizophrenia vs eponymous label vs descriptive label), symptoms (positive vs negative symptoms), and illness phase (active vs remittent symptoms). Stigmatised thoughts, attitudes, and behaviour were measured using the Social Distance Scale (SDS; Link et al., 1987) and selected items forming six factors (Fear/Dangerousness, Help/Interaction, Responsibility, Forced Treatment, Pity, and Anger; Brown, 2008) from the Attributional Questionnaire (AQ; Corrigan et al., 2004). Socially desirable response bias and familiarity with mental illness were controlled using the Marlow-Crowne Social Desirability Scale (Crowne & Marlow, 1960), and Level-of-Contact Report (Holmes, Corrigan, Williams, Canar & Kubiak (1999).ResultsData was analysed with a series of ANCOVA and ANOVA analyses. No group differences in either SDS or AQ scores were observed as a function of disorder label. Positive symptoms were observed to elicit significantly greater levels of fear/dangerousness responses and endorsement of forced treatment when compared to negative symptoms. However, negative symptoms elicited significantly greater anger responses. While only these isolated differences on stigma measures were observed for symptom profile contrasts, vignettes depicting an active illness phase elicited significantly greater levels of stigma on the SDS and most AQ factors when compared with vignette conditions depicting a symptomatically remittent protagonist. Lastly, no statistically significant interactions were observed between labels, symptomatology and illness phase.DiscussionThe results suggest that diagnostic label change may not be an effective strategy to reduce public stigma about schizophrenia in western countries. It is important to note, however, that public stigma elicitation is just one of the numerous considerations as regards the utility of label change, and that others, such as consumer perspectives, hold value independent of the current findings. The current findings also highlight that the symptomatology and illness phase of schizophrenia are likely to be implicated in eliciting public stigma about the disorder, and are worthy of further attention. While the current study investigated these phenomena at the broad symptom profile level, future research should investigate individual symptoms and their subtypes discretely, in order to inform a comprehensive, symptom-focussed model of elicited public stigma pertaining to schizophrenia.

Assault-related mild traumatic brain injury, expectations of injury outcome, and the effect of different perpetrators: A vignette study

ABSTRACTFew studies have examined the effect of varying the assault perpetrator on expectations of outcome from mild TBI. Using a cross sectional between groups design, individuals with no history of mild TBI were randomly allocated to one of two vignette conditions. The vignette depicted a mild TBI with fixed injury parameters and a different assault perpetrator (partner, n = 27; or stranger, n = 27). The participants were instructed to imagine that they had been injured as per the depiction, and then to anticipate the injury consequences 6-months later. An online questionnaire was used including: the Neurobehavioral Symptom Inventory, the Posttraumatic Stress Disorder Checklist-Civilian Version, the Impact of Events Scale-Revised, and the Perceived Ability to Cope with Trauma. The depicted injury was rated for the extent to which it was perceived as life-threatening, the subsequent diagnosis, and the global recovery prospects. The anticipated consequences of the injury (symptoms and trauma variables) did not differ across the conditions, all p’s > 0.05. The expected outcomes for an assault-related mild TBI were not affected by perpetrator type. However, the study had several limitations and further consideration of this factor may still be warranted.

What's in a Name? Health Care Providers' Perceptions of Pediatric Pain Patients Based on Diagnostic Labels.

Diagnostic labels can help patients better understand their symptoms and can influence providers' treatment planning and patient interactions. Recurrent pain is common in childhood; however, there are various diagnostic labels used. The objective of this study was to evaluate the influence of diagnostic labels on pediatric health care providers' perceptions of pediatric chronic pain patients. Using an online survey, providers were randomly assigned to 1 of 2 vignette conditions (differing only in diagnostic label provided) and completed questionnaires about their perceptions of the vignette patient. Responses from 58 participants were analyzed. The 2 groups, based on diagnostic conditions used (fibromyalgia and chronic widespread pain) did not differ significantly on general demographics and health care providers' perceptions of the patient. Perceived origin of the pain influenced providers' perceptions; pain of a perceived medical origin was negatively correlated with stigmatization and positively correlated with sympathy. Perceived psychological origin was positively correlated with stigmatization and providers' age. Health care providers' perceptions of children's pain are more likely influenced by the presumed etiology rather than the diagnostic label used. Pain believed to be more medically based was associated with more positive reactions from providers (ie, less stigmatization). Older providers in particular perceived the patient more negatively if they believe the pain to be psychologically based. The findings of this pediatric study replicated findings from adult literature on chronic pain, suggesting that children and adults are subject to negative perceptions from health care providers when the providers believe the pain to be psychological in origin.

The Gay Panic Defense: Legal Defense Strategy or Reinforcement of Homophobia in Court?

Gay panic refers to a heterosexual man violently responding to unwanted sexual advances from a gay man. In court, the defendant may argue he was provoked or temporarily insane. This study utilized 352 jury-eligible citizens to assess differences across mediums of gay panic. Participants were asked to read vignettes depicting a control, gay panic as provocation, or gay panic as insanity condition and provide verdicts and ratings of blame and responsibility. Participants also completed measures assessing political orientation and homonegativity. Data were analyzed via a MANCOVA, a chi-square goodness-of-fit test, and general linear modeling. Verdicts, victim blame, and ratings of responsibility differed across vignette conditions, with an observed leniency effect when gay panic was claimed in either context. Homonegativity also exacerbated patterns of prodefendant views, as participants higher in homonegativity assigned higher victim blame, lower defendant responsibility, and more lenient verdicts in the gay panic conditions. The effect of political orientation was nuanced, as only republicans in the provocation condition followed the anticipated pattern in rendering more lenient verdicts. Results provide additional support for the notion gay panic defenses may be, in part, fueled by political beliefs and prejudicial beliefs against persons of sexual minority status. Drawing from a justification-suppression model, it may be that in cases of gay panic, a context is created in which prejudiced ideologies can be openly expressed via leniency on the defendant. Implications may be relevant to future criminal law policies and practices, particularly advocacy and policy efforts, judicial training, and trial consultation to attorneys for juror selection and development of trial strategy.

Treatment recommendations for schizophrenia, major depression and alcohol dependence and stigmatizing attitudes of the public: results from a German population survey.

In addition to mental health literacy, several potentially conflicting emotions and attitudes among the public are hypothesized to guide their recommendations for specific mental health treatments. It is unclear whether evidence-based treatment strategies are guided by pro-social or stigmatizing attitudes and emotions. In a representative population survey in Germany (n=3642), we asked respondents to what extent they would recommend psychotropic medication, psychotherapy and relaxation techniques for a person with mental illness described in an unlabelled vignette. For each treatment recommendation, we used multinomial logistic regression analyses to obtain predicted probabilities. Predictors comprised illness recognition, vignette condition, causal beliefs (current stress, childhood adversities, biogenetic), emotions (fear, anger, pro-social reactions), social distance, age, gender and education. Fear predicted greater probability for recommending psychotropic drugs in all investigated illnesses (p<0.001), whereas associations of fear with recommending psychotherapy were generally lower and no associations with the recommendation for relaxation techniques were found. Anger was related to fewer recommendations for psychotherapy in all illnesses (p<0.01). Pro-social reactions were predominantly related to the recommendation of relaxation techniques for a person with schizophrenia or major depression (p<0.001). Higher desire for social distance predicted fewer recommendations for relaxation techniques in all three vignette conditions (p<0.05). Our study corroborates findings that treatment recommendations are not necessarily linked to pro-social reactions or mental health literacy. The recommendation for a treatment modality like psychotropic medication or psychotherapy can be linked to underlying fear, possibly reflecting a public desire for protection against people with mental illness.