Attitudes towards people with mental illness
Date
2015
Authors
Kenny, Amanda
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Rationale: Attitudes towards people with mental illness (PMI) are widely researched across clinical psychology, psychiatry, and population studies. Numerous scales that measure attitudes and related constructs exist, although the majority have limitations. Principal issues are lack of construct validity, conceptual clarity, and replicability of the factor structure. Objectives: The project aim was to develop an improved measure of attitudes towards PMI and position it within a nomological network of antecedents and consequences. A further goal was to assess the ability of the measure to detect change following interventions designed to improve attitudes. Finally, we aimed to create a brief version of the measure for use in time-constrained settings. Method and Results: The first two studies outline development of the new measure. In Study 1, participants (N = 301) completed questionnaires containing the preliminary 68 items. An exploratory factor analysis identified four factors - fear/avoidance, malevolence, authoritarianism, and unpredictability. The best 28 items formed the Attitudes towards People with Mental Illness (APMI) scale. Confirmatory factor analysis in Study 2 (N = 166) supported the four-factor structure, and the scale and its subscales were reliable. Overall attitudes and the subscales showed differential links to hypothetically related variables, supporting the nomological network of attitudes towards PMI. Antecedents included social dominance orientation, right-wing authoritarianism, Big Five personality traits (openness to experience and agreeableness), empathy, and past contact with PMI. Consequences included disliking and disrespect for people with specific mental illnesses, and self-reported past discriminatory behaviours. Differential associations between the APMI subscales and external variables provided evidence of convergent and discriminant validity. Study 3 (N = 152) used the APMI scale to assess the outcome of two interventions designed to improve attitudes, based on education or acceptance and commitment therapy (ACT). Participants completed the measure two weeks prior to and immediately post-intervention. The ACT intervention was superior at improving overall attitudes, seen specifically on subscales of authoritarianism and unpredictability. Fearful/avoidant attitudes improved in both conditions and malevolent attitudes worsened slightly following both interventions. The findings highlight the utility of the APMI scale to detect changes in specific attitudes. Study 4 (N = 180) aimed to develop a brief version of the scale, the APMI-12. Participants completed the original APMI scale and the best items were selected based on item analysis and confirmatory factor analysis. Reliability analyses showed that the overall scale and its subscales were reliable. The APMI-12 scale related to hypothesised antecedents and consequences, including social dominance orientation, right-wing authoritarianism, social distance, past contact with PMI, and behaviour in hypothetical scenarios. There was also evidence for convergent and discriminant validity of the subscales. Conclusions: This thesis presents development of two scales to measure attitudes towards people with mental illness - the APMI and APMI-12. Future research would benefit from their use as they address limitations in existing measures. The integration of varied streams of research is a valuable and novel contribution to the literature. The discussion outlines practical and theoretical implications, limitations, and directions for future research.
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Thesis (DPsych(Clinical))
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