Effects of labeling and interpersonal contact upon attitudes towards schizophrenia: implications for reducing mental illness stigma in urban China

As mental illness stigma contributes to poor outcomes for schizophrenia in China, locating strategies to reduce public stigma
is imperative. It is currently unknown whether diagnostic labeling and contact with different help-seeking sources increase
or decrease public stigma in China. Further, it remains unresolved whether prior personal contact acts to reduce stigma in
this context. Advancing understanding of these processes may facilitate stigma-reduction strategies.

We administered an experimental vignette randomly assigning one of four labeling conditions to respondents to assess social
distance towards a psychotic vignette individual in a sample of 160 Northern, urban Chinese community respondents.

As expected, respondents given a “non-psychiatric, indigenous label” + “lay help-seeking” condition endorsed the least social
distance. Unexpectedly, the labeling condition with a “psychiatric diagnostic label” + “lay help-seeking” condition elicited
the greatest social distance. Unlike Western studies, personal contact did not independently decrease community stigma. However,
prior contact reduced social distance to a greater extent in the labeling condition with a “non-psychiatric, indigenous label” + “lay
help-seeking” condition when compared with all other labeling conditions.

The results indicate that cultural idioms do provide some protection from stigma, but only among respondents who are already
familiar with what mental illness is. Our finding that the condition that depicted untreated psychosis elicited the greatest
amount of stigma, while the “treated psychosis” condition was viewed relatively benignly in China, suggests that improved
access to mental health services in urban China has the potential to decrease public stigma via labeling mechanisms.