Stigma towards people with mental health problems: an individualism-collectivism cross-cultural comparison.
This study explored whether the cross-cultural value paradigm ‘individualismcollectivism’ is a useful explanatory model for mental illness stigmatisation on a\ud cultural level. This has never before been directly investigated despite numerous clues of its potential importance in previous related literature. The paradigm asserts that in ‘collectivist’ cultures, people are more strongly interdependent with their in-groups, and are more likely to give priority to the goals of their in-groups than people from ‘individualistic’ cultures, who are instead more likely to value and desire autonomy and independence from their in-groups, and give priority to their personal goals than to their in-group goals. Three hundred and five individuals from four UK-based cultural groups (white-English, American, Greek/Greek Cypriot, and Chinese) were successfully recruited for a quantitative survey through the use of non-randomised snowball and quota sampling. Twenty-two of these individuals were later qualitatively interviewed in a one-to-one, semi-structured manner. Questions regarding where the four cultures fit within the individualism-collectivism paradigm, how acculturation affects the individualismcollectivism\ud paradigm, what other factors explain stigmatisation, and the level of stigmatising attitudes present in these cultures, were also integrated into the methodological components in an attempt to explore these other important themes. The results partially supported the hypothesis that the paradigm can be applied to explain mental illness attitudes. Increases in the paradigm’s explanatory power\ud corresponded with a cultures’ stigmatisation level. Specifically, the more stigmatising a culture’s mental illness attitudes are, the more likely collectivism effectively explains these attitudes. In contrast, the more positive a culture’s mental illness attitudes, the more likely individualism effectively explains attitudes. Educational level, mental illness experience, and, particularly, mental illness knowledge, were other powerful and consistent stigma explanatory factors, although the stigma affect of these and impact of other key themes were unique to each cultural group. The results\ud also revealed that successfully acculturating to a new culture can impact on one’s cultural values including levels of individualism-collectivism. The American cultural\ud survey group held the most positive mental illness attitudes, followed by the white English group. Both groups also scored high on levels of individualism. The\ud Greek/Greek Cypriots and Chinese held the least positive attitudes and were also found to be generally collectivistic. None of the survey groups’ scores were wholly stigmatising, which suggests a positive shift towards more tolerant attitudes having taken place in recent years even in the Greek/Greek Cypriot and Chinese cultures. This is illuminating as these are traditionally particularly stigmatising cultures, which qualitative interviewees also argued. A number of important recommendations for policy and practice that aim to reduce\ud stigma and highlight the importance of culture are proposed. These include anti-stigma campaigns needing to be culturally and linguistically appropriate and sensitive; using in-group, second-generation members of closed and collectivist communities/cultures to deliver of anti-stigmatising initiatives and; training practitioners to understand the impact of individualism-collectivism on mental health attitudes. Further, a consideration of the individualism-collectivism paradigm should be included in any future research aiming to provide a holistic understanding of the causes of mental illness stigma both on an individual and cultural level.
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