Public knowledge, beliefs and attitudes towards patients with schizophrenia: Buenos Aires

ORIGINAL PAPER

Public knowledge, beliefs and attitudes towards patientswith schizophrenia: Buenos Aires

Eduardo Adrian Leiderman • Gustavo Vazquez • Candela Berizzo •

Ana Bonifacio • Noelia Bruscoli • Juan I. Capria • Betina Ehrenhaus •

Manuel Guerrero • Maria Guerrero • Maria Lolich • Roumen Milev

Received: 16 December 2008 / Accepted: 3 February 2010

� Springer-Verlag 2010

Abstract

Objective The purpose of our study was to assess the

knowledge, social distance and perception of social dis-

crimination towards persons with schizophrenia in the

general adult population of Buenos Aires, Argentina.

Methods One thousand two-hundred fifty-four persons

were surveyed at different neighborhoods of the city of

Buenos Aires. Their knowledge about schizophrenia, per-

sonal social distance and perception of social discrimina-

tion were assessed with several questions. Afterwards, a

scale for each one of these measures was built.

Results Almost half of the general population believed

that patients with schizophrenia suffer from split person-

ality and that most of them are dangerous and violent.

Knowledge about schizophrenia in the general population

was moderate and it was associated with age and educa-

tion. Almost 80% of the population had less than one-third

of the maximum possible social distance score, but their

perception of social discrimination was high. Social dis-

tance was greater in the elderly. Knowledge was correlated

weakly with social distance. Respondents directly related

with patients suffering from schizophrenia were more

knowledgeable about the illness, but had the same social

distance and perception of social discrimination than the

rest of the general population.

Conclusions The persons surveyed felt their own atti-

tudes are more favorable to people with schizophrenia than

‘most other people’s’ attitudes. The elderly should be

specifically addressed in specially designed anti-stigma

campaigns.

Keywords Schizophrenia � Discrimination � Stigma �Social distance � Mental health literacy

Introduction

Schizophrenia is a severe and persistent mental disorder,

affecting approximately 0.5–1% of the population [4]. It is

often chronic and it can bring significant functional

impairment for the individual and create a burden for

society [12, 42]. Nevertheless, numerous factors are asso-

ciated with outcome, and different interventions may allow

the vast majority of patients to live in the community and

increase their likelihood of sustained recovery. Studies

have found that between 5 and 22% of the patients recover

from a first episode without subsequent recurrence of

symptoms [29, 54], and that almost 40% of people with

schizophrenia can enjoy a sustained and functional recov-

ery after one or more psychotic episodes [25].

Schizophrenia has always provoked public interest since

some of its symptoms, such as delusions and hallucina-

tions, are difficult to comprehend. Patients with schizo-

phrenia rarely commit serious crimes, but when they do,

they might be so bizarre and unpredictable, that the media

give them a significant attention [40, 53].

Stigma refers to the negative attitudes and beliefs held

towards patients with schizophrenia [49]. Knowledge about

schizophrenia, or lack thereof, can shape the attitudes and

behavior of the public. Discrimination occurs when the

rights and freedoms of a person with schizophrenia are

denied because of their illness. The experience of stigma

and discrimination because of schizophrenia may be

E. A. Leiderman (&) � G. Vazquez � C. Berizzo �A. Bonifacio � N. Bruscoli � J. I. Capria � B. Ehrenhaus �M. Guerrero � M. Guerrero � M. Lolich � R. Milev

Universidad de Palermo, Buenos Aires, Argentina

e-mail: [email protected]

123

Soc Psychiat Epidemiol

DOI 10.1007/s00127-010-0196-0

devastating for the individual and can be detrimental to

recovery [9, 33, 34]. Negative consequences, such as

reduced employment [39], lower self esteem [37] and

depression [36] have been reported with stigmatization,

and people who perceive discrimination are more disabled

and more symptomatic [22].

There have been numerous attempts to measure the

knowledge of the general population about mental illness

in general and schizophrenia in particular. Attitudes

towards people with schizophrenia have been usually

assessed by rating social distance. Most studies utilized a

modified version of a scale designed to measure attitudes

towards cultural minorities [10, 28].

The respondent’s sociodemographic characteristics,

such as age, social class and level of education have reg-

ularly been found to influence attitudes towards people

with mental illness on studies carried out in developed

countries [5, 55].

There is a scarcity of information about perception of

mental disorders and stigmatization of people with

schizophrenia in Latin America [52] and specifically in

Argentina. Up to date, only small studies about attitudes

towards mental illness in Argentina have been published.

These studies revealed that the surveyed have a propitious

attitude toward the people with mental illness (measured by

the Scale of Attitudes toward mental illness of Stefani) [45,

46]. The attitude was more favorable in individuals with

higher socioeconomical and education level and lower

degree of authoritarianism [45, 46]. However, large-scale

studies about attitudes towards mental illness have not been

done in this country.

In this study, we attempt to evaluate the knowledge,

social distance and perception of social discrimination in

the general adult population of Buenos Aires, Argentina

and compare them with other international studies. We also

try to determine whether demographic characteristics of the

respondents and their familiarity with people with schizo-

phrenia correlate with each one of the studied variables.

Methods

Sampling

We carried out a survey among inhabitants of Buenos

Aires, Argentina, aged 18 years and older, between May

and September of 2007. A non-probability sample of 1,254

respondents was selected using convenience sampling. The

survey was conducted by eight psychology students of the

University of Palermo at Buenos Aires. Raters received

several training sessions at the university to ensure inter-

rater objectivity. People were surveyed on the streets, in

parks, public transportation stations and commercial

centers of almost all neighborhoods of Buenos Aires City.

Raters were instructed to approach every person at a first

passed—first surveyed basis. Consent was considered to be

given with the agreement of the individual to complete the

interview. The calculated response rate for the survey was

67.5%.

Questionnaire

The survey consisted of an interviewer-assisted ques-

tionnaire of 33 items. The interviewer read the questions

carefully and probed all items. The survey was divided

into five sections. In the first section, demographic data

of the surveyed were collected (gender, age, education,

socioeconomical level). In the second section, we asked

about their existing relationship with persons with mental

illness and more specifically with persons suffering from

schizophrenia, along with a measure of personal experi-

ence with psychiatric or psychological treatment or work

in the mental health field. In the third section we asked

10 questions to assess the respondent knowledge about

schizophrenia. This questionnaire was partly derived from

the questions used in previous studies [23, 48]. In the

fourth section, the respondents’ social distance towards

people with schizophrenia was measured with the modi-

fied six-item version of the Bogardus social distance scale

for rating stigmatising attitudes toward cultural minorities

[10], which was used in previous studies [2, 23, 48]. The

following issues were investigated: marrying somebody

with schizophrenia, having a friend with schizophrenia,

being upset about working with someone with schizo-

phrenia, being disturbed by having a neighbor with

schizophrenia, being afraid of talking to someone with

schizophrenia, and being ashamed of having a family

member with schizophrenia. The answers were changed

into a Yes/No format to ‘‘force’’ the respondents into

making a choice. Finally, in the fifth section, the per-

ception of social stigmatization was assessed by 6 items

of the Link’s Discrimination—Devaluation scale [35].

The items are statements about the perceived social

stigmatization towards people with schizophrenia and

other mental illnesses. We added as in a previous study

[23] a gender-specific statement about the attitudes of

women to complement the item about men’s attitudes.

Again, the respondents were asked to answer in a Yes/No

format.

The translation-back-translation methodology was used

to create a semantic and cultural adaptation to our country

of the questionnaire of these two last sections, following

different guidelines [15, 44]. The first author of this study

(E.L.) originated a Spanish version of the questionnaire

which was translated into English by a professional offi-

cial public translator that was blind to the original


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questionnaire [13]. The English version was then revised

by the senior author (R.M.) of this article and back-

translated by the second author (G.H.V.). After appro-

priate corrections for nuance, the final version was used

for our study.

Statistical analysis

To analyse results by age, we divided the sample into three

groups: group 1: respondents from 18 to 30 years old,

group 2: respondents from 31 to 64 years old and group 3:

respondents 65 years of age or older.

Each answer for knowledge, social distance and per-

ception of social stigmatization was converted into a score.

The knowledge score reveals the number of correct

answers (0–10). This knowledge scale has an internal

consistency of 0.69 (Cronbach’s a). The social distance

score varies from 0 to 6, with 0 being the nearest social

distance achievable and 6 the most distant one. This scale

has an internal consistency of 0.70 (Cronbach0s a). The

perception of social stigmatization score varies from 0 to 7,

with 0 being the perception of the lower stigmatization by

society, and 7 the perception of the highest. The internal

consistency of this scale was calculated as being 0.77

(Cronbach0s a).

Relative frequencies of the answers are described.

Scores were calculated and compared between groups

using Mann–Whitney and Kruskal–Wallis tests for two or

more independent variables, respectively. Bonferonni’s

corrections were used to adjust for multiple post hoc

comparisons. Spearman correlation coefficients between

scores were used. Multiple linear regression analyses with

knowledge, social distance and perception of social stig-

matization scores as dependent variables and demographic

and familiarity factors as independent variables were per-

formed. Statistical tests were carried out using SPSS ver-

sion 10.0 (SPSS Inc, Chicago, IL, 1999).

Results

Demographics

Demographic data of the surveyed and their experience

with mental illness are presented in Table 1. Age, gender

and education profile of the surveyed were compared with

the Buenos Aires household census (2004–2006) [20, 21]

to assess whether the survey sample was representative of

the general population.

When compared with the census population, younger

and highly educated respondents were over represented;

while those with older age and without complete high

school education were under represented (v2(2) = 248.6,

P \ 0.001 for age, v2(2) = 236.5, P \ 0.001 for educa-

tion). Gender distribution of our sample was not different

than the one of the general population (v2(1) = 0.55,

P = 0.45) (Table 1).

Knowledge about schizophrenia

Detailed answers of the schizophrenia knowledge questions

are described in Table 2. The mean score of correct

answers for all the sample was 4.6 SD 2.4, the median was

5 (skewness = 0.11). Thirty-two percent of the sample had

a score between 0 and 3, 54.3% had a score between 4 and

7 and 13.7% had a score higher than 7.

Demographic variables

There were no significant differences of total knowledge

scores by gender (Table 5).

There was a statistically significant difference of

knowledge by age (Table 5). Mann–Whitney post hoc tests

using Bonferonni’s correction (i.e., 0.05/3 = 0.016)

revealed that older people had more correct answers than

younger ones (age group 1 vs. age group 3: Z = -3.79,

P \ 0.001; age group 2 vs. age group 3: Z = -2.76,

P = 0.006; the knowledge score between age group 1 and

age group 2 was not statistically significant: Z = -2.18,

P = 0.02). There was also a statistically difference of

knowledge by education and by socioeconomic class

(Table 5): post hoc comparisons of education level groups

with Bonferonni’s correction (0.05/6 = 0.008) showed that

people that had complete university or tertiary education

had more knowledge about schizophrenia compared with

the ones that had incomplete elementary school education

(Z = -3.5, P \ 0.001), complete elementary school edu-

cation (Z = -5.39, P \ 0.001) or complete high school

education (Z = -5.9, P \ 0.001).

Post hoc comparisons of socioeconomic class groups with

Bonferonni’s correction (0.05/10 = 0.005) showed that low

socioeconomic level group had significantly less knowledge

than low medium (Z = -3.3, P = 0.001), medium

(Z = -6.1, P \ 0.001) and high-medium level group

(Z = -5.6, P \ 0.001), and that low medium socioeco-

nomic group had less knowledge about schizophrenia com-

pared with the medium level (Z = -7.7, P \ 0.001) and

high-medium level group (Z = -5.3, P \ 0.001).

Familiarity variables

Knowledge scores were compared between the different

familiarity variables.

People who have some kind of relationship with a per-

son with mental illness or with patients with schizophrenia

(e.g. co-workers, neighbors and friends) had more


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Table 1 Demographics of the sample and comparison with census data

Sample surveyed (N = 1254) General population *

Age (in years)

18 to 30 :

31 to 64:

65 or more:

38.7 SD 14,9 (range: 18–84)

37.3%

56.3%

6.5%

22.7%

56.3%

21.6%

Gender Women

Men

55.3%

44.7%

54.3%

45.7%

Education Incomplete elementary

school

Complete elementary

school

Complete high school

Complete tertiary o

university education

1.3%

12.9%

51%

85.8%

34.8 %

5.1%

29.7%

65.2%

Socio-economical status Low class

Medium-low class

Medium class

Medium-high class

High class

3.5%

20.1%

68.7%

7.3%

0.5%

Relationship with a

person with mental

illness

Yes 33.4%

Relationship with a

person with

schizophrenia

Yes 11.5%

Lives with a person with

mental illness

Yes 9.8%

Lives with a person with

schizophrenia

Yes 2.3%

Has attended or is

attending a psychologist

or psychiatrist

Yes 44.3%

Works in the mental

health field

Yes 5.4%

aData from the annual household survey of the city of Buenos Aires. Educative aspects 2004–2005, demographic aspects 2006; Direccion

General de Estadısticas y Censos (2008)


123

knowledge about schizophrenia than people without that

contact (Table 5).

People living with persons with mental illness or

those with schizophrenia had more knowledge about the

illness than people who do not live with them (Table 5).

Those subjects attending psychological or psychiatric

treatment, or working in the mental health field also had

significantly more knowledge about schizophrenia than

respondents without those characteristics (U Mann–

Whitney Z = -8.09, P \ 0.001 and Z = 5.9, P \ 0.001,

respectively).

Multiple linear regression analysis revealed that

knowledge was poorly predicted by demographic and

familiarity factors (R2 = 0.133, F [8] = 23.7, P \ 0.001)

being socioeconomic class (b coefficient = 0.19, P \0.001), education level (b coefficient = 0.12, P \ 0.001),

age (b coefficient = 0.09, P \ 0.001), relationship with a

person with mental illness (b coefficient = -0.13,

P \ 0.001), relationship with a person with schizophrenia

(b coefficient = -0.07, P \ 0.05) and living with a person

with schizophrenia (b coefficient = -0.06, P \ 0.05)

significant predictor variables.

Social distance

The mean score for the social distance answers was 1.59

SD 1.42, the median was 1 (skewness = 1.21). Relative

frequencies of specific answers are detailed in Table 3.

A percentage of 79.4% of the sample had a score between 0

and 2, 15% had a score between 3 and 4 and 5.6% had a

score [ 4.


The only statistical difference by sex was in the marriage

item: women were more reluctant to marry a person with

schizophrenia (79.8%) than men (72.9%) (Pearson v2

[1] = 8.3, P = 0.002).

There was a positive correlation between age and social

distance. Older people had a significantly higher social

distance (rs = 0.156, P \ 0.001). Statistical analysis

showed that there were significant differences by age in the

questions related to marriage (‘‘would not marry’’ age

group 1: 69.1%, age group 2 : 80.8%, age group 3: 95.4%;

Pearson v2 [2] = 25.1, P \ 0.001), having a friend with

schizophrenia (age group 1: 76.3%, age group 2: 70.5%

and age group 3 : 64.6%; Pearson v2 [2] = 7.4, P \ 0.001),

and being disturbed about working with a person

with schizophrenia (age group 1: 20.6%, age group 2:

27.3% and age group 3: 35.3%; Pearson v2[2] = 11,3,

P = 0.003).

There was a significant statistical difference of mean

scores for social distance towards persons with schizo-

phrenia by education (Table 5). Mann–Whitney post hoc

test with Bonferonni’s correction (0.05/6 = 0.008)

revealed that the statistical difference was between the

complete elementary school group and the complete high

school group (Z = -2.7, P = 0.006). There was also a

significant difference of social distance score by socio-

economic class (Table 5). Mann–Whitney post hoc

comparisons with Bonferonni’s correction showed that

there was a statistical difference between the low medium

level socioeconomic group and the medium level group

(Z = -3.6, P \ 0.001) and between the medium level

group and the high-medium level group (Z = -3.2,

P = 0.001).


People who had an employment related to the mental

health field, lived with a person suffering from schizo-

phrenia or any other mental disorder, or had any kind of

Table 2 Knowledge about schizophrenia (N = 1,254)

People with schizophrenia Yes (%) No (%) Do not know (%)

1 Suffer from split or multiple personalities 44.4 20.7a 34.9

2 Listen to non existent voices 64.7* 9.6 25.7

3 Tend to socially withdraw 50.3* 23.8 35.9

4 Can have lack of will 31.9* 32.9 35.2

5 Are mentally retarded 13.3 63.3a 23.4

6 The majority is dangerous to others or has violent behavior 26.7 46a 27.3

7 Have bizarre or inadequate behavior 69.9* 12.1 18

8 The majority has a cure 22.2 32.8a 45

9 The causes of schizophrenia Genetic 18.1 Environmental 10.4 Both 36.9a 34.6

10 The most adequate treatment Medication 16 Psycho therapy 7.3 Both 51.4a Neither 0.8 24.5

a Answers that were considered correct to build the total knowledge score


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relationship with them, did not differ with regard to social

distance than the rest of the sample (Table 5).

Multiple linear regression analysis showed that social

distance score was poorly predicted by demographic and

familiarity factors (R2 = 0.02, F [8] = 3.4, P \ 0.001)

being age the only significant predictor variable (b coeffi-

cient = 0.12, P \ 0.001).

Perception of social stigmatization

Relative frequencies of perception of social stigmatization

are described in Table 4. The mean score for the perception

of social stigmatization towards patients with schizophre-

nia was 5.4 SD 1.86 (skewness = -1.11). The median was

6. A percentage of 10.1% had a score between 0 and 2,

31.8% had a score between 3 and 5, and 58.1% had a score

superior to 5.


There was no statistical difference by age or sex in per-

ception of social stigmatization scores (Table 5). On the

item level, the only statistical differences found were that

older people consider that young men would be reluctant to

date a person with schizophrenia in a lower percentage than

younger groups [age group 1 (70.1%) vs. age group 3

(53.6%): Pearson v2[1] = 8.6, P = 0.003, age group 2

(73%) vs. age group 3 (53.6%): Pearson v2[1] = 13.4,

P \ 0.001, the comparison between age group 1 and age

group 2 showed no statistically difference: v2[1] = 1–23,

P = 0.26], and that women perceived that the opinion of

people with schizophrenia is considered less serious in a

significant higher percentage than men (74.2 vs. 67.3%

Pearson v2 [1] = 7.1, P = 0.005).

Mean scores were different according to levels of edu-

cational attainment (Table 5). Mann–Whitney post hoc

tests with Bonferonni’s correction (0.05/6 = 0.008)

revealed that there was a significant statistical difference

between the complete tertiary or university education

group with the elementary school education group and the

high school education group (Z = -4.01, P \ 0.001;

Z = -2.9, P = 0.003, respectively) There was no differ-

ence between mean scores by socioeconomic class

(Table 5).


People who lived with a person with schizophrenia or had

some kind of relationship with them as well as people who

worked in mental health did not have a different perception

of social stigmatization than the rest of the sample

(Table 5).

Table 4 Perception of social stigmatization (N = 1,254)

Most people … Yes N (%)

General Men Women

Prefer to hire another person before hiring a patient with schizophrenia 1,093 (87.2) 488 (87.1) 605 (87.3)

Would avoid hiring a patient with schizophrenia to take care of their children 1,189 (94.8) 529 (94.5) 660 (95.1)

Young women would be reluctant to date a person with schizophrenia 904 (72.1) 403 (72) 501 (72.3)

Young men would be reluctant to date a person with schizophrenia 886 (70.7) 398 (71.1) 488 (70.4)

Think less of a person who has been in a mental hospital 980 (78.1) 431 (77) 549 (79.1)

Would take the opinion of a person with schizophrenia less seriously 892 (71.1) 377 (67.3) 515 (74.2)

Feel that entering a mental hospital is a sign of personal failure 829 (66.1) 364 (65) 465 (67)

Table 3 Social distance towards people with schizophrenia

Would you… Yes N (%)

General Men Women

Be ashamed of having in your family somebody with schizophrenia? 121 (9.6) 54 (9.6) 67 (9.7)

Be afraid of talking with someone with schizophrenia? 86 (6.9) 33 (5.9) 53 (7.6)

Be disturbed having a neighbor with schizophrenia? 169 (13.5) 83 (14.8) 86 (12.4)

Be disturbed about working with someone with schizophrenia? 318 (25.4) 154 (27.5) 164 (23.6)

Have a friend with schizophrenia? 907 (72.3) 410 (73.2) 497 (71.6)

Marry someone with schizophrenia? 292 (23.3) 152 (27.1) 140 (20.2)


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After performing a multiple linear regression analysis

we observed that perception of social stigmatization score

was poorly predicted by demographic and familiarity fac-

tors (R2 = 0.01, F [8] = 2, P \ 0.001) being education

level the only significant predictor variable (b coeffi-

cient = 0.09; P = 0.002).

Relationship between variables

We calculated the association between the three scores

studied using Spearman rank correlation. After alpha cor-

rection (0.05/3 = 0.01) the following correlations were

significant: Knowledge was correlated with social distance

Table 5 Mean results of knowledge, social distance and perception of social stigmatization scores by demographic and familiarity variables

Knowledge Social distance Perception of social

stigmatization

Gender

Men 4.59 1.57 5.33

Women 4.75 1.61 5.45

Z = -1.5, P = 0.126 Z = -0.48; P = 0.63 Z = -1.23, P = 0.21

Age

18–30 4.41 1.38 5.30

31–64 4.75 1.68 5.48

[64 5.63 2.02 5.25

v2 (2) = 15.5, P \ 0.001 v2 (2) = 27.5, P \ 0.001 v2 (2) = 3, P = 0.21

Educational level

Incomplete elementary 2.75 1.25 5.68

Complete elementary 4.09 1.83 4.99

Complete high school 4.39 1.50 5.36

Complete university/tertiary 5.40 1.66 5.59

v2 (3) = 54.5, P \ 0.001 v2 (3) = 8.4, P = 0.03 v2 (3) = 18.4, P < 0.001

Socioeconomic class

Low 2.63 1.56 5.40

Low medium 3.67 1.87 5.37

Medium 5.03 1.48 5.40

High medium 5.19 1.80 5.46

High 4.33 3.00 4.66

v2 (4) = 94.6, P < 0.001 v2 (4) = 22.6, P \ 0.001 v2 (4) = 0.03, P = 1

Familiarity

Related with person with mental illness 5.35 1.48 5.33

Not related with person with mental illness 4.34 1.65 5.43

Z = -7.08, P \ 0.001 Z = -1.7, P = 0.08 Z = -1,1, P = 0.09

Related with people with sch 5.95 1.43 5.54

Not related with people with sch 4.52 1.61 5.38

Z = -6.6, P < 0.001 Z = -1.7, P = 0.07 Z = 1.8, P = 0.06

Living

Living with person with mental illness 5.43 1.52 5.44

Not living with person with mental illness 4.60 1.60 5.39

Z = -3.5; P < 0.001 Z = -0.02, P = 0.9 Z = -0.01, P = 0.9

Living with people with sch 6.51 1.72 5.41

Not living with people with sch 4.64 1.59 5.40

Z = -3.6; P < 0.001 Z = -0.8, P = 0.3 Z = -0.6, P = 0.5

Knowledge scores are 0–10 (higher scores reflect greater knowledge), social distance scores are 0–6 (higher scores reflect greater social distance),

perception of social stigmatization is 0–7 (higher scores reflect greater perception of social stigmatization)

Mann–Whitney tests are used for comparison between two variables. Kruskal–Wallis tests are used for comparison between more than two

variables

P \ 0.05 or P \ 0.001 are bolded


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with a small effect size (rs = -0.07, P = 0.01) and social

distance score was correlated with the perception of social

stigmatization score with a medium effect size (rs = 0.33,

P \ 0.001).

We performed subgroup analyses in those groups that

had higher knowledge scores: In subjects older than

64 years old (N = 82), in individuals that have some kind

of relationship with people with schizophrenia (N = 144)

and in those who live with patients with schizophrenia

(N = 29) the knowledge about the illness was not signifi-

cantly correlated with social distance (rs = -0.181,

P = 0.1, rs = 0.02, P = 0.7 and rs = -0.29, P = 0.1,

respectively).

Discussion

Our study found that knowledge about schizophrenia was

moderate compared with other international studies [48,

51], although methodological differences between studies

(face to face interview in our study vs. telephone survey)

could account for some of the differences found. More than

40% of the surveyed answered al least half of the knowl-

edge questionnaire correctly. Nevertheless, almost half of

the respondents still considered schizophrenia as a split

personality as in previous research [48], denoting an erro-

neous understanding of the name of the illness. It is pos-

sible that this misunderstanding is due to the metaphorical

use of this word on the media [18] or other cultural influ-

ences [43].

Less than 7% of respondents considered psychotherapy

as the only treatment for schizophrenia unlike other

countries, such as Germany and Canada, where more than a

third of the respondents considered that option [23, 48].

This is quite surprising given the significant role that

psychotherapy and clinical psychology have in Buenos

Aires [3]. The therapeutic use of medication was consid-

ered by 67% of the surveyed, in accordance with the

extended and accepted use of psychotropics among the

general population in Buenos Aires [31]. Respondents who

were older, more educated and directly related with people

suffering from schizophrenia were more likely to correctly

answer those questions focused on knowledge. It is difficult

to know if the higher level of knowledge of the elderly is

due to a potential greater degree of contact with people

with schizophrenia in the community, or due to a higher

level of informal training about this illness. Personal

experiences, anecdotal evidence and television and movies

account as sources of information for the general popula-

tion [26].

Almost 80% of the sample had less than one-third of

the maximum possible social distance score. This result

reveals a somewhat higher social distance than in Canada

and Germany [23, 48] but lower than in Turkey and

Nigeria [2, 50]. As in previous surveys [5, 23, 48] social

distance increased with higher closeness of the relation-

ship, meaning that there are intimate and private areas of

life where people is reluctant to let persons with mental

illness enter. The fact that one in four people would be

disturbed about working with a person with schizophrenia

shows the social barrier that rehabilitation programs face

to integrate patients to the job market. This result is in

concordance with a recent study that found that the

majority of Chilean businessmen believed that people

with schizophrenia are not able to perform adequately in

their jobs [17]. The result on job discrimination in our

study is surprisingly higher than in developed countries

[23, 48] in spite of the better outcome in illness course

seen in undeveloped countries [25]. A potential explana-

tion for this result could be that Buenos Aires is mainly

composed of middle class inhabitants, and members with

schizophrenia of this social class in undeveloped countries

tend to have a less favorable outcome than the rest of the

population [30].

Sex difference was only found in the marriage item:

women were more reluctant to marry a person with

schizophrenia than men. This finding was similar than in a

previous study [23]. It may be that, in order to marry,

women appreciate the work ability and the economic

potential of their partner more than men [16]. Higher age

was also associated with greater rejection of people with

schizophrenia. This observation has been made in other

studies [5, 8, 14, 23, 32, 38, 48]. We can speculate that

older people have a tendency to be more rigid and con-

servative on their ideas and beliefs, and this fact may guide

them to have more stigmatizing attitudes toward the people

with mental illness. Besides, their physical fragility may

cause them to be more afraid of the supposed violent

consequences of the patients0 illness. These findings sug-

gest that it might be beneficial to design specific anti-

stigma programs directed to the elderly.

Social distance of respondents who are familiar with

people with schizophrenia or work in mental health was

not lower than in the general population. This finding has

also been reported in some studies [7, 32, 48], but not in

others [1, 6, 19]. It is possible that a higher knowledge

about the illness which could potentially allow for a lower

social distance is counteracted by the difficulties of daily

interaction. The tendency of professionals to focus on

their patients’ deficits and not on their abilities [47] may

account for the similar level of public stigma seen in

mental health workers and suggests that anti-stigma pro-

grams directed to the mental health provider community

may be beneficial.

The perception of social stigmatization in our study

was high compared with other studies in developed


123

countries [23, 24]. This could reveal an actual higher

discrimination towards people with schizophrenia in

Argentina, but also an overestimation of the stigmatiza-

tion. However, as was stated before, different assessment

methods between studies could account for the differences

found. Almost 80 percent of the population considered

that the opinion of a patient with schizophrenia is not

taken seriously compared with fifty percent of the German

sample [23]. In addition, almost 80% of the surveyed

affirmed that people would prefer to hire another person

before hiring a patient with schizophrenia, denoting again

the enormous difficulties to reintegrate patients in the

community.

Our sample did not show a higher rate of perception of

social stigmatizing among those persons that are related to

or live with people suffering schizophrenia, as it was

reported in a previous study [41]. As this perception was so

high among the general population a ceiling effect could be

considered for this negative finding.

Limitations

There are some limitations in our study that should be

taken in account when interpreting the results: although the

survey was done in public places and in almost all the

neighborhoods of the city, the over representation of

younger and more educated persons may reflect a selection

bias toward people that agreed to answer stigma questions.

In addition, the relative high percentage of persons with

mental health employment could account for this limita-

tion. Therefore, the generalization of these results should

be considered cautiously. This sample bias may account

also for the different levels of stigma noted in this study

compared to other international studies. Safety problems in

our country prevented us from conducting a random

household survey. It is also known that a face to face

interview could have increased the social desirability effect

[11]. A random telephone survey would have made the

sample more representative and, therefore, increase the

generalization of its results. It should be considered that

the measure of social distance reflects attitudes and not

actual behaviors, although it has been demonstrated that

there is a substantial association between them [27]. A way

to overcome the probable difference between the attitudes

reflected in this study and the actual behaviors is to also

study the discrimination perceived by the patients them-

selves. The concordance of the attitudes of the general

population and the discrimination perceived by the patients

and their relatives would confirm the results. Finally, the

dichotomizing of the variables may avoid more accurate

intermediate answers, but also of more arbitrary

interpretation.

Conclusions

Our study reveals that in Buenos Aires, although knowl-

edge about schizophrenia is similar to that in developed

countries, social distance towards people suffering from

schizophrenia is higher, and the perception of social stig-

matization is even greater. It seems that in order to

diminish discrimination we must consider other measures

besides education, such as increasing public anti-stigma

policies. Our study points out the need of specific cam-

paigns addressing the elderly, a group which showed less

tolerant views. Also, reducing the social distance held by

people living or working with persons suffering from

schizophrenia would potentially bring multiple benefits to

the quality of life of these patients.

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