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American Journal of Public Health logoLink to American Journal of Public Health
. 2013 Nov;103(11):2078–2089. doi: 10.2105/AJPH.2013.301321

Attitudes Toward Mental Illness in Adults by Mental Illness–Related Factors and Chronic Disease Status: 2007 and 2009 Behavioral Risk Factor Surveillance System

Rosemarie Kobau 1,✉, Matthew M Zack 1
PMCID: PMC3828701  PMID: 24028243

Abstract

Objectives. We examined how attitudes toward mental illness treatment and its course differ by serious psychological distress, mental illness treatment, chronic disease, and sociodemographic factors using representative state-based data.

Methods. Using data from jurisdictions supporting the Behavioral Risk Factor Surveillance System’s Mental Illness and Stigma Module (35 states, the District of Columbia, and Puerto Rico), we compared adjusted proportions of adults agreeing that “Treatment can help people with mental illness lead normal lives” (treatment effectiveness) and that “People are generally caring and sympathetic to people with mental illness” (supportive environment), by demographic characteristics, serious psychological distress, chronic disease status, and mental illness treatment.

Results. Attitudes regarding treatment effectiveness and a supportive environment for people with mental illness varied within and between groups. Most adults receiving mental illness treatment agreed that treatment is effective. Fewer adults with serious psychological distress than those without such distress agreed that treatment is effective. Fewer of those receiving treatment, those with psychological distress, and those with chronic disease perceived the environment as supportive.

Conclusions. These data can be used to target interventions for population subgroups with less favorable attitudes and for surveillance.

In the past decade, Centers for Disease Control and Prevention (CDC) population surveys and health information systems have expanded content on mental illness in recognition of its growing public health burden.1 For example, since 2006, the state-based Behavioral Risk Factor Surveillance System (BRFSS) has provided state and local estimates of mental illness with 2 modules developed by the CDC and the Substance Abuse and Mental Health Administration (SAMHSA). The BRFSS Mental Illness and Stigma Module was developed in 2005 to obtain state-level estimates of serious psychological distress and attitudes toward mental illness.2,3 Its development followed recommendations from the President’s New Freedom Commission on Mental Health and the 2005 Federal Action Agenda, Transforming Mental Health, which highlighted the need to “encourage help-seeking behaviors across the age span” and “make clear that recovery is possible” as a way to improve the acceptance and social inclusion of people with mental illness.4,5(p24)

These recommendations, in part, also guided the development and release of SAMHSA’s campaign, What a Difference a Friend Makes, launched in 2006 to improve support for young adults with mental illness.6 In support of this campaign, SAMHSA and the CDC identified relevant questions to assess public attitudes toward treatment effectiveness, attitudes about supportive behaviors toward people with mental illness, and experience with mental illness symptoms and mental illness treatment.2,3 The CDC partnered with states in 2007 and 2009 to examine attitudes toward mental illness on the state-based BRFSS. Previous studies have described general findings.2,3 Additionally, several state public health and mental health agencies have generated public reports with their data, demonstrating their value for the development and evaluation of mental health programs.7–9

We aimed to expand previous studies by using BRFSS Mental Illness and Stigma data from 2 years (1) to examine attitudes toward mental illness among those with serious psychological distress, those with selected chronic diseases, and those reporting receipt of mental illness treatment compared with those without these conditions and those not in treatment, and (2) to identify disparities in these attitudes among different subgroups. Although these limited BRFSS surveillance data may be used to advance research questions to augment the theoretical understanding of stigma, this is beyond the scope of the current study.

METHODS

Established in 1984 by the CDC, the BRFSS is a system of state-based health surveys that collects information by telephone on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury. All 50 states, the District of Columbia, Puerto Rico, the US Virgin Islands, and Guam collect data monthly (http://www.cdc.gov/brfss/BRFSS). The CDC and SAMHSA developed a Mental Illness and Stigma Module for the BRFSS to track the prevalence of serious psychological distress and attitudes toward mental illness by state. In 2007, 35 states, the District of Columbia, and Puerto Rico included this module on their BRFSS surveys; in 2009, 16 states did so.3 Fourteen states supported this module both years. For participating states and jurisdictions, the 2007 median Council of American Survey Research Organizations (CASRO)10 response rate and cooperation rate were 51% and 72%, respectively, and the comparable 2009 rates were 55% and 77%, respectively.3 The study sample included 243 062 adults.

BRFSS respondents expressed their attitudes toward mental illness by indicating their level of agreement on a 5-point scale with 2 statements: “Treatment can help people with mental illness lead normal lives,” and “People are generally caring and sympathetic to people with mental illness.”2,3 Before their inclusion in the BRFSS, the questions were assessed in cognitive testing with a sample of adults from the general population. The sample adults understood the questions the way the survey designers intended them to be understood. For example, respondents understood “normal lives” to mean “being able to do everyday things, like going to the grocery store, paying bills, things that you have to do to live.”3 The first statement, about attitudes toward treatment effectiveness, also demonstrated acceptable construct validity with expectations regarding mental illness recovery.11

The BRFSS includes the Kessler 6 Scale, which asks respondents how often in the past 30 days they felt 6 symptoms of mental illness (i.e., feeling nervous, depressed, hopeless, restless, like a failure, like everything was an effort). Each symptom is scored as an item on a 5-point scale, ranging from 0 (none of the time) to 4 (all of the time), and summed (score range = 0–24). We classified respondents scoring 13 or more on this scale as having serious psychological distress.12 The BRFSS asked respondents the question, “Are you now taking medicine or receiving treatment from a doctor or other health professional for any type of mental health condition or emotional problem?” Response options included yes, no, don’t know, and refused; we classified respondents answering yes as currently receiving treatment of a mental health or emotional problem. We classified respondents reporting any of the following doctor-diagnosed conditions as having a chronic disease: diabetes mellitus, cardiovascular disease (heart attack or myocardial infarction, coronary heart disease, or stroke), asthma, or arthritis.

Levels of agreement with each attitude statement served as dependent variables after adjustment for gender, age, racial/ethnic group, education, and household income. We used SUDAAN software release 10.0 (Research Triangle Institute, Research Triangle Park, NC) to account for the complex BRFSS sampling design and respondent sampling weights. We estimated adjusted percentages (“predicted marginals”) of responses to each item for select subgroups using logistic regression after adjustment for gender, age, racial/ethnic group, education, and household income. We describe the results in terms of the outcome of interest (e.g., percentage agreement or disagreement) rather than a calculated measure of association (e.g., parameter estimate). This is easier to understand, and there is no loss of data because adjusted percentages present estimates for all levels of an independent variable rather than all but a reference category (e.g., using White as a racial/ethnic group).13 Adjusted percentages whose 95% confidence intervals did not overlap were considered statistically significantly different. The smaller statistical significance level (P < .007) that this method implies also provides partial protection from multiple pairwise comparisons between levels of specific characteristics.14 With this statistically conservative method, we accept the lower statistical power of calling differences between groups that are truly different as not significantly different. We prefer to avoid calling differences between groups that are not truly different as significantly different. Tables exclude those who did not know how to answer or refused to answer the questions.

RESULTS

About 67% of adults surveyed strongly agreed with the statement that treatment can help people live normal lives (Table 1). Strong agreement with the statement was less prevalent among men than women and among younger adults aged 18 to 24 years (56%) and 25 to 34 years (64%) than among adults aged 55 years and older (70%); strong agreement was more prevalent among non-Hispanic Whites (69.5%) than among other racial/ethnic groups (range = 60.8%–65.3%). Slight agreement with the statement was more prevalent among Hispanic (30.4%) and “other non-Hispanic” adults (29.7%) than among other racial/ethnic groups. Compared with adults with some college or more and adults with household incomes of $35 000 or more, adults with less education and lower levels of household income were less likely to strongly agree that treatment is effective, with more in these groups tending to disagree with the statement. About the same percentages of agreement for this statement were seen among those with and without chronic disease.

TABLE 1—

Adjusted Percentages of Respondents Agreeing With Statements Regarding Mental Illness, by Sociodemographic and Chronic Disease Status: Behavioral Risk Factor Surveillance System, United States, 2007 and 2009

Level of Agreement,a % (95% CI)
Characteristic Sample Size, No. Agree Strongly Agree Slightly Neither Agree nor Disagree Disagree Slightly Disagree Strongly
“Treatment can help people with mental illness lead normal lives”
Overall 243 062 67.2 (66.7, 67.7) 25.8 (25.3, 26.3) 1.8 (1.6, 2.0) 3.7 (3.5, 4.0) 1.5 (1.3, 1.6)
Gender
 Male 93 981 62.1 (61.3, 62.8) 29.7 (29.0, 30.4) 2.0 (1.7, 2.3) 4.5 (4.1, 4.8) 1.8 (1.5, 2.0)
 Female 149 081 72.2 (71.7, 72.8) 22.0 (21.5, 22.6) 1.5 (1.3, 1.7) 3.0 (2.7, 3.3) 1.2 (1.0, 1.4)
Age group, y
 18–24 7 393 56.4 (54.1, 58.7) 35.2 (32.9, 37.4) 1.7 (0.9, 2.6) 5.3 (4.3, 6.2) 1.4 (0.9, 1.9)
 25–34 25 391 63.5 (62.3, 64.8) 28.8 (27.6, 30.0) 1.7 (1.4, 2.0) 4.3 (3.7, 5.0) 1.6 (1.2, 2.0)
 35–54 93 287 69.9 (69.2, 70.5) 23.9 (23.3, 24.5) 1.6 (1.4, 1.9) 3.2 (2.9, 3.5) 1.4 (1.2, 1.6)
 ≥ 55 116 991 69.7 (69.0, 70.4) 23.4 (22.7, 24.0) 2.0 (1.8, 2.3) 3.5 (3.1, 3.8) 1.5 (1.2, 1.7)
Race/ethnicity
 White, non-Hispanic 194, 639 69.5 (69.0, 70.0) 24.6 (24.1, 25.1) 1.6 (1.4, 1.7) 3.2 (3.0, 2.4) 1.1 (0.9, 1.3)
 Black, non-Hispanic 19 642 65.3 (63.7, 66.9) 25.1 (23.5, 26.6) 1.9 (1.4, 2.3) 5.7 (4.9, 6.5) 2.1 (1.7, 2.5)
 Hispanic 15 853 60.8 (59.0, 62.5) 30.4 (28.7, 32.0) 2.5 (1.8, 3.2) 4.3 (3.6, 5.0) 2.0 (1.5, 2.5)
 Other non-Hispanic 12 928 61.6 (59.3, 63.9) 29.7 (27.5, 31.9) 1.8 (1.2, 2.5) 4.6 (3.6, 5.5) 2.3 (1.5, 3.2)
Educational level
 < high school 19 848 63.2 (61.4, 65.1) 28.4 (26.6, 30.1) 1.9 (1.4, 2.4) 4.3 (3.6, 5.0) 2.2 (1.7, 2.7)
 High school graduate or GED 68 605 63.2 (62.3, 64.2) 28.6 (27.7, 29.5) 1.9 (1.6, 2.2) 4.6 (4.1, 5.0) 1.7 (1.4, 1.9)
 Some college 66 618 66.8 (65.9, 67.7) 26.3 (25.5, 27.2) 1.9 (1.5, 2.4) 3.7 (3.3, 4.1) 1.3 (1.0, 1.5)
 College graduate 87 991 72.1 (71.3, 72.9) 22.7 (22.0, 23.5) 1.5 (1.2, 1.8) 2.7 (2.3, 3.0) 1.1 (0.8, 1.3)
Annual household income, $
 < 20 000 43 265 62.2 (60.9, 63.6) 28.5 (27.2, 29.9) 2.3 (1.6, 2.9) 5.0 (4.3, 5.6) 2.0 (1.6, 2.3)
 20 000–34 999 51 921 64.6 (63.5, 65.6) 27.3 (26.2, 28.3) 2.0 (1.6, 2.3) 4.4 (3.9, 4.9) 1.8 (1.5, 2.2)
 35 000–49 999 39 279 67.8 (66.7, 68.9) 25.7 (24.6, 26.8) 1.8 (1.5, 2.1) 3.4 (3.0, 3.9) 1.3 (1.0, 1.5)
 50 000–74 999 42 157 68.8 (67.7, 69.8) 25.5 (24.5, 26.6) 1.6 (1.3, 2.0) 3.1 (2.6, 3.5) 1.0 (0.8, 1.3)
 ≥ 75 000 66 400 70.8 (69.9, 71.7) 23.9 (23.1, 24.8) 1.4 (1.1, 1.6) 2.8 (2.4, 3.2) 1.1 (0.8, 1.4)
Chronic diseaseb
 Yes 115 688 68.1 (67.4, 68.9) 24.7 (24.0, 25.4) 1.7 (1.4, 1.9) 3.9 (3.5, 4.3) 1.6 (1.3, 1.8)
 No 127 374 66.7 (66.1, 67.3) 26.5 (25.9, 27.1) 1.8 (1.6, 2.1) 3.6 (3.3, 3.9) 1.4 (1.2, 1.6)
“People are generally caring and sympathetic to people with mental illness”
Overall 242 922 22.7 (22.2, 23.1) 37.5 (37.0, 38.0) 2.8 (2.7, 3.0) 26.0 (25.6, 26.5) 11.0 (10.7, 11.3)
Gender
 Male 94 248 24.5 (23.9, 25.2) 40.3 (39.5, 41.1) 3.0 (2.7, 3.2) 23.1 (22.5, 23.8) 9.1 (8.6, 9.5)
 Female 148 674 20.9 (20.3, 21.4) 34.7 (34.2, 35.3) 2.7 (2.5, 2.9) 28.9 (28.4, 29.4) 12.8 (12.4, 13.2)
Age group, y
 18–24 7 419 18.8 (17.1, 20.6) 44.2 (41.9, 46.5) 1.9 (1.4, 2.4) 27.0 (24.9, 29.1) 8.1 (7.0, 9.2)
 25–34 25 447 19.4 (18.4, 20.4) 37.5 (36.3, 38.7) 2.7 (2.3, 3.1) 29.1 (28.0, 30.2) 11.4 (10.5, 12.2)
 35–54 93 378 21.6 (21.0, 22.2) 36.9 (36.2, 37.6) 2.9 (2.6, 3.1) 26.6 (26.0, 27.2) 12.0 (11.6, 12.5)
 ≥ 55 116 678 27.8 (27.1, 28.4) 35.9 (35.1, 36.6) 3.2 (3.0, 3.5) 23.0 (22.4, 23.5) 10.2 (9.8, 10.7)
Race/ethnicity
 White, non-Hispanic 194 436 20.2 (19.7, 20.6) 38.2 (37.7, 28.7) 2.8 (2.6, 3.0) 27.7 (27.3, 28.2) 11.1 (10.8, 11.5)
 Black, non-Hispanic 19 646 26.6 (25.2, 28.1) 33.3 (31.6, 34.9) 2.6 (2.1, 3.2) 22.7 (21.4, 24.1) 14.7 (13.6, 15.9)
 Hispanic 15 860 26.9 (25.3, 28.4) 38.3 (36.5, 40.1) 3.5 (2.9, 4.1) 22.8 (21.2, 24.4) 8.5 (7.5, 9.5)
 Other non-Hispanic 12 980 33.9 (31.6, 36.2) 35.2 (32.9, 37.6) 2.5 (1.8, 3.2) 18.3 (16.7, 20.0) 10.1 (8.8, 11.3)
Educational level
 < high school 19 834 33.0 (31.2, 34.8) 37.2 (35.2, 39.2) 2.3 (1.8, 2.9) 18.1 (16.6, 19.6) 9.3 (8.2, 10.4)
 High school graduate or GED 68 863 27.5 (26.6, 28.4) 36.8 (35.9, 37.8) 2.7 (2.4, 3.0) 22.7 (21.9, 23.5) 10.3 (9.7, 10.8)
 Some college 66 579 20.8 (20.1, 21.6) 37.3 (36.4, 38.2) 3.1 (2.8, 3.4) 26.8 (26.0, 27.6) 12.0 (11.4, 12.5)
 College graduate 87 646 16.9 (16.3, 17.6) 38.7 (37.9, 39.5) 3.0 (2.7, 3.2) 30.0 (29.2, 30.8) 11.4 (10.9, 11.9)
Annual household income, $
 < 20 000 43 325 25.3 (24.1, 26.4) 34.1 (32.7, 35.5) 3.5 (3.0, 4.0) 24.2 (22.9, 25.4) 13.0 (12.1, 13.8)
 20 000–34 999 51 966 24.3 (23.4, 25.3) 35.0 (33.9, 36.0) 3.1 (2.7, 3.5) 25.7 (24.8, 26.7) 11.8 (11.2, 12.5)
 35 000–49 999 39 216 23.5 (22.5, 24.6) 36.9 (35.7, 38.1) 2.6 (2.3, 2.9) 26.1 (25.1, 27.1) 10.9 (10.2, 11.5)
 50 000–74 999 42 112 21.1 (20.2, 22.1) 38.6 (37.6, 39.7) 2.6 (2.3, 3.0) 27.2 (26.3, 28.1) 10.4 (9.8, 11.1)
 ≥ 75 000 66 303 20.1 (19.3, 20.9) 40.7 (39.7, 41.6) 2.6 (2.3, 2.9) 26.5 (25.8, 27.3) 10.1 (9.6, 10.6)
Chronic diseaseb
 Yes 115 497 21.4 (20.8, 22.0) 35.1 (34.3, 35.9) 2.7 (2.4, 2.9) 27.7 (27.0, 28.4) 13.2 (12.7, 13.7)
 No 127 425 23.5 (22.9, 24.1) 38.8 (38.2, 39.5) 2.9 (2.7, 3.2) 25.1 (24.6, 25.6) 9.6 (9.2, 10.0)
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Note. CI = confidence interval; GED = general equivalency diploma.

a

Percentages were adjusted for the following variables: gender, age, race/ethnicity, education, and annual household income.

b

Chronic disease status includes respondents who self-reported any one of the following doctor-diagnosed conditions: diabetes mellitus, cardiovascular disease (heart attack or myocardial infarction, stroke, coronary heart disease), asthma, or arthritis.

Only about 23% of adults strongly agreed with the statement that people are caring and sympathetic to people with mental illness (Table 1). Significantly more women strongly disagreed with the statement (12.8%) than did men (9.1%), but more in both groups slightly disagreed (28.9% and 23.1%, respectively). Fewer young adults (18–34 years) strongly agreed than did older adults (≥ 35 years). More non-Hispanic Whites (11.1%) and non-Hispanic Blacks (14.7%) strongly disagreed than did Hispanics. Those with higher educational levels but lower income more often disagreed. For example, among college graduates, 30% slightly disagreed and 11% strongly disagreed, compared with 18.1% and 9.3% of adults with less than a high school degree who slightly or strongly disagreed, respectively. However, 13% of adults in households with income levels less than $20 000 strongly disagreed with the statement compared with 10.1% of those in households with income levels greater than $75 000. Slight and strong agreement with the statement was more prevalent among adults with chronic disease (27.7% and 13.2%, respectively) than among those without chronic disease (25.1% and 9.6%).

Attitudes by Serious Psychological Distress

Overall, fewer adults with serious psychological distress strongly agreed (56%), and more disagreed (13%), with the statement that treatment is effective than those without such distress (68% and 5%, respectively; Tables 2 and 3). Among adults with distress, more non-Hispanic Blacks slightly disagreed than non-Hispanic Whites (15.8% vs 6.9%). Fewer men (50.6%) than women (59.6%), and fewer adults living in households earning less than $35 000 a year (∼50%) than adults in households earning $75 000 a year or more (68.6%), strongly agreed that treatment is effective. Those with serious psychological distress were less likely to agree that treatment is effective than those without serious psychological distress; this held true for both men and women, those aged 25 years or older, all racial/ethnic groups except Hispanics, all educational levels, those with annual household income levels less than $50 000, and adults with or without chronic disease.

TABLE 2—

Level of Agreement With Statements Regarding Mental Illness Among Respondents With Serious Psychological Distress: Behavioral Risk Factor Surveillance System, United States, 2007 and 2009

Level of Agreement,a % (95% CI)
Characteristic Sample Size, No. Agree Strongly Agree Slightly Neither Agree nor Disagree Disagree Slightly Disagree Strongly
“Treatment can help people with mental illness lead normal lives”
Overall 9405 55.8 (53.5, 58.1) 28.9 (26.8, 31.0) 2.4 (1.7, 3.1) 8.6 (7.2, 10.0) 4.3 (3.3, 5.2)
Gender
 Male 2973 50.6 (46.8, 54.4) 31.4 (27.9, 34.9) 2.4 (1.2, 3.6) 10.0 (7.5, 12.4) 5.6 (3.7, 7.5)
 Female 6432 59.6 (56.9, 62.2) 27.1 (24.6, 29.5) 2.4 (1.7, 3.2) 7.6 (6.2, 9.1) 3.3 (2.6, 4.0)
Age group, y
 18–24 318 51.4 (41.5, 61.2) 33.2 (23.5, 42.9) 1.3 (0.1, 2.4) 10.8 (2.3, 18.4) 3.4 (0.4, 6.4)
 25–34 972 52.2 (46.4, 58.0) 29.6 (24.3, 35.0) 3.4 (1.0, 5.8) 8.9 (5.3, 12.5) 5.9 (2.0, 9.7)
 35–54 4335 55.9 (52.7, 59.0) 29.3 (26.3, 32.4) 2.4 (1.7, 3.1) 8.3 (6.6, 10.1) 4.1 (3.0, 5.2)
 ≥ 55 3780 59.7 (55.9, 63.5) 26.2 (23.0, 29.4) 2.1 (1.1, 3.0) 8.3 (6.2, 10.4) 3.7 (2.6, 4.8)
Race/ethnicity
 White, non-Hispanic 6650 57.7 (55.2, 60.3) 28.9 (26.5, 31.3) 2.2 (1.5, 2.8) 6.9 (5.6, 8.2) 4.3 (3.1, 5.5)
 Black, non-Hispanic 1192 54.9 (49.0, 60.9) 23.7 (19.1, 28.3) 1.3 (0.2, 2.4) 15.8 (10.4, 21.2) 4.3 (2.4, 6.1)
 Hispanic 1034 53.7 (47.3, 60.1) 29.6 (23.8, 35.4) 3.4 (1.4, 5.3) 9.0 (5.6, 12.4) 4.3 (1.3, 7.4)
 Other non-Hispanic 529 45.2 (35.0, 55.5) 38.5 (28.0, 49.1) 3.1 (0.0, 7.1) 9.3 (3.9, 14.6) 3.9 (1.6, 6.2)
Educational level
 < high school 2155 54.3 (49.4, 59.3) 28.6 (23.9, 33.3) 3.1 (1.1, 5.1) 9.4 (6.7, 12.1) 4.6 (2.5, 6.6)
 High school graduate or GED 3365 53.9 (50.2, 57.7) 31.3 (27.8, 34.8) 2.1 (1.3, 2.9) 8.5 (6.3, 10.8) 4.2 (2.8, 5.5)
 Some college 2481 58.9 (54.9, 62.9) 26.0 (22.5, 29.5) 1.8 (1.0, 2.6) 8.3 (5.9, 10.8) 4.9 (2.4, 7.5)
 College graduate 1404 57.5 (52.0, 62.9) 29.4 (24.3, 34.4) 2.9 (1.4, 4.5) 7.5 (4.1, 11.0) 2.7 (0.7, 4.7)
Annual household income, $
 < 20 000 4878 54.1 (50.8, 57.3) 30.7 (27.7, 33.8) 1.9 (1.3, 2.5) 8.4 (6.7, 10.2) 4.9 (3.5, 6.3)
 20 000–34 999 2327 52.6 (48.1, 57.1) 29.0 (25.0, 33.1) 4.0 (2.1, 6.0) 10.6 (7.5, 13.8) 3.7 (1.9, 5.6)
 35 000–49 999 940 56.1 (49.5, 62.7) 32.2 (25.6, 38.9) 2.4 (0.8, 4.0) 6.5 (3.7, 9.3) 2.7 (1.1, 4.3)
 50 000–74 999 639 61.1 (53.2, 69.0) 25.9 (19.5, 32.4) 0.5 (0.0, 1.2) 8.7 (2.0, 15.4) 3.7 (0.4, 7.1)
 ≥ 75 000 621 68.6 (61.2, 76.0) 19.5 (14.0, 25.0) 1.6 (0.4, 2.9) 5.2 (1.2, 9.2) 5.1 (1.7, 8.5)
Chronic diseaseb
 Yes 6756 54.8 (51.8, 57.8) 28.2 (25.5, 30.9) 2.6 (1.9, 3.4) 9.6 (7.5, 11.7) 4.8 (3.4, 6.2)
 No 2649 57.2 (53.4, 61.1) 30.0 (26.3, 33.6) 2.1 (1.0, 3.2) 7.2 (5.3, 9.1) 3.5 (2.0, 4.9)
“People are generally caring and sympathetic to people with mental illness”
Overall 9420 19.9 (17.8, 22.0) 24.2 (22.1, 26.3) 2.5 (1.9, 3.1) 27.8 (25.7, 30.0) 25.6 (23.6, 27.5)
Gender
 Male 2985 19.9 (16.3, 23.5) 26.6 (23.0, 30.1) 2.3 (1.4, 3.2) 26.6 (23.2, 30.1) 24.6 (21.4, 27.8)
 Female 6435 19.9 (17.7, 22.2) 22.4 (20.1, 24.7) 2.7 (1.9, 3.5) 28.7 (26.1, 31.3) 26.2 (24.0, 28.5)
Age group, y
 18–24 320 11.7 (6.0, 17.4) 27.9 (18.7, 37.2) 1.9 (0.0, 4.1) 33.4 (23.3, 43.5) 25.1 (15.3, 34.9)
 25–34 967 15.5 (11.3, 19.6) 24.2 (19.2, 29.1) 3.0 (1.2, 4.8) 32.3 (26.6, 38.0) 25.1 (20.1, 30.2)
 35–54 4346 21.3 (18.1, 24.6) 22.1 (19.4, 24.8) 2.2 (1.4, 2.9) 27.1 (24.0, 30.1) 27.3 (24.6, 30.1)
 ≥ 55 3787 24.4 (20.7, 28.1) 26.5 (22.5, 30.4) 2.9 (1.8, 4.0) 24.0 (20.7, 27.3) 22.3 (19.6, 25.0)
Race/ethnicity
 White, non-Hispanic 6666 17.0 (15.1, 18.9) 24.4 (22.1, 26.6) 2.9 (2.0, 3.8) 28.7 (26.3, 31.0) 27.1 (24.9, 29.3)
 Black, non-Hispanic 1193 25.2 (18.0, 32.5) 21.4 (16.4, 26.3) 0.5 (0.0, 1.1) 25.7 (20.0, 31.3) 27.2 (21.2, 33.2)
 Hispanic 1034 23.5 (18.1, 28.8) 26.3 (20.1, 32.4) 3.0 (1.6, 4.5) 28.3 (22.1, 34.5) 18.9 (13.5, 24.3)
 Other non-Hispanic 527 24.3 (15.0, 33.6) 23.5 (13.5, 33.4) 1.3 (0.0, 2.8) 24.4 (15.3, 33.4) 26.6 (19.4, 33.9)
Educational level
 < high school 2157 26.6 (22.4, 30.7) 23.5 (18.8, 28.1) 2.6 (1.1, 4.1) 29.8 (24.4, 35.1) 17.6 (14.2, 21.1)
 High school graduate or GED 3389 21.0 (18.0, 24.0) 26.5 (23.0, 30.0) 2.3 (1.4, 3.3) 25.3 (22.1, 28.5) 24.9 (21.7, 28.1)
 Some college 2481 13.5 (10.2, 16.8) 23.1 (19.6, 26.6) 2.4 (1.4, 3.4) 29.0 (25.4, 32.7) 32.0 (28.1, 35.8)
 College graduate 1393 15.7 (8.0, 23.4) 23.0 (18.0, 28.0) 3.1 (1.1, 5.1) 29.2 (23.8, 34.6) 29.0 (23.3, 34.8)
Annual household income, $
 < 20 000 4881 21.8 (18.3, 25.3) 24.3 (21.4, 27.3) 2.5 (1.6, 3.3) 24.5 (21.6, 27.4) 26.9 (24.1, 29.8)
 20 000–34 999 2328 19.9 (16.2, 23.6) 23.2 (19.3, 27.0) 2.7 (1.5, 4.0) 31.1 (26.6, 35.5) 23.1 (19.5, 26.7)
 35 000–49 999 950 18.9 (13.9, 23.8) 22.3 (17.0, 27.6) 1.9 (0.7, 3.1) 33.2 (26.9, 39.6) 23.8 (18.2, 29.4)
 50 000–74 999 642 17.1 (10.2, 24.0) 23.9 (16.5, 31.4) 4.0 (0.8, 7.2) 27.1 (20.9, 33.4) 27.8 (20.4, 35.2)
 ≥ 75 000 619 12.4 (7.8, 16.9) 29.6 (21.9, 37.2) 1.7 (0.1, 3.3) 30.0 (21.6, 38.5) 26.3 (18.8, 33.8)
Chronic diseaseb
 Yes 6763 16.7 (14.7, 18.6) 23.1 (20.3, 25.8) 2.3 (1.6, 2.9) 29.7 (26.9, 32.5) 28.3 (25.8, 30.9)
 No 2657 25.4 (21.1, 29.7) 25.6 (22.1, 29.0) 2.9 (1.8, 4.0) 25.0 (21.5, 28.5) 21.1 (18.0, 24.3)
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Note. CI = confidence interval; GED = general equivalency diploma.

a

Percentages were adjusted for the following variables: gender, age, race/ethnicity, education, and annual household income.

b

Chronic disease status includes respondents who self-reported any one of the following doctor-diagnosed conditions: diabetes mellitus, cardiovascular disease (heart attack or myocardial infarction, stroke, coronary heart disease), asthma, or arthritis.

TABLE 3—

Level of Agreement With Statements Regarding Mental Illness Among Respondents Without Serious Psychological Distress: Behavioral Risk Factor Surveillance System, United States, 2007 and 2009

Level of Agreement,a % (95% CI)
Characteristic Sample Size Agree Strongly Agree Slightly Neither Agree nor Disagree Disagree Slightly Disagree Strongly
“Treatment can help people with mental illness lead normal lives”
Overall 230 131 67.9 (67.3, 68.4) 25.7 (25.2, 26.1) 1.7 (1.5, 1.8) 3.5 (3.3, 3.8) 1.3 (1.1, 1.5)
Gender
 Male 89 446 62.7 (61.9, 63.5) 29.6 (28.9, 30.3) 1.9 (1.7, 2.1) 4.2 (3.9, 4.6) 1.6 (1.3, 1.8)
 Female 140 685 72.8 (72.3, 73.4) 21.8 (21.2, 22.4) 1.5 (1.3, 1.7) 2.8 (2.5, 3.1) 1.1 (09.-1.3)
Age group, y
 18–24 6 989 56.8 (54.4, 59.1) 35.4 (33.2, 37.7) 1.4 (0.9, 1.8) 5.1 (4.1, 6.1) 1.3 (0.8, 1.8)
 25–34 24 120 64.2 (62.9, 65.4) 28.7 (27.5, 29.9) 1.6 (1.3, 2.0) 4.1 (3.5, 4.7) 1.4 (1.0, 1.8)
 35–54 88 013 70.8 (70.1, 71.5) 23.5 (22.9, 24.2) 1.6 (1.3, 1.8) 2.9 (2.6, 3.2) 1.2 (1.0, 1.4)
 ≥ 55 111 009 70.0 (69.3, 70.7) 23.3 (22.6, 23.9) 2.0 (1.7, 2.2) 3.3 (3.0, 3.7) 1.4 (1.2, 1.7)
Race/ethnicity
 White, non-Hispanic 185 574 70.1 (69.6, 70.6) 24.4 (23.9, 24.9) 1.5 (1.4, 1.7) 3.0 (2.8, 3.3) 1.0 (0.8, 1.1)
 Black, non-Hispanic 17 868 65.9 (64.2, 67.5) 25.0 (23.4, 26.6) 1.9 (1.5, 2.3) 5.2 (4.4, 6.0) 2.0 (1.6, 2.4)
 Hispanic 14 531 61.1 (59.3, 62.9) 30.6 (28.9, 32.4) 2.2 (1.8, 2.6) 4.2 (3.4, 4.9) 1.9 (1.4, 2.4)
 Other non-Hispanic 12 158 62.1 (59.8, 64.5) 29.5 (27.2, 31.8) 1.8 (1.1, 2.4) 4.3 (3.4, 5.3) 2.2 (1.3, 3.1)
Educational level
 < high school 16 987 64.0 (62.0, 65.9) 28.2 (26.3, 30.1) 1.9 (1.5, 2.4) 3.9 (3.2, 4.7) 2.0 (1.4, 2.5)
 High school graduate or GED 64 052 63.7 (62.7, 64.6) 28.5 (27.5, 29.4) 1.9 (1.6, 2.2) 4.4 (4.0, 4.9) 1.5 (1.2, 1.8)
 Some college 63 386 67.3 (66.4, 68.2) 26.3 (25.5, 27.2) 1.7 (1.5, 2.0) 3.5 (3.1, 3.9) 1.1 (0.9, 1.4)
 College graduate 85 806 72.6 (71.8, 73.4) 22.6 (21.8, 23.3) 1.4 (1.1, 1.6) 2.5 (2.2, 2.9) 1.0 (0.7, 1.2)
Annual household income, $
 < 20 000 37 131 63.4 (61.9, 64.8) 28.3 (26.9, 29.7) 2.0 (1.6, 2.3) 4.6 (4.0, 5.3) 1.7 (1.3, 2.1)
 20 000–34 999 48 650 65.4 (64.3, 66.5) 27.0 (26.0, 28.0) 1.8 (1.5, 2.1) 4.1 (3.6, 4.6) 1.7 (1.3, 2.0)
 35 000–49 999 37 868 68.3 (67.2, 69.5) 25.4 (24.3, 26.5) 1.8 (1.5, 2.1) 3.3 (2.8, 3.8) 1.2 (0.9, 1.4)
 50 000–74 999 41 123 68.9 (67.9, 70.0) 25.5 (24.5, 26.5) 1.6 (1.3, 2.0) 3.0 (2.5, 3.4) 1.0 (0.7, 1.2)
 ≥ 75 000 65 359 70.9 (70.0, 71.8) 24.0 (23.1, 24.8) 1.3 (1.1, 1.6) 2.8 (2.4, 3.2) 1.0 (0.7, 1.3)
Chronic diseaseb
 Yes 106 844 69.1 (68.3, 69.9) 24.5 (23.7, 25.2) 1.6 (1.3, 1.8) 3.5 (3.2, 3.9) 1.3 (1.1, 1.6)
 No 123 287 67.2 (66.5, 67.8) 26.3 (25.7, 26.9) 1.7 (1.5, 1.9) 3.5 (3.2, 3.8) 1.3 (1.1, 1.5)
“People are generally caring and sympathetic to people with mental illness”
Overall 230 009 22.7 (22.2, 23.1) 38.1 (37.6, 38.6) 2.8 (2.6, 3.0) 26.1 (25.6, 26.5) 10.4 (10.1, 10.7)
Gender
 Male 89 704 24.6 (23.9, 25.3) 40.9 (40.2, 41.7) 3.0 (2.7, 3.3) 23.1 (22.5, 23.8) 8.4 (7.9, 8.8)
 Female 140 305 20.8 (20.3, 21.4) 35.3 (34.7, 35.9) 2.7 (2.5, 2.9) 29.0 (28.4, 29.5) 12.2 (11.8, 12.6)
Age group, y
 18–24 7 013 19.1 (17.3, 20.8) 44.4 (42.1, 46.8) 1.9 (1.4, 2.5) 27.0 (24.9, 29.2) 7.6 (6.4, 8.7)
 25–34 24 181 19.4 (18.4, 20.5) 38.4 (37.1, 39.6) 2.7 (2.3, 3.1) 29.0 (27.9, 30.1) 10.5 (9.7, 11.3)
 35–54 88 104 21.7 (21.0, 22.3) 37.7 (37.0, 38.4) 2.9 (2.6, 3.1) 26.6 (26.0, 27.2) 11.1 (10.7, 11.6)
 ≥ 55 110 711 27.6 (26.9, 28.3) 36.1 (35.4, 36.9) 3.2 (2.9, 3.4) 23.1 (22.5, 23.7) 10.0 (9.6, 10.5)
Race/ethnicity
 White, non-Hispanic 185 378 20.2 (19.8, 20.7) 38.8 (38.3, 39.4) 2.7 (2.5, 2.9) 27.8 (27.3, 28.2) 10.4 (10.1, 10.7)
 Black, non-Hispanic 17 894 26.5 (25.0, 27.9) 33.8 (32.1, 35.6) 2.7 (2.2, 3.2) 22.7 (21.3, 24.1) 14.3 (13.1, 15.5)
 Hispanic 14 537 26.9 (25.3, 28.5) 38.5 (36.7, 40.4) 3.6 (3.0, 4.2) 22.7 (21.0, 24.4) 8.3 (7.3, 9.3)
 Other non-Hispanic 12 200 34.3 (31.9, 36.6) 35.9 (33.5, 38.3) 2.5 (1.8, 3.2) 18.2 (16.5, 19.9) 9.2 (7.9, 10.5)
Educational level
 < high school 17 002 33.6 (31.7, 35.5) 38.7 (36.6, 40.8) 2.2 (1.7, 2.8) 16.6 (15.1, 18.0) 8.9 (7.7, 10.1)
 High school graduate or GED 64 283 27.6 (26.7, 28.5) 37.4 (36.5, 38.4) 2.7 (2.4, 3.0) 22.7 (21.9, 23.5) 9.5 (9.0, 10.1)
 Some college 63 245 21.1 (20.3, 21.9) 37.7 (36.8, 38.7) 3.1 (2.7, 3.4) 26.9 (26.1, 27.8) 11.2 (10.6, 11.7)
 College graduate 85 479 16.9 (16.3, 17.6) 39.2 (38.4, 40.0) 3.0 (2.7, 3.3) 30.0 (29.3, 30.8) 10.9 (10.4, 11.4)
Annual household income, $
 < 20 000 37 205 25.6 (24.4, 26.9) 35.1 (33.6, 36.6) 3.6 (3.1, 4.1) 24.5 (23.1, 25.8) 11.2 (10.4, 12.1)
 20 000–34 999 48 701 24.6 (23.6, 25.6) 35.6 (34.5, 36.7) 3.1 (2.7, 3.5) 25.6 (24.6, 26.5) 11.1 (10.4, 11.8)
 35 000–49 999 37 804 23.5 (22.5, 24.6) 37.5 (36.2, 38.7) 2.6 (2.3, 2.9) 26.0 (25.0, 27.0) 10.4 (9.7, 11.0)
 50 000–74 999 41 081 21.0 (20.0, 21.9) 39.1 (38.0, 40.2) 2.6 (2.2, 3.0) 27.3 (26.4, 28.2) 10.1 (9.4, 10.7)
 ≥ 75 000 65 218 20.1 (19.3, 20.9) 40.9 (40.0, 41.9) 2.6 (2.3, 2.9) 26.5 (25.7, 27.3) 9.9 (9.4, 10.4)
Chronic diseaseb
 Yes 106 665 21.7 (21.1, 22.4) 35.9 (35.1, 36.7) 2.7 (2.4, 3.0) 27.5 (26.8, 28.3) 12.1 (11.6, 12.6)
 No 123 344 23.3 (22.7, 23.9) 39.3 (38.6, 39.9) 2.9 (2.7, 3.1) 25.2 (24.7, 25.8) 9.3 (8.9, 9.7)
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Note. CI = confidence interval; GED = general equivalency diploma.

a

Percentages were adjusted for the following variables: gender, age, race/ethnicity, education, and annual household income.

b

Chronic disease status includes respondents who self-reported any one of the following doctor-diagnosed conditions: diabetes mellitus, cardiovascular disease (heart attack or myocardial infarction, stroke, coronary heart disease), asthma, or arthritis.

Fewer adults with serious psychological distress strongly agreed (19.9%), and at least 1 in 4 strongly disagreed, with the statement that people are caring and sympathetic to people with mental illness (Table 2). Strong agreement was less prevalent among younger adults aged 18 to 24 years (11.7%) than among adults aged 35 years and older (> 21%). More non-Hispanic Whites disagreed strongly (27.1%) with the statement than did Hispanics (18.9%). Among adults with distress, those with at least a high school degree or GED were more likely to strongly disagree (> 24.9%) than those with less than a high school education (17.6%). Among adults with distress, fewer at the highest income levels (12.4%) strongly agreed with the statement than those at the lowest income levels (21.8%). Adults with both chronic disease and distress were more likely to strongly disagree (28.3%) than those with distress but without chronic disease (21.1%).

Compared with adults without serious psychological distress, adults with such distress were less likely to agree and more likely to strongly disagree with the statement that people are caring and sympathetic to people with mental illness (Table 2). This pattern of less agreement among those with such distress occurred especially among men, non-Hispanic Whites, those who had not graduated from college, those with an annual household income of $75 000 or more, and those with a chronic disease.

Attitudes by Receipt of Mental Health Treatment Status

Seventy-seven percent of those who reported currently receiving treatment for a mental health or emotional problem strongly agreed that treatment is effective (Table 4), with significantly more women (80%) than men (72.2%) strongly agreeing. Among those receiving treatment, strong agreement was more likely among adults aged 35 years and older (> 78%) than among younger adults (< 74%), Whites (79.2%) than all other racial/ethnic groups (range = 68.5%–73%), college graduates than those with less education, and those living in households earning more than $75 000 (85.4%) than those living in households earning less than $50 000 (79.1%). The occurrence of a chronic disease did not change the level of agreement that treatment is effective.

TABLE 4—

Level of Agreement With Statements Regarding Mental Illness Among Respondents Receiving Mental Health Treatment: Behavioral Risk Factor Surveillance System, United States, 2007 and 2009

Level of Agreement,a % (95% CI)
Characteristic Sample Size, No. Agree Strongly Agree Slightly Neither Agree nor Disagree Disagree Slightly Disagree Strongly
“Treatment can help people with mental illness lead normal lives”
Overall 32 489 77.3 (76.3, 78.4) 16.8 (15.9, 17.8) 1.0 (0.8, 1.2) 3.6 (3.0, 4.2) 1.3 (1.0, 1.6)
Gender
 Male 8 621 72.2 (70.3, 74.2) 20.1 (18.4, 21.9) 1.2 (0.8, 1.7) 4.7 (3.5, 5.9) 1.7 (1.1, 2.3)
 Female 23 868 80.0 (78.9, 81.1) 15.1 (14.1, 16.2) 0.9 (0.6, 1.1) 3.0 (2.4, 3.6) 1.0 (0.7, 1.3)
Age group, y
 18–24 588 69.9 (63.6, 76.1) 24.3 (18.3, 30.4) 0.8 (0.0, 1.9) 4.4 (1.2, 7.6) 0.6 (0.0, 1.5)
 25–34 2 718 73.7 (70.6, 76.9) 18.5 (15.7, 21.3) 1.2 (0.3, 2.0) 5.0 (2.8, 7.2) 1.6 (0.2, 3.0)
 35–54 13 673 78.4 (77.0, 79.8) 16.0 (14.7, 17.2) 1.1 (0.7, 1.4) 3.3 (2.6, 4.0) 1.3 (0.9, 1.6)
 ≥ 55 15 510 78.7 (77.2, 80.2) 16.0 (14.7, 17.4) 0.9 (0.6, 1.2) 3.2 (2.6, 3.9) 1.2 (0.8, 1.5)
Race/ethnicity
 White, non-Hispanic 27 666 79.2 (78.1, 80.2) 16.0 (15.0, 16.9) 0.9 (0.7, 1.2) 2.8 (2.3, 3.2) 1.2 (0.8, 1.6)
 Black, non-Hispanic 1 982 73.0 (69.2, 76.8) 18.4 (15.1, 21.7) 0.5 (0.2, 0.9) 6.4 (3.9, 8.9) 1.7 (0.9, 2.4)
 Hispanic 1 671 68.5 (64.0, 72.9) 21.8 (17.7, 25.9) 2.2 (1.2, 3.2) 6.4 (3.5, 9.2) 1.2 (0.5, 1.9)
 Other non-Hispanic 1 170 71.8 (65.7, 77.8) 20.6 (15.3, 25.9) 0.8 (0.0, 1.7) 4.9 (1.5, 8.4) 1.9 (0.8, 3.0)
Educational level
 < high school 3 208 70.2 (66.6, 73.8) 21.4 (18.1, 24.8) 1.1 (0.4, 1.7) 5.1 (3.2, 6.9) 2.3 (1.2, 3.4)
 High school graduate or GED 9 219 74.4 (72.5, 76.4) 18.3 (16.6, 19.9) 1.2 (0.8, 1.6) 4.9 (3.6, 6.2) 1.2 (0.8, 1.5)
 Some college 9 491 78.1 (76.4, 79.9) 17.0 (15.4, 18.7) 0.8 (0.4, 1.1) 2.9 (2.2, 3.7) 1.1 (0.7, 1.6)
 College graduate 10 571 82.7 (81.0, 84.4) 13.8 (12.2, 15.3) 1.0 (0.5, 1.5) 1.8 (0.9, 2.6) 0.8 (0.4, 1.2)
Annual household income, $
 < 20 000 8 962 69.2 (66.9, 71.5) 22.0 (19.9, 24.0) 1.4 (1.0, 1.9) 5.1 (3.7, 6.4) 2.3 (1.6, 2.9)
 20 000–34 999 7 194 74.5 (72.4, 76.6) 18.7 (16.8, 20.6) 1.3 (0.8, 1.9) 4.3 (3.1, 5.4) 1.3 (0.8, 1.8)
 35 000–49 999 4 838 79.1 (76.6, 81.6) 16.1 (13.8, 18.4) 0.9 (0.4, 1.5) 3.2 (1.8, 4.5) 0.7 (0.4, 1.1)
 50 000–74 999 4 882 81.5 (78.9, 84.0) 14.9 (12.5, 17.2) 0.4 (0.1, 0.8) 2.5 (1.0, 4.1) 0.7 (0.0, 1.3)
 ≥ 75 000 6 613 85.4 (83.5, 87.4) 12.1 (10.4, 13.9) 0.6 (0.2, 1.0) 1.4 (0.6, 2.1) 0.5 (0.0, 0.9)
Chronic diseaseb
 Yes 21 083 76.4 (75.0, 77.7) 17.1 (15.9, 18.3) 1.2 (0.9, 1.6) 3.8 (3.0, 4.5) 1.5 (1.0, 2.0)
 No 11 406 78.7 (77.1, 80.4) 16.5 (15.0, 18.0) 0.6 (0.3, 0.9) 3.3 (2.4, 4.3) 0.8 (0.4, 1.1)
“People are generally caring and sympathetic to people with mental illness”
Overall 32 290 16.9 (16.0, 17.8) 30.9 (29.8, 32.0) 2.9 (2.5, 3.3) 30.4 (29.3, 31.4) 18.9 (18.0, 19.9)
Gender
 Male 8559 17.8 (16.3, 19.4) 32.8 (30.8, 34.8) 2.9 (2.2, 3.6) 29.0 (27.0, 30.9) 17.4 (15.7, 19.2)
 Female 23 731 16.4 (15.4, 17.5) 29.9 (28.6, 31.2) 2.8 (2.4, 3.3) 31.1 (29.9, 32.3) 19.7 (18.7, 20.8)
Age group, y
 18–24 585 14.8 (9.8, 19.8) 38.6 (31.3, 46.0) 3.0 (0.1, 5.8) 27.9 (21.7, 34.1) 15.7 (10.3, 21.2)
 25–34 2716 10.8 (8.8, 12.9) 31.6 (28.3, 34.9) 2.3 (1.3, 3.2) 34.3 (31.0, 37.6) 21.0 (17.9, 24.1)
 35–54 13 641 16.1 (14.8, 17.4) 30.2 (28.7, 31.8) 2.8 (2.2, 3.4) 30.7 (29.2, 32.2) 20.1 (18.8, 21.4)
 ≥ 55 15 348 21.5 (20.0, 23.0) 30.2 (28.6, 31.8) 3.2 (2.6, 3.8) 28.2 (26.6, 29.8) 16.9 (15.6, 18.2)
Race/ethnicity
 White, non-Hispanic 27 496 16.0 (15.1, 16.9) 31.5 (30.3, 32.6) 2.9 (2.4, 3.3) 31.2 (30.1, 32.4) 18.4 (17.5, 19.3)
 Black, non-Hispanic 1966 19.5 (16.2, 22.7) 28.1 (23.7, 32.4) 2.3 (1.0, 3.5) 25.2 (21.1, 29.3) 25.0 (20.8, 29.1)
 Hispanic 1665 19.0 (15.1, 22.9) 32.2 (27.0, 37.5) 3.0 (1.9, 4.1) 27.0 (22.4, 31.6) 18.8 (14.0, 23.6)
 Other non-Hispanic 1163 27.0 (20.2, 33.9) 20.3 (15.2, 25.3) 3.5 (1.1, 5.9) 28.0 (21.8, 34.2) 21.2 (16.7, 25.6)
Educational level
 < high school 3173 24.5 (21.3, 27.8) 28.9 (24.8, 33.1) 3.9 (1.9, 5.9) 25.9 (21.8, 29.9) 16.8 (13.6, 19.9)
 High school graduate or GED 9188 21.2 (19.3, 23.0) 28.4 (26.3, 30.4) 2.1 (1.6, 2.6) 29.8 (27.7, 31.9) 18.6 (16.8, 20.4)
 Some college 9436 15.0 (13.4, 16.6) 31.4 (29.3, 33.4) 2.8 (2.2, 3.4) 30.6 (28.7, 32.4) 20.3 (18.7, 21.9)
 College graduate 10 493 12.5 (11.1, 13.9) 33.1 (31.2, 35.0) 3.3 (2.5, 4.1) 32.1 (30.2, 33.9) 19.0 (17.4 20.7)
Annual household income, $
 < 20 000 8904 18.2 (16.3, 20.2) 26.7 (24.5, 29.0) 2.8 (2.1, 3.5) 27.6 (25.3, 29.8) 24.7 (22.4, 26.9)
 20 000–34 999 7132 19.0 (17.1, 20.9) 27.1 (24.9, 29.4) 3.5 (2.5, 4.4) 29.7 (27.6, 31.9) 20.6 (18.6, 22.7)
 35 000–49 999 4811 17.5 (15.4, 19.6) 31.6 (28.9, 34.4) 3.2 (1.9, 4.4) 31.6 (28.8, 34.4) 16.1 (14.3, 18.0)
 50 000–74 999 4860 14.8 (12.9, 16.8) 33.8 (31.2, 36.5) 3.0 (1.8, 4.1) 33.1 (30.5, 35.6) 15.3 (13.3, 17.2)
 ≥ 75 000 6583 14.7 (12.8, 16.7) 35.1 (32.6, 37.6) 2.3 (1.7, 3.0) 31.3 (28.9, 33.6) 16.6 (14.7, 18.5)
Chronic diseaseb
 Yes 20 961 16.1 (15.0, 17.2) 29.2 (27.7, 30.7) 2.8 (2.3, 3.4) 30.7 (29.2, 32.1) 21.1 (19.9, 22.4)
 No 11 329 18.3 (16.7, 20.0) 32.9 (31.2, 34.7) 2.9 (2.3, 3.5) 30.0 (28.3, 31.6) 15.9 (14.4, 17.4)
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Note. CI = confidence interval; GED = general equivalency diploma.

a

Percentages were adjusted for the following variables: gender, age, race/ethnicity, education, and annual household income.

b

Chronic disease status includes respondents who self-reported any one of the following doctor-diagnosed conditions: diabetes mellitus, cardiovascular disease (heart attack or myocardial infarction, stroke, coronary heart disease), asthma, or arthritis.

More of those receiving treatment strongly agreed (77%; Table 4) that treatment is effective than did those not receiving treatment (66%; Table 5). This pattern of more strong agreement about treatment effectiveness among those receiving treatment held true among men and women, all age groups, all racial and ethnic groups, all educational levels, all annual household income levels, and both those with and without a chronic disease.

TABLE 5—

Level of Agreement With Statements Regarding Mental Illness Among Respondents Not Receiving Mental Health Treatment: Behavioral Risk Factor Surveillance System, United States, 2007 and 2009

Level of Agreement,a % (95% CI)
Characteristic Sample Size, No. Agree Strongly Agree Slightly Neither Agree nor Disagree Disagree Slightly Disagree Strongly
“Treatment can help people with mental illness lead normal lives”
Overall 210 155 66.0 (65.4, 66.5) 26.9 (26.4, 27.4) 1.9 (1.7, 2.1) 3.7 (3.5, 4.0) 1.5 (1.3, 1.7)
Gender
 Male 85 227 61.2 (60.4, 62.0) 30.6 (29.8, 31.3) 2.1 (1.8, 2.4) 4.4 (4.0, 4.8) 1.7 (1.5, 2.0)
 Female 124 928 71.0 (70.4, 71.6) 23.1 (22.5, 23.7) 1.6 (1.4, 1.8) 3.0 (2.7, 3.3) 1.2 (1.0, 1.4)
Age group, y
 18–24 6801 55.1 (52.7, 57.5) 36.3 (33.9, 38.6) 1.8 (0.9, 2.7) 5.4 (4.4, 6.4) 1.5 (0.9, 2.0)
 25–34 22 650 62.3 (61.0, 63.6) 30.1 (28.8, 31.3) 1.8 (1.4, 2.1) 4.3 (3.6, 4.9) 1.6 (1.2, 2.1)
 35–54 79 470 68.7 (67.9, 69.4) 25.1 (24.4, 25.8) 1.7 (1.5, 2.0) 3.1 (2.8, 3.5) 1.4 (1.2, 1.6)
 ≥ 55 101 234 68.7 (68.0, 69.5) 24.1 (23.4, 24.8) 2.2 (1.9, 2.4) 3.5 (3.1, 3.9) 1.5 (1.3, 1.8)
Race/ethnicity
 White, non-Hispanic 166 617 68.1 (67.6, 68.7) 25.9 (25.3, 26.4) 1.7 (1.5, 1.9) 3.3 (3.0, 3.5) 1.1 (0.9, 1.3)
 Black, non-Hispanic 17 622 64.8 (63.1, 66.5) 25.5 (23.9, 27.1) 2.0 (1.5, 2.4) 5.6 (4.7, 6.4) 2.2 (1.7, 2.6)
 Hispanic 14 174 60.0 (58.2, 61.9) 31.1 (29.4, 32.9) 2.5 (1.8, 3.3) 4.2 (3.4, 5.0) 2.1 (1.6, 2.7)
 Other non-Hispanic 11 742 60.8 (58.4, 63.2) 30.5 (28.1, 32.8) 1.9 (1.3, 2.6) 4.5 (3.5, 5.5) 2.4 (1.4, 3.3)
Educational level
 < high school 16 580 62.5 (60.5, 64.5) 29.1 (27.2, 31.1) 2.0 (1.4, 2.6) 4.2 (3.4, 5.0) 2.2 (1.6, 2.7)
 High school graduate or GED 59 268 61.9 (60.9, 63.0) 29.8 (28.8, 30.8) 2.0 (1.7, 2.3) 4.5 (4.1, 5.0) 1.7 (1.4, 2.0)
 Some college 57 013 65.3 (64.3, 66.2) 27.6 (26.6, 28.5) 2.1 (1.6, 2.6) 3.8 (3.3, 4.2) 1.3 (1.0, 1.6)
 College graduate 77 294 70.8 (69.9, 71.6) 23.8 (23.0, 24.6) 1.5 (1.2, 1.8) 2.8 (2.4, 3.2) 1.1 (0.8, 1.4)
Annual household income, $
 < 20 000 34 178 61.2 (59.7, 62.8) 29.6 (28.1, 31.1) 2.4 (1.7, 3.2) 4.8 (4.2, 5.5) 1.9 (1.5, 2.3)
 20 000–34 999 44 636 63.2 (62.1, 64.4) 28.4 (27.3, 29.5) 2.1 (1.7, 2.4) 4.4 (3.9, 4.9) 1.9 (1.5, 2.3)
 35 000–49 999 34 387 66.4 (65.2, 67.6) 26.8 (25.7, 28.0) 1.9 (1.6, 2.3) 3.5 (3.0, 4.0) 1.3 (1.0, 1.6)
 50 000–74 999 37 209 67.3 (66.2, 68.5) 26.7 (25.6, 27.8) 1.8 (1.4, 2.1) 3.1 (2.6, 3.6) 1.1 (0.8, 1.3)
 ≥ 75 000 59 745 69.3 (68.4, 70.3) 25.1 (24.2, 26.0) 1.4 (1.2, 1.7) 3.0 (2.5, 3.4) 1.2 (0.8, 1.6)
Chronic diseaseb
 Yes 94 340 66.7 (65.9, 67.6) 26.0 (25.2, 26.9) 1.8 (1.5, 2.0) 3.9 (3.5, 4.3) 1.6 (1.3, 1.8)
 No 115 815 65.6 (64.9, 66.3) 27.4 (26.8, 28.0) 1.9 (1.7, 2.2) 3.6 (3.3, 4.0) 1.4 (1.2, 1.6)
“People are generally caring and sympathetic to people with mental illness”
Overall 210 225 23.4 (22.9, 23.9) 38.3 (37.8, 38.9) 2.8 (2.6, 3.0) 25.5 (25.0, 25.9) 10.0 (9.7, 10.3)
Gender
 Male 85 559 25.2 (24.4, 25.9) 41.0 (40.2, 41.8) 3.0 (2.7, 3.3) 22.6 (21.9, 23.3) 8.2 (7.8, 8.7)
 Female 124 666 21.5 (21.0, 22.1) 35.5 (34.8, 36.1) 2.7 (2.5, 2.9) 28.6 (28.0, 29.1) 11.8 (11.4, 12.2)
Age group, y
 18–24 6830 19.2 (17.4, 21.1) 44.6 (42.1, 47.0) 1.8 (1.3, 2.3) 26.9 (24.7, 29.0) 7.5 (6.4, 8.6)
 25–34 22 708 20.4 (19.3, 21.5) 38.3 (37.0, 39.6) 2.7 (2.3, 3.2) 28.5 (27.3, 29.6) 10.1 (9.3, 10.9)
 35–54 79 596 22.5 (21.8, 23.1) 37.9 (37.2, 38.7) 2.9 (2.6, 3.1) 26.0 (25.3, 26.6) 10.8 (10.3, 11.2)
 ≥ 55 101 091 28.4 (27.6, 29.1) 36.5 (35.7, 37.2) 3.2 (3.0, 3.5) 22.4 (21.8, 23.0) 9.6 (9.1, 10.1)
Race/ethnicity
 White, non-Hispanic 166 591 20.8 (20.3, 21.3) 39.2 (38.6, 39.7) 2.7 (2.5, 3.0) 27.2 (26.7, 27.7) 10.1 (9.7, 10.4)
 Black, non-Hispanic 17 644 27.2 (25.7, 28.7) 33.7 (32.0, 35.5) 2.7 (2.1, 3.2) 22.5 (21.0, 23.9) 13.9 (12.7, 15.1)
 Hispanic 14 187 27.4 (25.7, 29.0) 38.7 (36.7, 40.6) 3.6 (3.0, 4.2) 22.6 (20.9, 24.3) 7.8 (6.8, 8.8)
 Other non-Hispanic 11 803 34.4 (32.0, 36.8) 36.5 (34.0, 38.9) 2.5 (1.8, 3.2) 17.6 (15.9, 19.3) 9.0 (7.7, 10.3)
Educational level
 < high school 16 610 34.0 (32.0, 36.0) 38.2 (36.0, 40.3) 2.2 (1.7, 2.7) 17.2 (15.6, 18.7) 8.5 (7.3, 9.7)
 High school graduate or GED 59 552 28.3 (27.3, 29.2) 37.9 (36.8, 38.9) 2.8 (2.4, 3.1) 21.9 (21.0, 22.7) 9.2 (8.7, 9.8)
 Some college 57 031 21.6 (20.8, 22.5) 38.1 (37.1, 39.1) 3.1 (2.8, 3.5) 26.3 (25.4, 27.2) 10.8 (10.3, 11.4)
 College graduate 77 032 17.5 (16.8, 18.2) 39.4 (38.6, 40.3) 2.9 (2.6, 3.2) 29.7 (28.9, 30.5) 10.5 (9.9, 11.0)
Annual household income, $
 < 20 000 34 304 26.6 (25.2, 27.9) 35.6 (34.0, 37.2) 3.7 (3.1, 4.2) 23.6 (22.2, 25.0) 10.6 (9.7, 11.4)
 20 000–34 999 44 742 25.1 (24.0, 26.1) 36.1 (34.9, 37.2) 3.1 (2.7, 3.5) 25.2 (24.2, 26.2) 10.6 (9.9, 11.3)
 35 000–49 999 34 352 24.2 (23.0, 25.3) 37.6 (26.3, 38.8) 2.5 (2.2, 2.9) 25.5 (24.5, 26.5) 10.3 (9.5, 11.0)
 50 000–74 999 37 186 21.8 (20.8, 22.9) 39.2 (38.0, 40.3) 2.6 (2.2, 3.0) 26.5 (25.5, 27.5) 9.9 (9.2, 10.6)
 ≥ 75 000 59 641 20.7 (19.8, 21.5) 41.2 (40.2, 42.2) 2.6 (2.3, 2.9) 26.0 (25.2, 26.9) 9.5 (8.9, 10.0)
Chronic diseaseb
 Yes 94 278 22.4 (21.7, 23.1) 36.2 (35.4, 37.1) 2.7 (2.4, 2.9) 27.1 (26.3, 27.9) 11.6 (11.1, 12.1)
 No 115 947 24.0 (23.4, 24.6) 39.4 (38.7, 40.1) 2.9 (2.7, 3.2) 24.6 (24.1, 25.2) 9.1 (8.7, 9.5)
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Note. CI = confidence interval; GED = general equivalency diploma.

a

Percentages were adjusted for the following variables: gender, age, race/ethnicity, education, and annual household income.

b

Chronic disease status includes respondents who self-reported any one of the following doctor-diagnosed conditions: diabetes mellitus, cardiovascular disease (heart attack or myocardial infarction, stroke, coronary heart disease), asthma, or arthritis.

Among adults receiving mental illness treatment, only about 17% strongly and 31% slightly agreed that people are caring and sympathetic to people with mental illness (Table 4). Among the treated, those aged 55 years or older and those who were high school graduates or less agreed more strongly with the statement than younger or more educated persons. However, adults receiving treatment agreed with the statement less often than those not receiving treatment, a pattern that held true for both men and women, those aged 25 years or older, all racial and ethnic groups except “other non-Hispanics,” all educational levels, all annual household income levels, and those with and without a chronic disease.

DISCUSSION

We found that attitudes regarding the effectiveness of mental health treatment, and how supportive others are to people with mental illness, varied by study subgroup. Notably, attitudes regarding treatment effectiveness varied by serious psychological distress status, suggesting possible unmet needs in those with untreated, or ineffectively treated, mental illness symptoms. The perception of an unsupportive environment was particularly common for women, those aged 18 to 34 years, White non-Hispanics, college graduates, those with annual household incomes of $50 000 or more, adults with serious psychological distress, those receiving treatment for a mental health or emotional problem, those with chronic disease, and those with chronic disease and serious psychological distress.

The more favorable attitudes regarding treatment effectiveness (compared with perceptions of a supportive environment) among all adults may result from successful efforts of past public education campaigns, direct-to-consumer advertising, or changing social norms about the use and benefits of psychiatric medications.2,11,15 These generally favorable attitudes toward treatment effectiveness extend other findings suggesting that treatment-based stigma may be lower for most adults than other forms of stigma.16,17

These data also serve as one possible indicator of adults’ mental health literacy in the states surveyed to track changes over time.18 That adults with serious psychological distress had more negative views about treatment effectiveness suggests a potential information or treatment gap in this group. Perhaps these adults were less sure about the possible benefits of mental health treatment, were less satisfied with care they received for a mental health problem, or knew of unsuccessful treatment in family or friends. In a posthoc analysis (using the same methodology controlling for covariates), designed to further examine how attitudes varied by serious psychological distress and treatment effectiveness, we found that 81.5% (95% confidence interval [CI] = 80.4%, 82.6%) of adults without serious psychological distress, and who were receiving treatment, strongly agreed that treatment is effective, compared with only 57.5% (95% CI = 54.6%, 60.5%) of those with serious psychological distress who were receiving treatment. This suggests that because treatment may be working for those without symptoms but in treatment, they are more likely to consider the statement to be true. However, it is possible that for adults receiving treatment who continue to have serious psychological distress, their treatment may not (yet) be working for them, so they hold less favorable views for this statement. This has important implications, because if such attitudes motivate behavior, individuals with more unfavorable attitudes might cease treatment, increasing their risk of negative outcomes. It also suggests the need for close monitoring of patients’ perceptions of treatment efficacy, relative to their needs, values, and preferences.19

Social support confers a number of advantages on health, including preventing felt stigma up to a year after onset of mental illness.20 The public’s perception of an unsupportive environment suggests the need for more studies examining felt stigma versus enacted stigma, and overt instances of discrimination. Such studies may determine whether people have experienced unsupportive behaviors or social exclusion themselves, or witnessed this for others, or whether they simply perceive that others are more unsupportive on the basis of social comparison effects, interviewer effects, or other factors. This perception of an unsupportive environment also reinforces the need for continued vigilance in the use of supportive language and behaviors modeled in the campaign What a Difference a Friend Makes, and in SAMHSA’s Campaign for Social Inclusion.21

Many adults with chronic conditions such as arthritis, cancer, heart disease, and epilepsy experience concurrent depression and anxiety, further complicating self-management of these disorders and adversely affecting quality of life.22 The approximately 15% of adults with chronic disease, serious psychological distress, and negative attitudes toward treatment effectiveness might be at greater risk of poorer health outcomes associated with lack of mental illness treatment or ineffective treatment. Because this is a cross-sectional study, more research is required to examine reasons for the large proportion of adults with chronic disease and serious psychological distress who disagreed with the statement that people are caring and sympathetic to people with mental illness. These adults might have faced additional obstacles and frustrations in navigating disconnected health care delivery systems.19 They might have experienced more unequal or negative social exchange because of limitations associated with their chronic disorder. Other factors not accounted for in this study (e.g., quantity and quality of social ties) might explain these findings. Finally, it is also possible that untreated or ineffectively treated mental illness contributes to these negative attitudes in adults with chronic disease.

The ability to adjust for confounding factors and the large sample size allowing for an examination of the distribution of agreement in subgroups were strengths of this study. After adjustment, attitudes varied significantly by sociodemographic characteristics, although not always in expected patterns. For example, adults at higher educational and income levels tended to perceive a more unsupportive environment. An assessment of the full distribution of responses highlights additional opportunities to focus intervention efforts; differences between slight and strong agreement, and between slight and strong disagreement, might inform the development of more targeted messages to nudge the attitudes of persons more unengaged, ambivalent, or unsure in their beliefs, contrasted with messages that more aggressively sway those with more strongly held beliefs.23 Some state-level factors have also influenced these attitudes.3 For example, adults who lived in states with higher per capita expenditures on mental health services were more likely to agree that treatment is effective, and were more likely to report receiving treatment.3 Such state-level factors remain amenable to intervention to improve mental health literacy and access to care. Ensuring that individuals with mental illness symptoms, and those with co-occurring chronic disease and mental illness symptoms, obtain high-quality care is crucial to overall population health.19

These data can be used by public health and mental health stakeholders to target interventions for population subgroups with less favorable attitudes, particularly those with serious psychological distress, and to track changes in these attitudes over time.1,3

The findings in this report are subject to several limitations. First, BRFSS surveys include only noninstitutionalized adults with telephones. Persons in institutions and in households without telephones are excluded, groups that might include a higher proportion of persons with mental health symptoms. Second, because states commonly use only English- or Spanish-language surveys, persons who speak other primary languages are excluded, which could affect race- and ethnicity-specific results. Third, because not all states asked these questions about attitudes toward mental illness, these data are not nationally representative, so no conclusions can be drawn about the entire US population. The question on caring and sympathy requires further examination regarding its interpretation and association with other beliefs.24 Fourth, it is unknown whether individuals who agree that treatment is effective would actually seek professional treatment of themselves or whether they would encourage others to seek care. It is also unclear what type of treatment respondents had in mind when answering this question. Finally, a comprehensive assessment of stigma and stigmatizing behaviors may not be possible in a necessarily brief BRFSS module, because of the multifaceted complexity and variability of the concept across a wide range of mental illnesses and population perspectives.25

Acknowledgments

This article was prepared for the May 2013 theme issue on Stigma and Mental Health. External funding for the May 2013 issue was provided by the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, and The Carter Center.

Human Participant Protection

Institutional review board approval was not necessary because this study involved analysis of publicly available surveillance data.

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