An Anonymous Survey Method for Obtaining Sensitive, Personal, or Embarrassing Information in the Context of Mental Illness Stigma

Abstract

This case study describes an attempt to determine how the almost universal stigma that attaches to mental illness manifests itself in different parts of the world. We wanted to know whether there was an innate human aversion to certain behaviors or whether exclusion and disrespect were learned. We used an online world survey method in which we asked 596,712 random, anonymous Web users from 229 territories whether (a) they had close contact with someone who suffered from a mental illness such as depression, psychosis, or addiction, and (b) what adjectival phrases they would endorse to describe mental illness. We also asked respondents to state their sex and age so that we could check how representative they were of the demographics of their region. Because all participants were anonymous, they did not need to be concerned about giving the socially expected or “right” response. Their answers were free of “social desirability bias.” We found intriguing differences among geographic regions in (a) the degree of daily contact with persons who lived with mental illness, (b) the association of mental illness with violence, and (c) the belief that recovery was possible. Our method allowed us to collect a very large number of answers from all parts of the world. The interpretation of our findings, however, proved to be difficult. Numerous hypotheses were, nevertheless, generated. The realization that mental illness stigma varies among cultures indicates that it is not inevitable, and holds out the promise that it can be altered, perhaps eradicated, by appropriate intervention.

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