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WELL WHAT DO YOU THINK (2004): THE SECOND NATIONAL SCOTTISH SURVEY OF PUBLIC ATTITUDES TO MENTAL HEALTH, MENTAL WELL-BEING AND MENTAL HEALTH PROBLEMS

CHAPTER NINE: ATTITUDES TOWARDS SPECIFIC SYMPTOMS OF MENTAL ILL-HEALTH

9.1 This chapter builds on findings presented in chapter eight by exploring respondents' attitudes towards specific symptoms of mental ill-health. The symptoms include those associated with depression, schizophrenia and severe stress.

MENTAL HEALTH 'SCENARIOS'

9.2 Three scenarios depicting people with symptoms of depression, schizophrenia or stress were adapted from a study by Link et al (1999) on public recognition of mental illness. Each scenario was constructed to meet the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for the disorder in question. The person in the scenario was either male or female (named Robert or Shona) giving six scenarios in total. Each respondent in the survey was presented with one of the six scenarios (without being given a diagnosis) and asked a series of questions about the person in the scenario and the symptoms he/she displayed. The questions focused on the likely cause(s) of the symptoms, possible sources of help, the likelihood of them harming themself or others, and the extent to which respondents would be willing to interact with him/her. At the end of the section, respondents were asked to say what condition they thought was being described in the scenario. Given that there were six scenarios, each was considered by a relatively small sub group of the full sample: this point should be borne in mind when considering the findings. The full text of the six scenarios is provided in Annex F.

OVERVIEW of attitudes towards symptoms of depression, schizophrenia and stress

9.3 The three sets of symptoms depicted in the scenarios elicited different reactions from respondents. At the most general level and consistent with wider research, the symptoms of schizophrenia appeared to be seen as more 'serious' and more in need of specialist or medical treatment than the symptoms of either depression or stress. For all the scenarios, the gender of the person depicted had a significant impact on perceptions of, and attitudes towards, the individual exhibiting the symptoms under consideration.

9.4 The most commonly suggested cause of all three sets of symptoms was stressful or disturbing events in Robert's/Shona's life. That said, in each case a majority also mentioned a chemical imbalance in the brain, abuse suffered in childhood or physical illness. Those who were shown the schizophrenia scenarios were more likely than other respondents to mention a chemical imbalance in the brain, while those shown the depression scenarios were more likely to mention physical illness. Robert's/Shona's own character or personality was mentioned by higher than average proportions of those shown the stress scenarios.

9.5 Respondents who were shown the female versions of the depression or schizophrenia scenarios were more likely to associate the symptoms depicted with upbringing than those shown the corresponding male versions. Meanwhile, those shown the male versions were more likely to mention physical illness. For the stress scenarios the reverse was the case - upbringing was mentioned by a higher proportion of those shown the male version of the scenario, and physical illness by a higher proportion of those shown the female version.

9.6 Between 2002 and 2004 there were significant decreases in the proportions of respondents who felt that the symptoms of depression and stress might be associated with Robert's/Shona's own personality, a genetic or inherited condition or physical illness. The perceived causes of depression were unchanged.

9.7 In general, family doctors, qualified counsellors and family members were seen as the best sources of help for the people in each of the scenarios. However, half of those shown either of the schizophrenia scenarios mentioned a psychiatrist. Friends and neighbours were also seen as possible sources of help, but more especially by those who were shown one of the female scenarios. Among respondents shown the depression or stress scenarios, the proportions mentioning informal sources of help including family members, friends and neighbours rose significantly between 2002 and 2004. Meanwhile there was a slight decline in the proportions mentioning qualified counsellors.

9.8 Whichever version of scenario respondents were shown, a majority felt that the best place for Robert/Shona to live was in his/her own home with support from family members or friends. However, a significant minority of those shown either of the schizophrenia scenarios felt that Robert/Shona should live in special housing with professional support in the community.

9.9 A majority of those shown the schizophrenia scenarios and around half of those shown the depression scenarios thought that Robert/Shona might harm him/herself. Of those shown the stress scenarios, a minority held this view. Consistent with these findings, very few respondents shown the stress or depression scenarios thought Robert/Shona were likely to harm others, but around a third of those shown the schizophrenia scenario thought this likely.

9.10 For all scenarios, majorities said that they would be willing to interact with Robert/Shona under a range of circumstances including doing him/her a favour, making friends with him/her, moving next door to, or spending an evening socialising with him/her. However smaller proportions were willing to have Robert/Shona marry into the family and fewer than half in each case said that they would allow him/her to provide childcare for someone in their family.

9.11 These findings are broadly consistent with results from the 2003 DoH survey and the Mental Health Ireland study. In both studies, majorities disagreed with the statements, 'A person would be foolish to marry someone who has suffered from mental illness, even though they seem fully recovered' (62% and 75% respectively) and 'I would not want to live next door to someone who has been mentally ill' (62% and 88% respectively). However, minorities agreed that 'women who were once patients in a mental hospital can be trusted as babysitters' (Taylor Nelson Sofres, 2003; Millward Brown 2003).

9.12 In general terms, willingness to interact with Robert/Shona was highest among respondents who were shown the stress scenarios and lowest among those who were shown the schizophrenia scenarios. For each of the scenarios, respondents were generally more willing to interact with a female displaying the symptoms depicted than with a male showing the same symptoms.

9.13 While majorities of those shown the depression scenarios were able to attribute the symptoms to the condition correctly, this was not the case for either the schizophrenia or stress scenarios. Indeed, almost half of those considering the stress scenarios thought that Robert/Shona was exhibiting symptoms of depression. Likewise, a significant proportion of those shown the schizophrenia scenario gave diagnoses of depression, a nervous breakdown or a personality disorder.

9.14 The remainder of this chapter explores perceptions of, and attitudes towards, symptoms of depression, schizophrenia and stress in more detail, drawing comparisons throughout with findings from the 2002 survey.

DEPRESSION

Symptoms of Depression

9.15 The symptoms described in the depression scenarios were felt to have a number of different causes. A majority of respondents shown both the male and female version of the depression scenario mentioned stressful or disturbing events in Robert/Shona's life, a chemical imbalance in the brain, physical illness and abuse experienced in childhood. Around two in five also mentioned Robert's/Shona's upbringing and his/her personality.

9.16 Respondents who were shown the female version of the depression scenario were more likely to suggest that upbringing or abuse suffered in childhood could have caused the symptoms than those who were shown the male version. Meanwhile, those who were shown the male version were more likely to feel that the symptoms could have been caused by physical illness or were Robert's own fault.

9.17 Comparing the findings in 2002 and 2004, the proportions saying that the symptoms may have been caused by fate, Robert's/Shona's own personality or a genetic or inherited problem were significantly lower. Among those shown the male version of the scenario, the proportion saying that the symptoms might have been caused by physical illness also fell.

Table: 9.1: Depression scenario. Likely causes of depression

Q In your opinion, how likely or unlikely do you think it is that Robert's/Shona's condition might be caused by each of the following?

	% Likely
	Depression (Male)		Depression (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Robert's/Shona's own character or personality	51	45	48	41
Chemical imbalance in the brain	64	66	69	69
The way Robert/Shona was brought up	45	37	36	44
Stressful or disturbing events in Robert's/Shona's life	93	92	92	93
Genetic or inherited problem	55	45	50	46
Abuse Robert/Shona suffered as a child	61	52	52	57
Fate	31	24	25	19
Physical illness	83	65	74	72
Robert's/Shona's own fault	21	21	14	13

Source: MORI

Support mechanisms for the person in the depression scenario

9.18 Asked to consider the most appropriate sources of help for the person in the depression scenario, the majority of respondents mentioned a family doctor or a family member. The next most common responses were a qualified counsellor, a psychiatrist, or a friend or neighbour. As can be seen from table 9.2 below, respondents who were shown the female version of the scenario were twice as likely to mention friends or neighbours as possible sources of help than those who were shown the male version.

9.19 Between 2002 and 2004, the proportion of respondents who felt that family members would be the best sources of help for someone, whether male or female, displaying symptoms of depression increased significantly. Meanwhile, the proportion who mentioned qualified counsellors and psychiatrists fell - particularly among respondents considering the female version of the scenario.

Table 9.2: Depression scenario. Support for Robert/Shona

Q Say it was possible for any of the people on this card to help Robert/Shona. Who would be the three best people to do this?

	Depression (Male)		Depression (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Someone in the family	42	53	38	52
A friend or neighbour	23	17	28	36
A nurse	3	3	3	4
A home help/carer	3	2	4	4
A psychiatrist	29	26	33	26
A psychologist	15	17	20	15
A family doctor	66	71	56	65
A social worker	9	7	5	6
A qualified counsellor	59	51	58	47
A voluntary organisation or charity	7	11	11	16
Someone with the same problem	33	25	34	21
Someone else	1	2	-	2
No one	-	-	-	-
None of these	-	*	-	-
Don't know	-	1	1	1

Source: MORI

Where the person described in the depression scenario should live

9.20 There was overwhelming agreement that the best place for the person in both of the depression scenarios to live would be in their own homes, with support from family members or friends.

9.21 These findings are not directly comparable with those from 2002 as the response options included in the two surveys differ. In 2002, a majority felt that Robert/Shona should live in his/her own home but around half of this group also felt that he/she should also have help from professionals such as community mental health teams.

Table 9.3: Depression scenario. Suitable place for Robert/Shona to live

Q If all of these options on this card were possible, where do you think it would be best for Robert/Shona to live?

	Depression (Male)		Depression (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
In their own home by themselves	1	n/a	1	n/a
In their own home (or family's) home with support from family members or friends	43	80	39	81
In their own (or family's) home with help from professionals (for example, community mental health teams)	44	n/a	49	n/a
In special housing with professional support in the community	8	14	8	13
In a residential or nursing home	1	1	1	1
In hospital	1	2	1	3
Somewhere else	-	-	-	-
Wherever he/she wants	1	-	1	*

Source: MORI

Depression scenario: possibility of harm/violence

9.22 Around half of respondents considering the depression scenarios thought that Robert/Shona might do something harmful or violent to him/herself as a consequence of the symptoms they were experiencing. However, this view was less prevalent among respondents to the 2004 survey than the 2002 survey.

Table 9.4: Depression scenario. Likelihood of doing something harmful/violent to him/herself

Q In your opinion, how likely is it that Robert/Shona would do something harmful or violent to him/herself?

	Depression (Male)		Depression (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Very likely	10	5	11	10
Somewhat likely	41	42	44	39
Somewhat unlikely	32	36	24	29
Very unlikely	11	11	18	17
Don't know	6	6	4	5

Source: MORI

9.23 A minority of respondents felt that a person displaying depressive symptoms was likely to do something harmful or violent to others. Again, this view has become significantly less common over time. Indeed, among those shown the male version of the scenario, the proportion saying that Robert was likely to harm others almost halved between 2002 and 2004.

Table 9.5: Depression scenario. Likelihood of doing something harmful/violent to others

Q In your opinion, how likely is it that Robert/Shona would do something harmful or violent to others?

	Depression (Male)		Depression (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Very likely	*	1	1	3
Somewhat likely	21	10	11	10
Somewhat unlikely	41	41	39	36
Very unlikely	33	40	46	48
Don't know	5	7	3	4

Source: MORI

9.24 Consistent with the findings in 2002, almost all respondents felt that the people in the depression scenarios should have the same rights at work as anyone else (93% of those shown the male version of the scenario and 96% of those shown the female version).

Social interaction with the person in the depression scenario

9.25 Respondents were asked how willing they would be to interact with Robert/Shona under a number of different circumstances. These ranged from doing him/her a favour, to working with him/her or having him/her provide childcare for someone in their family. The childcare item was introduced in 2004 for the first time and was adapted from the 2003 DoH survey discussed above (Taylor Nelson Sofres 2003).

9.26 Respondents were generally sympathetic towards the people in the depression scenarios. Thus a large majority said that they would be willing to do a favour for Robert/Shona; make friends with him/her; spend an evening socialising with; or move next door to, him/her. Around half said that they would be willing to have him/her marry into their family. However, a considerably smaller proportion said that they would be willing to have Robert/Shona provide childcare for someone in their family - 23% of those shown the male version of the scenario and 28% of those shown the female version.

9.27 Willingness to interact with the people in the depression scenarios varied somewhat depending on which version of the scenario respondents were asked to consider. In particular, those presented with the male version were a little less likely to say they would be willing to spend an evening socialising with, or work closely with, Robert than those presented with the female version.

9.28 A comparison of the results for 2002 and 2004 indicates that there has been a significant increase in the proportion of respondents willing to interact with the people depicted in the depression scenarios for almost all of the circumstances described.

Table 9.6: Depression scenario. Social interaction with Robert/Shona

Q How willing would you be to…?

	% Willing
	Depression (Male)		Depression (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Move next door to Robert/Shona	62	79	74	75
Spend an evening socialising with Robert/Shona	67	75	68	81
Make friends with Robert/Shona	75	82	74	86
Start working closely with Robert/Shona	61	73	54	80
Have Robert Shona marry into the family	32	49	46	57
Do Robert/Shona a favour if they asked you to	88	90	88	92
Have Robert/Shona provide childcare for someone in your family (e.g. babysitting, childminding)	n/a	23	n/a	28

Source: MORI

Diagnosis of depression

9.29 Respondents were asked to pick from a list of 14 options, the most likely diagnosed mental health problem relating to the symptoms described. A majority of those shown one of the depression scenarios were able to fit the symptoms to the condition correctly, though the figure was slightly higher among those shown the female version than among those shown the male version.

9.30 The question was asked differently in the 2002 survey, meaning that data are not directly comparable. Rather than being asked to select a diagnosis from a list of conditions, respondents were asked simply how likely it was that Robert/Shona was exhibiting symptoms of depression, schizophrenia and stress. Again, a large majority shown the depression scenarios said that it was likely that Robert/Shona was experiencing depression. However, similar proportions also felt that he/she might be experiencing stress and around a quarter thought that he/she might be experiencing schizophrenia.

Table 9.7: Depression scenario. Diagnosis

The description I read out for Shona/Robert was designed with one particular mental health problem in mind. Which one of these do you think it is most likely to be?

	Depression (Male)	Depression (Female)
Base: All respondents presented with scenario	(199)	(231)
	%	%
Alzheimer's Disease/dementia	-	-
Anxiety Disorder	6	2
Depression	69	75
Eating disorder (anorexia, bulimia)	-	-
Manic depression (bipolar affective disorder)	5	4
Nervous breakdown	6	7
Obsessive/compulsive behaviour/disorder	-	-
Panic attacks	1	*
Personality disorder	5	2
Phobias (e.g. Agoraphobia)	-	*
Post-natal depression	-	2
Schizophrenia	1	1
Self harm	-	*
Severe stress	5	3
Other	*	1
Don't know	3	2

Source: MORI

SCHIZOPHRENIA

Symptoms of Schizophrenia

9.31 As in the case of depression, respondents tended to account for the symptoms of schizophrenia primarily in terms of stressful or disturbing events in Robert's/Shona's life. That said, a large majority also mentioned a chemical imbalance in the brain, and abuse suffered as a child. The gender of the person in the scenario appeared to have little impact on the results, though respondents shown the female version were more likely to mention upbringing as a possible cause than those shown the male version. Between 2002 and 2004, the perceived causes of the symptoms in the schizophrenia scenario remained fairly stable.

9.32 We can compare these findings with results from a recent Canadian survey of attitudes towards people with schizophrenia. The survey was conducted by telephone among 1,653 respondents (aged 15+) residing in two adjacent rural and urban health regions in Alberta, Canada. Among other things, respondents were asked a prompted question about causes of schizophrenia. Two thirds were able to mention a cause. Of this group, most identified a biological cause usually suggesting that schizophrenia is a brain disease. Few identified a psycho-social cause such as poor upbringing by parents, physical abuse or traumatic shock (Stuart and Arboleda-Florez 2001).

Table 9.8: Schizophrenia scenario. Likely causes of schizophrenia

Q In your opinion, how likely or unlikely do you think it is that Robert's/Shona's condition might be caused by each of the following?

	% Likely
	Schizophrenia (Male)		Schizophrenia (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Robert's/Shona's own character or personality	56	51	60	50
Chemical imbalance in the brain	75	76	77	78
The way Robert/Shona was brought up	49	48	41	38
Stressful or disturbing events in Robert's/Shona's life	90	90	89	94
Genetic or inherited problem	62	57	60	58
Abuse Robert/Shona suffered as a child	59	63	61	64
Fate	26	24	24	23
Physical illness	58	56	68	59
Robert's/Shona's own fault	15	12	18	9

Source: MORI

Support mechanisms for the person in the schizophrenia scenario

9.33 A family doctor was seen as the best person to help someone displaying symptoms of schizophrenia, though around half of respondents also mentioned a psychiatrist or a counsellor. Again there was little variation in the results depending on which version of the scenario respondents were asked to consider.

Table 9.9: Schizophrenia scenario. Support for Robert/Shona

Q Say it was possible for any of the people on this card to help Robert/Shona. Who would be the three best people to do this?

	Schizophrenia (Male)		Schizophrenia (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Someone in the family	42	39	31	36
A friend or neighbour	15	16	19	17
A nurse	4	3	5	5
A home help/carer	9	3	6	2
A psychiatrist	52	50	46	48
A psychologist	27	26	26	30
A family doctor	55	60	55	55
A social worker	12	6	5	10
A qualified counsellor	47	53	53	50
A voluntary organisation or charity	4	12	8	11
Someone with the same problem	21	18	28	25
Someone else	1	3	2	1
No one	*	-	*	-
None of these	-	-	-	-
Don't know	*	2	1	1

Source: MORI

Where the person described in the schizophrenia scenario should live

9.34 Respondents were somewhat divided on the question of where the people in the schizophrenia scenarios should live. Whereas around three in five felt that Robert/Shona should live in their own home, most of the remaining respondents felt that they should live in special housing with professional support in the community. This is consistent with findings from the Canadian study of attitudes to people with schizophrenia, mentioned above, in which a majority of respondents felt that people with schizophrenia could be successfully treated outside of hospital but needed prescription drugs to control their symptoms (Stuart and Aroboleda-Florez 2001).

Table 9.10: Schizophrenia scenario. Suitable place for Robert/Shona to live

Q If all of these options on this card were possible, where do you think it would be best for Robert/Shona to live?

	Schizophrenia (Male)		Schizophrenia (Female)
Base: All respondents presented with scenario	2002	2004	2002	2002
	%	%	%	%
In their own home by themselves	1	n/a	3	n/a
In their own home (or family's) home with support from family members or friends	24	58	26	61
In their own (or family's) home with help from professionals (for example community mental health teams)	49	n/a	50	n/a
In special housing with professional support in the community	21	30	6	31
In a residential or nursing home	3	4	2	4
In hospital	1	3	3	3
Somewhere else	1	-	*	-
Wherever he/she wants	-	-	-	-

Source: MORI

Schizophrenia scenario: possibility of harm/violence

9.35 As in 2002, around seven in ten of those shown either version of the scenario felt that Robert/Shona was likely to do something harmful or violent to him/herself, while roughly half this proportion felt that he/she might do harm to others. Respondents considering the male version of the scenario were more likely to say the person might harm others than those shown the female version.

9.36 The finding that people with schizophrenia are perceived to be more likely than those with depression to do harm to themselves or others is consistent with wider research. For example, a survey carried out in Germany in 2001 found that people with schizophrenia were far more frequently considered dangerous and unpredictable than those with depression. The survey was conducted among 5,025 adults aged 18+ (Angermeyer and Matschinger 2003).

Table 9.11: Schizophrenia scenario. Likelihood of doing something harmful/violent to him/herself

Q In your opinion, how likely is it that Robert/Shona would do something harmful or violent to him/herself?

	Schizophrenia (Male)		Schizophrenia (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Very likely	10	11	18	11
Somewhat likely	54	56	50	55
Somewhat unlikely	22	20	19	26
Very unlikely	12	5	8	4
Don't know	3	8	5	3

Source: MORI

Table 9.12: Schizophrenia scenario: Likelihood of doing something harmful/violent to others

Q In your opinion, how likely is it that Robert/Shona would do something harmful or violent to others?

	Schizophrenia (Male)		Schizophrenia (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Very likely	4	5	5	5
Somewhat likely	35	35	31	27
Somewhat unlikely	37	34	36	42
Very unlikely	21	20	21	22
Don't know	4	6	6	4

Source: MORI

9.37 Although approximately a third of respondents considering these scenarios felt that Robert/Shona might do something harmful to others, 84% of those shown the male version of the schizophrenia scenario and 89% of those shown the female version felt that Robert/Shona should have the same rights at work as anyone else. These figures are broadly in line with the comparable results for 2002.

Social interaction with the person in the schizophrenia scenario

9.38 A large majority of those shown the schizophrenia scenarios said that they would be willing to do Robert/Shona a favour, spend an evening socialising with him/her, work closely with and make friends with him/her - though in each case the figures were higher among those shown the female version of the scenario than among those shown the male version. Forty four per cent of those shown the female version of the scenario and 27% of those shown the male version said they would be willing to have Robert/Shona marry into their family. Likewise, 23% and 10% respectively said they would be willing to have him/her provide childcare. Again, the findings in 2004 were very similar to those in 2002.

Table 9.13: Schizophrenia scenario. Social interaction with Robert/Shona

Q How willing would you be to…?

	% Willing
	Schizophrenia (Male)		Schizophrenia(Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Move next door to Robert/Shona	62	58	68	74
Spend an evening socialising with Robert/Shona	68	65	75	74
Make friends with Robert/Shona	66	76	81	80
Start working closely with Robert/Shona	63	63	65	72
Have Robert Shona marry into the family	28	27	42	44
Do Robert/Shona a favour if they asked you to	91	88	94	94
Have Robert/Shona provide childcare for someone in your family (e.g. babysitting, childminding)	n/a	10	n/a	23

Source: MORI

Diagnosis of schizophrenia

9.39 Around two in five of those shown the male version of the schizophrenia scenario and 36% of those shown the female version correctly attributed the symptoms described. The remaining respondents suggested a range of diagnoses. For example, 10% of those shown the male version and 17% of those shown the female version thought Robert/Shona was exhibiting signs of stress, and around one in ten in each case though he/she is was a nervous breakdown. Eight per cent in each case thought that Robert/Shona had a personality disorder.

9.40 In 2002, when a narrower range of diagnostic options was presented to respondents, around three quarters of those shown the schizophrenia scenarios thought that Robert/Shona was exhibiting symptoms of schizophrenia and around 9 in 10 thought it was depression or stress. As noted earlier, in 2002 people had the option of selecting more than one condition, if they felt that was appropriate.

9.41 The finding that respondents in 2004 were better able to recognise symptoms of depression than symptoms of schizophrenia stands in contrast with results from other studies. In a recent survey conducted in Switzerland, respondents were shown vignettes depicting people with depression and schizophrenia. The symptoms described in the depression scenarios were correctly diagnosed by 40% of respondents. The schizophrenic symptoms, meanwhile, were correctly identified by a much higher 74%. The survey was conducted among a representative sample of 844 adults. (Nordt et al 2003)

Table 9.14: Schizophrenia scenario. Diagnosis

Q The description I read out for Shona/Robert was designed with one particular mental health problem in mind. Which one of these do you think it is most likely to be?

	Schizophrenia (Male)	Schizophrenia (Female)
Base: All respondents presented with scenario	(209)	(228)
	%	%
Alzheimer's Disease/dementia	1	*
Anxiety Disorder	6	6
Depression	10	17
Eating disorder (anorexia, bulimia)	-	-
Manic depression (bipolar affective disorder)	6	4
Nervous breakdown	11	12
Obsessive/compulsive behaviour/disorder	2	3
Panic attacks	3	1
Personality disorder	8	8
Phobias (e.g. Agoraphobia)	1	3
Post-natal depression	-	1
Schizophrenia	44	36
Self harm	-	-
Severe stress	4	6
Other	1	-
Don't know	3	2

Source: MORI

STRESS

Symptoms of Stress

9.42 The most likely cause of the symptoms depicted in the stress scenarios was felt to be stressful or disturbing events in Robert's/Shona's life. The next most commonly suggested causes were Robert's/Shona's own character or personality and physical illness. Robert's/Shona's upbringing and abuse suffered in childhood were identified as possible causes of the symptoms by around half of those considering either of the stress scenarios.

9.43 Respondents shown the male version of the scenario were more likely to associate symptoms of stress with upbringing and abuse suffered in childhood, while those shown the female version were more likely to suggest physical illness as a possible cause.

9.44 Between 2002 and 2004 there was a significant decline in the proportions of respondents who said that physical illness or Robert's/Shona's own character or personality may have caused the symptoms described. Among those shown the male version of the scenario, the proportion identifying genetic or inherited problems as a possible cause also declined.

Table 9.15: Stress scenario. Likely causes of stress

Q In your opinion, how likely or unlikely do you think it is that Robert's/Shona's condition might be caused by each of the following?

	% Likely
	Stress (Male)		Stress (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Robert's/Shona's own character or personality	69	56	71	56
Chemical imbalance in the brain	57	57	56	54
The way Robert/Shona was brought up	48	45	46	39
Stressful or disturbing events in Robert's/Shona's life	90	88	85	84
Genetic or inherited problem	51	44	46	42
Abuse Robert/Shona suffered as a child	52	50	46	44
Fate	28	30	29	37
Physical illness	61	55	69	64
Robert's/Shona's own fault	20	21	21	19

Source: MORI

Support mechanisms for the person in the stress scenario

9.45 A family doctor was seen as the best source of help for the people in the stress scenarios, though at least two in five of those shown either version of the scenario also suggested a family member or a qualified counsellor. A significant minority felt that Robert/Shona could be helped by someone with the same problem.

9.46 As in the case of depression, those shown the female version of the scenario were more likely to mention friends and neighbours as sources of support than those shown the male version. Those shown the male version were more likely to mention health care professionals including a psychiatrist, family doctor or counsellor.

9.47 Between 2002 and 2004, the proportion of respondents mentioning informal sources of help including family members, friends and neighbours increased significantly. Meanwhile there was a fall in the proportion mentioning a qualified counsellor and, among those considering the female version of the scenario, a family doctor.

Table 9.16: Stress scenario. Support for Robert/Shona

Q Say it was possible for any of the people on this card to help Robert/Shona. Who would be the three best people to do this?

	Stress (Male)		Stress (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Someone in the family	47	53	41	48
A friend or neighbour	22	31	33	45
A nurse	2	3	4	2
A home help/carer	5	4	6	3
A psychiatrist	27	25	22	20
A psychologist	16	15	19	15
A family doctor	63	64	66	58
A social worker	8	5	8	8
A qualified counsellor	53	47	52	42
A voluntary organisation or charity	6	5	12	8
Someone with the same problem	37	29	28	31
Someone else	2	1	*	1
No one	*	*	-	1
None of these	-	-	-	-
Don't know	-	1	-	1

Source: MORI

Where the person described in the stress scenario should live

9.48 A majority of respondents felt that the best place for the people in the stress scenarios to live would be in their own home. However, around one in ten felt that they should live in special housing with professional support in the community.

Table 9.17: Stress. Suitable place for Robert/Shona to live

Q If all of these options on this card were possible, where do you think it would be best for Robert/Shona to live?

	Stress (Male)		Stress (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
In their own home by themselves	4	n/a	4	n/a
In their own (or family's) home with support from family members or friends	47	84	49	82
In their own (or family's) home with help from professionals (for example, community mental health teams)	39	n/a	38	n/a
In special housing with professional support in the community	6	10	6	14
In a residential or nursing home	2	1	1	1
In hospital	3	1	*	-
Somewhere else	*	2	-	-
Wherever he/she wants	-	-	*	-

Source: MORI

Stress scenario: possibility of harm/violence

9.49 Around one in five of those shown either of the stress scenarios thought it likely that Robert/Shona would do something harmful or violent to him/herself. Roughly half this proportion thought that he/she would do something harmful to others. These findings are consistent with those reported in 2002.

Table 9.18: Stress scenario. Likelihood of doing something harmful/violent to him/herself

Q In your opinion, how likely is it that Robert/Shona would do something harmful or violent to him/herself?

	Stress (Male)		Stress (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Very likely	3	2	6	1
Somewhat likely	21	19	17	20
Somewhat unlikely	44	47	39	45
Very unlikely	30	26	33	27
Don't know	2	7	6	7

Source: MORI

Table 9.19: Stress scenario. Likelihood of doing something harmful/violent to others

Q In your opinion, how likely is it that Robert/Shona would do something harmful or violent to others?

	Stress (Male)		Stress (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Very likely	2	1	1	*
Somewhat likely	13	11	11	9
Somewhat unlikely	40	44	31	43
Very unlikely	43	38	51	42
Don't know	2	6	6	6

Source: MORI

9.50 Once again there was consensus that the people in the stress scenarios should have the same rights as anyone else. Ninety-four per cent of those shown the male version of the scenario and 97% of those shown the female version agreed with this proposition (The comparable results for 2002 stood at 96% and 96% respectively).

Social interaction with the person in the stress scenario

9.51 In terms of respondents' willingness to interact with someone displaying symptoms of stress, the findings are generally positive. Once again, a large majority said they would be willing to move next door to Robert/Shona, spend an evening socialising with him/her, make friend with, or start working closely with, him/her. Fewer were willing to have Robert/Shona marry into the family though the balance of opinion was still positive overall. Again, there was a lack of willingness to have Robert/Shona provide childcare but this was a little less pronounced than in the cases of the depression or schizophrenia scenarios.

9.52 Under some circumstances respondents were more willing to interact with a female showing symptoms of stress than with a male showing the same symptoms. This was particularly the case with respect to spending an evening socialising with him/her, having him/her marry into the family and having him/her provide childcare.

9.53 There were few significant differences in the results for 2002 and 2004, though among those shown the female version of the scenario there was a slight increase in the proportions saying that they would be willing to start working closely with Shona or have her marry into their family.

Table 9.20: Stress scenario. Social interaction with Robert/Shona

Q How willing would you be to…?

	% Willing
	Stress (Male)		Stress (Female)
Base: All respondents presented with scenario	2002	2004	2002	2004
	%	%	%	%
Move next door to Robert/Shona	82	79	77	82
Spend an evening socialising with Robert/Shona	79	79	87	84
Make friends with Robert/Shona	87	86	92	88
Start working closely with Robert/Shona	82	78	74	80
Have Robert Shona marry into the family	54	52	56	67
Do Robert/Shona a favour if they asked you to	95	94	97	95
Have Robert/Shona provide childcare for someone in your family (e.g. babysitting, childminding)	n/a	33	n/a	41

Source: MORI

Diagnosis of stress

9.54 Few respondents were able to attribute the symptoms described to the condition of stress. Indeed, almost half thought Robert/Shona was exhibiting symptoms of depression and around one in five thought he/she was experiencing an anxiety disorder.

9.55 In 2002 almost all respondents who were shown the stress scenarios said they thought it likely that Robert/Shona was exhibiting symptoms of stress and depression. Around a quarter thought that it might be schizophrenia.

Table 9.21: Stress scenario. Diagnosis

Q The description I read out for Shona/Robert was designed with one particular mental health problem in mind. Which one of these do you think it is most likely to be?

	Stress (Male)	Stress (Female)
Base: All respondents presented with scenario	(213)	(202)
	%	%
Alzheimer's Disease/dementia	1	*
Anxiety Disorder	17	16
Depression	48	50
Eating disorder (anorexia, bulimia)	-	*
Manic depression (bipolar affective disorder)	*	2
Nervous breakdown	7	4
Obsessive/compulsive behaviour/disorder	*	-
Panic attacks	2	1
Personality disorder	3	3
Phobias (e.g. Agoraphobia)	-	-
Post-natal depression	-	1
Schizophrenia	1	1
Self harm	-	*
Severe stress	15	17
Other	*	-
Don't know	6	4

Source: MORI

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