Intergroup contact and prejudice against people with schizophrenia.

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Intergroup Contact and Prejudice Against People With Schizophrenia a

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Keon West , Miles Hewstone & Simon Lolliot a

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Goldsmiths, University of London

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University of Oxford Accepted author version posted online: 10 Feb 2014.Published online: 08 Apr 2014.

Click for updates To cite this article: Keon West, Miles Hewstone & Simon Lolliot (2014) Intergroup Contact and Prejudice Against People With Schizophrenia, The Journal of Social Psychology, 154:3, 217-232, DOI: 10.1080/00224545.2014.888327 To link to this article: http://dx.doi.org/10.1080/00224545.2014.888327

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The Journal of Social Psychology, 154: 217–232, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0022-4545 print / 1940-1183 online DOI: 10.1080/00224545.2014.888327

Intergroup Contact and Prejudice Against People With Schizophrenia Downloaded by [Chinese University of Hong Kong] at 07:04 23 February 2015

KEON WEST Goldsmiths, University of London

MILES HEWSTONE SIMON LOLLIOT University of Oxford

ABSTRACT. There is a growing awareness that responses to mental health disorders differ according to the label. Still, research on contact and prejudice against people with mental health disorders has generally focused on the broader label, “mental illness,” as though various disorders were interchangeable. The present research specifically investigated the relationship between intergroup contact and avoidance of people with schizophrenia—a particularly stigmatized and challenging group—as well as mediators of that relationship. In Study 1, 78 students completed measures of their prior contact with and prejudice against people with schizophrenia. Prior contact predicted less desired avoidance of people with schizophrenia, and this relationship was mediated by more favorable attitudes. Study 2 (N = 122) replicated the results of Study 1, and also found that less fear and less intergroup anxiety mediated the relationship between contact and avoidance. This suggests that contact may effectively reduce prejudice, even against this highly stigmatized group. Keywords: contact hypothesis, mental illness, prejudice, schizophrenia

OVER 450 MILLION PEOPLE WORLDWIDE are affected by mental health disorders, and prejudice against these people is a widespread global concern (World Health Organization, 2010). Research conducted in multiple countries has shown that prejudice against people with mental illnesses (PWMI) is a persistent international problem found in the lay community (Arkar & Eker, 1992; Chou & Mak, 1998; Chung, Chen, & Liu, 2001; Holmes, Corrigan, & Williams, 1999), and among medical and mental health personnel (Chinsky & Rappaport, 1970; Hicks & Spaner, 1962; Schulze & Angermeyer, 2003). This prejudice has profound negative implications for the personal and professional lives of people with mental illnesses (Bordieri & Dhremer, 1986; Wahl, 1999) and can lead to serious practical and emotional difficulties (Ilic et al., 2012).

Address correspondence to Keon West, Goldsmiths, University of London, Psychology Department, London SE14 6NW, UK. E-mail: [email protected]

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THE JOURNAL OF SOCIAL PSYCHOLOGY


Furthermore, research shows that prejudice varies according to diagnostic label and that, even among PWMI, people with schizophrenia are considered particularly dangerous and unpredictable (Crisp, Gelder, Goddard, & Meltzer, 2005), and suffer from particularly severe prejudice (Angermeyer & Matschinger, 2003; Norman, Windell, & Manchanda, 2012). Furthermore, this kind of prejudice is more widely accepted than other prejudices (West & Hewstone, 2012a) and has persisted, or even increased, as tolerance for other previously stigmatized groups has grown (Angermeyer & Matschinger, 1997; Hinshaw & Cicchetti, 2000; Stier & Hinshaw, 2007; Trute, Tefft, & Segall, 1989). Intergroup Contact Social-psychological research on intergroup contact provides a possible means of reducing this prejudice. Gordon Allport (1954) hypothesized that contact, or social interaction, with members of an outgroup (i.e., a group to which you do not belong) would lessen intergroup hostility and lead to more positive intergroup relations, particularly if the contact was positive or of high quality (Allport, 1954). A large volume of subsequent research has supported this premise (see Brown & Hewstone, 2005; Harwood, Hewstone, Paolini, & Voci, 2005; Paolini, Hewstone, Cairns, & Voci, 2004; Tam, Hewstone, Kenworthy, & Cairns, 2009; Vonofakou, Hewstone, & Voci, 2007; West & Hewstone, 2012b), including a meta-analysis of 515 studies on intergroup contact (Pettigrew & Tropp, 2006). Contact is now one of the most widely used interventions for the reduction of prejudice and the improvement of intergroup relations (Oskamp & Jones, 2000). Contact has been shown to reduce prejudice against PWMI (for a review see Couture & Penn, 2003) and forms the basis of large-scale national interventions to reduce this prejudice (EvansLacko et al., 2012, 2013; London & Evans-lacko, 2010). However, as noted by Couture and Penn (2003), this research is “plagued with various methodological problems” (p. 291), one of which is the lack of attention to the specificities of the label or prejudice. For example, in the assessment of both contact and prejudice, it has been common to ask about participants’ experiences with and attitudes toward, for example, “a patient in a psychiatric hospital” (Trute & Loewen, 1978, p. 389), or “the mentally ill” (Brockington, Hall, Levings, & Murphy, 1993, p. 93), rather than specifying any particular disorder (see also: Brockman & D’Arcy, 1978; Desforges et al., 1991; Malla & Shaw, 1987; Shera & Delva-Tauiliili, 1996). Some research has investigated the effects of imagery-based interventions (e.g., West, Holmes, & Hewstone, 2011) or multimedia-based interventions (West & Turner, 2014) on prejudice against people with schizophrenia, and other research has investigated the effects of direct contact on attitudes toward a particular individual with schizophrenia (Yang et al., 2012). However, very little research has investigated the effects of direct contact on people with schizophrenia as a group (though for a recent exception, see Giacobbe, Stukas, & Farhall, 2013). This relative lack of research should be addressed, as there are reasons to suspect that the effects of contact may differ according to diagnostic label, and that people with schizophrenia may be a particularly challenging group (West, Hewstone, & Holmes, 2010). Should Contact Reduce Prejudice Against People With Schizophrenia? In two large-scale nationally representative surveys in the UK (Crisp, Gelder, Rix, Meltzer, & Rowlands, 2000; Crisp et al., 2005), Crisp and colleagues found that different mental illness labels


WEST, HEWSTONE, AND LOLLIOT

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were associated with different stereotypes: specifically, people with schizophrenia were considered more dangerous and more unpredictable than people with most other mental health disorders (e.g., depression). Similar results have been found in Germany (Angermeyer & Matschinger, 2003). Numerous studies have also found that participants report stronger prejudice against people with schizophrenia than they do against people with several other mental health disorders, such as depression (Angermeyer & Matschinger, 1997; Link, Phelan, Bresnahan, Stueve, & Pescosolido, 1999; Norman et al., 2010; Sugiura, Sakamoto, Kijima, Kitamura, & Kitamura, 2000). Applying the stereotype content model, Sadler, Meagor, and Kaye (2012) also found that people with schizophrenia were perceived particularly negatively. While people with certain disorders were considered warm, but incompetent (e.g., people with neuro-cognitive deficits) and others were considered hostile, but competent (e.g., people with sociopathic tendencies) people with schizophrenia were considered both hostile and incompetent. It is noteworthy that this is in contrast with the overall category of PMWIs, which was perceived as warm, but incompetent. Lastly, research using imagery-based interventions derived from intergroup contact has found mixed results; these techniques have both reduced (Stathi, Tsantila & Crisp, 2012) and increased (West & Bruckmüller, 2013; West et al., 2011) prejudice against people with schizophrenia. Generally, these imagery-based techniques guide participants to imagine positive interactions with people from other groups (Stathi, Crisp, Turner, West, & Birtel, 2013), which leads to improved attitudes. However, when people with schizophrenia are used as the target group, participants sometimes imagine negative interactions, even when encouraged to imagine positive ones, and this can render the intervention ineffective or counter-effective (West et al., 2011). This suggests that positive contact with people with schizophrenia may be difficult to imagine, and that real contact may not always be beneficial.

CURRENT RESEARCH In this research, two studies specifically investigated the relationship between contact with and prejudice against people with schizophrenia. In Study 1 we hypothesized that people who had experienced contact with a person with schizophrenia would report more positive attitudes and less desire to avoid people with schizophrenia. In Study 2 we conducted a more rigorous test of the relationship between contact and prejudice, taking into account both the quantity and quality of contact, and providing evidence for a model of contact and prejudice that includes multiple constructs central to the stigma: fear, intergroup anxiety, attitudes and avoidance.

STUDY 1 We hypothesized that intergroup contact would predict more positive attitudes and a lower desire to avoid people with schizophrenia. Attitude toward the outgroup is the most commonly used dependent variable in contact research, and previous research has reliably shown that contact improves outgroup attitudes (Brown & Hewstone, 2005). A desire for avoidance is central to the stigma of mental illness and similarly widely researched (Corrigan et al., 2002; Corrigan, Green, Lundin, Kubiak, & Penn, 2001). Furthermore, using attitudes to predict behavioural intentions

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(see Brown & Hewstone, 2005), we hypothesised that attitudes should mediate the relationship between contact and desired avoidance.

METHOD


Participants Seventy-eight undergraduate students at a British University (23 male and 55 female, mean age = 18.74; SD = 2.19) completed a survey assessing their previous contact with and evaluation of people with schizophrenia. Participants received course credit for taking part in the research. Measures To determine if participants had experienced contact with a person with schizophrenia, we asked them simply to indicate (yes or no) if they had ever knowingly interacted with a person with schizophrenia. To measure attitudes toward people with schizophrenia, we asked participants to respond to six items on 7-point semantic differential scales (from Wright, Aron, McLaughlinVolpe, & Ropp, 1997): cold–warm, positive–negative (reversed), friendly–hostile (reversed), suspicious–trusting, respectful–contempt (reversed), admiration–disgust (reversed), α = .84. This measure has been widely used in previous research to assess attitudes toward various groups (e.g., Turner, Hewstone, & Voci, 2007; Turner, Hewstone, Voci, & Vonofakou, 2008) including people with schizophrenia (West et al., 2011). To assess avoidance we asked participants to report their agreement with the statement, “I would try to avoid a person with schizophrenia,” on a scale ranging from 1 (not at all) to 7 (very much). This item has been successfully used in scales in previous research (Corrigan et al., 2002). The order in which the questions were presented was randomized; we found no differences as a function of either order or gender for any variables in this study (.28 > p > .69). After completing the measures, participants were asked for demographic information, thanked and debriefed.

RESULTS AND DISCUSSION The Relationship Between Contact and Prejudice Using multivariate analysis of variance to investigate differences between our conditions, we found the expected multivariate effect of intergroup contact on our outcome variables, F (2, 75) = 4.10, p = .02, ηp 2 = .10. As hypothesized, participants who had experienced contact with people with schizophrenia (N = 18) reported more favourable attitudes (M = 4.97, SD = .64) than did participants who had not (M = 4.43, SD = .89), F (1, 76) = 5.82, p = .02, ηp 2 = .07. Similarly, participants who had experienced contact with people with schizophrenia also reported less desire to avoid people with schizophrenia (M = 1.61, SD = .61) than did participants who had not (M = 2.57, SD = 1.47), F (1, 76) = 12.64, p = .009, ηp 2 = .09.


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Attitudes


β = .54, p = .018

β = –.90, p < .001

β = –.95, p = .009 Contact

Avoidance

β = –.46, p = .14 Z = 2.44, p = .01

FIGURE 1 Mediational model of the role of attitudes in explaining the effects of contact on avoidance (Study 1).

Mediational Analyses We tested whether attitudes mediated the relationship between contact and avoidance of people with schizophrenia using Preacher-Hayes bootstrap tests (Hayes, 2009). Bias corrected bootstrapping techniques are favored over conventional forms of mediation tests (e.g., Sobel’s Z) because of (a) their ability to handle skewed data and (b) their superior ability to detect significant mediation effects with smaller sample sizes, while (c) retaining the most power (Fritz & Mackinnon, 2007). As hypothesized, we found a non-zero indirect effect of contact on avoidance through attitudes (–.96 to –.15 with a point estimate of –.49, model p = .018) using a 95% bias-corrected bootstrap confidence interval based on 5000 bootstrap samples (see Figure 1). The direct path from contact to avoidance was not significant (c = –.46, p = .14), indicating indirect-only mediation (for an explanation of different types of mediation, see Zhao, Lynch & Chen, 2010). The question of causal direction has long been debated in contact research (Pettigrew & Tropp, 2006), making it important to test whether contact predicts less prejudice, or whether the stronger path is from less prejudice to more contact. We thus tested the reverse model, in which avoidance predicted less contact and attitudes mediated this relationship. This time the 95% confidence interval included zero (–45. to .17), indicating a failure of the reversed model. To summarize, in Study 1 we found that prior contact predicted less desired avoidance of people with schizophrenia, and that this relationship was mediated by an improvement in intergroup attitudes. In Study 2 we aimed to replicate the results of Study 1, and build on the model of the relationship between contact and prejudice.

STUDY 2 Study 1 used straightforward methodology recommended when testing an initial hypothesis (Arkar & Eker, 1992; Kulik, Martin, & Scheibe, 1969; Wolff, Pathare, Craig, & Leff, 1996). Our next step was to build on and improve the model in terms of both measures and included


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variables. Study 2 had three aims: (a) to replicate the findings of Study 1, (b) to improve on the measurement used in Study 1, particularly by measuring the quality and quantity of contact, and (c) improve the model of the relationship between contact and prejudice with the inclusion of more mediating variables. Since the earliest research on contact it was hypothesized that both the quantity and quality of contact contribute to its effectiveness (Allport, 1954). Subsequent research has supported this claim, finding that unpleasant or superficial contact can worsen attitudes (Wallach, 2004), while more frequent and higher quality contact is more effective (Allport, 1954; Pettigrew & Tropp, 2006). Such research highlights the importance of taking both the quantity and quality of contact into account (Voci & Hewstone, 2003). In Study 1 we found that contact predicted more positive attitudes and less avoidance. To improve our understanding of how contact has its effects on outcomes including attitudes and avoidance, we also included two important mediators of the effects of contact on prejudice used in prior research: fear and intergroup anxiety. Throughout the available research, there is widespread agreement that fear and avoidance are central features of the stigma associated with mental health difficulties. The fear of people with mental health difficulties is tied to the perception that they are dangerous and unpredictable (Link et al., 1999), and results in avoidance of them (Trute & Loewen, 1978). Similar results have been found in numerous large-scale population surveys in various countries including Canada (Taylor & Dear, 1981), England (Brockington et al., 1993), and Hong Kong (Chou & Mak, 1998). Intergroup anxiety, or “anxiety stemming from contact with outgroup members” (Stephan & Stephan, 1985 p. 158), is one of the most important constructs in the intergroup relations literature. Much research has investigated it as a consequence of intergroup interactions (e.g., Blair, Park, & Bachelor, 2003; Littleford, Wright, & Sayoc-parial, 2005), a predictor of prejudice (e.g., Littleford et al., 2005; Van Zomeren, Fischer, & Spears, 2007), and as a mediator of the effects of contact on prejudice (e.g., Barlow, Louis, & Hewstone, 2009; Pettigrew & Tropp, 2008; Turner, Hewstone, & Voci, 2007; Voci & Hewstone, 2003). We thus included both fear and intergroup anxiety in our second model of contact and prejudice against people with schizophrenia. Hypotheses We predicted that participants who had experienced contact with people with schizophrenia would report less fear, less intergroup anxiety, more positive attitudes, and less avoidance of people with schizophrenia than those who had not. We then used prior research to formulate our hypotheses concerning the relationships between the variables. A wealth of previous research has found that intergroup contact predicts more favorable attitudes toward the outgroup, and that this relationship is mediated by a reduction in intergroup anxiety (see Pettigrew & Tropp, 2006; 2008 for reviews and meta-analyses). Previous research on contact with and prejudice against people with mental health difficulties has found that contact predicts less fear, which in turn predicts less avoidance (Corrigan et al., 2001). Furthermore, previous research has found that more favouable attitudes predict less avoidance of people with mental health problems (Angermeyer & Matschinger, 1997) and that the intergroup anxiety toward people with schizophrenia depends on the fear that the person may do something bad to you (Greenland, Xenias, & Maio, 2012). We included all these paths in our proposed model.


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METHOD


Participants One hundred twenty-two university students (48 male and 74 female, mean age = 18.67; SD = 2.08) were asked to complete questionnaires concerning their prior contact experiences (if any) with people with schizophrenia, intergroup anxiety, fear, attitudes toward people with schizophrenia, and desired avoidance of people with schizophrenia. Participants received course credit for taking part in the research. Measures As in Study 1, we asked participants to indicate (yes or no) if they had ever knowingly interacted with a person with schizophrenia. We also included more detailed measures of both quantity and quality of contact adapted from previous contact research (Brown & Hewstone, 2005; Tam et al., 2009; Voci & Hewstone, 2003). To assess quantity of contact, we asked participants to report, on a 7-point Likert scale ranging from 1 (none at all) to 7 (very much) how much contact they had with people with schizophrenia “at class or work,” “in casual social situations,” “in intimate social situations,” and “in all social situations.” (Cronbach’s α = .68). To assess the quality of self-reported prior contact, we asked participants to report, on a 7-point scale scale ranging from 1 (not at all) to 7 (very) how “pleasant,” “friendly,” “negative” (reversed), “enjoyable,” “difficult” (reversed), “cooperative,” “natural,” and “superficial” (reversed) their contact experiences with people with schizophrenia had been (α = .75). To assess fear, we used six questions previously used by Corrigan and colleagues (2002) and (2001). We asked participants to respond to the following statements using 7-point Likert scales ranging from 1 (none at all) to 7 (very much): “Persons with schizophrenia terrify me;” “How scared of a person with schizophrenia would you feel?”; “How frightened of a person with schizophrenia would you feel?”; “I would feel unsafe around persons with schizophrenia”; (scored on a scale ranging from 1 (strongly agree) to 7 (strongly disagree)) (reversed); “How dangerous do you feel a person with schizophrenia is?”; and “I would feel threatened by a person with schizophrenia.” In the studies from which these items were taken, they were part of two separate scales that measured “perceptions of dangerousness” and “fear.” However, in this present study, a principal-components analysis revealed a single-factor solution for this 6-item scale, which accounted for 64% of the variance (.69 < all λ’s < .88); hence a single aggregate score was created for this “fear” measure (α = .88). To assess intergroup anxiety, we asked participants to complete a widely used shortened measure based on Stephan and Stephan’s (1985) original scale (see Turner, Crisp, & Lambert, 2007; Turner, West, & Christie, 2013; Turner & West, 2012; Voci & Hewstone, 2003; West et al., 2011). Participants indicated how they would feel if they met a person with schizophrenia in the future. They reported, on a 7-point scale ranging from 1 (not at all) to 7 (very), how “awkward,” “happy” (reversed), “self-conscious,” “competent” (reversed), and “relaxed” (reversed) they would feel. This scale did not attain the conventional level of reliability in this study (α = .58). However, item deletion did not result in a more reliable scale and since this scale has been used in previous studies, we retained all five items.


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We measured attitudes toward people with schizophrenia using the same 6-item scale used in Study 1, α = .84. We improved upon our single-item measure of avoidance by using the three-item ‘avoidance’ scale used by Corrigan and colleagues (2002). We asked participants to respond to the following statements: “I think persons with schizophrenia pose a risk to other people unless they are hospitalized” (scored on 7-point scale ranging from 1 (not at all) to 7 (very much)); “I would try to avoid a person with schizophrenia” scored on 7-point scale ranging from 1 (definitely) to 7 (definitely not)) (reversed); and “If I were a landlord, I probably would rent an apartment to a person with schizophrenia” (scored on 7-point scale ranging from 1 (not at all) to 7 (very much) (reversed); α = .61). The different sections of the questionnaires were counterbalanced, and no order effects were detected. We found no differences as a function of order or gender for any variables in this study (all p > .05). After completing the measures, participants were asked for demographic information, thanked and debriefed.

RESULTS Contact vs. No Contact Table 1 shows the means and standard deviations of all variables used in this study. Correlations between all variables are shown in Table 2. We found the expected multivariate effect of intergroup contact on our outcome variables, F (4, 116) = 2.56, p = .04, ηp 2 = .08. Participants who had experienced contact with people with schizophrenia (N = 43) compared with participants who had not (N = 79), reported less intergroup anxiety (M = 4.01 vs. M = 4.43), F (4, 119) = 6.59, p = .01, ηp 2 = .05, more favourable attitudes (M = 4.74 vs. M = 4.35), F (4, 119) = 5.46, p = .02, ηp 2 = .04, less desired avoidance of people with schizophrenia (M = 2.64 vs. M = 3.24), F (4, 119) = 8.35, p = .005, ηp 2 = .07, and less fear of people with schizophrenia (M = 2.94 vs. M = 3.35), though this last difference was not quite significant at the 5% level F (4, 119) = 3.92, p = .05, ηp 2 = .03. Effects of Quality and Quantity Of Contact For these analyses, we used only participants who had experienced contact with at least one person with schizophrenia. As done in previous research, we took both the quantity and quality

TABLE 1 Means and Standard Deviations of Outcome Variables According to Prior Contact (Study 2) Item Fear Intergroup anxiety Attitudes Avoidance

Prior contact

No prior contact

F

p

ηp 2

2.94 (.93) 4.01 (.66) 4.74 (.90) 2.64 (.93)

3.35 (1.11) 4.43 (.93) 4.34 (.82) 3.24 (1.10)

3.92 6.59 5.46 8.35

.05 .01 .02 .005

.03 .05 .04 .07

Note: Standard deviations shown in parentheses.


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TABLE 2 Correlations Between All Variables (Study 2)


Item 1. 2. 3. 4. 5. 6. 7.

Contact quantity Contact quality Contact index Fear Anxiety Attitudes Avoidance

1.

2.

3.

4.

5.

6.

7.

1 .14 .94∗∗∗ −.35∗ −.41∗∗ .28 −.44∗∗

.14 1 .44∗∗ −.43∗∗ −.30 .52∗∗∗ −.41∗∗

.94∗∗∗ .44∗∗ 1 −.41∗∗ −.46∗∗ .41∗∗ −.52∗∗∗

−.36∗ −.43∗∗ −.41∗∗ 1 .45∗∗ −.42∗∗ .50∗∗

−.41∗∗ −.30 −.46∗∗ .48∗∗∗ 1 −.44∗∗ .28

.28 .52∗∗∗ .41∗∗ −.48∗∗∗ −.49∗∗∗ 1 −.62∗∗∗

−.44∗∗ −.41∗∗ −.52∗∗∗ .62∗∗∗ .49∗∗∗ −.62∗∗∗ 1

Note: The contact index is the product of the scores for quality and quantity of contact. Scores in the upper right are correlations between variables using all participants (N = 122), scores on the lower left are correlations using only participants who had experienced contact (N = 43). ∗ p < .05, ∗∗ p < .01, ∗∗∗ p < .001.

of contact into account by creating a single measure using the product of quantity of contact and quality of contact scores (Brown, Eller, Leeds, & Stace, 2007; Voci & Hewstone, 2003). This index of contact was correlated with fear (r = –.41, p = .007), intergroup anxiety (r = –.46, p = .003), attitudes (r = .41, p = .006), and avoidance (r = –.52, p < .001). However, none of the correlations between variables was high enough to suggest collinearity (–0.62 < all r’s < 0.49; see Table 2). We tested our model using a path model with observed variables. We assessed the goodness-of-fit of the model, and alternative models, by using the chi-square test, chi-square/degree of freedom ratio, the comparative fit index (CFI) and the root mean square error of approximation (RMSEA) (Byrne, 2001). While structural equation modelling requires quite large numbers of participants, path analysis can be successfully carried out using much smaller numbers (see Tam, Hewstone, Kenworthy, & Cairns, 2009). We found support for our model in which contact predicted fear (β = –0.078, p < .001), intergroup anxiety (β = –0.058, p < .001), and avoidance (β = −0.048, p = .002); fear predicted intergroup anxiety (β = 0.20, p = .016), attitudes (β = –0.25, p < .001), and avoidance (β = 0.30, p < .001); intergroup anxiety predicted attitudes (β = –0.34, p < .001); and attitudes predicted avoidance (β = –0.45, p < .001). Our model fit the data well, χ 2(2) = 1.61, p = .45, χ2/df = .80; CFI = 1.00.; RMSEA < .001, accounting for 58.5% of the variance in avoidance scores (see Figure 2). We also tested two theoretically plausible alternative models, comparing the fit of the original model to that of the alternative models by using the change in χ 2 values and the change in degrees of freedom (see Byrne, 2001). First we tested a model in which all possible paths were included. This model included a direct path from contact to attitudes and a direct path from intergroup anxiety to avoidance. However, this model did not fit the data significantly better than our proposed, more parsimonious model; χ2(1) = .039, p = .84, χ2/df = .039; CFI = 1.00; RMSEA < .0001; χ 2 = 1.57, df = 1, p > .10, and neither the direct path from contact to attitudes (β = 0.023, p = .24) nor the direct path from intergroup anxiety to avoidance (β = −0.051, p = .88) was significant. We then tested a model in which all theoretically plausible paths were reversed, with avoidance predicting attitudes, intergroup anxiety and fear, which in turn predicted contact. However, this

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.30*** Fear –.25*** –.078***

.20* R2 = .59


Contact –.058***

Intergroup Anxiety

Attitudes –.34***

Avoidance –.45***

–.048*** FIGURE 2 Relationship between contact with and avoidance of people with schizophrenia, mediated by fear, intergroup anxiety, and attitudes (Study 2). Note: Model fit: χ 2(2) = 1.61, p = 0.45, χ 2/df = 0.80; CFI = 1.00.; RMSEA < 0.001. ∗p

< .05, ∗∗ p < .01, ∗∗∗ p < .001.

reversed model fit the data significantly worse than our proposed model; χ 2(3) = 18.99, p < .001, χ 2/df = 6.33; CFI = .91; RMSEA = .21; χ 2 = 17.38, df = 1, p < .001. Furthermore, in this model, fear did not predict contact, β = –0.46, p = .069, though all other paths were significant.

GENERAL DISCUSSION Much research has investigated the association between contact and prejudice against the general category of people with “mental illnesses” (e.g., Brockman & D’Arcy, 1978; Desforges et al., 1991; Malla & Shaw, 1987; Shera & Delva-Tauiliili, 1996). However, a steadily increasing volume of research emphasizes the differences in the ways that people with different disorders are perceived, and that these differences could alter the effectiveness of prejudice-reducing interventions (Crisp et al., 2000, 2005; Sadler et al., 2012). Unfortunately this message has, for the most part, not yet influenced research investigating prejudice-reducing interventions nor the interventions attempting to apply this research (West, Hewstone, & Holmes, 2010). These two studies address this relative lack of research, and specifically investigate the relationship between contact with people with schizophrenia, and prejudice against people with schizophrenia. Below we discuss our findings, implications for using contact to reduce prejudice against people with schizophrenia, limitations of this research and opportunities for future research.


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Contact and Prejudice Against People With Schizophrenia Intergroup contact is one of the most widely researched (Pettigrew & Tropp, 2006) and widely used interventions for the reduction of prejudice and the improvement of intergroup relations (Oskamp & Jones, 2000), and currently forms the basis of many interventions aimed at reducing prejudice against people with mental health problems (Evans-Lacko et al., 2012, 2013). However, contact is not universally effective, nor is it equally effective for all groups, nor under all conditions. Due to varying stereotypes, varying strength of prejudice, and varying success of other contact-based interventions, there is reason to believe that the success of contact as a prejudice-reducing mechanism would also vary depending on the group, or type of mental health difficulty. Furthermore, even among groups of people with mental health difficulties, people with schizophrenia are perceived particularly negatively (Crisp et al., 2000, 2005; Sadler et al., 2012), and suffer from particularly severe stigmatization (Norman et al., 2012), and could possibly be a particularly challenging target group for contact-based interventions. However, our results were positive. Across two studies, and using both a simple and a more nuanced test, we found that contact was associated with less fear, less intergroup anxiety, more favourable attitudes and less avoidance. We were also able to find support for a model that incorporated two of the most important outcome variables: attitudes and avoidance, as well as two of the most important mediators: fear and intergroup anxiety. These results not only encourage the further investigation of contact as a means of reducing prejudice against this negatively viewed group, but also indicate that contact may reduce the most central and damaging aspects of stigma against people with schizophrenia. Limitations of This Study and Directions for Future Research Sample sizes and samples of convenience. We recognize the limits of generalizability of findings using a sample of convenience (i.e., university students) and the increased risk of Type I errors with a small sample size (particularly in Study 1). However, it should be noted that most psychological research relies on similar samples. Since the 1960s, most social psychological research has been conducted on university students using academic-like tasks in academic settings (Sears, 1986). Furthermore, we similarly acknowledge that our participants, on average, did not display very high levels of prejudice against people with schizophrenia, perhaps because we used university samples. In both Study 1 and Study 2 participants’ attitude scores were above the mid-point of the scale, and their avoidance scores were below the mid-point of the scale. This was true whether they had experienced contact or not. These low levels of prejudice do not detract from the apparent effectiveness of contact in these studies, and Study 2’s replication of Study 1’s findings increase our confidence in the reliability of these effects. However, both our sample sizes and our participant populations reduce the generalizability of our data; we cannot be certain that our results would generalize to individuals with very high levels of prejudice against people with schizophrenia. Given the emerging stage of empirical research on contact and attitudes toward people with schizophrenia, our data remain useful, as they permit the formulation of hypotheses for later testing with larger and more representative samples. This is, in all areas of research, necessary before conclusions can be drawn with a reasonable degree of certainty. Our data should, however,

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be viewed as preliminary and suggestive rather than definitive. Replication with larger samples representative of the general public will be especially valuable in determining the extent to which the present findings can be generalized. Correlational data. Considering the correlational and cross-sectional nature of this data, causal inferences (such as stating that contact with members of this group led to less prejudice against them rather than the inverse), cannot be made, even when using the most rigorous of statistical techniques (MacCallum & Austin, 2000). However, it is worth noting that this research does not exist in a vacuum, and that a large amount of previous research, including the extensive meta-analysis by Pettigrew and Tropp (2006), indicates that, even though the relationship between contact and prejudice is bi-directional, contact predicts prejudice far better than prejudice predicts contact. The use of longitudinal and experimental data in previous similar studies also justifies the assertion that contact influences prejudice (although the reverse, self-selection effect also occurs; see Pettigrew & Tropp, 2006). Furthermore, where possible, we have conducted additional analyses to increase confidence in our findings, including analyses of reverse causation and comparing alternative models to determine whether our proposed model fit the data best. Future research should nonetheless endeavor to employ genuine experimental designs where possible to enable statements of causality to be made. Additional variables. Prejudice against people with mental health disorders is complex: it often includes positive and negative aspects that combine in counter-intuitive ways. For example, Angermeyer and Matschinger (2005) found that encouraging a biological (rather than a social) cause of schizophrenia reduced the blame placed on the sufferer for his (/her) condition, but also increased the perceived severity of the condition, worsened the expected prognosis, and increased prejudice. We acknowledge that we focused heavily on negative aspects of reactions to people with schizophrenia and did not include some widely-acknowledged positive, neutral or ambivalent aspects such as goodwill and empathy (Wolff et al., 1996), bio-genetic causal beliefs (Angermeyer & Matschinger, 2005), the belief that people with mental illnesses should be cared for (Brockington et al., 1993), the desire to keep people with mental illnesses locked way for their own good (Taylor & Dear, 1981) and the widely used dimensions of warmth and competence (Fiske, Cuddy, Glick, & Xu, 2002; Sadler et al., 2012). A good understanding of all these variables is essential for tackling mental-health related stigma, and we acknowledge that including these variables would have provided a fuller picture of the effects of contact on this prejudice. However, we focused on the aspects of the stigma of schizophrenia related to fear and avoidance because these are the central features of the stigma, and particularly relevant in the case of schizophrenia (Corrigan et al., 2002, 2001). Future research, however, should investigate other relevant mediators and outcome variables to provide a more complete picture of the relationship between contact and prejudice against this outgroup. Concluding Remarks With the growing understanding that perceptions of and reactions to people with mental health difficulties vary according to the specific mental health disorder, responsible research must take up the challenge of investigating prejudice and the effectiveness of interventions more


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specifically. This research helps to fill this gap, investigating the effects of contact on prejudice, specifically against people with schizophrenia. Future research, similar to this current research, could help clarify the most effective ways to reduce prejudice against people with various, and often very different, mental health difficulties, such as depression, phobias, and eating disorders. These findings could inform anti-stigma campaigns, enabling them to generate more specific and effective interventions. In doing so we can make significant progress in reducing this widespread and debilitating prejudice, leaving more resources available to handle the mental health problems themselves.

AUTHOR NOTES Keon West is a Lecturer in the Psychology Department of Goldsmiths, University of London. Miles Hewstone is a Professor in the Psychology Department at the University of Oxford. Simon Lolliot is a Postdoctoral Researcher in the Psychology Department at the University of Oxford.

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Received October 12, 2012 Accepted January 22, 2014

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