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Reducing Negative Perceptions as it relates to the topic of Stereotypes, prejudice, and discrimination
Reducing Negative Perceptions as it relates to the topic of Stereotypes, prejudice and discrimination
Article Review Summary: Follow the template provided – however, make sure to use APA formatting such as double space and such. Find an article that relates to the week’s readings. discusses social psychology as it relates to Stereotypes, Prejudice, and Discrimination. Read the complete article and then summarize the article in approximately 350 words or more.
Article Review: Reducing Negative Perceptions Assignment
Once you have chosen an article that relates to the topic, summarize the article in at least 350 words.
Your Article Review Assignments should include the following components:
· Introduction: Include general information about the article in the introduction, including a very brief overview of the previous literature on the topic and identifying the gap in the literature that demonstrates the need for this article.
· Hypothesis Section: what the article attempts to find out or answer
· Methods Section: how the article answers the question or questions it proposes
· Results Section: what the article found
· Practical Significance/Discussion: What the results actually mean
· References page: Title and authors of the article in current APA format
Be careful to ensure that your answers to the above information make sense to you. You want to be able to develop the skill of making complex/academic information easy to understand to non-academic people. Make sure to explain any complex ideas in plain language, and do not assume the reader already knows what you are talking about. Summarize these articles succinctly but yet thoroughly. No quoting. Make sure that your Turnitin score is below 25%.
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Article Review Grading Rubric
28 to >26.0 pts
26 to >22.0 pts
22 to >1.0 pts
1 to >0 pts
The paper meets or exceeds content requirements: The article contains: Title page (title and authors of the article) Purpose (why the article was written in introduction and what it attempts to answer in separate hypothesis section) Method (how it answers the questions it proposes in methods section) Results (what the article found) Discussion (what the results mean)
The paper meets most of the content requirements: The article contains: Title page (title and authors of the article) Purpose (why the article was written in introduction and what it attempts to answer in separate hypothesis section) Method (how it answers the questions it proposes in methods section) Results (what the article found) Discussion (what the results mean)
The paper meets some of the content requirements: The article contains: Title page (title and authors of the article) Purpose (why the article was written in introduction and what it attempts to answer in separate hypothesis section) Method (how it answers the questions it proposes in methods section) Results (what the article found) Discussion (what the results mean)
12 to >11.0 pts
11 to >10.0 pts
10 to >1.0 pts
1 to >0 pts
Format and word count
The paper meets or exceeds structure requirements: Proper spelling, grammar, and APA formatting are used. The summary is at least 350 words.
The paper meets most of the structure requirements: Proper spelling, grammar, and APA formatting are used. The summary is at least 350 words.
The paper meets some of the structure requirements: Proper spelling, grammar, and APA formatting are used. The summary is at least 350 words.
Total Points: 40
Journal Article Summary
Social Psychology Article
Journal Article Summary
Social Psychology Article
List the article introduction information here.
List the purpose this article was written.
What is this paper’s contribution/question/s that it is trying to provide information on.
Describe the sample of this study.
Describe the measures that were used in this study.
Describe how this study was done.
What did this study find? You can include both stats and an explanation of the stats.
Why is this study relevant/meaningful?
Haney, C., Banks, C., & Zimbardo, P. (1973). A study of prisoners and guards in a simulated prison. Naval Research Reviews, 9(1), 1-17.
R E S E A R C H A R T I C L E
Stigma towards psychosis: Cross-cultural
differences in prejudice, stereotypes, and
discrimination in White British and South Asians
Sehar Ahmed1 | Michèle D. Birtel1,2 | Melissa Pyle3 |
Anthony P. Morrison1,3
1Division of Psychology and Mental Health,
University of Manchester, Manchester, M13
2School of Human Sciences, University of
Greenwich, London, SE10 9LS, UK
3Psychosis Research Unit, Greater
Manchester Mental Health NHS Foundation
Trust, Manchester, M25 9WS, UK
Michèle D. Birtel, School of Human Sciences,
University of Greenwich, London, SE10 9LS,
Email: [email protected]
Public stigma towards people with mental health problems
has been demonstrated in Western societies. Little is known
about non-Western cultures and whether cultures differ in
their perceptions of people with mental health problems.
Aim of this study was to examine cultural differences in
prejudice, stereotypes, and discrimination towards people
with psychosis. Participants were from White British and
South Asian backgrounds (N = 128, aged 16–20 years) rec-
ruited from two schools and colleges in the United King-
dom. They completed a cross-sectional survey on affective,
cognitive, and behavioural dimensions of stigma. Results
revealed significant cultural differences on all three stigma
dimensions. South Asians attributed higher anger (prejudice)
and dangerousness (stereotypes) to people with psychosis
than White British. They also reported lower willingness to
help, greater avoidance, and higher endorsement of segre-
gation (discrimination). The effects of ethnic group on help-
ing intentions, avoidance, and segregation endorsement
were mediated by anger and by dangerousness. Under-
standing cultural differences in stigma towards psychosis
will be important for designing stigma interventions as well
as treatments for people with different cultural
Received: 25 March 2019 Revised: 8 August 2019 Accepted: 9 August 2019
J Community Appl Soc Psychol. 2019;1–15. wileyonlinelibrary.com/journal/casp © 2019 John Wiley & Sons, Ltd. 1
J Community Appl Soc Psychol. 2020;30:199–213. wileyonlinelibrary.com/journal/casp © 2019 John Wiley & Sons, Ltd. 199
K E Y W O R D S
cultural differences, mental health, psychosis, South Asians,
1 | INTRODUCTION
Public stigma towards people with mental health problems is widespread in Western countries, with psychosis being
one of the most stigmatized mental health problems (Barry, McGinty, Pescosolido, & Goldman, 2014; Crisp, Gelder,
Rix, Meltzer, & Rowlands, 2000; Huggett et al., 2018; Phelan, Link, Stueve, & Pescosolido, 2000; Wood, Birtel,
Alsawy, Pyle, & Morrison, 2014). Mental health problems are universal; however, culture can influence the severity
of stigma experienced; for example, stigma can be more severe in non-Western cultures with a higher emphasis on
family and relationships such as Asian cultures (Lauber & Rössler, 2007; Ng, 1997). Additionally, migration status is
associated with psychosis (Cantor-Graae & Selten, 2005) and stigma (Major & O’Brien, 2005). With the world
becoming more and more socially diverse, ethnic minority group members living in a dominant White society face
challenges not only in terms of adapting to the host culture (Berry, 1997) but also utilize mental health services less
(Kapadia, Nazroo, & Tranmer, 2016), experience discrimination, and generally report poorer health (Major, Mendes,
& Dovidio, 2013) than ethnic majority group members.
Whereas there is a wealth of research on the negative consequences of stigma on people’s quality of life (Cor-
rigan, Markowitz, Watson, Rowan, & Kubiak, 2003; Major et al., 2013; Major & O’Brien, 2005), little is known about
cultural differences in the type of stigma towards psychosis. Previous research has mainly focused on examining
mental health stigma in Western cultures; however, these findings cannot be generalized to individuals from non-
Western cultures living in a Western culture, such as South Asians living in the United Kingdom. The present study
aimed at addressing this empirical gap in cross-cultural differences, by comparing White British and South Asian
young people living in the United Kingdom in their prejudice, stereotypes, and discrimination towards people with
2 | PSYCHOSIS
Psychosis (also labelled “psychotic experiences” or “psychotic episode”) is a mental health problem with symptoms of
auditory hallucinations, delusional beliefs, and disorganized thinking and speech. These experiences can severely dis-
tress individuals and change their behaviour (National Health Service [NHS] Choices, 2018). The Adult Psychiatric
Morbidity Survey in England in 2014 (McManus, Bebbington, Jenkins, & Brugha, 2016) estimated the lifetime preva-
lence of a psychotic disorder at 0.7%. In our study, we focused on young people (16–20 years old) and ethnic minori-
ties (South Asians) as they are particularly vulnerable. First, it is often during adolescence when the first episode of
psychosis occurs (NHS, 2016; Kessler et al., 2007). Among the 16- to 24-year-olds, the prevalence is estimated at
0.4%, then increasing among the 25- to 34-year-olds (0.5%) and 35- to 44-year-olds (1%; McManus et al., 2016).
Not only treatment is most effective when accessed at early stages, but also stigma interventions that are incorpo-
rated in schools’ curriculum (such as increasing knowledge or intergroup contact; Rüsch, Angermeyer, & Corrigan,
2005) can challenge prejudice and discrimination from an early age on. Second, ethnic minorities are at greater risk
for mental health problems such as psychosis (Major et al., 2013). In the United Kingdom, South Asians are the larg-
est ethnic minority group with over three million people (Office for National Statistics, 2011). South Asians have a
greater risk for psychotic disorders in England (0.9% prevalence) compared with Whites (0.5%). In particular, cities in
the North West of England where our data collection took place have one of the highest numbers of people with
2 AHMED ET AL.200 AHMED ET AL.
psychosis (McManus et al., 2016; Public Health England, 2016). In addition to the severe consequences of psychosis
for people’s quality of life, it is also one of the most stigmatized mental health problems (Crisp et al., 2000; Wood
et al., 2014).
3 | STIGMA TOWARDS PSYCHOSIS
On the basis of the multicomponent model of attitudes (Zanna & Rempel, 1988), public stigma has been conceptual-
ized as having three components, it is the combination of negative affect (feelings such as anger), derogatory cogni-
tive beliefs (stereotypes and inaccurate knowledge), and hostile behaviour (discrimination; Brown, 2011; Corrigan &
Watson, 2002; Thornicroft, Rose, Kassam, & Sartorius, 2007). Belonging to a stigmatized group can result in a deval-
uation of one’s social identity (Crocker, Major, & Steele, 1998; Steele, Spencer, & Aronson, 2002) and social identity
threat (Major & O’Brien, 2005) as well as internalized stigma and label avoidance (Corrigan & Watson, 2002; Link,
Struening, Neese-Todd, Asmussen, & Phelan, 2001). Processes of negative affect, stereotypes, discrimination, and
social identity threat can have a wider impact on health and general quality of life of people with mental health prob-
lems (Corrigan & Watson, 2002; Link et al., 2001; Link, Struening, Rahav, Phelan, & Nuttbrock, 1997; Perlick et al.,
2001; Rosenfield, 1997; for a review, see Major et al., 2013).
People with psychosis experience severe public stigma in terms of negative affective reactions, false stereotypi-
cal beliefs, and discriminatory behaviour (Barry et al., 2014; Corrigan et al., 2003; Crisp et al., 2000; Phelan et al.,
2000; Wood et al., 2014). In fact, psychosis is associated with the most negative stereotypes than other mental
health problems such as depression or anxiety disorder. For example, people with psychosis are seen as a danger to
others and as unpredictable (Angermeyer, Breier, Dietrich, Kenzine, & Matschinger, 2005; Crisp et al., 2000; Wood
et al., 2014).
Corrigan and colleagues’ attribution model of public stigma towards people with mental health problems (Cor-
rigan, 2000; Corrigan, 2012; Corrigan et al., 2003), in line with the multicomponent model of attitudes, distinguishes
between affective prejudice (anger, pity, and fear), stereotypes (blame and beliefs about dangerousness) and discrimi-
nation (unwillingness to help, social avoidance, recommendations for mandatory treatment, and the segregation of
people with mental health problems from the community). Attributions about the cause and controllability of mental
health problems such as beliefs that people are responsible for and have control over their condition (blame) as well
as perceptions that they are dangerous can lead to negative affective reactions of anger, fear, and pity, which in turn
can lead to discriminatory behaviour such as withholding help and rejection (avoidance, recommendations for segre-
gation, and coercion; Corrigan et al., 2003).
Research on mental health problems including psychosis has largely focused on Western cultures, whereas less is
known about how the type of stigma differs in non-Western cultures, in particular in those with migration status in a
majority host society. Importantly, cultural differences in perceptions of mental health problems have implications
for designing interventions to reduce stigma. If there are cultural differences in the endorsement of stereotypes,
which can lead to discriminatory behaviour, then interventions may need to be tailored to specific cultures in order
to be effective.
4 | CULTURE AND MENTAL HEALTH STIGMA
Previous research suggests that mental health cannot be understood in isolation from its sociocultural context and
that Western concepts cannot be directly applied to non-Western cultures but that culture influences stigma
towards mental health (for a review, see Abdullah & Brown, 2011; Lauber & Rössler, 2007). Mental health problems
and the stigma associated with them exist universally. However, explanations for mental disorders and the severity
of stigma varies between cultures. For example, in Asian cultures the distinction between physical and mental health
problems, between the body and the mind, does not exist as it does in Western cultures. This means that in Asian
AHMED ET AL. 3AHMED ET AL. 201
cultures, mental health is somaticized and medicalized, that is, there is a tendency to experience psychological symp-
toms as somatic symptoms and to focus on medical instead of psychological help. Additionally, explanations for men-
tal health problems are reported to be different (Lauber & Rössler, 2007; Mirza, Birtel, Pyle, & Morrison, 2019).
Whereas Western cultures rather seem to emphasize biological or psychosocial approaches to treatment, in Asian
countries, larger emphasis is placed on religious, supernatural, and magical approaches. Furthermore, Mirza et al.
(2019) found that South Asian adolescents living in the United Kingdom tend to report greater supernatural causes
as explanations for mental health problems such as psychosis, in particular, when they experience low to moderate
psychotic experiences. As a consequence, when healthcare is sought, it focuses on somatic symptoms (Lauber &
Rössler, 2007). In the United Kingdom, statistics show that South Asians are less likely to engage with mental health
services and less likely to complete treatment than Whites (Baker, 2018). Research has suggested several reasons for
the barriers to mental health help seeking in ethnic minorities. First, causal explanations of mental health can impact
help seeking. South Asians have a greater tendency to attribute psychosis to supernatural causes and seek help from
faith institutions first, which can delay help seeking from services providing medication and therapy (Burns,
Jhazbhay, & Emsley, 2011; Islam, Rabiee, & Singh, 2015). Second, stigma from the public generally prevents people
from disclosing or seeking help for their mental health problem (Schulze & Angermeyer, 2003). Such stigma can be
greater in non-Western cultures, which tend to place greater importance on family and relationships than Western
cultures. Therefore, stigma can affect the relations of an individual to a greater extent (Lauber & Rössler, 2007).
Although the majority of the literature examined mental health stigma in the Western world (e.g., Barry et al.,
2014; Crisp et al., 2000), stigmatizing attitudes and discriminatory behaviour towards people with mental health
problems is not limited to Western countries. There is evidence that stigma can be found across a range of different
cultures and countries, including South Asian populations originating from Pakistan, India, and Sri Lanka (Lauber &
Rössler, 2007). Lauber and Rössler’s (2007) review suggested that the tendency to view people with mental health
problems in a negative light is shared with Western societies. However, stigma from close others such as family
members is reported to be larger and to have more devastating social consequences in terms of social distance,
devaluation, and marriage in Asian cultures. Pawar, Peters, and Rathod (2014) conducted a study in India in which
90% of patients had experienced mental health stigma and 86% had perceived discrimination from their colleagues,
friends, and superiors. Tabassum, Macaskill, and Ahmad (2000) also reported that some of the most commonly
endorsed attitudes by South Asians about mental health revolved around social avoidance and not having close rela-
tionships and contact with those with mental health difficulties. Research also suggests that messages about the dan-
gers of people with mental health difficulties are being conveyed to children by their parents, resulting in them
distancing themselves further (Salve, Goswami, Sagar, Nongkynrih, & Sreenivas, 2013). Additionally, stigma from
health professionals is also shared between both Western and non-Western cultures, for example, in Western coun-
tries such as the Unites States, the United Kingdom, and Australia (Nordt, Rössler, & Lauber, 2006; Van Boekel,
Brouwers, Van Weeghel, & Garretsen, 2013), Pakistan (Naeem et al., 2006), and Sri Lanka (Fernando, Deane, &
There is currently little insight into cross-cultural differences in the type of stigma towards psychosis, in particu-
lar, considering ethnic minorities living in a dominant Western culture. The United Kingdom’s largest ethnic minority
group, South Asians, have to cope with different issues than those living in their home countries. For example, they
can experience discrimination and poor well-being due to their stigmatized minority group status (Major et al., 2013;
Major & O’Brien, 2005), and visible ethnic differences in migrants can increase the risk for psychosis (for a meta-anal-
ysis, see Cantor-Graae & Selten, 2005). South Asians abroad also have to deal with acculturation processes, that is,
negotiating conflicts between their original cultural identity and the new identity and social norms of their host cul-
ture. These processes can result in acculturative stress and, depending on the outcome of this conflict between origi-
nal and new identity, to a reduced well-being (Berry, 1997). Additionally, experiencing psychosis would mean that
South Asians living in the United Kingdom would not only belong to a minority group based on ethnicity but also to
an additional minority group based on mental health.
4 AHMED ET AL.202 AHMED ET AL.
5 | THE PRESENT RESEARCH
Psychosis typically emerges during the developmental period of adolescence (Garralda & Raynaud, 2012; Vos &
Begg, 2003). Understanding cultural differences in the perception and stigmatization of psychosis is important
in order to design effective interventions to reduce negative attitudes and discrimination towards people with
psychosis from an early age on. The present study was conducted in a large ethnically diverse city in Northern
England. The city has an overall population of 2.7 million, with the largest ethnic groups being White British
(79.8%) and Asian British (10.2%; composed of 4.8% Pakistani; 2% Indian; and 1.3% Bangladeshi; Office for
National Statistics, 2011).
Although there is evidence for stigma towards mental health problems in both Western and non-Western cul-
tures, little research has been carried out examining the type of stigma towards psychosis, in particular, in non-
Western cultures living in a dominant White culture. We compared White British and South Asian British young
people living in the United Kingdom in their type of stigma towards people with psychosis, distinguishing between
negative affective reactions (prejudice) and negative cognitive biases (stereotypes) as well as discriminatory behav-
iour. Whereas Mirza et al. (2019) found that South Asians living in the United Kingdom tend to report lower inten-
tions to have contact with people with psychosis, an indication of stigma, we focused on disentangling the
different dimensions of stigma associated with negative affect, cognition, and behaviour, using Corrigan et al.’s
(2003, 2012) attribution model of stigma. We predicted that affective prejudice (anger, pity, and fear) and stereo-
types (perceived blame and dangerousness) towards people with psychosis would be associated with discrimina-
tory behaviour (withholding help and rejection responses). Furthermore, evidence suggests that stigma towards
people with mental health problems may be greater in Asian cultures (Lauber & Rössler, 2007). We tested the fol-
• H1 South Asians will report greater affective prejudice (anger, fear, and pity) towards people with psychosis
than White British.
• H2 South Asians will report more negative stereotypes (blame and dangerousness) towards people with psy-
chosis than White British.
• H3 South Asians will report more discriminatory behaviour (withholding help, avoidance, endorsement of segre-
gation, and coercion) towards people with psychosis than White British.
• H4 The relationship between ethnic group and discriminatory behaviour will be mediated by affective prejudice
and by stereotypes.
Additionally, intergroup contact theory (Allport, 1954) suggests that contact with stigmatized groups, such as
people with psychosis, is associated with lower stigma towards those groups (Pettigrew & Tropp, 2006; Reinke, Cor-
rigan, Leonhard, Lundin, & Kubiak, 2004). For example, contact with people with schizophrenia is associated with less
social avoidance, due to more positive attitudes (West, Hewstone, & Lolliot, 2014). Due to the stigma of mental
health in the South Asian community, those with mental health problems may isolate themselves from others
(Rathod, Kingdon, Phiri, & Gobbi, 2010) and therefore have less contact with people with psychosis. For this reason,
intergroup contact was included as a covariate to control and adjust for these participant characteristics. We mea-
sured contact towards people with mental health problems more generally, instead of contact specifically towards
people with psychosis, as intergroup contact research suggests that contact not only reduces prejudice towards the
AHMED ET AL. 5AHMED ET AL. 203
group one has interacted with but also towards other stigmatized groups (for an overview, see Vezzali & Stathi,
2017). Identification with being British was used as a proxy measure to test whether our South Asian sample had
adapted to the British culture or, in other words, whether the cultural identity of South Asians living in the United
Kingdom was significantly different from a British identity.
6 | METHOD
6.1 | Participants
One hundred seventy-three young people took part in the study: 109 White British and 64 South Asians. In line
with the definition by the Office for National Statistics, South Asian refers to those individuals originating from
the South Asian subcontinent, including those from India, Pakistan, Bangladesh, and Sri Lanka, but who live in the
United Kingdom. The ethnic identity of participants was determined by them self-reporting their ethnicity.1 The
exclusion criteria were as follows: not speaking or understanding English due to all measures being in English.
Thirty-two completions of the 205 participants had to be excluded from the analysis as they did not meet our
inclusion criteria of identifying themselves as either White British or South Asian. The analysis plan for this pro-
ject included an a priori decision on comparing equal sample sizes. This decision was based on recommendations
on power in unequal cell sample sizes (StataCorp, 2013). This planned strategy was then followed once data were
collected. Due to the inequality of cell sample sizes, an equivalent sample size for both groups was used via ran-
dom subsampling in SPSS, and 64 cases were randomly selected from the 109 White British group, resulting in a
final sample size of 128 participants (64 White British and 64 South Asians) included in the analysis (64 women
and 64 men). In order to detect a medium effect for both α and β paths using the bias-corrected bootstrap test
of mediation with a power of .8, the required sample size is N = 71 (Fritz & MacKinnon, 2007). Those included in
the analysis were between the age of 16 and 20 years (MWhite = 16.95, SDWhite = 0.88, MAsian = 16.53, SDAsian =
0.80; for more demographics see Table 1).
6.2 | Procedure
Head teachers of one secondary school and one college in a city in Northern England were contacted via email
and telephone. Then, they were given a copy of the participant information sheet and consent forms for the par-
ticipants and for the parents of participants younger than 18 years. These were collected from the head teachers
a week later by the researcher, and participants were given an envelope containing a set of questionnaires
through the head teacher. Upon completion, participants were asked to put the questionnaires in the envelopes,
seal them, and return to the head teacher who passed them on to the researcher. Ethical approval was received
by the local institutional research and ethics committee (Ref: 15173). As young people may not be familiar with
the term psychosis and as its cultural meanings may vary, a brief definition of psychosis from the NHS were given
6.3 | Measures1
6.3.1 | Prior contact with people with mental health problems
Prior contact was measured by asking participants to indicate whether they had any previous contact with a person
with a mental health problem (0 = no, 1 = yes).
6 AHMED ET AL.204 AHMED ET AL.
6.3.2 | Identification with being British
The five items of the Group Identification Scale (Hornsey & Hogg, 2000) were used on a 7-point Likert scale ranging
from 1 = strongly disagree to 7 = strongly agree, for example, “I feel British.” A composite score was created by the
mean of these items (Cronbach’s αWhite = .90; Cronbach’s αAsian = .90).
Stigma towards psychosis was measured adapting the Attribution Questionnaire (Corrigan et al., 2003). All three
dimensions towards people with psychosis were measured: prejudice (anger, pity, and fear), stereotypes (blame and
dangerousness), and discrimination (helping, avoidance, segregation, and coercion). Participants were presented with
a vignette about a person named Harry who was described as having psychosis and were asked to rate statements
about Harry on a 9-point Likert scale ranging from 1 = not at all to 9 = very much. A composite score was created by
the mean of the items for each subscale, with most subscales having three items apart from anger and pity (two
items). Cronbach’s alpha was calculated for the three-item scales (criterion: α ≥ .60) and a correlation coefficient for
the two-item scales (criterion: r ≥ .50): anger, for example, “I would feel aggravated by Harry” (rWhite = .58; rAsian =
.59); fear, for example, “How scared of Harry would you feel?” (αWhite = .89; αAsian = .85); pity, for example, “How
much sympathy would you feel for Harry?” (rWhite = .58; rAsian = .62); dangerousness, for example, “I would feel
unsafe around Harry” (αWhite = .85; αAsian = .84); blame, for example, “I would think that it was Harry’s own fault that
he is in the present condition” (αWhite = .45; αAsian = .53); helping, for example, “I would be willing to talk to Harry
about his problems” (αWhite = .74; αAsian = .88); segregation, for example, “I think Harry poses a risk to his neighbours
unless he is hospitalised” (αWhite = .79; αAsian = .70); avoidance, for example, “If I were an employer, I would interview
Harry for a job” (αWhite = .67; αAsian = .60, reverse coded); and coercion, for example, “How much do you agree that
Harry should be forced into treatment with his doctor even if he does not want to” (αWhite = .59; αAsian = .43). The
TABLE 1 Participant demographics (frequencies)
Demographics White British South Asian
Gender M:F 14:50 50:14
White British 64
Asian Pakistani 39
Asian Indian 19
Asian Bangladeshi 5
Asian Sri Lankan 1
No religion 33 18
Christian 28 2
Muslim 0 33
Sikh 0 2
Hindu 1 6
Other 1 1
English 64 49
AHMED ET AL. 7AHMED ET AL. 205
scales for blame and coercion lacked internal consistency, and thus, no further analyses were conducted considering
7 | RESULTS
7.1 | Preliminary analyses
White British (n = 45) reported significantly more previous contact with a person with a mental health problem than
South Asians (n = 25), χ2 (1) = 13.44, p < .001. White British reported stronger identification with being British (M =
5.35, SD = 1.53) than South Asians (M = 4.64, SD = 1.51), t(126) = 2.64, p = .009, indicating that South Asians per-
ceived themselves as culturally different from White British people.
7.2 | Stigma dimensions
Descriptive statistics for all dependent measures are reported in Table 2. In order to test whether White British and
South Asians differed in stigma towards psychosis (while controlling for contact), one-way analyses of covariance
were carried out with the six stigma subscales. Ethnicity was coded as White British = 0 and South Asians = 1. Prior
contact with people with mental health problems was entered as a covariate. Results demonstrated a significant
effect on all three dimensions. South Asians reported higher levels of anger, F(1, 124) = 7.60, p = .007, partial η2 =
.06 (H1), dangerousness, F(1, 124) = 4.95, p = .028, partial η2 = .04 (H2), segregation, F(1, 124) = 4.19, p = .043, partial
η2 = .03 (H3), and avoidance, F(1, 124) = 6.76, p = .010, η2 = .05 (H3) as well as lower helping intentions, F(1, 124) =
8.24, p = .005, partial η2 = .06 (H3) than White British. The covariate was significant only for helping intentions, F(1,
124) = 6.36, p = .013, partial η2 = .05. There were no significant differences between White British and South Asians
for fear and pity, ps > .05.2, 4
7.3 | Mediation models
7.3.1 | Anger
We computed mediation analyses to assess whether the effects of ethnicity on discriminatory behaviour (reduced
helping intentions, avoidance, and endorsement of segregation) were mediated by variation in perceived anger.
Ethnicity was coded as White British = 0 and South Asians = 1. Bootstrapping analyses (1,000 subsamples, 95%
bias corrected, and accelerated confidence interval) were conducted using the PROCESS macro provided by
Hayes (2016, Model 4). Contact was entered as a covariate. Results can be found in Table 3. As hypothesized,
ethnicity significantly predicted helping, avoidance, and segregation, p < .05 for all total effects. Being of South
Asian ethnic background was associated with lower helping intentions, and greater avoidance and segregation
TABLE 2 Means (and standard deviations) for the stigma dimensions
Stigma dimension White British South Asian
Anger 2.41 (1.52) 3.16 (1.54)
Fear 2.70 (1.61) 3.14 (1.59)
Pity 7.22 (1.63) 6.88 (1.57)
Dangerousness 3.12 (1.67) 3.67 (1.57)
Helping 7.43 (1.41) 6.26 (1.97)
Segregation 2.51 (1.50) 2.98 (1.42)
Avoidance 4.00 (1.79) 4.93 (1.70)
8 AHMED ET AL.206 AHMED ET AL.
recommendation. There were significant indirect effects of ethnicity on helping, avoidance, and segregation,
through anger. As hypothesized (H4), the relationships between ethnicity (predictor) and helping, avoidance, and
segregation (outcome variables) were mediated by anger. Being of South Asian ethnic background was associated
with higher attributed anger and, in return, with lower helping intentions, greater avoidance, and higher segrega-
7.3.2 | Dangerousness
We then computed similar mediation analyses to assess whether the effect of ethnicity on discriminatory behaviour
(reduced helping, avoidance, and segregation) was mediated by variation in perceived dangerousness. Contact was
entered as a covariate. Results can be found in Table 4. As hypothesized, ethnicity significantly predicted helping,
avoidance, and segregation, p < .05 for all total effects. Being of South Asian ethnic background was associated with
lower helping intentions, and greater avoidance and segregation recommendation. There were significant indirect
effects of ethnicity on helping, avoidance, and segregation, through dangerousness. As hypothesized (H4), the rela-
tionships between ethnicity (predictor) and helping, avoidance, and segregation (outcome variables) were mediated
by dangerousness. Being of South Asian ethnic background was associated with higher attributed dangerousness
and, in return, with lower helping intentions, greater avoidance, and higher segregation recommendation.3, 4
8 | DISCUSSION
Previous research has focused on examining mental health stigma in Western cultures, little research has compared
Western with non-Western cultures living in a dominant White culture in their type of stigma. The current study
compared White British and South Asian young people in the United Kingdom in their affective prejudice, stereo-
types, and discriminatory behaviour towards people with psychosis.
First, following Corrigan et al.’s (2003, 2012) attribution model of stigma, we found support for our hypotheses
that South Asians endorse greater affective prejudice and more negative stereotypes towards people with psychosis
TABLE 3 Total, direct, and indirect effects of ethnic group on discriminatory behaviour, mediator: anger
95% BCa CI
Dependent variable B SE (B) p LL UL
Total effect −0.91 0.32 .005 — —
Direct effect −0.57 0.30 .062 — —
Indirect effect −0.34 0.15 — −0.66 −0.08
Total effect 0.56 0.27 .043 — —
Direct effect 0.16 0.24 .516 — —
Indirect effect 0.41 0.16 — 0.09 0.74
Total effect 0.82 0.32 .011 — —
Direct effect 0.49 0.30 .110 — —
Indirect effect 0.34 0.15 — 0.07 0.67
Note. Contact was entered as a covariate. B, unstandardized coefficient; SE, standard error; p, reported two tailed; 95% BCa
CI, 95% bias-corrected confidence interval; LL, lower limit; UL, upper limit.
AHMED ET AL. 9AHMED ET AL. 207
than White British. Specifically, they attributed higher anger and dangerousness to people with psychosis for their
condition. Second, we found support for our hypothesis that South Asians report greater willingness to engage in
discriminatory behaviour towards people with psychosis than White British. Specifically, they reported greater inten-
tions to withhold help, avoidance, and endorsement of segregation between people with psychosis and the commu-
nity. We also found support for our hypothesis that these cultural differences in self-reported discriminatory
behaviour are mediated by prejudice (anger) and stereotypes (dangerousness).
Our findings are in line with evidence on cultural differences, which suggest that stigma towards people with
mental health problems can be greater in Asian cultures (Lauber & Rössler, 2007). Although evidence indicates
that social distance is one of the most common endorsed consequences of having a mental health problem among
South Asians (Tabassum et al., 2000), our findings indicate that this also specifically applies to psychosis and
extends to other consequences such as withholding help, avoidance, and recommending segregation between
people with psychosis and the community. Intergroup contact theory (Allport, 1954) suggests that White British
may also be less stigmatizing towards people with psychosis due to greater prior contact with people with mental
health problems (Pettigrew & Tropp, 2006). Furthermore, due to the stigma of mental health in the South Asian
community, contact with people with mental health problems may be reduced because of self-isolation of those
with mental health problems (Rathod et al., 2010). Future research should examine the role of prior intergroup
contact in cross-cultural studies on mental health stigma further, using more refined measures of contact quantity
Although we found support for cultural differences in the endorsement of prejudice, stereotypes, and discrimina-
tory behaviour, we did not find support for cultural differences on all measures of affective prejudice (fear and pity).
One reason may be that stereotypes and discriminatory behaviour are associated with cultural norms and expecta-
tions; for example, South Asians may not be able to help or socially engage with people with psychosis due to the
stigma and consequences attached to it. However, they may still experience similar emotions as White British; for
example, they may not differ in their (internally experienced) fear or pity for people with psychosis. There may also
be a complex relationship between cultural origin and migrant status in South Asians. Future research will need to
investigate whether stigma is generally more severe in non-Western compared with Western cultures or whether
TABLE 4 Total, direct, and indirect effects of ethnic group on discriminatory behaviour, mediator: dangerousness
95% BCa CI
Dependent variable B SE (B) p LL UL
Total effect −0.91 0.32 .005 — —
Direct effect −0.71 0.31 .024 — —
Indirect effect −0.20 0.11 — −0.45 −0.02
Total effect 0.56 0.27 .043 — —
Direct effect 0.21 0.23 .355 — —
Indirect effect 0.35 0.15 — 0.06 0.63
Total effect 0.82 0.32 .011 — —
Direct effect 0.49 0.28 .090 — —
Indirect effect 0.34 0.16 — 0.07 0.66
Note. Contact was entered as a covariate. B, unstandardized coefficient; SE, standard error; p, reported two tailed; 95% BCa
CI, 95% bias-corrected confidence interval; LL, lower limit; UL, upper limit.
10 AHMED ET AL.208 AHMED ET AL.
only specific aspects of stigma (cognitive and behavioural components) are more severe by using more refined mea-
sures of affective prejudice such as intergroup anxiety or empathy.
In addition to explanations focusing on how culture can affect stigma, another explanation for our findings could
be that because South Asians living in the United Kingdom are an ethnic minority group in a majority host society,
they may tend to avoid further associations with other minority groups, such as people with mental health problems.
Another reason may be limitations in our design. The vignette was based on a person named Harry, which indicated
that the person with psychosis is from a White British ethnic background, so an outgroup member for South Asians
and an ingroup member for White British. A fruitful avenue for future research may be to vary the main character of
the vignette, using a White British and a South Asian name or removing the name from the vignette to test whether
naming the target of the stigmatized group influences affective reactions. In general, using scales developed for
research in Western countries may not be easily applicable to cross-cultural studies. They may lead to lower reliabil-
ity (as some scales in our study) as well as an inability to capture potential cultural differences. An important avenue
for future research is to develop scales that make it possible to capture the culture-specific experiences of mental
health and that are developed with researchers and service users from non-Western cultures.
Due to the challenge of obtaining the same number of South Asian participants as White British participants, the
cell sample sizes were unequal and the overall sample size lower than planned. This is a limitation of the current
study, in terms of power and the type of analyses that are possible (such as more complex models). Future studies
should consider strategies reaching out to minority participants in order to obtain larger sample sizes to test more
complex models. Another limitation of the current study is that we did not collect more information about the South
Asian sample. Although we had included a measure of identification with being British as a proxy measure of adap-
tion, future research should consider important variables such as British citizenship or length of stay in the United
8.1 | Implications
Stigma greatly impacts the health of people with mental health conditions further. It is associated with poorer well-
being such as lower self-esteem, depression, and poor sleep (Birtel, Wood, & Kempa, 2017; Corrigan & Watson,
2002; Link et al., 2001). Additionally, stigma has implications for the diagnosis, treatment, and management of psy-
chosis. Help seeking is frequently delayed due to fear of social exclusion from close others and society (Schulze &
Angermeyer, 2003; Wright, Gronfein, & Owens, 2000). Stigma is a major barrier to help seeking (Schomerus &
Angermeyer, 2008). Subsequently, this impedes timely diagnosis and treatment, hinders recovery and rehabilitation,
and ultimately compromises the quality of life of those with mental health difficulties. Mental health services are
reported to be underutilized by ethnic minorities, particularly South Asians (Kapadia et al., 2016). However, cross-
cultural differences exist when it comes to mental health causal beliefs, which can influence the willingness to seek
help. Spiritual and supernatural explanations are commonly held by South Asians regarding the causes of psychosis,
including the will of God, karmic retribution, and evil eye (Kulhara, Avasthi, & Sharma, 2000; Mirza et al., 2019).
South Asians are more likely to seek help from informal services, including religious leaders, prayer, and God as first
ports of call (Conrad & Pacquiao, 2005). This help seeking pattern has also been extended to South Asians living in
the United Kingdom, where there is also a reluctance to visit health practitioners for mental health problems (Fenton
& Sadiq-Sangster, 1996). Appropriate and timely help seeking from formal mental health services such as early inter-
vention services can mean better outcomes, including symptom reduction and fewer relapses (McGorry, Killackey, &
Therefore, there is a need to understand cultural differences in stigma towards people with psychosis in order to
tackle the negative consequences of stigma on help seeking and well-being and to make service accessible and effec-
tive for those from ethnic minority backgrounds, in particular adolescents.
AHMED ET AL. 11AHMED ET AL. 209
9 | CONCLUSION
The present study contributes to understanding the processes of prejudice, stereotypes, and discrimination towards
people with psychosis in its sociocultural context. Developing a deeper understanding of cross-cultural differences in
psychosis specifically and of mental health in general may provide valuable insights for practitioners. Increased sensi-
tivity to associations between culture and mental health will enable educators and policymakers to tailor stigma
interventions and clinicians to develop treatment approaches to South Asian communities.
1 This study, a student project, was part of a larger research project that involved two students with different research
questions and different dependent measures. Therefore, other measures were administered, which were not part of the
present investigation (see Mirza et al., 2019).
2 When including the full sample, analyses yielded similar results: In the analyses of covariance, South Asians (vs. White Brit-
ish) reported significantly higher levels of anger, F(1, 168) = 8.89, p = . 003, η2 = .05 (H1), and avoidance, F(1, 168) = 7.61,
p = .006, η2 = .04 (H3), and significantly lower helping intentions, F(1, 168) = 13.70, p < .001, η2 = .08 (H3); danger, F(1,
168) = 2.84, p = .094, η2 = .02 (H2) and segregation, F(1, 168) = 2.43, p = .121, η2 = .01 (H3), showed a trend to be higher
for South Asians. In the mediation analyses, there were significant indirect effects between ethnicity and helping inten-
tions (b = −.31, SE = 0.13, 95% CI [−0.60, −0.09]), avoidance (b = .31, SE = 0.12, 95% CI [0.08, 0.57]), and segregation (b =
.37, SE = 0.14, 95% CI [0.10, 0.67]) via anger.
3 Entering both mediators (anger and dangerousness) simultaneously in the same mediation models yielded similar results.
Specifically, for segregation both anger (b = .22, SE = 0.12, 95% CI [0.01, 0.50]) and dangerousness (b = .23, SE = 0.12,
95% CI [0.03, 0.52]) were significant mediators, for helping intentions anger (b = −.32, SE = 0.15, 95% CI [−0.66, −0.05])
but not dangerousness (b = −.03, SE = 0.08, 95% CI [−0.24, 0.11]) was a significant mediator, and for avoidance danger-
ousness (b = .28, SE = 0.15, 95% CI [0.03, 0.62]) but not anger (b = .11, SE = 0.10, 95% CI [−0.05, 0.33]) was a significant
4 When intergroup contact was excluded as a covariate, the ANCOVAs yielded similar results: South Asians reported signifi-
cantly higher levels of anger, F(1, 126) = 7.73, p = .006, partial η2 = .06 (H1), and avoidance, F(1, 126) = 9.14, p = .003, η2
= .07 (H3), marginally significantly higher levels of dangerousness, F(1, 126) = 3.72, p = .056, partial η2 = .03 (H2), and seg-
regation, F(1, 126) = 3.45, p = .066, partial η2 = .03 (H3), as well as significantly lower helping intentions, F(1, 126) =
14.93, p < .001, η2 = .11 (H3), than White British. In the mediation analyses, anger (but not dangerousness) mediated the
effects of ethnicity on discriminatory behaviour, that is, helping intentions (b = −.32, SE = 0.14, 95% CI [−0.62, −0.08]),
segregation (b = .39, SE = 0.15, 95% CI [0.12, 0.70]), and avoidance (b = .35, SE = 0.14, 95% CI [0.10, 0.64]).
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How to cite this article: Ahmed S, Birtel MD, Pyle M, Morrison AP. Stigma towards psychosis: Cross-
cultural differences in prejudice, stereotypes, and discrimination in White British and South Asians. J
Community Appl Soc Psychol. 2019;1–15. https://doi.org/10.1002/casp.2437
AHMED ET AL. 15
cultural differences in prejudice, stereotypes, and discrimination in White British and South Asians.
J Community Appl Soc Psychol. 2020;30:199–213. https://doi.org/10.1002/casp.2437
AHMED ET AL. 213
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