Soc Psychiatry Psychiatr Epidemiol (2016) 51:1257–1264

DOI 10.1007/s00127-016-1215-6

ORIGINAL PAPER

Beliefs about dangerousness of people with mental health

problems: the role of media reports and personal exposure
to threat or harm
N. J. Reavley1 • A. F. Jorm1 • A. J. Morgan1,2

Received: 22 November 2015 / Accepted: 21 March 2016 / Published online: 5 April 2016
 Springer-Verlag Berlin Heidelberg 2016

Abstract Conclusions Media reports may play a greater role in

Purpose To assess the associations between beliefs about forming attitudes in low prevalence disorders and further
the dangerousness of people with mental health problems efforts to reduce any adverse impact of media reporting
and exposure to media reports of violence or personal should focus on these disorders. The study also supports
experiences of fear, threat or harm. the effectiveness of contact with people with mental health
Methods Telephone interviews were carried out with problems in reducing beliefs about dangerousness.
5220 Australians aged 18?. Respondents heard a vignette
of a person with depression or early schizophrenia and Keywords Mental illness stigma
Violence
Population
were asked whether they believed him to be dangerous. survey
Other questions covered past 12-month recall of media
reports of violence and mental health problems, contact
with and experiences of fear, threat or harm by people with Introduction
mental health problems. Multinomial logistic regression
was used to assess the associations between beliefs about Stigma has been defined as: ‘‘a mark of shame, disgrace or
dangerousness and media and these types of contact with disapproval which results in an individual being rejected,
people with mental health problems. discriminated against, and excluded from participating in a
Results For the early schizophrenia vignette, recall of number of different areas of society’’ [1]. Often cited as an
media reports and having felt afraid of someone were issue of concern for people with mental health problems,
associated with beliefs about dangerousness. For the there is an extensive literature on stigma, its causes and the
depression vignette, media reports about violence and impact that it has on people with mental health problems
mental health problems or the experiences of feeling afraid [2, 3]. While it is often referred to as a unitary construct,
or having been threatened or harmed were not strongly there is evidence that there are multiple dimensions of
associated with beliefs about dangerousness. For both stigma, one of which is a belief in the dangerousness of a
vignettes, knowing someone with a mental health problem person with a mental health problem [4, 5]. It appears that
and having a higher level of education were associated with this belief has increased in Australia in recent years [6],
less belief in dangerousness. although this is not a consistent finding in other countries.
Surveys comparing beliefs in the US public in 1996 and
2006 on attitudes to vignettes portraying schizophrenia,
& N. J. Reavley major depression and alcohol dependence did not show
[email protected] changes [7, 8].
1 Evidence suggests that most people with mental health
Centre for Mental Health, Melbourne School of Population
and Global Health, The University of Melbourne, 207 problems are not violent and they are, in fact, more likely
Bouverie Street, Parkville, Melbourne, VIC 3010, Australia to be victims of violence than perpetrators, including vic-
2
School of Psychology and Public Health, La Trobe tims of homicide [9, 10]. Where associations between
University, Bundoora, Australia violence and schizophrenia, other psychoses and bipolar

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1258 Soc Psychiatry Psychiatr Epidemiol (2016) 51:1257–1264

disorder are found, much of the relationship is due to out by the survey company The Social Research Centre. A
associated substance misuse or lack of treatment [11–15]. ‘dual frame’ approach was used, with the sample contacted
Factors associated with beliefs about the dangerousness by random-digit dialling of both landlines and mobile
of people with mental health problems are likely to be phones. This approach was taken in order to minimise the
varied and complex. Researchers have explored a number potential bias of collecting data solely from households
of these, including characteristics of people who hold the with a landline telephone connection, as the latter approach
beliefs, characteristics of the person with mental health may under-sample young people, particularly young men
problems, exposure to mental health problems in oneself or [28]. Interviews were conducted between October and
others, exposure to violence by people with mental health December 2014. The average interview length was
problems, and media reporting of violent acts committed 19.4 min. Ethics approval was obtained from the Univer-
by people with mental health problems [4]. sity of Melbourne Human Research Ethics Committee.
A relatively large number of studies have explored the
associations between contact (which is most often through Survey interview
family and friends) with people with mental health prob-
lems and belief in dangerousness. Most have shown that Initial questions covered sociodemographic information
contact is associated with less belief in dangerousness, (age, gender, marital status, postcode, country of birth,
although this may depend on the quality of the contact and language spoken at home, level of education and Aborig-
there are many studies which do not report associations [4]. inal and Torres Strait Islander status). It also included
There is also some evidence that negative experiences, questions about the respondent’s own experience of mental
such as being threatened or physically harmed, are asso- health problems and whether they knew someone else with
ciated with greater belief in dangerousness [16]. Some mental health problems (defined in the following way ‘‘by
evidence suggests that personal experience of mental dis- a ‘mental health problem’ we mean a period of weeks or
orders has a weak association with less belief in danger- more when you are feeling depressed, anxious, or emo-
ousness [17, 18], but other studies report no association tionally stressed, and these problems are interfering with
[19, 20]. your life. Mental health problems could include, for
Media reporting of violent acts [21–23] has also been example, depression, anxiety disorders, eating disorders,
linked to greater beliefs in dangerousness. Studies have schizophrenia, bipolar disorder, or personality disorders’’,
shown that newspaper reports are more likely to discuss and see [27] for more detail). Respondents were randomly
people with mental health problems in the context of assigned to receive either a vignette describing a 30-year-
dangerousness or violence rather than treatment, recovery old male with depression or a 24-year-old male with early
and advocacy action [21, 24]. High-profile media reports of schizophrenia. The vignettes, which have been previously
mental illness-related gun violence in the US may be par- published and widely used, describe a person who met
ticularly damaging [25, 26]. ICD-10 [29] and DSM-IV [30] criteria for major depres-
However, there are no previous population studies that sion and schizophrenia [31].
have attempted to specifically compare the impact of media
exposure, personal experience of violence or threat, and Depression vignette
beliefs about dangerousness of people with mental health
problems. Therefore, the aim of the current study was to John is 30 years old. He has been feeling unusually sad and
carry out a national survey on beliefs about dangerousness miserable for the last few weeks. Even though he is tired all
and the relationship with exposure to media reports of the time, he has trouble sleeping nearly every night. John
violence or personal experiences of fear, threat or harm. doesn’t feel like eating and has lost weight. He can’t keep
his mind on his work and puts off making decisions. Even
day-to-day tasks seem too much for him. This has come to
Methods the attention of his boss, who is concerned about John’s
lowered productivity.
The survey involved computer-assisted telephone inter-
views (CATI) with a national sample of 5220 members of Early schizophrenia vignette
the Australian general community aged 18 and over [27].
This survey sample was sufficient to give a standard error John is 24 and lives at home with his parents. He has had a
of ±0.007 for a prevalence rate of 50 %, ±0.006 for a few temporary jobs since finishing school but is now
prevalence rate of 25 % and ±0.004 for a prevalence rate unemployed. Over the last 6 months he has stopped seeing
of 10 %. For a sub-sample of 1000, the respective standard his friends and has begun locking himself in his bedroom
errors were 0.02, 0.01 and 0.009. The survey was carried and refusing to eat with the family or to have a bath. His

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parents also hear him walking about his bedroom at night dangerousness were assessed with multinomial logistic
while they are in bed. Even though they know he is alone, regression. The dependent variables ‘personal belief in
they have heard him shouting and arguing as if someone dangerousness’ and ‘perceived belief in dangerousness’
else is there. When they try to encourage him to do more were each coded into three categories: ‘strongly agree’,
things, he whispers that he won’t leave home because he is ‘agree’ and ‘strongly disagree/disagree/neither agree nor
being spied upon by the neighbour. They realize he is not disagree’, with the last of these used as the reference cate-
taking drugs because he never sees anyone or goes gory. Covariates were gender, age (coded into three groups:
anywhere. 18–29 years, 30–59 years, 60? years), country of birth
Respondents were then asked to indicate how strongly (other vs Australia), language spoken at home (other vs
they agreed or disagreed with the following two state- English), level of education (bachelor or above vs below
ments: (1) John is dangerous; and (2) Most other people bachelor) and knowing someone with a mental health
believe that John is dangerous. Response options were problems (yes vs no). All analyses were performed using
‘strongly agree’, ‘agree’, ‘neither agree nor disagree’, Intercooled Stata 13 (StataCorp LP, TX, USA).
‘disagree’, or ‘strongly disagree’.
Subsequent questions covered exposure to media reports
of violence and mental health problems and personal Results
experience of fear or physical harm by a person with
mental health problems. The media-related questions were Overall, 5220 interviews were completed, with 2589 on
as follows: ‘Over the last 12 months have you heard or landlines and 2631 on mobiles. The standard response rate
read in the media about someone being physically harmed for the survey was 37.5 %. 2641 people received the
by a person with a mental health problem?’ and, if yes, depression vignette and 2579 received the early
‘Can you tell me what you remember about it?’ and ‘Did schizophrenia vignette. Among those given the depression
you see or hear this news story in… (1) the newspaper, (2) vignette, 13.3 % (95 % CI 11.8–15.0) agreed or strongly
a magazine, (3) radio, (4) TV, (5) the internet, (6) some- agreed that John is dangerous while 20.2 % (95 % CI
where else. Multiple answers were accepted. 18.3–22.2) agreed that other people would perceive John as
Personal exposure questions were as follows: ‘Over the dangerous. Among those given the early schizophrenia
last 12 months, have you ever felt afraid of a person who vignette, 28.3 % (95 % CI 26.2–30.5) agreed or strongly
you thought had a mental health problem?’ and, if yes, agreed that John is dangerous while 56.3 % (95 % CI
‘Can you please tell me what made you feel afraid?’; ‘Over 53.9–58.6) agreed that other people would perceive John as
the last 12 months have you been threatened or physically dangerous. Personal belief in dangerousness and perceived
harmed by a person who you thought had a mental health belief in dangerousness were weakly positively correlated
problem?’ and, if yes, ‘Can you please tell me what hap- (r = 0.38, p \ 0.001) (supporting previous findings that
pened?’; ‘Does your job involve working with people who these are separate constructs and that the scale items should
have mental health problems?’, and, if yes, ‘What type of not be combined [32]).
job do you do?’. Just over 60 % of respondents recalled media reports of
someone being physically harmed by a person with a
Statistical analysis mental health problem in the previous 12 months, with TV
being the most common source of such reports (recalled by
The data were initially analysed using percent frequencies 43.7 % of respondents). 15 % of people had felt afraid of a
and 95 % confidence intervals. A pre-weight was applied person in the last 12 months, 10 % had been threatened or
to adjust for the dual frame design and the respondent harmed and 13 % of people reported working with people
chance of selection. The achieved sample was close to the with mental health problems (see Table 1).
Australian national population in terms of geographic dis-
tribution, however, there was an under-representation of Personal beliefs about dangerousness
males and of younger adults, and an over-representation of
university-educated individuals and people with an Eng- Factors associated with beliefs about dangerousness are
lish-speaking background. These biases were adjusted for presented in Table 2 for each vignette. For the depression
by ‘raking’ (also known as rim weighting or iterative and early schizophrenia vignettes, respondents with a
proportional fitting) to account for known population pro- higher level of education were less likely to agree or
portions of gender, age, education level, region and tele- strongly agree with the statement that ‘John’ is dangerous
phone status. (see Table 2). For both vignettes, those speaking a lan-
Associations between media reports, personal experience guage other than English at home were more likely to
of fear, personal experience of threat or harm, and beliefs in strongly agree.

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Table 1 Media or personal

% (95% CI)
exposure to physical harm by
people with mental health Recall media reports of someone being physically harmed 62.6 (61.0–64.3)
problems
Type of media
Newspaper 23.9 (22.6–25.2)
Magazine 3.1 (2.7–3.7)
Radio 13.6 (12.6–14.7)
TV 43.7 (42.1–45.3)
The internet 13.1 (12.0–14.2)
Other 1.6 (1.3–2.1)
Felt afraid of a person with mental health problems 15.0 (13.9–16.2)
Threatened or harmed by a person with mental health problems 10.1 (9.1–11.1)
Work with people with mental health problems 13.6 (12.6–14.7)

Table 2 Associations between exposure and belief in dangerousness

Depression vignette Early schizophrenia vignette
Agree vs disagree/neither Strongly agree vs disagree/ Agree vs disagree/neither Strongly agree vs disagree/
[RRR (95 % CI)] neither [RRR (95 % CI)] [RRR (95 % CI)] neither [RRR (95 % CI)]

Gender
Female vs male 0.57 (0.31–1.06) 0.77 (0.54–1.08) 0.68 (0.44–1.03) 0.86 (0.66–1.12)
Age
30–59 vs 18–29 0.98 (0.43–2.23) 1.05 (0.65–1.71) 1.56 (0.78–3.09) 1.07 (0.74–1.55)
60? vs 18–29 1.11 (0.47–2.58) 0.87 (0.51–1.47) 1.48 (0.70–3.15) 1.33 (0.90–1.96)
Country of birth
Other vs Australia 1.33 (0.72–2.48) 0.99 (0.64–1.52) 1.23 (0.73–2.05) 1.09 (0.80–1.49)
Language spoken at home
Other vs English 1.05 (0.50–2.22) 1.93 (1.18–3.16)** 1.31 (0.69–2.47) 1.48 (1.01–2.17)*
Level of education
Bachelor or above 0.28 (0.13–0.61)** 0.59 (0.40–0.88)* 0.47 (0.29–0.75)** 0.64 (0.49–0.84)**
vs below bachelor
Knows someone with a mental health problem
Yes 0.75 (0.41–1.38) 0.53 (0.36–0.76)** 0.55 (0.36–0.86)* 0.80 (0.60–1.05)
Recall media reports of harm
Yes 0.62 (0.34–1.14) 0.94 (0.65–1.38) 1.43 (0.85–2.39) 1.38 (1.03–1.84)*
Felt afraid of someone
Yes 0.63 (0.22–1.83) 0.98 (0.55–1.74) 2.02 (1.10–3.73)* 1.10 (0.73–1.65)
Threatened or harmed
Yes 1.81 (0.60–5.43) 1.59 (0.83–3.06) 1.43 (0.72–2.84) 0.71 (0.41–1.24)
Work with people with mental health problems
Yes 1.01 (0.51–2.0) 1.00 (0.65–1.54) 1.00 (0.59–1.67) 0.83 (0.61–1.14)
* p \ 0.05, ** p \ 0.01

For the early schizophrenia vignette, recall of media For the depression vignette, knowing someone with a
reports of harm was associated with a greater likelihood of mental health problem was associated with a lower likeli-
strongly agreeing that ‘John’ is dangerous. However, a post hood of strongly agreeing and, for the early schizophrenia
hoc analysis exploring the associations between types of vignette, with a lower likelihood of agreeing with the state-
media exposure (newspaper, magazine, radio, TV or the ment. For the early schizophrenia vignette, having felt afraid
internet) and personal beliefs in dangerousness did not of someone with a mental health problem was associated
show any significant associations. with a greater likelihood of agreeing that ‘John’ is dangerous.

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Perceived beliefs about dangerousness Discussion

For the depression vignette, those speaking a language This paper reports results of the first national population-
other than English at home were more likely to strongly based survey to assess the associations between beliefs
agree that other people would consider ‘John’ dangerous about the dangerousness of a person ‘John’ with mental
and those with a higher level of education were less likely health problems and media reports and the following types
to agree. Those who knew someone with a mental health of contact: knowing someone, feeling afraid, being
problem were less likely to agree and those who had been threatened or harmed and working with people with mental
threatened or harmed were more likely to agree that other health problems. Experiences of being harmed or threat-
people would view ‘John’ as dangerous (Table 3). ened, or feeling afraid of a person with a mental health
For the early schizophrenia vignette, those aged between problem, did not consistently predict a belief in danger-
30 and 59 years and those aged 60 and over were less ousness. A minority of respondents believed in the dan-
likely than those aged between 18 and 29 to agree that gerousness of ‘John’, and consistent with previous
‘John’ would be perceived as dangerous. Those with a research, this belief was more common for early
higher level of education were less likely to agree with the schizophrenia than for depression [33]. It is possible that
statement that others would view ‘John’ as dangerous. the description of John as ‘shouting or arguing’ in the early
People who knew someone with a mental health problem schizophrenia vignette is one factor contributing to the
were more likely to agree that ‘John’ would be perceived as higher prevalence of beliefs about dangerousness.
dangerous. Those who had felt afraid of someone and those Media exposure to stories about violence and mental
who work with people with mental health problems were health did not predict personal beliefs about dangerousness
also more likely to strongly agree with the statement about of people with mental health problems, other than for the
perceived dangerousness. association with strong agreement in the early

Table 3 Associations between exposure and perceived belief in dangerousness

Depression vignette Early schizophrenia vignette
Agree vs disagree/neither Strongly agree vs disagree/ Agree vs disagree/neither Strongly agree vs disagree/
[RRR (95 % CI)] neither [RRR (95 % CI)] [RRR (95 % CI)] neither [RRR (95 % CI)]

Gender
Female vs male 0.78 (0.58–1.05) 0.83 (0.42–1.64) 0.85 (0.67–1.06) 1.11 (0.76–1.61)
Age
30–59 vs 18–29 0.92 (0.62–1.36) 2.14 (0.70–6.53) 0.60 (0.44–0.84)** 0.70 (0.42–1.16)
60? vs 18–29 0.79 (0.51–1.22) 2.39 (0.82–7.01) 0.61 (0.42–0.87)** 0.58 (0.32–1.03)
Country of birth
Other vs Australia 0.96 (0.69–1.34) 0.84 (0.41–1.73) 1.14 (0.87–1.49) 0.78 (0.46–1.31)
Language spoken at home
Other vs English 1.75 (1.17–2.61)** 1.66 (0.72–3.85) 1.06 (0.75–1.5) 1.79 (0.99–3.24)
Level of education
Bachelor or above vs 0.39 (0.28–0.54)*** 0.56 (0.28–1.11) 0.84 (0.66–1.05) 0.61 (0.42–0.89)*
Below bachelor
Knows someone with a mental health problem
Yes 0.61 (0.45–0.83)** 0.87 (0.47–1.63) 1.38 (1.08–1.75)** 1.21 (0.81–1.81)
Recall media reports of harm
Yes 0.80 (0.59–1.09) 0.51 (0.26–1.01) 1.12 (0.88–1.43) 1.17 (0.78–1.75)
Felt afraid of someone
Yes 1.36 (0.91–2.02) 1.30 (0.45–3.71) 1.24 (0.87–1.78) 1.69 (1.01–2.83)*
Threatened or harmed
Yes 1.79 (1.10–2.90)* 1.88 (0.56–6.32) 1.16 (0.76–1.80) 1.50 (0.82–2.76)
Work with people with mental health problems
Yes 1.12 (0.78–1.60) 1.26 (0.57–2.74) 0.99 (0.76–1.29) 1.59 (1.06–2.38)*
* p \ 0.05, ** p \ 0.01

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1262 Soc Psychiatry Psychiatr Epidemiol (2016) 51:1257–1264

schizophrenia vignette. Evidence for the impact of media The results of the current study are also similar to those
reports on beliefs about dangerousness tends to come from that show that working with people with mental health
studies assessing beliefs before and after violent events [22, problems is not likely to increase personal belief in dan-
34] or from experiments that expose people to media gerousness [20, 42, 43]. Those working in the area were
reports of violent crime associated with mental health more likely to strongly agree with the statement about
problems and then assess beliefs about dangerousness [26, perceived dangerousness, which is likely to reflect greater
35]. These studies also tend to focus on more severe awareness of stigmatizing attitudes towards people with
problems, particularly psychosis. It seems likely that when mental health problems. The current findings are also in
people are asked to think more broadly about mental health line with those studies showing that knowing someone with
problems and dangerousness (as was done in the current mental health problems is linked to lower likelihood of
study), their exposure to media reports is only one factor in believing in dangerousness [16, 18, 42, 44–46]. Moreover,
forming their views and is outweighed by other factors, in the current study, correlation between knowing someone
particularly knowing someone with a mental health prob- with a mental health problem and being threatened was
lem. This is likely to be particularly true of a person with weak (p = 0.15, p \ 0.001). This provides further support
depression as, due to the higher prevalence rates, contact for interventions that aim to increase contact with people
with a person with this mental health problem is much with mental health problems as an anti-stigma strategy [47,
more common than contact with a person with 48], although there is little evidence for longer term
schizophrenia. Thus, it is plausible that media influences impacts [49]. However, further studies should explore
would be greater in the latter case. This is supported by the whether the impact of contact on stigma varies according to
results of a recent study which examined beliefs about mental health problem or level of contact [50].
dangerousness before and after the Germanwings plane In line with previous studies, including those conducted
crash (in which a pilot with depression deliberately flew the using the same vignettes in Australia, perceived belief in
plane into a mountainside) [36]. The study showed that dangerousness was more common than personal belief,
while beliefs in unpredictability increased, beliefs about possible due to a phenomenon known as ‘pluralistic igno-
dangerousness did not. rance’, where most people erroneously perceive that they
It is also possible that efforts to improve the portrayal of have different attitudes to the majority [33]. While previous
mental health problems in the media in Australia in recent Australian studies [5] have shown lower stigmatising atti-
years have mitigated the adverse impact on beliefs about tudes in females, the results of the current study reflect the
dangerousness. Such efforts have been largely driven by results of a review of factors predicting belief in danger-
initiatives aiming to improve media reporting of suicide ousness which did not show any consistent association with
[37, 38]. A recent analysis of the portrayal of mental health age and gender [4]. The lower levels of stigma in those with
in Australian daily newspapers showed that, while news- a higher level of education and those speaking English at
paper coverage of mental health favoured stories about home are also consistent with the wider literature [4].
illness over wellbeing, the issue was typically reported Limitations of the study include potential recall bias and
responsibly and positive mental health messages were the relatively low response rate of 37 % which, while in
common [39]. However, psychotic disorders were over- line with other similar Australian surveys, may limit the
represented in discussions of illness and were often dis- generalisability of the results [51].
cussed in relation to criminal behaviour. Moreover, stories
which focused on unspecified ‘mental illness’ were also
more likely to focus on such behaviour. There is evidence Conclusions
that the public associates the term ‘mental illness’ with
schizophrenia rather than depression [40] and it is recom- Beliefs about the dangerousness of a person with depres-
mended that media guidelines should encourage the use of sion were not strongly associated with media reports about
specific diagnostic labels and should not contribute to the violence and mental health problems, or the experiences of
use of the term ‘mental illness’ to lower prevalence feeling afraid or having being threatened or harmed.
disorders. However, some links were seen in the case of
Findings in the current study are in line with those of a schizophrenia. It is likely that media reports play a greater
previous survey of young Australians aged between 12 and role in forming attitudes in low prevalence disorders and
25, which investigated recall of news stories about mental further efforts to reduce any adverse impact of media
health problems and associations with stigma [41]. The reporting should focus on more severe disorders. The study
results showed that recall of news stories about mental also provides further support for the effectiveness of con-
health problems was not generally associated with stig- tact with people with mental health problems in reducing
matising attitudes. beliefs about dangerousness.

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Soc Psychiatry Psychiatr Epidemiol (2016) 51:1257–1264 1263

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