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Soc Sci Med. 2014 Feb;103:60-6. doi: 10.1016/j.socscimed.2013.11.014.

Public attitudes regarding individual and structural discrimination: two sides of the same coin?

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Center for Public Mental Health, Untere Zeile 13, A-3482 Gösing/Wagram, Austria. Electronic address:
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Str. 55, D-04103 Leipzig, Germany. Electronic address:
Department of Sociomedical Sciences, Columbia University, 722 West 168th Street, New York, NY 10032, USA. Electronic address:
Department of Psychiatry, University of Greifswald, Rostocker Chaussee 70, D-18437 Stralsund, Germany. Electronic address:


Public attitudes and beliefs are relevant to both individual and structural discrimination. They are a reflection of cultural conceptions of mental illness that form a reality that people must take into account when they enact behavior and policy makers must confront when making decisions. Understanding and keeping track of these attitudes is critical to understanding individual and structural discrimination. Theories of stigma posit that both forms of discrimination are distinct phenomena. Practically nothing is known about how attitudes regarding individual and structural discrimination relate. Our study addresses this gap by examining how attitudes toward allocating financial resources to the care of people with depression (structural discrimination) have developed over the last decade in Germany, compared to the public's desire for social distance from these people (individual discrimination). Previous studies have shown the public being more ready to accept cutbacks for the care for mentally ill persons than for medically ill persons. These preferences could have changed with regard to depression, since there is a growing awareness among the German public of an "epidemic of depression". The idea of a high prevalence of depression may have led to a heightened perception of personal susceptibility for this disorder, making the public become more reluctant to accept cutbacks for the care of people with depression. On the other hand, there is reason to assume that the growing awareness of high prevalence of depression among the general public has not affected individual discrimination of persons suffering from this disorder. The two assumptions were tested comparing data from population surveys conducted in Germany in 2001 and 2011. Within ten years, the proportion of respondents who opposed cutting money from depression treatment tripled from 6% to 21%. In contrast, the public's desire for social distance from persons with depression remained unchanged. Moreover, both trends proved to be independent from each other. Our findings suggest that attitudes relevant to structural and individual discrimination are not necessarily linked together and may lead to divergent results. This means that a comprehensive understanding of stigma must consider both forms of discriminating attitudes together. Studying both simultaneously may deepen our understanding of each and point to novel ways to produce change.


Attitudes; Depression; Individual discrimination; Population study; Structural discrimination

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