Social context, stigma, and the role of causal attributions: Public evaluations of mental illness in South Africa

Although recent medical advances have increased our understanding of mental illness, people with mental illness continue to experience stigma. Only a few studies have addressed mental illness stigma in Africa, and they tend to be non-representative. Using a population-based sample of 1,550 adults from the Stigma in Global Context-Mental Health Study, this study applies the Etiology and Effects of Stigma Model to frame and evaluate mental illness stigma in South Africa. Analyses investigate causal attributes, stigma, and the links between them, taking into account how demographics structure both.;Findings show that causal attributions are complex and that mental illness stigma exists in South Africa with schizophrenia drawing more stigma than depression. South Africans are hesitant to engage people with mental illness in marital relations and childcare. For the most part, social-demographic characteristics of persons described with mental illness are not associated with stigma. However, Blacks stand out as recipients of negative White responses. Gender is only significant when interacted with selected causal attributions. For example, males who endorse normal ups and down as cause of illness are more intolerant than females. Biogenetic causes are associated with intolerance, while non-biogenetic attributes reveal tolerant attitudes. Further, Black, male, and lowly educated respondents are more likely to endorse non-biogenetic causes for mental illness.;In sum, the South African context is not unique; however, unlike other past studies, race and ethnicity matter. This is not surprising given South Africa's history of apartheid and its vestiges that have structured interaction and development of the nation's diverse racial groups. Corresponding to the Etiology and Effects of Stigma Model, causal attributions and selected socio-demographic characteristics influence mental illness stigma in South Africa. The respondents' race has direct influence while gender is indirectly related to stigma. Internal attributions lead to increased stigma while externalized causes are associated with more tolerance. This study extends stigma work to non-western contexts and advances our general knowledge of disease stigma in Africa. Therefore, it informs anti-stigma efforts in South Africa and contributes to the ongoing debate on the association between knowledge of mental illness labels, attributions, and stigma.