Stigma and mental illness

The following is a sample Paper 3 that looks at focus groups. Below you will first find the stimulus piece, followed by the static questions.  A copy of the mock paper is included to give students as an in-class assessment.

Potential answers are included in the hidden boxes below.

Student copy

Stimulus piece

Schizophrenia has been found to be one of the most stigmatizing conditions. Most research on stigma has looked more at public opinions about the disorder, rather than at the views of those living with schizophrenia. Aiming to explore stigma from the perspective of people with schizophrenia, a focus group study was carried out at the four centers in Germany. For each of the centers, three separate focus groups were established. One with people suffering from schizophrenia, one with their relatives and one with mental health professionals. 83 individuals participated in the study. Participants were recruited through letters of invitation that were distributed through the centers’ out-patient department.

Focus groups consisted of 8 – 12 participants. The moderator asked the group the following opening question: What has changed for you after you first developed schizophrenia? Tell me concrete incidences and stories that you have experienced. The focus of the discussion was concrete stigmatization experiences, ideas about the causes of stigmatization and suggestions for anti-stigma interventions.

The focus group sessions were audio and video recorded and transcripts were coded using an inductive method. Once the focus groups of those living with schizophrenia had been analyzed, a content analysis was carried out on the transcripts of relatives and mental health professionals.

Results revealed several dimensions of stigma, including changes in interpersonal interaction, discrimination in the workplace and inequity in access to health care. For most of the patients, the diagnosis of schizophrenia had resulted in a reduction of social contacts. Relatives, too, observed how friends of the patient usually stayed away, did not come to see them at hospital or often avoided speaking with them. While the patients’ experience of stigma is dominated by the hurt they experience through the loss of social contacts and the fact that the illness shapes people’s perception of them, relatives feel that patients are particularly discriminated against through deficits in the quality of the treatment they receive, especially compared with health services available for patients with physical illness.

Source: Schulze, B, M. Angermeyer. Subjective experiences of stigma: A focus group study of schizophrenic patients, their relatives and mental health professionals. Social Science & Medicine 56 (2003) 299 - 312.


1a. Identify the method used and outline two characteristics of the method.

The study used a focus group method; focus groups are "group interviews" where a facilitator asks questions and keeps the group on task, but works as a normal conversation among a group of people.  A second characteristic is that focus groups tend to help the researcher understand if an idea or concern is of one participant or whether it is a common concern for participants. This is because when a participant hears what another person says, they may agree, but they would have come up with that idea on their own in a one-on-one interview.

1b. Describe the sampling method used in the study.

The participants were invited from an opportunity sample.  The sample is from three different centers.  An opportunity sample is a sample that already exists in some form and fits the characteristics sought by the researcher. From the opportunity sample, people were identified by administration as appropriate to the study and then sent letters asking them to volunteer.

1c. Suggest an alternative or additional research method giving one reason for your choice.

An alternative research method would be a case study.  A case study would look at one (or more) people living with schizophrenia in depth over a period of time.  This would then allow researchers to determine if feelings of stigma were persistent over time, over whether this changed over time.  It could be that thoughts on stigma were the result of conformity effects in the focus group, or that there were recent events in the lives of individuals that influenced their responses.  This would be controlled for in a longitudinal case study.

2. Describe the ethical considerations that were applied in the study and explain if further ethical considerations could be applied.

Informed consent would have to be gained from all participants, explaining the goals of the study and how the informatoin would be used.  The anonymity of the participants would have to be guaranteed.  As the focus groups were both video and audio recorded, it is essential that the researchers clarify how these recordings will be used so that the participants are not in any way compromised.  The researchers did not deceive the participants in any way, but they would still need to be debriefed and informed of the results.  Additionally, they would have to have the right to withdraw from the study at any time. 

3. To what extent could you generalize the findings of this study?

The study cannot be generalized to a large extent.  First, the study takes place by obtaining participants from four centers by "invitation." It is questionable as to why these particular patients were chosen.  It was not a random selection, so there could be biased in the sample which makes it difficult to generalize to the population of patients from the individual centers.  However, there were roughly 30 participants from each center; therefore, depending on how large the out-patient pool was for each of the centers, the number of participants may increase the possibility of generalizing the findings.
In addition, the study was done in Germany.  Germany is an individualisitic culture with rather small family sizes.  This could have an influence on an individual's feelings about stigma and feeling alone.  Germany also follows a medicalized model of mental illness, which may influence their approach to people with the disorder; this may differ from other countries.  Because the symptoms of schizophrenia are rather different from many other disorders - and the stereotypes and misunderstandings about the disorder more extreme than many other disorders, it may be difficult to transfer the results to draw conclusions about stigma with regard to other disorders such as depression, anxiety disorders or eating disorders.
Finally, the results could be generalized to support theories of stigma in mental illness.  Using this study in combination with other similar studies done on different populations, this could be used to help support the theory that the labeling of an individual with a diagnosis has negative social and personal consequences.
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