Change in newspaper coverage of schizophrenia in Japan over 20-year period

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Abstract

In Japan, schizophrenia was renamed in 2002 to reduce the stigma that people with schizophrenia are dangerous. However there has been little research on the potential anti-stigma effect of renaming. The present study aimed to examine whether portrayals of schizophrenia in newspapers as dangerous have been varied across renaming of the disease. To achieve this goal, newspaper articles containing the previous and new Japanese names for schizophrenia, published in the decades before and after the renaming, were identified through the database of the three largest Japanese national broadsheets. Identified articles were divided into two categories: a negative category, including a subcategory “danger”; and a positive category. Articles containing bipolar disorder were adopted as a control. The ratio of the number of articles on schizophrenia and danger to that of bipolar disorder was analysed as a variable of interest. The trend of this ratio was investigated to examine whether portrayals of schizophrenia changed after renaming. The search identified 4677 articles on schizophrenia, 53.0% of which were categorised as negative and 38.9% as danger. The search identified 525 articles on bipolar disorder, 24.6% of which were categorised as negative and 11.2% as danger. There was an increase of the ratio before schizophrenia was renamed (r = 0.54, p = 0.104), and a significant decrease after renaming (r =  0.69, p = 0.028). Fisher's r-to-z transformation demonstrated a significant change in the trend of the ratio across renaming (Z = 2.72, p = 0.007). Renaming schizophrenia might be associated with mitigation in potentially stigmatised depiction of schizophrenia associated with violence in newspaper reports.

Introduction

Individuals with schizophrenia suffer from stigma all over the world (Ando et al., 2013, Thornicroft et al., 2009). Previous studies in Japan, Australia, and the United States have highlighted that a large part of the general population held stereotypes that individuals with schizophrenia were dangerous (Corrigan et al., 2002, Griffiths et al., 2006). In newspapers, 14–49% of articles on mental illness were linked to danger (Goulden et al., 2011, Magliano et al., 2011, Nawkova et al., 2012, Whitley and Berry, 2013). Furthermore, newspaper coverage of schizophrenia has been shown to be disproportionately negative compared with other psychiatric conditions in previous studies in the United Kingdom (Goulden et al., 2011, Thornicroft et al., 2013), Belgium (Thys et al., 2013), Czech Republic, Croatia, and Slovakia (Nawkova et al., 2012). Media coverage and the attitudes of the general public toward mental illness influence each other (Goulden et al., 2011, Klin and Lemish, 2008, Stout et al., 2004). Among some media sources, newspaper coverage was used to investigate the effect of anti-stigma campaigns in some countries (Thornicroft et al., 2013, Whitley and Berry, 2013). This is because newspaper coverage may be considered to be an index of wider public opinion and it is suitable for research as material can be collected over a number of years to analyse trends.

In Japan, in 1990s, the stereotype that individuals with schizophrenia are dangerous was of particular interest, as several murders in the late 1980s were committed by criminals who might have had a diagnosis of schizophrenia. In 1993, the National Federation of Families with Mentally Ill (NFFM, “Zenkoku-seishin-shogaisha-kazokukai-rengoukai”) concerned that stigma was increasing, and requested that the Japanese Society of Psychiatry and Neurology (JSPN) consider renaming schizophrenia. They felt that the previous Japanese name for schizophrenia “seishin-bunretsu-byo”, which literally means “mind-split-disease”, may evoke a stereotype that the mind of individuals with schizophrenia was split, meaning that they were unpredictable, untreatable, and dangerous (Sato, 2002). In 2002, the JSPN accepted their request and changed the Japanese name for schizophrenia to “togo-sitcho-syo”, which literally means “integration disorder.” The new name was less stigmatising because it gave an impression that the condition was not irreversible but controllable. Renaming was accompanied by public education effort explaining why the name had to be changed. This was the first nationwide anti-stigma intervention in Japan. Also, this was the first attempt in the world to reduce stigma by renaming schizophrenia (Desapriya and Iwase, 2002, Kim, 2002, Sato, 2006). Following Japan's example, similar approaches were adopted in South Korea in 2012 (Lee et al., 2013) and Taiwan in 2014 (Sartorius et al., 2014). In the present study, we aimed to examine whether social attitude toward individuals with schizophrenia changed over 20-year period, the decades before and after renaming by quantitatively investigating newspaper coverage about schizophrenia in Japan. Based on previous studies that found articles linking schizophrenia and danger were the most stigmatizing (Stout et al., 2004), and the intent of the NFFM and JSPN that renaming schizophrenia would reverse the increase in stigma based on this stereotype, we hypothesised that increasing stigma against people with schizophrenia had been mitigated after renaming.

Section snippets

Design

The present study is a retrospective survey that aimed to examine how newspaper articles associated schizophrenia and danger over a 20-year period: 10 years before and 10 years after renaming of schizophrenia, as compared with the control condition (bipolar disorder). During the study period, studies shows that social attitude towards psychiatric illnesses, not only schizophrenia, had changed greatly. For example, the number of outpatients using psychiatry services in Japan has almost doubled (

Schizophrenia

The search over the three electronic databases yielded 5045 potentially relevant articles, of which 4918 articles were available. Of the available articles, 4693 were eligible for inclusion and 225 articles were excluded as they did not focus on schizophrenia. Sixteen articles contained metaphorical usage of the term schizophrenia and were discarded. A total of 4677 articles were included in the analysis: 1241 articles for the period before renaming and 3436 articles for the period after

Discussion

During study period, there was an increase of the ratio of articles on schizophrenia and danger to that of bipolar disorder during the first decade, and a significant decrease during the second decade. Fisher's r-to-z transformation demonstrated a significant change in the trend of the ratio between the two decades, from increasing to decreasing.

Our results support the hypothesis that there was a change in newspaper coverage of schizophrenia that individuals with schizophrenia were dangerous

Role of funding source

This work was supported by Grant-in-Aid for Scientific Research on Innovative Areas (23118001 & 23118004; Adolescent Mind & Self-Regulation) from the Ministry of Education, Culture, Sports, Science and Technology of Japan and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King's College London Foundation Trust.

Contributors

AA, YA and CH designed this study. AA collected data. AA and YA performed data analysis. RG originally made the method (coding frame) used in data analysis and AA and YA modified the coding frame in order to adjust it to Japanese condition. AA, YA and CH interpreted the data. AA, YA wrote the manuscript. RG, KK and GT also took part in writing paper. AA and YA equally contribute to this work. All authors contributed to and have approved the final manuscript.

Conflict of interest

AA received the 2015 JSPN International Presentation Award from the JSNP for the presentation related to this study.

YA received the 2015 JSPN Award for Special Contributions to Psychiatric Research from the JSNP for other studies.

Acknowledgement

Supported in part by Japan Society for the Promotion of Science (YA).

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