Continuum beliefs of mental illness: a systematic review of measures

S Tomczyk; S Schlick; T Gansler; T McLaren; H Muehlan; L-J Peter; G Schomerus; S Schmidt

doi:10.1007/s00127-022-02345-4

Continuum beliefs of mental illness: a systematic review of measures

Soc Psychiatry Psychiatr Epidemiol. 2023 Jan;58(1):1-16. doi: 10.1007/s00127-022-02345-4. Epub 2022 Aug 5.

Authors

S Tomczyk¹, S Schlick², T Gansler², T McLaren², H Muehlan², L-J Peter³, G Schomerus^{3

4}, S Schmidt²

Affiliations

¹ Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Straße 13, 17489, Greifswald, Germany. samuel.tomczyk@uni-greifswald.de.
² Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Straße 13, 17489, Greifswald, Germany.
³ Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany.
⁴ Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.

Abstract

Purpose: The continuum of mental health/illness has been subject to scientific debate for decades. While current research indicates that continuum belief interventions can reduce mental health stigma and improve treatment seeking in affected populations, no study has yet systematically examined measures of continuum beliefs.

Methods: This preregistered systematic review summarizes measures of continuum beliefs. Following the PRISMA statement, three scientific databases (PubMed, PsycInfo and PsycArticles via EBSCOhost, Web of Science) are searched, instruments are described and discussed regarding their scope, and methodological quality.

Results: Overall, 7351 records were identified, with 35 studies reporting relevant findings on 11 measures. Most studies examined general population samples and used vignette-based measures. Schizophrenia and depression were most commonly examined, few studies focused on dementia, ADHD, OCD, eating disorders, and problematic alcohol use, or compared continuum beliefs across disorders. Validity was very good for most measures, but reliability was rarely tested. Measures mostly assessed beliefs in the normality of mental health symptoms or the normality of persons with such symptoms but rarely nosological aspects (i.e., categorical v continuous conceptualization of mental disorders).

Conclusions: Current research provides psychometrically sound instruments to examine continuum beliefs for a variety of mental disorders. While studies suggest utility for general population samples and mental health professionals, more research is necessary to corroborate findings, for instance, regarding age (e.g., in adolescents), gender, or type of mental disorder. Future research should also compare self-report ratings, and vignette-based measures, include measures of nosological concepts to fully grasp the continuum concept of mental illness.

Preregistration: PROSPERO: CRD42019123606.

Keywords: Assessment; Continuum; Mental health; Public health; Stereotyping; Systematic review.

Publication types

Systematic Review
Review

MeSH terms

Adolescent
Humans
Mental Disorders* / psychology
Mental Disorders* / therapy
Mental Health
Reproducibility of Results
Schizophrenia*
Social Stigma

Abstract

Publication types

MeSH terms

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