title: Do attitudes towards persons with mental illness worsen during the course of life? An age-period-cohort analysis.
abstract: OBJECTIVE
  Cross-sectional studies frequently find higher age associated with negative attitudes towards persons with mental illness. We explore whether attitudes worsen over the life span, or follow a cohort pattern.
  
  
  METHODS
  Using data from three identical population surveys in Germany from 1990, 2001 and 2011 (combined sample n = 7835), we performed age-period-cohort analyses determining the association of age, time period and birth-cohort with social distance from a person with either depression (n = 3910) or schizophrenia (n = 3925), using linear and nonlinear partial least squares regression models.
  
  
  RESULTS
  Social distance increases with age, independent from cohort and period effects, cumulating to an increase of 2.4 (schizophrenia) and 2.3 (depression) on the 28 point social distance scale over the life span (youngest to oldest participant). We found a cohort effect in depression, but not schizophrenia, with decreasing social distance until 1970 and a slight increase in younger cohorts. Period effects were visible particularly in schizophrenia, with growing social distance over time.
  
  
  CONCLUSIONS
  Considering demographic change and the vulnerability of older persons to severe outcomes of mental illness such as suicide, the observed increase of negative attitudes over the life span seems highly relevant. We discuss the role of conservatism and preferences for agreeable social contacts in older age.
authors: Department of Psychiatry, University of Greifswald, Greifswald, Germany.|HELIOS Hanseklinikum Stralsund, Stralsund, Germany.
authors: G
authors: G
authors: Schomerus
authors: Institute of Community Medicine, University of Greifswald, Greifswald, Germany.
authors: S
authors: S
authors: Van der Auwera
authors: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.|Institute of Health Economics and Health Services Research, University of Hamburg, Hamburg, Germany.
authors: H
authors: H
authors: Matschinger
authors: Institute of Community Medicine, University of Greifswald, Greifswald, Germany.
authors: S E
authors: SE
authors: Baumeister
authors: Department of Public Health, University of Cagliari, Cagliari, Italy.|Center for Public Mental Health, Gösing am Wagram, Austria.
authors: M C
authors: MC
authors: Angermeyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D028642:Persons with Psychiatric Disorders; D008875:Middle Aged; D012559:Schizophrenia / Q000453:epidemiology; D055815:Young Adult
keywords: age-period-cohort analysis; social distance; socio-emotional selectivity hypothesis; stigma