Mental Illness Stigma Research Based on the Quad Model and ReAL Model: From Personal-centered Perspective

Abstract Background：Currently, there remain some ambiguities in the research on mental illness stigma. One issue is that studies on the relationship between explicit and implicit stigmas of mental illness are divided into two camps: the high-correlation theory, which suggests a unity between the two, and the low-correlation theory, which advocates for their separation. Another issue is the "relativity" of the results from Implicit Association Tests (IATs), which has led to controversy over research conclusions. Methods：A total of 62 college students were recruited as volunteers to participate in the study, which employed a range of psychological scales, including emotional scales, social distance scales, and stereotype scales. The explicit attitudes of the participants toward mental illness were examined through latent profile analysis, while the implicit attitudes were assessed using Implicit Association Tests(IAT), analyzed based on the quad model and the ReAL model. Additionally, the study explored the relationship between explicit and implicit attitudes toward mental illness. Results：Based on the heterogeneity in college students' explicit attitudes toward mental illness, they could be divided into two subgroups, named "Acceptance Group" (39.66%) and "Stigma Group" (60.34%), respectively. The "mental Illness patients - negative" automatic activation parameter (AC, Quad model, χ2(1)=28.807, p<0.001) and the evaluative associative processing parameter for mental Illness patients (A, ReAL model, χ2(1)=10.826, p<0.01) reached significance, both indicating that college students have a significant negative implicit attitude towards mental Illness. The evaluative associative processing parameter A for the "acceptance group" of college students was not significantly different from 0.5 (χ2(1)=1.202, p=0.273), while the A parameter for the "stigma group" of college students was significantly less than 0.5 (χ2(1)=3.888, p<0.05), indicating that the acceptance group subjects held a neutral implicit attitude towards mental Illness patients, while the stigma group subjects held a negative implicit attitude. Conclusion: College students exhibit both explicit and implicit stigma towards mental illness. Over 60% of the participants showed a tendency for explicit stigma, with the most prominent issue being discriminatory behavior towards individuals with mental illness, followed by negative perceptions of mental illness. College students with neutral implicit beliefs tended to display accepting explicit attitudes, whereas those with implicit stigma tended to show stigmatizing explicit attitudes.