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Internal motivation to respond without prejudice as a mediator of gender-attitudes toward mental illness.

Attitude towards mental illness has been one of the foci in rehabilitation research (Corrigan, 2003; Corrigan, 2004; Corrigan & Lam, 2007; Corrigan, Lickey, Schmook, Virgil, & Juricek, 1999; Corrigan & Penn, 1999; Corrigan, Powell, & Rusch, 2012; Diksa & Rogers, 1996; Garske & McReynolds, 2005; Garske & Stewart, 1999; Gill, Murphy, & Birkmann, 2005; Hampton, Yeung, & Nguyen, 2007; Kelly, Deane, Kazantzis, & Crowe, 2007; Pluta, 2006). Over the past several decades, the majority of the research on attitudes toward mental illness focused on correlates of attitudes toward people with mental illness (PWMI) and modification of negative attitudes toward PWMI (Corrigan, 2000; Corrigan & Watson, 2007; Diksa & Rogers, 1996; Garske & McReynolds, 2005; Garske & Stewart, 1999; Gill et al., 2005; Hand & Tryssennaar, 2006; Holzinger, Floris, Schomerus, Carta, & Angermeyer, 2012;Luty, Umoh, & Nuamath, 2009; Pinto-Foltz & Logsdon, 2009; Seo & Chen, 2009). A body of research found that (a) negative perceptions or stigmatizing attitudes exist towards PWMI, (b) the negative attitudes were related to psychosocial variables such as attribution (how people use information to arrive at causal explanations for events or conditions such as mental illness) and the degree of contact that people had with PWMI, and (c) the negative attitudes were associated with various demographic variables, including age, ethnicity, gender, and education (Angermeyer, 2006; Bhugra, 1989; Corrigan, 2012; Corrigan & Miller, 2004; Corrigan & Penn, 1999; Fabian & Edwards, 2002; Gill et al., 2005).

Using the attribution theory of social psychology (Weiner, 1995), Corrigan and his associates systematically investigated the relationship between attributions and negative perceptions or stigmatizing attitudes toward PWMI. Findings from their studies indicated that people made attributions about the cause and controllability of an individual's mental illness (Corrigan, Markowitz, Watsaon, Rowan, & Kubiak, 2003). The public tends to believe that mental illness is associated with certain personality traits, character weakness (e.g., the absences of moral standards) and deviate behaviors (Corrigan et al., 2000; Lam, Tsang, Chan, & Corrigan, 2006). These attributions led to inferences (ideas or conclusions that are drawn from personal beliefs) about individuals' "deserving" or "being responsible" for getting the disease as well as concepts that PWMI are dangerous or might harm others (Link, Phelan, Bresnahan, Stueve, & Pescosolido, 1999; Pescosolido, Monahan, Link, Stueve, & Kikuzawa, 1999). Empirical studies showed that these inferences (responsibility and being dangerous) yielded emotional reactions including anger (Corrigan, Larson, & Kuwabara, 2007), fear (Angermeyer & Matschinger, 1996; Corrigan et al., 2007; Levey & Howells, 1995) and shame (Corrigan & Miller, 2004; Corrigan, Watson, & Miller, 2006). Because of these emotional reactions, people may have negative attitudes toward PWMI (Corrigan, et al., 2007; Corrigan et al., 2003; Corrigan, Watson, & Miller, 2006; Rusch, Corrigan, Todd, & Bodenhausen, 2010; Rusch, Todd, Bodenhausen, Olschewski, & Corrigan, 2010).

In addition, researchers reported that individuals who were younger, with more education about PWMI, and had more contact with PWMI were more likely to have positive attitudes toward PWMI than those who were older, with less education, and had less contact with PWMI (Bhugra, 1989; Corrigan, Edwards, Green, Diwan, & Penn, 2001; Gill et al., 2005; Holmes, Corrigan, Williams, Canar, & Kubiak, 1999; Zuniga & Fisher, 2010).

Gender Differences in Attitudes

Previous studies revealed that gender was correlated with attitudes toward mental illness (Angermeyer, 2006; Corrigan & Penn, 1999; Corrigan & Watson, 2007; Gordon, Tantillo, Feldman, & Perrone,2004; Hampton & Zhu, 2011; Holzinger et al., 2012; Laws & Kelly, 2005; Leong & Zachar, 1999; Panek & Jungers, 2008; Panek & Smith, 2005; Vilchinsky, Werner, & Findler, 2010; Williams & Pow, 2007). Females were more likely to have favorable attitudes toward mental illness than males (Angermeyer, 2006; Corrigan & Penn, 1999; Corrigan & Watson, 2007; Hampton & Zhu, 2011), although this gap is closing in more recent research (Holzinger, Floris, Schomerus, Carta, & Angermeyer, 2012).

Leong and Zachar (1999) investigated 290 Caucasian undergraduates' attitudes toward PWMI. Eighty-six percent of the participants were 17-20 years old. Cohen and Struening's (1962) Opinions about Mental Illness (OMI) scale was used to measure attitudes toward PWMI. The OMI measures five constructs, including authoritarian (viewing PWMI as a class of people inferior to normal individuals), benevolent (a kindly paternalism with origins in religion and humanism), socially restrictive (desire to restrict PWMI from society), and mental hygiene ideology (viewing mental problems as a treatable illness). Leong and Zachar (1999) found significant differences in opinions about mental illness between male and female students. Males were less benevolent and more restrictive than females, while females were more benevolent, less authoritarian, less socially restrictive, and had higher mental hygiene ideology. (Leong & Zachar, 1999).

Similarly, Gordon et al. (2004) examined 218 undergraduates' attitudes regarding interpersonal relationships with PWMI. The average age of the participants was 21 years with an age range of 18-35 years. The majority of the participants (85.8%) were Caucasian, and the remaining participants were Asian and Latin Americans. The researchers found that female students had less need for social distance from PWMI and had greater knowledge of mental illness. In a study of cultural influences on attitudes toward PWMI, Hampton and Zhu (2011) recruited two hundred and forty students from Asian, Latino, and Caucasian backgrounds. The OMI scale was used to measure attitudes, and the Level of Contact Scale (Tsang, Tam, Chan, & Cheung, 2003) that measures the intensity of individuals' exposure to an interaction with PWMI was used to measure the covariant contact with PWMI. A 2 (gender) x 3 (culture) MANCOVA was performed. Results indicated that female students in all three ethnic groups had more positive attitudes toward PWMI than did male students and that females had significantly less authoritarianism and social restrictive opinions compared to their male counterparts.

The same pattern was found in the teenager population. Williams and Pow (2007) distributed a 30-item questionnaire that measured perceptions of mental health issues to 496 fifth-year pupils from three schools in the United Kingdom. Forty nine percent of the participants were boys, and 51 % were girls. The results showed that boys were more than twice as likely to believe that the public should be better protected from people with mental health problems (29.0% vs. 14.3%), more likely to find it hard to talk to someone with mental health problems (30.6% vs. 16.3%), and significantly less likely to believe that people recover from such problems (25.7% vs. 37.8%).

Gender differences in attitudes toward PWMI merits further examination, as the previous studies did not indicate why these differences exist. Further investigations will help researchers and practitioners better understand how males and females develop their attitudes so to provide effective interventions accordingly. Previous researchers postulate that motivations to respond without prejudice may be partially responsible for gender differences in attitudes (Ratcliff, Lassiter, Markman & Snyder, 2006). These researchers called for further investigations on the role of motivations to respond in mediating the relationship between gender and attitudes (Ratcliff et al., 2006). In the following sections, the concept of motivation to respond without prejudice and its importance in attitude research will be further discussed.

Motivation to Respond without Prejudice

Motivation to respond without prejudice is a social psychology concept that was originally developed in studies of prejudice against African Americans. Researchers in social psychology report that, in the past 50 years, there have been dramatic changes in Caucasian's self-reported attitudes toward African Americans in conjunction with many legislative changes promoting the rights of African Americans (Plant & Devine, 1998). However, the presence of external social pressure (e.g., political correctness) has created challenges for attitude researchers and practitioners as they try to understand the motivations underlying non-prejudiced responses and develop appropriate interventions (Plant & Devine, 1998). The question is whether the self-reported non-prejudiced responses are due to "pervasive external social pressure" or do they reflect true attitudes/perceptions. By the same token, the rehabilitation field witnesses the similar changes and challenges. With the passing of the Rehabilitation Act and the Americans with Disabilities Act, the public are more aware of the rights of people with disabilities. Results of stigma/attitude research using self-reported instruments indicate that the public's perceptions of people with disabilities are changing to a positive direction (Angermeyer, 2006; Holzinger, Floris, Schomerus, Carta, & Angermeyer, 2012). However, some respondents of these studies may have learned to conceal overt expressions of prejudice and present themselves in a socially acceptable manner (Pruett & Chan, 2006). In order to facilitate attitude changes it is important to discern motivations underlying responses to people with disabilities (Kurita & Kusumi, 2009).

According to Plant and Devine (1998), people may be motivated to respond without prejudice for internal (personal) reasons or for external (normative) reasons. Internal motivation to respond without prejudice derives from internalized, personally important, non-prejudiced beliefs (Devine, Plant, Amodio, Harmon-Jones, & Vance, 2002). Stated differently, internal motivation reflects both how a person views the "self' in terms of egalitarian standards and the extent to which these self-perceptions motivate, and subsequently enable the person to control prejudiced responses (Devine et al., 2002). Conversely, external motivation to respond without prejudice results from the desire to avoid negative reactions from others, if one were to respond with prejudice (Devine, et al., 2002). In other words, others or society impose the standard against which one's prejudice-relevant responses are evaluated.

Plant and Devine (1998) developed the Internal and External Motivation to Respond without Prejudice toward African Americans Scale (IMS/EMS). The IMS measures individuals' beliefs and self-concepts that drive the person to behave in a non-prejudicial manner, with high scores indicating higher internal motivation to respond. An example item is "I am personally motivated by my beliefs to be non-prejudiced toward Black people." The EMS measures individuals' non-prejudicial responses under social pressure. An example question is "I try to hide any negative thoughts about Black people in order to avoid negative reactions from others." In recent years, research examining motivation to respond without prejudice has been expanded to assess attitudes toward gay men and lesbians (Ratcliff, Lassiter, Markman & Snyder, 2006) as well as attitudes toward people with disabilities (Kurita & Kusumi, 2009; Pruett & Chan, 2006).

Ratcliff et al (2006) observed that there were gender differences in internal motivation to respond without prejudice toward gay men and lesbians. Females tended to have a higher level of internal motivation to respond without prejudice than did males and this difference in internal motivation contributed to gender differences in attitudes toward gay men and lesbians (Ratcliff et al., 2006). The results elucidate the relationships between gender, internal motivation to respond without prejudice, and attitudes. Like gay men and lesbians, PWMI have been discriminated against in society. The literature indicates that females tend to have more favorable attitudes toward PWMI than did males. Ratcliff et al. (2006) suggested that females may have high levels of non-prejudicial internal motivation than men, and that non-prejudicial internal motivation may at least partially mediate (reduce) the impact of gender on attitudes toward mental illness.

Pruett and Chan (2006) developed an implicit measure of attitudes namely the Disability Attitude Implicit Association Test (DA-IAT). The researchers validated the DA-IAT with 223 students in rehabilitation counseling services. Hierarchical regression analyses were used to examine relationships between demographics and scores of the Attitudes towards Disabled Persons Scale (an explicit measure of attitudes developed by Yuker and Block in 1986) and DA-IAT. The researchers found that, among five independent variables: (1) social desirability response bias, (2) fear of death, (3) internal motivation to respond without prejudice, (4) external motivation to respond without prejudice, and (5) contact with persons with disabilities, the external motivation variable was the best predictor for Attitudes Towards Disabled Persons Scale--the explicit measure of disability-relevant attitudes. However, external motivation did not contribute to the prediction of the implicit measure of attitudes toward people with disabilities: the DA-IAT. The internal motivation variable was not related to either the explicit or implicit measures of attitudes toward people with disabilities.

Kurita and Kusumi (2009) conducted a study to examine the impact of internal and external motivation to respond without prejudice on implicit (not overtly expressed) and explicit (express externally) attitudes toward people with disabilities among 140 Japanese undergraduate students. A 2 (high IMS vs. low IMS) x 2 (high EMS vs. low EMS) analysis of variance was conducted. The researchers found that participants with high internal motivation to respond without prejudice had lower level of implicit prejudice toward people with disabilities than did participants with low internal motivation to respond. Conversely, participants with high external motivation had higher level of implicit prejudice than did participants with low external motivation. Based on the results of the study, Kurita and Kusumi (2009) suggested that "internal motivation to overcome prejudice might result in responding without prejudice" but "regulations by external motivation might only hid prejudices, not overcome prejudice."

In Kurita and Kusumi's (2009) study of Japanese undergraduate students, the Filtering Unconsciousness Matching of Implicit Emotions test was used as the measure of implicit attitudes. In Pruett and Chan's (2006) investigation, the DA-IAT was used to assess implicit attitudes and the participants were U.S undergraduates. The differences in research samples and instruments might be partially responsible for the inconsistent findings between the aforementioned two studies. Nevertheless, the lack of congruent findings in the literature merits further investigation as such investigations will provide more information on the relationship between internal and external motivations to respond without prejudice and attitudes toward people with disabilities. Moreover, previous researchers have called for further research on the mediating role of motivation (the extent that it accounts for the relationship between gender and attitudes) on gender differences in attitudes (Ratcliff et al., 2006). Such investigations will advance understanding of the role of gender and motivation in forming attitudes toward PWMI. Accordingly, the purpose of the present study was to empirically examine relationships among gender, motivation to respond without prejudice, and opinions about mental illness in university students. The authors hypothesized that (a) gender would predict authoritarian (viewing PWMI as a class of people inferior to normal individuals) and social restrictiveness (desire to restrict PWMI from society) opinions about mental illness (Figure 1, Path c), and (b) the relationship between gender and authoritarian and social restrictive opinions about mental illness would be at least partially mediated by internal motivation to respond without prejudice (Path c'). In other words, gender would influence motivation to respond without prejudice (Path a), which in turn would influence authoritarian and social restrictive opinions about mental illness (Path b).

Method

Participants

An Ex Post Facto Research design was applied. Three hundred and seventy students from four diversity education classes at a public university in the Southwest region of the U.S. participated in the study. Diversity education is a requirement for all undergraduate students attending the university. Of the participants, 59% were females and 41% were males. The age of the participants ranged from 18 to 32 years old with a mean of 22 (SD = 2.05). Caucasian students constituted 45% of the total participants; the remaining participants included 28% Asian Americans (the majority were Chinese, Japanese, Korean, Pilipino, and Vietnamese Americans), 21% Latino Americans (the majority were Mexican Americans), 5% African Americans, .7% multiple race Americans, and .3% Native Americans. Ethnic background of the participants reflected the racial diversity of the student population at the university. About 35% of the participants were seniors, 48% were juniors, 16% were sophomores, and 1% were freshmen. Twenty three percent of the participants were majoring in Business (e.g., accounting, finance, and economics), 45% in Liberal Arts (e.g., interior design, library science, and language), 16% in Human Services (e.g., pre-nursing, speech pathology, and social work); 11% in Science. Less than 5% had not decided a major.

Instruments

The Internal and External Motivation to Respond without Prejudice toward People with Disabilities Scale (IMS/EMS; Pruett & Chan, 2006). The IMS was originally developed to measure motivations of Caucasian Americans to respond without prejudice toward African Americans (Plant & Devine, 1998). Pruett and Chan (2006) modified the IMS/ EMS by substituting the words "people with disabilities" for "Black people." In the present study, the authors substituted the words "people with mental illness" for "Black people." The adapted measure contained two subscales: IMS and EMS. Each subscale consisted of 5 items measured on a 1 (strongly disagree) to 9 (strongly agree) Likert rating scale. The IMS measures individuals' beliefs and self-concepts that drive the person to behave in a non-prejudicial manner, with high scores indicating higher internal motivation to respond. An example item is "I am personally motivated by my beliefs to be non-prejudiced toward people with mental illness." The EMS measures individuals' non-prejudicial responses under social pressure. An example question is "I try to hide any negative thoughts about people with mental illness in order to avoid negative reactions from others." Pruett and Chan (2006) reported that the Cronbach's alpha reliability was .70 for the IMS and .84 for the EMS. In the present study, the alpha reliability was .76 for the IMS and .85 for the EMS, indicating that the scales were reliable with the research sample.

The Opinions about Mental Illness Scale (OMI, Cohen & Struening, 1962).The OMI was developed to identify opinions about mental illness. Although developed more than 40 years ago, the OMI is still being used as a measure of attitudes (Hampton & Zhu, 2011; Murray & Steffen, 1999; Wallach, 2004). The OMI contains 51 items, which are scored on a 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). As discussed earlier, there are five subscales in the OMI: Authoritarianism, Benevolence, Mental Hygiene Ideology, Social Restrictiveness, and Interpersonal Etiology. In the present study, only the Authoritarianism and Social Restrictiveness subscales were used as these scales had an acceptable reliability in previous studies with university students (Hampton & Zhu, 2011).

The Authoritarian Opinions about Mental Illness (AOMI) subscale measures perceptions of people with mental illness as a class of people inferior to normal individuals. An example question is "there is something about people with mental illness that makes it easy to tell them apart from normal people." High scores indicate an endorsement of the authoritarian opinions. The Social Restrictiveness subscale (SRS) measures the desire to restrict people with mental illness from society. An example question is "the best way to handle patients in mental hospitals is to keep them behind locked doors." Higher scores on the subscale indicate an endorsement of the ideas represented by the subscale. According to Cohen and Struening (1962), the alpha reliability was .80 for the AOMI and .76 for the SRS. In the present study, the alpha reliability was .73 for the AOMI and .72 for the SRS. These results indicated that the AOMI and the SRS were reliable instruments for measuring authoritarian and social restrictive opinions with the participants of the current study.

The Contact with Disabled Persons Scale (CDPS). The CDPS was developed by Yuker and Hurley (1987) to measure the amount of contact individuals have had with people with disabilities. In the present study, the authors substituted the words "people with mental illness" for "people with disabilities." The adapted measure contained 20 items that were rated on a 5-point Likert-type scale ranging from 1 (never) to 5 (very often). According to Yuker and Hurley (1987), the median split-half coefficients of the CDPS was .93 and the median Cronbach alpha coefficients of the CDPS was .92. In the present study, the Cronbach alpha coefficient of the CDPS was .91, indicating that the scale was reliable with the research sample. This instrument was included as a control variable since contact with people with mental illness was reported as one of the major factors affecting the public's attitudes toward people with mental illness (Corrigan, 2012; Corrigan & Miller, 2004).

A Demographic Information Sheet (DIS) was developed. The DIS included participants' age, gender, ethnicity, education level, and major in college.

Procedures

An approval from the Institutional Review Board of the university was obtained. The authors contacted instructors of several general education classes that included students from a variety of college majors. After obtaining approval from the instructors, a written informed consent and the research questionnaire were distributed at the beginning of the class. The purpose and confidentiality of the study were explained to students in the classes. Students were instructed that the study focused on perceptions of mental illness, such as chronic schizophrenia, depression, and anxiety, with a difficulty to cope in everyday life. Those who volunteered to participate completed the research instruments in class. It took a maximum 15 minutes to complete the questionnaire. A total of 379 questionnaires were distributed and 370 students completed the questionnaire. The return rate was 97%.

Results

Preliminary Analyses

Preliminary analyses examined gender differences in the mediator variables (internal motivation to respond without prejudice, external motivation to respond without prejudice), the outcome variables (authoritarian and social restrictive opinions), and the control variable (contact with PWMI). A one-way analysis of variance (ANOVA) was conducted. The means and standard deviations of the variables are presented in Table 1. As expected the differences in internal motivation, authoritarian and social restrictive opinions between male and female students were statistically significant. Females had less authoritarian [F (1, 364) = 21.53,p< .0001] and less social restrictive [F (1, 367) = 15.30, p < .0001] opinions about PWMI than did males. Females also had higher levels of internal motivation to respond without prejudice than did males [F (1, 368) = 24.60, p < .0001]. There were no significant gender differences in external motivation to respond without prejudice and contact with people with disabilities.

Testing Mediation

Statistical mediation is a hypothesized causal chain in which one variable affects a second variable that, in turn, affects a third variable. In the present study, a mediating model was used to identify the impact of internal and external motivation to respond (the mediators) on the relationship between gender (the predictor) and attitudes toward mental illness measured by two outcome variables-authoritarian and social restrictive opinions. The authors hypothesized that gender would influence motivation to respond, which in turn influences authoritarian and social restrictive opinions.

According to Baron and Kenny (1986), in order for the motivation variables to function as mediators, they must be associated with the predictor variable (gender) and the outcome variables (authoritarian and social restrictive opinions). Additionally, the predictor variable (gender) must be related to the outcome variables. Following Baron and Kenny (1986)'s suggestion, two steps were taken. First, the authors examined if there were relationships between the mediators (internal and external motivation to respond), the predictor (gender), the outcome variables (authoritarian and social restrictive opinions) as well as the control variable (contact) using a correlation analysis method. Second, the authors explored if motivations to respond mediate the relationship between gender and authoritarian/social restrictive opinions using a multiple regression method and a test of partial mediation suggested by Kenny, Kashy, and Bolger (1998).

Correlation analyses. Zero-order correlations for all variables were conducted to examine relationships among gender, internal motivation to response, external motivation to response, contact with people with disabilities, authoritarian and social restrictive opinions. Because gender is a categorical variable, a dummy coding method was used to code the gender variable. Female was coded "0" and male was coded "1" in the correlation and regression analyses. Results revealed that (a) gender was significantly correlated with internal motivation (-.250), authoritarian opinions (.389), and social restrictive opinions (.390) at the .01 level; (b) gender was not related to external motivation and contact with people with disabilities; (c) internal motivation was significantly correlated with authoritarian opinions (.505), and social restrictive opinions (.504) at the .01 level. Thus, only internal motivation to respond met the above-mentioned mediation criteria by Baron and Kenny (1986). This variable (internal motivation to respond without prejudice) was used in the subsequent mediation tests. External motivation to respond and contact with persons with disabilities failed to meet the criteria and were excluded from the subsequent analyses.

Multiple regression analyses. Two sets of hierarchical multiple regression analyses with authoritarian and social restrictive opinions as the respective criterion variable were performed. In the first set of multiple regression analysis, authoritarian opinions were used as the criterion variable. Gender of participants was entered in the first block (0 = female, 1 = male), and internal motivation to respond scores (mediator) were entered in the second block. Internal motivation was entered after gender so that the mediating role (influence) of internal motivation to respond on the relationship between gender and authoritarian opinions about PWMI could be examined. If the relationship between gender and authoritarian opinions is no longer statistically significant after including the internal motivation variable in the regression equation, this means that internal motivation fully mediates the influence of gender on authoritarian opinions. If the relationship between gender and authoritarian opinions remains statistically significant but is significantly reduced after inclusion of internal motivation in the regression equation, this indicates a partial mediation.

Results showed that on the first step of the regression analysis, gender was a reliable predictor of authoritarian opinions, t = 4.68, p < .001. When internal motivation variable was entered on the 2nd step, gender remained significant, t = 3.35, p < .01, and internal motivation accounted for additional variance (influence), t = -4.11, p < .001. Although entering internal motivation into the second block did not completely reduce the variance (influence) accounted for by gender in authoritarian scores, the un-standardized coefficients did reveal a drop from 16.64 to 12.19. To assess whether this change was statistically significant, a test of partial mediation (Kenny, Kashy, & Bolger, 1998) was conducted. As depicted in Figure 2, the paths from gender of participants to authoritarian opinions (Path c), gender of participants to internal motivation scores (Path a), and internal motivation scores to authoritarian opinions (Path b) were all significant (allps < .001). Extracting the variance associated with internal motivation produced a significant reduction (from .37 to .27) in the beta weight of the direct path between gender of the respondents and authoritarian opinions (Z = 4.92, p < .05), thereby providing evidence for partial mediation.

In the second set of multiple regression analysis, social restrictive opinions were used as the criterion variable. Gender of participants was entered in the first block (0 = woman, 1 = man), and internal motivation scores (mediator) were entered in the second block. Results showed that on the first step of the regression analysis, gender was a reliable predictor of social restrictive opinions, t = 3.86, p < .001. When internal motivation variable was entered on the second step, gender remained significant, t = 2.16, p < .01, and internal motivation accounted for additional variance (influence), t = - 4.41, p < .0001. Although entering internal motivation into the 2nd block did not completely reduce the variance (influence) accounted for by gender in social restrictive scores, the un-standardized coefficients did reveal a drop from 14.39 to 9.93. Extracting the variance (influence) associated with internal motivation produced a significant reduction (from .38 to .28) in the beta weight of the direct path between gender of the respondents and social restrictive opinions (Z = 4.97, p < .05), thereby providing evidence for partial mediation (see Figure 3).

Discussion

The purpose of this study was to examine the mediating role of motivation to respond without prejudice in gender differences in attitudes toward mental illness. As hypothesized, the results indicated that (a) gender alone predicted attitudes toward mental illness as female university students had less negative opinions about mental illness than did male students, and (b) the influence of gender on authoritarian and social restrictiveness opinions about mental illness was partially mediated by internal motivation to respond without prejudice.

These findings extend the attitude literature by identifying the mechanism (the mediating role of internal motivation to respond without prejudice) that underlies the relationship between gender and attitudes toward mental illness. In other words, internal motivation to respond without prejudice as a mediator accounted for the relationship between gender (the predictor) and attitudes toward people with mental illness (the outcome variables). Female students in the present study appeared to possess higher levels of internalized and personally important non-prejudiced standards than did males. The internalized non-prejudice standards might develop from a sense of personal moral obligation rather than societal pressure (Monteith & Walters, 1998). Because female participants had higher levels of internalized and personally important non-prejudiced standards, they were less likely to have, and thus act upon, prejudiced responses that were inconsistent with their personal moral standards. Conversely, female participants in the present study did not have higher levels of external motivation to respond without prejudice compared to their male counterparts. The finding implies that societal pressures did not make a difference between female and male participants regarding external motivation to respond without prejudice toward mental illness. It also shows that external motivation to respond did not play a role in mediating the relationship between gender and attitudes toward mental illness. These findings suggest that future studies may focus on the relationship between internal motivation to respond without prejudice and attitudes toward people with mental illness.

It is interesting to note that regardless of gender of the respondents, participants with high levels of external motivation to respond tended to have more negative opinions about mental illness. The finding implies that societal pressure alone may not induce positive attitudes toward mental illness. Rather, the pressure may result in negative responses. However, this assumption needs to be further explored as the participants of the present study only included students in one university.

The findings on the role of contact in attitudes toward mental illness were somehow inconsistent. Participants who had more contact with people with mental illness had less social restrictive views about people with mental illness than those who had less contact. The finding was congruent with previous studies that also found the important role of contact in developing positive attitudes toward people with disabilities (Corrigan, 2012; Pruett & Chan, 2006; Yuker & Hurley, 1987). Conversely, contact with people with mental illness was unrelated to authoritarian opinions about mental illness. This implies that increasing contact with people with mental illness might reduce social restrictive type of opinions about mental illness, but it may not influence authoritarian type of opinions about mental illness.

Implications for Future Research

The present study has further research implications. First, future studies may extend the exploration of the mediating role of internal motivation to respond without prejudice in gender differences in attitudes to other disability populations such as people with intellectual and physical disabilities. Second, some previous research on gender roles revealed that feminine self-concepts tended to embody communal behaviors such as warmth and compassion and masculine self-concepts tended to embody dominance-oriented behaviors that are not related to concern with the welfare of others (Bern, 1974; Ratcliff et al., 2006). It is possible that individuals' internal motivation to respond without prejudice may derive from endorsement of feminine self-concepts and that these self-concepts may serve as an antecedent to internal motivation to respond without prejudice (Ratcliff et al., 2006). From this perspective, future studies may explore factors such as gender roles that affect the development of internal motivation to respond without prejudice and develop interventions that foster the growth of internal motivation to respond without prejudice. Third, future research may further explore the relationship between external motivation to respond without prejudice and attitudes toward mental illness with larger samples that include participants from different backgrounds.

Implications for Rehabilitation Counseling

Findings of the present study have several implications for practice. First, although male participants in the present study tended to have lower levels of internal motivation to respond without prejudice and more negative responses about mental illness than did female participants, the authors do not mean to imply that males are somehow deficient in comparison. Instead, the authors suggest that socially learned gender-role beliefs may contribute to male participants' lower levels of internal motivation to respond without prejudice and higher levels of negative responses about mental illness. From this perspective, rehabilitation counselors may develop interventions that focus on challenging the traditional gender role belief systems that may help both males and females to endorse self-concepts that embody communal behaviors such as warmth and compassion for others as part of themselves. This could be done by advocating gender equity and social justice for all and by teaching and modeling egalitarianism upon which internal motivation is based (Kurita & Kusumi, 2009). The endorsement of such self-concepts may result in high levels of internally motivated non-prejudice toward people with mental illness.

Second, results of the present study indicated that high levels of contact with people with mental illness were related to less social restrictiveness opinions about mental illness. Rehabilitation counselors may develop outreach activities that focus on increasing the public's contact with people with mental illness. For example, rehabilitation counselors may share successful stories of people with mental health disabilities with local mass media and encourage people to be involved in local community activities. One of these activities is NAMI (the National Alliance on Mental Illness) walks that involves families and friends of people with mental health disabilities walking together to advocate for people with mental health disabilities (Corrigan & Rao, 2012). Another is "Mad Pride" organized by the users of mental health services and their allies. "Mad Pride" promotes the civil liberties, social status, and creative talents of people with mentally ill. Rehabilitation counselors may continuously invite successful clients to attend psycho-educational workshops to share their experiences (Corrigan & Rao, 2012).

Third, people with chronic mental illness constitute a large percentage of the clients served by the federal-state rehabilitation system and private psychiatric rehabilitation agencies (Bemacchio et al., 2009; Boutin & Accordino, 2009; Cimera, 2009; Williams, Dutta, Kundu, & Welch, 2008). Rehabilitation counselors working in these systems need to be aware of the attitudinal barriers these clients may face when interacting with others. Counselors may work with clients with psychiatric disabilities to develop self-advocacy skills that facilitate the understanding of mental illness among people they encounter such as college students/coworkers. These skills can be developed through modeling, role-playing, and education in the context of university campuses and other natural settings.

Finally, rehabilitation counselors are instrumental in assisting clients with psychiatric disabilities to obtain vocational rehabilitation services, yet they do not live in a vacuum (Garske & Thomas, 1990). Their own socialization process could have an impact on their opinions about PWMI. When working with clients with chronic mental illness, rehabilitation counselors may need to pay more attention to their own socially-learned gender-role beliefs, internal egalitarian standards and the extent to which these self-views motivate and subsequently enable them to control prejudiced responses and prevent their potential bias from affecting service delivery.

Limitations

Several limitations to the present study are acknowledged. First, participants were from one university. The representativeness of the sample was limited, given the mean age, educational level, and the geographic location of the sample. Because all participants were university students, findings of the present study cannot be generalized to the general public or professional rehabilitation counselors. Second, the present study used a direct measure of attitudes toward PWMI. Several researchers pointed out that a direct measure of attitudes has a number of disadvantages including attempting to give a good impression of oneself as open-minded (Antonak & Livneh, 2000; Wang, Thomas, Chan, & Cheing, 2003). Hence, social desirability might have affected individuals' responses to the instruments and the results of this study must be interpreted with caution. Finally, the attitude instruments were developed in the 1960s when the recovery model of PWMI didn't exist. The instruments do not include questions on recovery of PWMI or rehabilitation potential for improvement of PWMI. The lack of such questions may affect the generalizability of the results.

Conclusions

The present investigation made an effort to understand the role of motivation to respond without prejudice in mediating gender differences in attitudes toward mental illness. To the authors' best knowledge, the present study was the first investigation that focused on the mediating role of internal motivation to respond without prejudice in gender differences in attitudes toward PWMI. Results of the study revealed that internal motivation to respond without prejudice partially mediated the influence of gender on attitudes toward mental illness. The findings help clarify the relationships between gender, internal motivation to respond without prejudice and attitudes and helped bridge the gap in the current understanding of why there existed gender differences in attitudes toward PWMI. More investigations are needed to further examine the relationships between gender, internal motivation, and attitudes toward mental illness.

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Nan Zhang Hampton

San Diego State University

Seneca Sharp

University of Wisconsin at Madison

Dr. Nan Zhang Hampton, Department of Administration, Rehabilitation, and Postsecondary Education, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182.

Email: nhampton@mail.sdsu.edu
Table 1

Correlations between Gender, Motivation, Contact, Authoritarian
and Social Restrictiveness (N = 370)

Variables          Gender      IMS        EMS

Gender ^            --      -.250 **    -.011
IMS                            --        .051.
EMS                                       --
Contact
AOMI
SRS
Female (n = 220)
  M                           39.94      26.47
  SD                           6.21      11.06
Male (n = 150)
  M                           35.50      26.05
  SD                           7.72      10.61

Variables          Contact     AOMI       SRS

Gender ^            -.060      .389 **    .390 **
IMS                  .071     -.505 **   -.504 **
EMS                 -.112 *    .151 **    .112 *
Contact               --      -.043       .101 **
AOMI                            --        .667 **
SRS                                        --
Female (n = 220)
  M                 31.55     17.48      13.61
  SD                 7.94      6.10       5.49
Male (n = 150)
  M                 30.70     20.81      15.93
  SD                 7.03      7.57       5.70

Note: IMS = internal motivation score; EMS = external
motivation score; AOMI = authoritarian

Opinion score; and SRS = social restrictiveness score;
M = mean; SD = standard deviation.

* p < .05, ** p < .01
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Publication:The Journal of Rehabilitation
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Date:Jul 1, 2014
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