The weighted and un-weighted demographic and socioeconomic characteristics of the participants can be found in previous publications [15
]. The overall and gender specific percentages of various stigmatizing attitudes towards depression are presented in Table . Overall, unpredictability emerged as the most prevalent stigmatizing view of depression, with 45.9% of participants reporting that they believed the person with depression in the case vignette to be unpredictable. This was followed by the refusal to vote for depressed individuals (39.5%), not wishing to employ individuals suffering from depression (22.1%), depressed individuals being dangerous (21.9%), that people with depression could "snap out of it" if they wanted (16.7%), and that they would not tell others of their depression (13.6%).
Percentages of various stigmatizing attitudes overall and by gender*
Men reported higher proportions of stigmatizing attitudes than women on all items, except in their views of the depressed person as dangerous. In some stigmatizing attitudes, such as whether or not John or Mary should be avoided, the difference between men and women was only 3.4%, while 18.2% more of men than women reported that they would not vote for a politician if they knew the person was depressed (48.4% versus 30.2%, χ2 (1) = 102.02, p < 0.001). Men were more than twice as likely as women to believe that individuals suffering from depression could "snap out of it" (23.4% to 10.3%, χ2 (1) = 90.48, p < 0.001) or should be avoided (4.8% to 1.4%, χ2 (1) = 29.08, p < 0.001). It is also worth noting that over half (57.8%) of male respondents reported that depressed individuals were unpredictable, compared to 42.2% of female participants (χ2 (1) = 15.63, p < 0.005).
Table contains age specific percentages of stigmatizing attitudes among the participants. As seen from the table, the trends were not consistent across items. When asked if depressed individuals could "snap out" of their illness, the percentages of stigmatizing attitude decreased with age (χ2 (3) = 28.17, p < 0.005). Conversely, when asked if they would not vote for a politician if they knew the person had depression, the percentages increased with age (χ2 (3) = 35.53, p < 0.001). With respect to whether depression was a real medical illness, those over 65 and under 24 years old were more likely to endorse that depression was not a real illness, compared to those aged 25-64 (15% & 12.1% vs. 7.0%. χ2 (3) = 26.75, p < 0.005).
Percentages of various stigmatizing attitudes by age*
The estimated percentages of stigmatizing attitudes by educational levels are in Table . Significant differences by educational levels were found in 5 of 9 stigma-related questions. Participants who were at the higher educational level were less likely to report that "X could snap out of it" (13.0% versus 22.8%, χ2 (2) = 37.15, p < 0.001), "a problem like X's is a sign of personal weakness" (6.8% versus 13.0%, χ2 (2) = 21.84, P < 0.005), "X's problem is not a real medical illness" (5.9% versus 13.5%, χ2 (2) = 47.25, p < 0.001), "People with a problem like X's are dangerous" (14.9% versus 27.8%, χ2 (2) = 48.45, p < 0.001) and "People with a problem like X's are unpredictable" (38.7% versus 53.0%, χ2 (2) = 40.23, p < 0.001). Educational levels were not related to other stigmatizing attitudes.
Percentages of various stigmatizing attitudes by educational levels*
Participants who were not born in Canada were more likely to report stigmatizing attitudes than those who were born in Canada on 5 out of 9 questions (see Table ). When compared to individuals born in Canada, individuals not born in Canada were more likely to endorse that individuals could "snap out" of their depression (29.6% vs. 15.1%, χ2 (1) = 50.12, p < 0.001); perceive depression as a sign of personal weakness (26.0% vs. 7.3%, χ2 (1) = 136.11, p < 0.001); or believe it best to avoid individuals with depression (9.0% vs. 2.3%, χ2(1) = 50.97, p < 0.001). Individuals born outside Canada were more likely to believe that depression was not a real medical illness (17.6% vs. 7.2%, χ2 (1) = 46.65, p < 0.001), or that they would not vote for a candidate they knew to be depressed (47.5% vs. 38.3%, χ2 (1) = 11.91, p < 0.005). The two groups were not significantly different in other stigmatizing attitudes (unpredictability, danger, employment, and notification of illness).
Percentages of various stigmatizing attitudes by immigration status*
Neither employment status (working or not working), nor whether participants lived in a rural or urban setting were found to have significant differences with respect to the stigmatizing attitudes in bivariate analysis. Results are available upon request.
We found that participants with an annual income of $80,000 or more were more likely to indicate they would not vote for an individual if they knew them to be depressed than those with an annual income below $30,000 (46.5% vs. 33.5%, χ2 (3) = 23.41, p < 0.005). Participants who were married or in a common-law relationship (41.3%) and those who were divorced, separated or widowed (43.8%) indicated that they would not vote for a candidate with depression (χ2 (2) = 16.87, p = 0.005). Only 33.1% of those who were single or never-married expressed a similar attitude. Marital status and income were not found to be correlated with other stigmatizing attitudes.
Among health professionals, 29.2% indicated that they would not vote for a politician if they knew they were depressed, compared to 40.5% of those who were not health professionals (χ2 (1) = 12.91, p < 0.005). Mental health professionals were less likely than non-mental health professionals to withhold their condition from others (2.9% versus 13.8%) (χ2 (1) = 5.76, p < 0.005).
In multivariate linear regression modeling (F = 28.69, p < 0.001), we found effect modifications between gender and case recognition (β = -1.17, standard error = 0.57, p = 0.04) and between gender and immigration status (β = 1.59, standard error = 0.74, p = 0.03). This indicated that, the relationship of gender on stigma scores was modified by case recognition, and by immigration status. Women participants who could recognize depression in the case vignette were more likely to have lower stigma scores, while women who were immigrants were likely to have higher stigma scores. As such, multivariate linear regression models were conducted in men and in women separately. The results of the multivariate linear regression modeling are in Table .
Results of multivariate linear regression modeling of stigma, overall and by gender
Gender specific regression modeling (F = 8.06, p < 0.001 in men, F = 13.63, p < 0.001 in women) showed that immigration status and income levels were positively associated with stigma in men; while educational levels, rural/urban residence and case recognition were negatively associated with stigma scores in men (Table ). In women, immigration status was positively associated with stigma; educational levels, being a health professional and case recognition were negatively associated with stigma. This indicated that, while male and female immigrants were more likely to have high stigma scores than non-immigrants, the effect was more pronounced in women. Men with a higher income were more likely to have high stigma scores. Individuals with a higher level of education were less likely to have high stigma scores. Females who were health professionals were less likely to have high stigma scores. Men who lived in an urban setting were less likely to have high stigma scores. For both men and women the ability to recognize depression was associated with lower stigma scores, and this effect was more pronounced in women than men.