Chile Media Papers
Chile Media Papers
Chile Media Papers
Chilean Press
Introduction
People with a mental disorder (MD) diagnosis are stigmatised (Henderson et al., 2014;
Holder et al., 2019). Stigma is a labelling process based on negative stereotypes and
prejudices that lead to discrimination against people who present an attribute evaluated as
negative by their community (Link & Phelan, 2001). Stigma has important consequences
(Corrigan, 2016), finding a job and having a home; it decreases their self-esteem and
empowerment (Yanos et al., 2020); it is a barrier to accessing health services (Fox et al.,
2018); and it impacts on morbidity and mortality rates (Lawrence & Kisely, 2010). In brief,
stigma is a serious threat to full and active citizenship and wider social inclusion (Stuart,
2006).
One of the ways in which structural stigma occurs is through the media (Corrigan et al.,
2005). These have a great influence on public attitudes towards people with MD (Babić
et al., 2017; Pratiwi et al., 2018). Various studies show how the way in which information
about people with MD is delivered encourages positive attitudes or, on the contrary,
contributes to the formation of prejudices (Alyousef et al., 2019; Corrigan et al., 2013; Ross
et al., 2019). The media often present distorted and negative images of MDs, associating
them with aggressiveness, lack of control, and criminality; people with MD are seen as a
danger to others and to themselves (Aci et al., 2020; Bowen et al., 2019; Klin & Lemish,
2008; Nawková et al., 2012; Subramanian, 2018). Further research indicates that these lead
to public perceptions that people with MD are violent and characterized by outbursts of
anger, childlike behaviours and severe symptoms (Quintero Johnson & Riles, 2016;
Reavley et al., 2016). This media coverage models the public's reactions towards people
with MD, generating fear, rejection and, in general, the feeling that they are a threat to the
societal order, which maintains and feeds back into the stigma circle (Ma, 2017; Murphy
The media present a negative image of different diagnoses (Bowen, 2016; Koike et al.,
2016; MacLean et al., 2015); however, some such as schizophrenia generate greater
prejudices (Guarniero et al., 2017; Reavley et al., 2016). Differences have also been found
by sex and age group, the news about adult men with MD is usually more negative, than
those of children and women (Slopen et al., 2007; Whitley et al., 2015). Moreover, it has
been found that not only the image of people with psychiatric diagnoses is distorted but
also other aspects such as the causes of the disorders and their treatments (Klin & Lemish,
2008; Subramanian, 2018). Finally, another way to perpetuate stigma is to not include the
perspective of those affected in the press. This generates the vision, on the one hand, that
they are unable to express their point of view and, on the other one, that the professionals
are the only experts in what happens to them (Guarniero et al., 2017; Ohlsson, 2018;
Subramanian, 2018).
Over the last decade, different interventions have been developed and implemented to
reduce the stigmatisation exercised by the press (Maiorano et al., 2017), meaning that
research that carries out a longitudinal evaluation of the occurrence of stigma should show
some modification of the negative image broadcast by the media. However, the results are
contradictory. Some studies show that the way in which mental health issues and mental
disorders are treated has improved (Economou et al., 2015; Hildersley et al., 2020; Whitley
& Wang, 2017); others indicate that information that encourages prejudices and stereotypes
is maintained (McGinty et al., 2016; Murphy et al., 2013); and, finally, it has also been
found that stereotypes linked to dangerousness have decreased, but others associated with
disability have increased (Rhydderch et al., 2016). Given that the above-described studies
were conducted in a variety of locales, the lack of consistency in the findings indicate the
importance of local context and the delivery of interventions tailored to the local setting.
Research evaluating the occurrence of stigma towards MD in the media has been carried
out mainly in English-speaking countries. In the two most recent systematic reviews on the
subject, no study in Spanish is found (Ma, 2017; Ross et al., 2019), despite being one of the
Over the last decade, only two studies on the subject have been published in Spain and two
in Latin America. One Spanish study by Aragonès et al. (2014) found high levels of
stigmatisation in the press while another, in the research by Cano-Orón et al. (2020), 26%
of the studied media refers to MDs negatively and 18% metaphorically, which can also
contribute to stigmatisation. Regarding Latin America, it was found that in Brazil the press
reinforces the relationship between schizophrenia and violence, and rarely includes the
opinion of those affected by this diagnosis (Guarniero et al., 2017). In Colombia, research
that aimed to determine the relevance given to mental health and the quality of the
information provided by journalists found that they inadequately address mental health
of mental disorders and which consider different variables such as age group, the chances
of recovery of those affected, and the causes, among others, but the aforementioned studies
from Brazil and Colombia suggest that there may be high-levels of stigmatization in the
Considering the relevance that the media have in shaping the population's attitudes towards
mental disorders, the consequences of stigma for those affected, the scarce information on
how the media stigmatise in Latin American countries, and the possible differences with
information would also allow generating a baseline that will facilitate the evaluation of
Given this situation, the primary objective of this study was to assess the tone and content
of Chilean newspaper articles about mental disorder from 2000 to 2019. A secondary
Method
Design
Standard procedures for the analysis of news content in the media (Krippendorff, 2004;
Riffe et al., 2019) were followed, which involved systematically collecting the news and
administering a standardised codebook adapted from the previous work of other authors
described in detail elsewhere (Whitley & Berry, 2013a, 2013b; Whitley & Wang, 2017).
The digital editions of four national circulation Chilean newspapers in Spanish were
search engine Google News was used to identify and retrieve the news. The time range
defined for the search was from January 1, 2000 to December 31, 2019. The news items
that included any of the following keywords in the title, subtitle and/or body of the
disorder). The words Alzheimer, drug addiction, and dementia were excluded, as well as
news related to opinion columns, letters to the editor, editorials, obituaries, advertisements,
book and movie reviews, classified advertisements, and metaphorical use of keywords (e.g.
schizophrenic music). In addition, news items that mentioned some of the key words in
passing were excluded, without constituting a main or secondary topic of the article.
Procedure
Taking into account the 12 selected keywords, a total of 1945 news items were retrieved,
1284 were duplicated and 276 were excluded according to the criteria already defined. The
Two researchers performed the coding process for which they received intensive training
and supervision from the first author of the study, as well as from another author (RW)
during their visit to Chile in August 2018. The researchers also received remote training
and advice from the latter author during the study execution. As part of the training, articles
on stigma were consulted in the media, the codebook used was discussed, and 30 news
items were coded as a pilot test to clarify doubts about the procedure. Likewise, supervision
An inter-rater reliability analysis was also carried out with the answers to the 10 key
questions (Table 1). For this purpose, the Krippendorf's alpha coefficient (De Swert, 2012;
Krippendorff, 1970). For the first 30 pilot-coded news items, an average value of 0.83 was
obtained, indicating a high level of agreement. With news items that had values below 0.80,
discussion sessions were held with the first author of the study to clarify concepts and solve
discrepancies between the two coders and thus increase the level of agreement (De Swert,
2012). Krippendorf's alpha value for the total news items (n=385) was 0.96, reflecting a
In the coding procedure, each researcher independently read each news item and recorded
the code in a database created from the content of the codebook, supported by SPSS
software version 26.0 (IBM Corp., 2019) to facilitate the analysis. Table 1 shows the
codebook used.
Table 1. Codebook
Analysis
After encoding the news, a descriptive analysis was performed from the calculation of the
frequencies and percentages for each of the variables in the codebook. Because the study is
longitudinal in type, a trend analysis was also performed using the technique called moving
average, appropriate for measurements that are performed repeatedly over time (Streiner,
1997). Firstly, the values of each answer option were counted for each month for each key
optimistic/positive overall tone on mental health, whether the story stigmatised in tone
and/or content, and whether recovery/rehabilitation was a significant topic in the news.
Later the averages of four consecutive periods were calculated to obtain the moving
averages throughout time. Finally, the values of each period were plotted in the range of 19
years considered in the study in order to identify whether there were positive changes in the
Results
A total of 385 news items published during the period 2000-2019 was analysed in four
Chilean newspapers in digital version. All the news items analysed were published in
Spanish, with a national scope, covering all the regions of the country.
A large proportion of the news items has an overall positive/optimistic tone (43.5%) 57.5%
does not stigmatise; however, only 18.4% emphasises recovery as part of the content. As
for public stigma, in the majority of the news items no link was found between mental
the scarcity of resources or poor quality of care, which are aspects of structural stigma, are
Table 2
25.7%). A significant share of news items did not record any diagnostic category, making a
general reference to mental health (n=58; 15.1%). Subsequently, the affirmative coding of
the key questions in each type of disorder was analyzed (Figure 1).
Figure 1
stigma
Figure 1 highlights that the most positive tone in the news items is found in anxiety
disorders (66.7%) and schizophrenia has the lowest percentage (34.6%), along with
unspecified mental disorders (29.3%). The same difference is observed with respect to
percentages of news stigmatising in tone and content are observed for bipolar disorder
(27.7%) and schizophrenia (30.8%). Finally, schizophrenia appears to be the most linked to
danger, violence and/or criminality (28.8%); while depression is most associated with
Regarding the opinion of experts, people with a psychiatric diagnosis, their families or
friends, a predominance of positive over negative quotes, both direct and indirect, was
found in all categories. However, the aforementioned experts are quoted much more
frequently than people diagnosed with mental disorders or their families and/or friends.
Table 3
Distribution of frequencies and percentages for key players quotes in the news
Considering only the news items containing positive and negative quotes, the proportion
between these varies by player. While, in relation to experts, for every ten positively cited
news items there is one cited negatively; in people diagnosed with mental disorder, the
difference is narrower, with three news items cited negatively for every four news items
(...) The doctors, seeing that her disorders were "incurable", considered that the woman was
"totally competent", and that depression and her other disorders "did not affect" her mental
faculties, so they requested euthanasia, which in Holland is legal since 2002 (El Mercurio,
10/05/2016).
As explained by its director, Mariane Krause, "our purpose is to extend the effectiveness of
interventions by identifying various agents, whether social, cultural, genetic, among others
Mostrador, 10/11/2015).
Mental health interventions are not discussed in the majority of the news items (n=238;
61.8%). Within the news items that do consider them, 97.5% (n=118) did so positively and
The majority of the news items do not refer to the etiology of the disorder or its treatment
(n=257; 68.7%). However, among those that do, the presence of a mixed approach (n=62;
16.2%) predominates over the biological and psychosocial approaches (7.1% and 7.7%
respectively).
As for the motive for the news, it was observed that most items correspond to popular
scientific dissemination articles (n=289; 75.2%), while the rest correspond to situations
relative to individuals diagnosed with some mental health disorder (n=75; 24.8%).
The majority of the news items analysed do not specify any age group, (n=222; 57.7%), but
among those that do, those centred on adults predominate (n=68; 17.8%), followed by
young adults (n=52; 13.4%), girls, boys or adolescents (n=31; 8.1%), and older adults
(n=12; 3.1%).
(Figure 2), the difference regarding the positive or optimistic vision of mental health among
children and adolescents (54.8%) stands out compared to older adults (16.7%). In the last
group, in addition, the highest percentages occur for the stigmatisation of the story in tone
and content (25%), the variables scarcity of resources or poor quality of care (20.8%), and
the link with the danger, violence or criminality (25%). Regarding recovery and/or
rehabilitation as a significant issue, the group of young adults shows the highest percentage
(39.8%), followed by adults (29.9%), the lowest being observed in the news about children
Distribution of percentages according to age group and variables associated with stigma
As for the description of the protagonists of the story regarding their sex, it was observed
that the majority of the news items analysed does not specify it (n=173; 44.8%). Among
those who do specify it, there is an emphasis on news centred on women (n=112; 29.2%) or
2006 to 2010, 2011 to 2015 and 2016 to 2019. These results show a trend towards general
health, which is supported by the reduction of news items that are neither classified as
positive nor optimistic (Figure 3). Stigmatisation in news tends to decrease, in general. This
is seen both between the first and second five-year periods, and between the fourth and
fifth. Similarly, the percentage of news stories whose stories are not stigmatising has risen
Figure 3
Finally, reference to recovery and/or rehabilitation as a significant topic in news items rises
by almost ten percentage points, while news items that do not include these topics decrease
Discussion
This is one of the few studies examining newspaper coverage of mental disorder in a Latin
American country.
It emphasises that, broadly speaking, the majority of the news items were positive and
consequently only a lower percentage stigmatises people with psychiatric diagnoses and
links them to violence and danger. In addition, a sustained decrease in stigmatisation over
the past two decades was found. The positive tone of the news increases, the association
with violence and danger decreases, and reference to rehabilitation and recovery increases.
These results differ from those found in other low- and middle-income countries, where
there are higher levels of stigma in the press (Aci et al., 2020; Guarniero et al., 2017;
Nawkova et al., 2012). Indeed, the decrease in stigmatization in the news in recent decades
is consistent with what has been found in other research in Anglophone countries where
anti-stigma interventions have been carried out in the mass media. In the study by Whitley
and Wang, over a period of 11 years, the positive tone in the news, the opinion of those
affected and experts, references to scarce resources and interventions increased (Whitley &
Wang, 2017). Similar results were found in the UK, where there was a significant increase
in anti-stigma news in the press over the last 12 years (Y. Li et al., 2021); the allusion to
recovery and successful treatment increased, and those with stigmatizing content were
reduced, specifically seeing people with mental disorders as dangerous, victims and with
In Chile, there have been no mass campaigns for the reduction of stigma or interventions
towards the mass media, and the press media only have very general protocols of action
based on the law on freedom of opinion and information (Law 19733, 2001); however,
stigma has diminished. Despite these positive results, there was also little reference to
rehabilitation and recovery of mental disorders and the scarcity of resources or the quality
of care in the health system. In addition, it is the experts who appear as the main voices on
the subject, the vision of users and family members being relegated to the background.
These aspects suggest that, although manifest stigma has decreased, as shown by other
research (Cano-Orón et al., 2020; Ma, 2017), there still remain subtler aspects of
Respect for human rights and, in this case in particular, the rights of those of people with
(Organización Mundial de la Salud [OMS], 2006) and in Chile (Ministerio de Salud del
Gobierno de Chile [MINSAL], 2017). Stigma transgresses these rights and creates multiple
negative consequences and is therefore the subject of attention. In this context, there would
towards people with MD. Stigma has transformed and become more subtle; the idea that
people with mental disorders need others to speak for them and have difficulties recovering
still is passed on. In addition, health system deficits to meet the mental health needs of the
population, which in the case of Chile are significant (MINSAL, 2014), are rendered
invisible. If so, it would be necessary to include ways of evaluating stigma that look for
these and other aspects. Reavley et al. (2016), found that the association of MDs with
danger had decreased, but that their association with disability had increased, i.e.
In this study, news items about depression and anxiety, which are less stigmatised
diagnostic categories, were almost twice as many (39.7%) as those relative to more
stigmatised ones such as schizophrenia and bipolar disorder (19.8%), which is consistent
with other studies and could also help explain the low stigmatization found (Y. Li et al.,
2021).
Though in general, stigmatisation was low, 30.8% of news items about schizophrenia
stigmatises and 28.8% associates it with violence, which is in line with what is found in
other research showing schizophrenia as one of the most stigmatised disorders (Bowen
It stands out that when experts are cited, it is done in a fundamentally positive way (10/1),
while when commenting on specific people with diagnoses, there is a much higher
proportion of negative news items (4/3). It seems that when mental health issues are raised
in an abstract way, the character of the news is more positive than when done in a concrete
and therefore personalised way. It would be desirable for interventions aimed at changing
press coverage of mental disorders and mental health to consider how news is addressed in
Moreover, the majority of the news items did not provide information on causes and forms
of mental health intervention, even though they were primarily classified as scientific
improved in Chile's press. Information allows to educate the population and thus reduce
Older adults were the most stigmatised age group. Socially, there is a negative view of
aging (C. Li et al., 2020; Scazufca et al., 2016), to which suffering from a mental disorder
is added, which shows the intersectionality of stigma. Different identities subject to stigma
converge in a person or social group, affecting their well-being (Turan et al., 2019). Special
attention should be placed in the news on these groups, and in this particular case on the
elderly.
The highest percentage of news items was focused on women which is coincidental with
the fact that mood and anxiety disorders are diagnostic categories referred to and are most
This research has some limitations that are important to consider. Only press articles that
could be obtained through the Google News search engine were accessed, which leaves out
part of what was published during time range considered in this study. Having considered
newspapers from 2000 onwards, we may not have had access to articles that were only
Only four newspapers were accessed, although they are the most recognised in the country,
there is a significant number left out, especially the digital ones that have emerged in recent
years. Besides, we only considered the press, and excluded television and radio. Moeover,
we did not consider social networks such as Facebook or Instagram, which are currently a
Our results have some implications that need to be mentioned. Although stigmatization
towards mental disorders is generally low, there is still much room for improvement. It
would be important to educate journalists to increase the amount of news that considers the
recovery and rehabilitation of those affected, especially in disorders such as bipolar and
disorders, and in the case of schizophrenia, reduce its association with violence. Finally, it
is essential to consider the point of view of those affected and their families and reduce the
negative view of mental disorders in older adults. The next step would be to establish
simple guidelines and trainings for journalists that emphasize these aspects, which should
In general, low stigmatization towards of MDs was found in the news and this was reduced
steadily over time, even without large-scale interventions. Although there are aspects to
improve in some particular areas, suggesting that manifest stigma has diminished, but more
subtle forms still remain, the results show that the stereotype of low- and middle-income
countries having worse stigma than rich Anglophone countries is not always correct.
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