Abstract
Objective
Stigma is a significant barrier to engagement with psychosis services. This study explored whether trauma-informed mental health services are perceived as less stigmatizing and more effective than traditional biomedical services, and examined individual-level predictors of such perceptions.
Methods
A cross-sectional online survey was conducted with 1460 participants via Amazon Mechanical Turk. Respondents were randomly assigned to read one of two vignettes describing either a trauma-informed or traditional biomedical psychosis service. Attitudes toward the service were measured using service-related attitudinal questions grounded in the tripartite framework Olson and Zanna (Annu Rev Psychol. 1993;44:117–154) and informed by stakeholder perspectives. Multivariate Analysis of Variance (MANOVA) compared differences across service-model vignettes. Exploratory factor analysis identified two latent factors, perceived stigma and service effectiveness, which were used as regression outcomes to determine individual predictors. Four hierarchical regressions investigated predictors of mental health attitudes and knowledge, adverse childhood experiences (ACEs), and social desirability, and their impact on stigma and service effectiveness.
Results
Trauma-informed services were rated significantly less stigmatizing and more effective across all dimensions (P < .001, η2 = .02–.10). Perceived stigma was strongly associated with positive mental health attitudes, greater ACE exposure, and liberal political orientation. Notably, mental health knowledge was linked to higher stigma, suggesting that factual understanding alone may not reduce negative perceptions.
Conclusions
Trauma-informed services are perceived as less stigmatizing and more effective than traditional biomedical models. Findings highlight the influence of individual attitudes and experiences on stigma, supporting contact-based, context-aware public campaigns to improve perceptions of psychosis and promote compassionate, trauma-informed mental health care.
Stigma is a significant barrier to engagement with psychosis services. This study explored whether trauma-informed mental health services are perceived as less stigmatizing and more effective than traditional biomedical services, and examined individual-level predictors of such perceptions.
Methods
A cross-sectional online survey was conducted with 1460 participants via Amazon Mechanical Turk. Respondents were randomly assigned to read one of two vignettes describing either a trauma-informed or traditional biomedical psychosis service. Attitudes toward the service were measured using service-related attitudinal questions grounded in the tripartite framework Olson and Zanna (Annu Rev Psychol. 1993;44:117–154) and informed by stakeholder perspectives. Multivariate Analysis of Variance (MANOVA) compared differences across service-model vignettes. Exploratory factor analysis identified two latent factors, perceived stigma and service effectiveness, which were used as regression outcomes to determine individual predictors. Four hierarchical regressions investigated predictors of mental health attitudes and knowledge, adverse childhood experiences (ACEs), and social desirability, and their impact on stigma and service effectiveness.
Results
Trauma-informed services were rated significantly less stigmatizing and more effective across all dimensions (P < .001, η2 = .02–.10). Perceived stigma was strongly associated with positive mental health attitudes, greater ACE exposure, and liberal political orientation. Notably, mental health knowledge was linked to higher stigma, suggesting that factual understanding alone may not reduce negative perceptions.
Conclusions
Trauma-informed services are perceived as less stigmatizing and more effective than traditional biomedical models. Findings highlight the influence of individual attitudes and experiences on stigma, supporting contact-based, context-aware public campaigns to improve perceptions of psychosis and promote compassionate, trauma-informed mental health care.
| Original language | English |
|---|---|
| Article number | sgag014 |
| Number of pages | 11 |
| Journal | Schizophrenia Bulletin Open |
| Volume | 7 |
| Issue number | 1 |
| Early online date | 23 Apr 2026 |
| DOIs | |
| Publication status | Early online date - 23 Apr 2026 |
Bibliographical note
Publisher Copyright:© The Author(s) 2026. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 3 Good Health and Well-being
Keywords
- early psychosis
- trauma-informed
- psychosis
- mental health attitudes
- mental health services
- stigma
Fingerprint
Dive into the research topics of 'Comparing public attitudes to traditional biomedical versus trauma-informed approaches in psychosis services'. Together they form a unique fingerprint.Student theses
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Implementing trauma-informed approaches in psychosis services
Kearns, J. (Author), Mulholland, C. (Supervisor), Davidson, G. (Supervisor) & Shannon, C. (Supervisor), Dec 2026Student thesis: Doctoral Thesis › Doctor of Philosophy (Thesis with Publications)
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