“Broken souls” vs. “mad ax man” – The portrayal of depression and schizophrenia in the German media. A comparison between 2010 and 2020

“Broken souls” vs. “mad ax man” – The portrayal of depression and schizophrenia in the German media. 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A comparison between 2010 and 2020 Madeleine Sittner, Theresia Rechenberg, Sven Speerforck, Matthias Claus Angermeyer, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4125072/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Population studies show the stigma of depression to diminish, while the stigma of schizophrenia increases. To find out whether this widening gap is reflected in media portrayal of both disorders, this study compares the portrayal of depression and schizophrenia in German print media in 2010 vs. 2020. Methods We conducted a qualitative content analysis using a mixed deductive-inductive approach to establish a category system. In total, we analyzed 854 articles with the summative approach by Mayring. Results The study found a widening gap in the portrayal of schizophrenia and depression in German media between 2010 and 2020. Schizophrenia was depicted increasingly negative between 2010 and 2020, covering more negative stereotypes and focusing on its biological causes. Depression received increased attention and more neutral und professional coverage, with a greater emphasis on psychosocial causes and discussion of treatment options. Conclusion By showing a widening gap the study highlights how media may shape public views on mental illnesses and reflects public attitudes at the same time. It emphasizes the need for responsible reporting to combat stigma and promote understanding. Therefore, the authors recommend a balanced coverage that includes accurate professional information about all mental illnesses. media coverage stigma depression schizophrenia German print media comparison Figures Figure 1 Introduction There appears to be a widening gap in the stigmatization in the general public between depression and schizophrenia [ 1 ]. This has been shown for the desire for social distance, pro-social actions and emotional reactions as an ongoing trend over the past 30 years [ 2 ] and does not only occur in Germany, but has also been observed in the USA [ 3 ]. The widening gap has most recently become visible when comparing public attitudes towards continuum beliefs for the two disorders in 2011 and 2020 [ 1 ]. Schomerus et al. [ 1 ] found that more people subscribed to continuum beliefs for depression between 2011 and 2020, while support for continuum beliefs in schizophrenia declined. Furthermore, the study showed a decrease in the perceived “otherness” for depression, whereas it remained at a high level for schizophrenia. Continuum beliefs are associated with less stigmatizing attitudes [ 4 , 5 ], correlating with reduced fear and social distance, decreased perception of dangerousness and unpredictability, and stronger pro-social responses [ 4 ]. Moreover, according to Link & Phelan, the perception of “otherness” is the centerpiece in the stigma process [ 6 ]. It has been suggested that differences in media coverage could be one of the reasons for the widening gap in stigmatization [ 1 , 7 ]. Analyses of print media in the U.S. have already revealed an emphasis on portraying individuals with mental illnesses as dangerous, often utilizing stigmatizing language. [ 8 , 9 ]. In both US-American and English print media, "schizophrenic" was found to be often used as a metaphor rather than a term for illness [ 10 , 11 ]. A content analysis conducted in 2018 on three German newspapers similarly shed light on the divergence in the media coverage of depression and schizophrenia [ 7 ]. First of all, depression received the highest media coverage among all psychiatric disorders, considerably surpassing schizophrenia [ 7 ]. Second, there was a greater emphasis on medical information for depressive disorders, while schizophrenia was most often reported in relation to crime and criminality [ 7 ]. In the past, a correlation between print media coverage and attitudes was suspected, but so far, it has not been demonstrated in temporal conjunction with studies of public attitudes and to our knowledge, there has been no comparative study exclusively focusing on depression and schizophrenia in the German media. This paper aims to address this gap of knowledge. Therefore, we conducted a qualitative content analysis of all articles mentioning depression or schizophrenia in three nationwide German newspapers for the years 2010 and 2020. We aimed to examine the evolving differences in media coverage of depression and schizophrenia between 2010 and 2020. This involved assessing the overall connotation of articles, the share in reporting, professional contributions, article sections and the quantity and type of reported stereotypes, causes and treatment options. Given the results of the previous studies, we hypothesize that there will be a greater emphasis on depression in media coverage compared to schizophrenia. We expect a more qualitative and less stereotypical portrayal of depression, with greater focus on providing medical information and discussion of treatment options. Furthermore, we anticipate that this difference will intensify between 2010 and 2020. Methods Selection of articles We decided to analyze three newspapers that are considered influential in shaping public opinion, according to the criteria of Wilke [12]. These newspapers are BILD Zeitung , which had the highest daily sales in Germany in both 2010 and 2020 [13, 14], Süddeutsche Zeitung , which is particularly popular among journalists [12], and Spiegel , which was the most frequently cited newspaper overall in 2010 and 2020 [15, 16]. We received access to the archived material of the three newspapers via online archives. We included all regional issues, online articles and also extra issues like Bild am Sonntag, BILD Plus and BILD Sport. To filter suitable articles, we conducted a keyword search with the root words “depress” and “schizophr”. Unfortunately, in the case of the Spiegel archive, we couldn’t perform a search using root words, so we had to conduct separate searches for each keyword, namely “Depression”, “depressiv”, “Schizophrenie”, “schizophren”. To limit the number of articles, we narrowed the search period to the second quarter of 2010 and 2020. Our inclusion criteria were as follows: articles had to be in German, could be either printed or online, and search results could also include captions of pictures, headlines, announcements or advertisements. Additionally, we also accounted for articles where the terms “depress” or “schizophr” were used metaphorically, since we recognize that this figurative usage also shapes the readers’ understanding and view of the disorders. This way, a total number of 854 articles could be taken into account. Analyzing the articles In order to comprehensively analyze articles and extract valuable information, we employed two coding units. First, an Excel spreadsheet was created to capture details about the entire article, such as its overall connotation or the section in which it was published. Second, we had a closer look at the text passages within the articles. These text passages were selected based on their inclusion of the root words “depress” or “schizophr” or their relevance to the meaning of these keywords and were treated as coding units. To evaluate these coding units, we used a qualitative content analysis, which is a systematic, rule-based, data-reducing procedure [17]. Specifically, the summative approach defined by Mayring suited our project best. Initially, a text passage was paraphrased by removing irrelevant text components or repetitive phrases that did not contribute to the core content. Subsequently, the paraphrased statements were generalized to a defined level of abstraction, ensuring that the original meaning was preserved in the new statement. Finally, redundant statements were eliminated, and the generalized information could now be assigned to a category based on predefined coding guidelines [17]. To assist in this process, we utilized MaxQDA (version 22.2.0) as computer-assisted coding tool. Examples of our approach can be seen in Table 1. Table 1 : Examples of the summative approach in qualitative content analysis by Mayring text passage paraphrase generalization category "According to media reports, the single mother suffered from depression after her divorce." 1 After the divorce, the woman suffered from depression. Divorce can be a trigger for depression. causes - psychosocial stress factors The depressed man made a confession: he had stabbed the oldest of his three children. 2 The depressed man stabbed his child. People with depression may become violent. stereotypes – dangerousness "However, the trial is solely about whether the defendant, who suffers from schizophrenia, needs to be detained in a psychiatric hospital on a long-term basis." 3 The defendant, who suffers from schizophrenia, may be detained in a psychiatric hospital on a long-term basis. People with schizophrenia may be detained in psychiatric care. therapy – detention Creating a category system To establish our category system, we used a mixed deductive-inductive approach. The deductive aspect drew upon previous research studies that had analyzed print media. Consequently, main categories were formulated, encompassing aspects that apply to both schizophrenia and depression in a comparable manner (e.g. “treatment” or “causes”). After reviewing 10% of the articles, these main categories were extended and supplemented with subcategories. While making sure the main categories stayed the same for schizophrenia and depression, subcategories could vary between the disorders, thereby indicating distinctions in news coverage for each disorder. Operationalization of the research questions Based on previous media analyses of the portrayal of mental illness in print media [18–23], we used the following operationalization: The overall connotation of the article: After an initial reading of each article, we determined whether the connotation appeared appreciative, neutral or pejorative. For instance, if “depression” was depicted within the context of crime or racism or if “schizophrenic” was used metaphorically to describe something contradictory or demonic, it would be categorized as having a “pejorative connotation”. To assess the overall impression conveyed to readers, we also identified appreciative or pejorative text passages. We also took into account implicit evaluations, such as the use of terms like “psycho-clinic” instead of “psychiatry” or “psycho-prison” instead of forensic psychiatry. The share in reporting for each disorder: To measure the interest the media shows for both diseases, we compared the total number of articles about one disorder. Furthermore, we evaluated how many times the root words “depress” and “schizophr” appeared within one article (single or multiple references). We noted whether depression and schizophrenia were the main topics of the article, side topics, marginal notes or used metaphorically. Drawing from the approach of Hoffmann-Richter and other researchers [18–20], we designated articles as “main topic” when the focus was on one of the disorders, and as “side topic” when the focus was on another subject, but “schizophr” or “depress” were used to explain or influence a significant part of the article. When the root words were mentioned without significantly altering the article, we categorized it as a “marginal note”. Finally, metaphorical usage was considered as a transfer of meaning detached from the actual concept of the disorder. The number of times professionals get to speak in an article: This category is intended to provide an indication of the professionally accurate portrayal of disorders in the media. The term “professionals” refers to psychiatrists, psychologists, psychotherapists, alternative practitioners for psychotherapy, or researchers in psychiatry-related areas. Non-specialist occupations and non-psychiatric researchers were categorized as “others”. The section an article is published in: By evaluating the sections in which articles are published, we determined how the media portrays disorders, whether it leans towards a scientific, political or cultural perspective, and how often those affected had an opportunity to voice their views. We assigned our own names for the sections, as the wording varied among the newspapers. The section “Medicine & Health” included articles with specialized medical information, excluding the latest research findings, which were categorized under “science, technology & research”. “Reports from affected people” presented direct quotes from individuals, while journalistic discussions of affected individuals in the third person were categorized under “individual life stories”. The number and type of stereotypes the disorders are linked to : Link & Phelan [4] defined stereotypes as crucial in the process of stigmatization. We decided to analyze our articles based on the stereotypes initially defined by Hayward & Bright [23] and subsequently used in other studies [21, 22] to be able to compare our results. We examined possible stereotypical portrayals in both coding units: text passages and whole articles. Coding units were labeled as “dangerousness” when an affected person was portrayed as a threat to others, “unpredictability” when a general inability to control oneself was implied, “personal negligence” when a (partial) self-inflicted guilt of the affected person was suggested, and “incurability” when depression or schizophrenia were presented as chronic disorders without effective cures. The only positive stereotype, “creativity and brilliancy”, referred to cases where affected individuals were depicted as exceptionally creative or ingenious. The number and type of reported causes of the disorders: To capture the reported causes of the disorders, we built upon categories previously defined by other researchers [19, 24]. These included “biological factors” (e.g., heredity or neurotransmitter imbalances), “influences from socialization” (e.g., violence in childhood, parental conflicts), “psychosocial stress factors” (e.g., performance pressure, social isolation), “intrapsychic factors” (e.g., unconscious conflicts) and other (e.g., fate, misfortune) [19]. We inductively expanded these categories to include “combination of biological factors and environmental factors” and “consumption of alcohol or drugs”. In 2020, we observed several phrases suggesting a pandemic-related origin of the disorders, leading us to add the subcategory “COVID-related stress” within the “psychosocial stress factors” category. This subcategory included persistent stress, anxiety, social isolation, and loneliness triggered by the COVID-19 pandemic and associated mobility restrictions. The number and type of reported treatment options for the disorders: To evaluate the reported treatments we distinguished between established psychiatric methods (e.g., psychotherapy, psychopharmacotherapy or psychosocial rehabilitation) and other methods (e.g., music, arts and sports therapy, as well as self-healing, retribution, telephone counselling). In the top-level category “treatment”, we also included the subcategories “start, course and outcome of treatment” (e.g., passages discussing treatment duration), “detention” (related to a crime) and “prevention” of the disorders. Proof of reliability For reliability testing, a sample of 10% of the articles was randomly selected and re-coded by TR. Consistency was determined by considering it a match when both coding persons assigned the same code an equal number of times in an article. After discussing non-agreements, some categories were renamed, defined more precisely and distinguished better from other categories. Reliability for the coding unit “article” was evaluated using kappa and interpreted following Landis & Koch [25], resulting in kappas from 0.644 (substantial) to 0.959 (almost perfect, for details, see table S1). For the coding unit “text passage”, an interrater agreement of 80,19% was calculated with the assistance of MaxQDA. After creating the final version of this paper, English language editing was carried out with the help of ChatGPT. Results In the following section, we give an overview of our main findings. For detailed data, please refer to table 2 for coding unit “article” and table 3 for coding unit “text passage”. Addressing the first research question provides a valuable starting point for understanding the subsequent results, as it examines the differential portrayal of schizophrenia and depression in media reporting. We found that articles on schizophrenia generally leave a more negative impression than those on depression. In 2020, the overall connotation of these articles is even more pejorative compared to 2010 and additionally we found more derogatory text passages, which degrade sufferers for example as “mad” 4 or “being nuts” 5 . In contrast to this, the reporting on depression is perceived as predominantly neutral. Between 2010 and 2020, the number of articles with negative connotation and the number of text passages categorized as pejorative decreases. Nevertheless, also in reports about depression we find attention-grabbing headlines, miscalling psychiatrist institutions for instance as “island of broken souls” 6 . The share in reporting for depression is higher than for schizophrenia in both years. Between 2010 and 2020 the priority in news coverage increased for depression, while it decreased for schizophrenia. In fact, the number of articles about depression is more than ten times higher in 2020 than about schizophrenia, while it was only about six times higher in 2010. But not only does the reader get more information about depression, the information is also given more often by professionals . Whereas in 2010 more professionals had their say in the news coverage on schizophrenia than on depression, in 2020 the opposite presents. Upon reviewing the sections in which articles were published, more noticeable changes between the two compared years become apparent. News on schizophrenia remain mainly in the department “individual life stories”, in which – for schizophrenia - only criminal cases are reported. Here, the number of articles in this section rises in 2020. The articles captivate readers with striking headlines, unveiling the most bizarre and brutal crimes committed by individuals with schizophrenia, as later revealed within the pages. BILD Zeitung for example published a report titled “mad ax man attacks pensioner” 5 or Süddeutsche Zeitung informs about an “attack with potato peeler” planned by a person with schizophrenia 7 . In contrast, coverage of depression in the same category of individual life stories is comparatively lower overall and declined further in 2020 compared to 2010. Here, alongside a few criminal cases, the section holds various reports on people who overcame the disorder or prevention tips from affected celebrities. In 2020, news reports on depression are most commonly part of the section “society”. For both disorders, there are few reports in the “medicine & health” section. In exploring the stereotypical portrayal in the media coverage, we observed similar trends in both coding units, articles and text passages (see figure 1). Both disorders are most frequently associated with the stereotype of “dangerousness”, with individuals with schizophrenia being portrayed as significantly more dangerous overall than those with depression, and this portrayal increased further in 2020 compared to 2010. The same applies to the stereotype "unpredictability," which is also often used. This results in 40% of all articles reporting on schizophrenia in 2020 describing sufferers as dangerous and 15% describing them as unpredictable. Taking into consideration that in another 30% of all articles “schizophr” is only used metaphorically, this leaves very little room for informative content. Furthermore, the only positively connoted stereotype of "creativity & brilliancy " is used more often for schizophrenia than for depression. However, this positive representation decreases from 8,9% to 2,5% of all articles between 2010 and 2020. Shifting our focus to the reported causes of depression and schizophrenia, we also found notable variations between the compared years. In 2010, there are more text passages about the causes of schizophrenia than those of depression. In 2020, the opposite occurs and causes for depression take the lead, while the percentage of text passages on causes for schizophrenia decline drastically from 19,2% to 5,9%. But not only the number, but also the type of reported causes differs: For schizophrenia, biological factors are predominantly mentioned in both years. In 2010, a combination of biological factors and environmental factors is also frequently brought up, which is in line with the current professional opinion. In 2020 on the other hand, next to biological factors, the consumption of alcohol or drugs is presented as a prominent factor contributing to schizophrenia. In articles addressing depression on the other hand, psychosocial stress factors are seen as the main cause for the disorder, increasing in-between 2010 and 2020 from 9,2% to 15% of all text passages. In 2020, the stress due to the COVID pandemic and the associated limitations thereby play the most important role, covering a noteworthy 9,3% of all analyzed text passages. In contrast to that, not a single article mentions schizophrenia in relation to COVID. The category of “ treatment ” aligns with the previously described trend. The proportion of text passages about treatment options for depression increases from 11,3% to 20,8%, while the numbers stay approximately the same for schizophrenia. Notably, there is a clear emphasis on the detention of individuals with schizophrenia in psychiatric institutions, particularly in 2020 compared to 2010. In fact, media reports on detention is four times more than about established psychiatric treatment in 2020. In the reporting on depression, established psychiatric procedures such as medications or psychotherapy are prominent in both years. Lastly, discussions on prevention are exclusively found in the news coverage on depression, and only in the year 2020. Table 2 : Results of the categories with coding unit "article” depression 2010 percent (n) depression 2020 percent (n) schizo-phrenia 2010 percent (n) schizo-phrenia 2020 percent (n) Total number of articles 100 (326) 100 (432) 100 (56) 100 (40) overall connotation of the article pejorative neutral appreciative 44,3 (144) 55,2 (180) 0,6 (2) 18,3 (79) 79,9 (345) 1,9 (8) 66,1 (37) 30,4 (17) 3,6 (2) 77,5 (31) 20,0 (8) 2,5 (1) Frequency of reporting “depress”/”schizophr” used as single reference multiple references main topic side topic marginal note metaphor 81,9 (267) 17,5 (57) 7,7 (25) 34,7 (113) 23,0 (75) 34,7 (113) 76,6 (331) 23,4 (101) 4,9 (21) 38,4 (166) 27,6 (119) 29,2 (126) 85,7 (48) 14,3 (8) 5,4 (3) 39,3 (22) 23,2 (13) 32,1 (18) 87,5 (35) 12,5 (5) 0 (0) 50 (20) 20 (8) 30 (12) Professionalism in reporting “depress”/”schizophr” used by professionals others 12,0 (39) 88,0 (287) 23,8 (103) 76,2 (329) 19,6 (11) 80,4 (45) 12,5 (5) 87,5 (35) sections medicine & health science, technology & research economy & finances culture & arts sports politics reports from affected people individual life stories society 8,9 (29) 5,5 (18) 12,0 (39) 22,1 (72) 9,2 (30) 8,0 (26) 4,6 (15) 19,0 (62) 10,7 (35) 14,8 (64) 2,8 (12) 19,4 (84) 15,3 (66) 1,2 (5) 6,0 (26) 5,1 (22) 8,6 (37) 26,9 (116) 1,8 (1) 21,4 (12) 3,6 (2) 23,2 (13) 10,7 (6) 3,6 (2) 1,8 (1) 25,0 (14) 8,9 (5) 7,5 (3) 2,5 (1) 2,5 (1) 27,5 (11) 2,5 (1) 15 (6) 2,5 (1) 37,5 (15) 2,5 (1) stereotypical portrayal dangerousness unpredictability creativity & brilliancy incurability personal negligence 8,3 (27) 3,1 (10) 1,2 (4) 0,3 (1) 0,0 (0) 5,3 (23) 1,2 (5) 0,5 (2) 0,2 (1) 0,2 (1) 26,8 (15) 12,5 (7) 8,9 (5) 7,1 (4) 0 (0) 40,0 (16) 15,0 (6) 2,5 (1) 0,0 (0) 0,0 (0) Table 3 : Results of the categories with coding unit "text passages” depression 2010 percent (n) depression 2020 percent (n) schizo-phrenia 2010 percent (n) schizo-phrenia 2020 percent (n) Total number of text passages 100 (764) 100 (1081) 100 (271) 100 (119) text passages with evaluative tone appreciative pejorative 0,9 (7) 8,5 (65) 0,3 (3) 3,5 (38) 0,0 (0) 7,7 (21) 0,0 (0) 12,6 (15) stereotypical portrayal dangerousness unpredictability creativity & brilliancy incurability personal negligence 3,7 (28) 1,6 (12) 0,7 (5) 0,1 (1) 0,0 (0) 2,4 (26) 0,5 (5) 0,1 (1) 0,1 (1) 0,1 (1) 6,6 (18) 3,3 (9) 2,6 (7) 1,5 (4) 0 (0) 13,4 (16) 5,0 (6) 1,7 (2) 0,0 (0) 0,0 (0) causes biological factors combination of biological factors & environmental factors influences from socialization psychosocial stress factors COVID-related stress consumption of alcohol or drugs intrapsychic factors other total 1,0 (8) 0 (0) 0,9 (7) 9,2 (70) 0,0 (0) 0,9 (7) 0,3 (2) 2,4 (18) 14,7 (118) 0,7 (8) 0,1 (1) 1,9 (20) 5,7 (62) 9,3 (101) 0,3 (3) 0,1 (1) 2,9 (31) 21,0 (227) 10,3 (28) 3,7 (10) 0,4 (1) 2,2 (6) 0,0 (0) 2,6 (7) 0,0 (0) 0,0 (0) 19,2 (52) 1,7 (2) 0,0 (0) 0,8 (1) 0,8 (1) 0,0 (0) 1,7 (2) 0,0 (0) 0,8 (1) 5,9 (7) treatment established psychiatric methods other methods start, course and outcome of treatment detention prevention total 7,5 (57) 2,0 (15) 1,4 (11) 0,4 (3) 0,0 (0) 11,3 (86) 9,4 (102) 5,8 (63) 3,5 (38) 0,1 (1) 1,9 (21) 20,8 (225) 8,1 (22) 2,2 (6) 2,6 (4) 1,5 (7) 0,0 (0) 14,4 (39) 2,5 (3) 0,8 (1) 1,7 (2) 10,1 (12) 0,0 (0) 15,1 (18) Discussion Our qualitative content analysis of newspaper articles showed a widening gap between both disorders in all examined research questions. Depression got covered more often and there is a more professional picture drawn, while schizophrenia got covered less and with less reference to professional care between 2010 and 2020. The trend towards reporting more about depression, which Kroll et al. [ 19 ] already noted in German print media between 1990 and 2000, thus seems to be continuing. While for both disorders we found very little reports in sections dedicated to the medicine and health, there is a big interest in crimes, especially when committed by people with schizophrenia. In 2010, there were a number of articles about new research about schizophrenia and its causes, but this scientific interest was nearly completely non-existent in 2020. For depression, in 2020 we found most articles in the section “society”, which we see strongly connected to the COVID-19 pandemic. The worsening of a preexisting depression seems to be the prime example to show negative side effects of establishing too many restrictive rules, while there is not a single mention of schizophrenia in this context. Also, the media begin to talk about prevention of depression – but never of schizophrenia. In 2020, individuals with symptoms of schizophrenia are portrayed as more dangerous and unpredictable. The frequent reproduction of the stereotype "dangerousness" corresponds to the research results of Schlier & Lincoln [ 21 ] from an analysis of German print media in 2011. On the other hand, every single stereotype is used less frequently for individuals with depression in 2020. Also, the German newspapers draw a picture of a close relationship between “genius” and “madness” only for schizophrenia [ 26 ], but vanishingly little for depression. But the use of this one positive stereotype of creativity also decreases for schizophrenia between 2010 and 2020. Altogether, the reader is prone to an understanding of people with schizophrenia as a threat to society. Stereotypes are a key component of theoretical models of stigma, as they are believed to instigate adverse emotional reactions and discriminatory behavior [ 27 ]. Therefore, it is even more concerning that the widening gap also enlarges for the stereotypical portrayal of depression and schizophrenia in the German media. The media views biological factors as the predominant cause for schizophrenia in both years. This corresponds with the stereotypical portrayal of persons with schizophrenia as dangerous or unpredictable, even more so since several studies have linked biogenetic causal theories and the perception of dangerousness and unpredictability [ 28 – 30 ]. Also, we assume that the increased mention of drugs and alcohol as the cause of schizophrenia in 2020 contributes to the increasingly negative image about the disorder. The media’s emphasis on psychosocial factors as the primary cause for depression aligns with previous analyses of German print media [ 19 ] and the beliefs held by patients themselves [ 24 ]. There exists substantial evidence of reduced discrimination, fear and distance if psychiatric symptoms are viewed as understandable responses to life events [ 31 , 32 ]. Therefore, increased media coverage on psychosocial causes for depression might be part of the explanation why we see less stigmatization on depression over the past decades in Germany and the USA [ 2 , 3 ]. As highlighted in the study introduction, various international cross-sectional studies have reported similar findings regarding the depiction of stereotypes or metaphorical usage, aligning with our study [ 8 – 11 ]. A longitudinal study conducted in England also revealed an improvement in reporting on depression over time, but negative portrayals persisted for schizophrenia in a comparison between 1992 and 2008 [ 33 ]. Hence, one can reasonably infer that our study findings may be applicable in other nations as well. Limitations Although this study has substantial findings, it is essential to consider the broader context of media consumption in Germany. Given that television and radio remain the most widely used media [ 34 ], it is important to acknowledge that newspapers may not be the most important influence on the public’s opinion about psychiatric disorders. In fact, newspapers and magazines, including online articles, account for only 3.3% of daily media consumption [ 34 ], and their reach continues to slowly decline [ 35 ]. Consequently, further studies should prioritize moving image and audio media, with particular attention to emerging social media platforms like Instagram and TikTok, since their frequency of usage has been increasing especially among younger people [ 35 ]. Another limitation of this study may be the late reliability check. Ideally, a second intercoder could have conducted an analysis of a subset of articles during the category system's development to detect potential weaknesses earlier in the project. Conducting the reliability check after completing the coding of all articles, we later realized that certain coding instructions lacked the requisite specificity. Consequently, we made minor adjustments to our category system towards the project's conclusion. Conclusion This research was conducted to understand the interrelations between media portrayal and the widening gap in public stigmatization between depression and schizophrenia observed between 2010 and 2020 [ 1 ]. We found a widening gap in all investigated categories. The study’s main findings reveal an intensifying negative and less professional portrayal of schizophrenia as well as an increasing prominence of depression, its treatment and prevention in media coverage. Although these findings are in line with the changes in continuum beliefs, we must consider that the portrayal of schizophrenia and depression in German media can be both a result and a cause of a stigmatizing image of society regarding these conditions. Based on these findings, we recommend a balanced coverage including accurate professional information about causes, treatment and prevention of all mental illnesses. One could argue, it is not the media’s responsibility to educate about disorders, but the primary emphasis should not center on the exploitation of individual life narratives or the pursuit of unusual or sensational narrative. The media should let affected persons have their say more often instead of writing about them from an evaluative outside perspective and reduce the proportion of the metaphorical use of “schizophrenic”, as this often reinforces the image of a split personality [ 36 ]. This way, we may be able to combat stigma and promote understanding. Declarations Funding This study used internal funds only. Declaration of interest Georg Schomerus is an editorial board member of the journal Psychiatrische Praxis and Associate Editor of Stigma and Health . Sven Speerforck is an editorial board member of the journal Sozialpsychiatrische Informationen and a member of the scientific advisory board of the journal Psychiatrische Praxis . All other authors have no relevant financial or non-financial interests to disclose. Authors contributions All authors contributed to the study conception and design. GS, SS, MCA and MS conceptualized the study. MS conducted the article preparation and analysis under the guidance of TR. TR performed the re-coding for reliability testing. The first draft of this paper was written by MS and all authors provided feedback on previous drafts. All authors read and approved the final version of the manuscript. 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Das Narrenschiff im Psychiatrie-Verl, Bonn Michael Kroll SD, Matthias C, Angermeyer (2003) Die Darstellung der Depression in deutschen Tageszeitungen: Eine Trendanalyse. Psychiatr Prax 30:367–371. https://doi.org/10.1055/s-2003-43244 Rottleb U, Steinberg H, Angermeyer MC (2007) Die Darstellung der Psychiatrie in der „Leipziger Volkszeitung. Psychiatr Prax 34:e17–e25. https://doi.org/10.1055/s-2007-970835 Schlier B, Lincoln TM (2014) „Bluttaten und „schizophrene Politik: Stigmatisierung von Schizophrenie in 4 großen deutschen Printmedien aus dem Jahr 2011. Psychotherapeut 59:293–299. https://doi.org/10.1007/s00278-014-1058-0 Angermeyer MC, Matschinger H (2004) The Stereotype of Schizophrenia and Its Impact on Discrimination Against People With Schizophrenia: Results From a Representative Survey in Germany. Schizophr Bull 30:1049–1061. https://doi.org/10.1093/oxfordjournals.schbul.a007120 Hayward P, Bright JA (1997) Stigma and mental illness: A review and critique. J Mental Health 6:345–354. https://doi.org/10.1080/09638239718671 Holzinger A, Müller P, Priebe S, Angermeyer MC (2001) Die Ursachen der Schizophrenie aus der Sicht der Patienten. Psychiatr Prax 28:174–179. https://doi.org/10.1055/s-2001-13262 Landis JR, Koch GG (1977) The Measurement of Observer Agreement for Categorical Data. Biometrics 33:159–174. https://doi.org/10.2307/2529310 Lombroso C (1864) Genial’nost’ipomeshatel’stvo [Genius and Insanity], F. St. Petersburg Schomerus G, Schwahn C, Holzinger A et al (2012) Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta psychiatrica Scandinavica 125:440–452. https://doi.org/10.1111/j.1600-0447.2012.01826.x Read J, Haslam N, Sayce L, Davies E (2006) Prejudice and schizophrenia: a review of the ‘mental illness is an illness like any other’ approach. Acta psychiatrica Scandinavica 114:303–318. https://doi.org/10.1111/j.1600-0447.2006.00824.x Read J, Law A (1999) The Relationship of Causal Beliefs and Contact With Users of Mental Health Services To Attitudes To the Mentally Ill. Int J Soc Psychiatry 216–229. https://doi.org/10.1177/002076409904500309 Angermeyer MC, Holzinger A, Carta MG, Schomerus G (2011) Biogenetic explanations and public acceptance of mental illness: Systematic review of population studies. Br J Psychiatry 199:367–372. https://doi.org/10.1192/bjp.bp.110.085563 Longdon E, Read J (2017) ‘People with Problems, Not Patients with Illnesses’: Using Psychosocial Frameworks to Reduce the Stigma of Psychosis. Isr J Psychiatry Relat Sci 24–30 Walker I, Read J (2002) The Differential Effectiveness of Psychosocial and Biogenetic Causal Explanations in Reducing Negative Attitudes toward Mental Illness. Psychiatry 65:313–325. https://doi.org/10.1521/psyc.65.4.313.20238 Goulden R, Corker E, Evans-Lacko S et al (2011) Newspaper coverage of mental illness in the UK, 1992–2008. BMC Public Health 11:796. https://doi.org/10.1186/1471-2458-11-796 Leibiger J, Giersberg F (2020) Mediennutzung in Deutschland 2020 Adler M, Krapf T, Teichmann J (2022) Media Activity Guide 2022 Schomerus G, Kenzin D, Borsche J et al (2007) The association of schizophrenia with split personality is not an ubiquitous phenomenon. Soc Psychiat Epidemiol 42:780–786. https://doi.org/10.1007/s00127-007-0235-7 Footnotes Süddeutsche Zeitung (11.05.2010) Frau tötet Spielkameradin ihrer Tochter. Süddeutsche Zeitung (09.04.2010) Karlsruhe überprüft Urteil im Mordfall Büsra. Bildzeitung (10.06.2020) Prozess um tödliche Gartenzwerg-Attacke. DER SPIEGEL (03.04.2020) Zum Gefechtstraining in die Slowakei. BILD Deutschland (25.06.2020) Irrer Axtschläger greift Rentnerin an. SPIEGEL Wissen (03.05.2010) Insel der kaputten Seelen. Süddeutsche Zeitung München (17.06.2010) Attacke mit dem Kartoffelschäler. Additional Declarations Competing interest reported. Georg Schomerus is an editorial board member of the journal Psychiatrische Praxis and Associate Editor of Stigma and Health. Sven Speerforck is an editorial board member of the journal Sozialpsychiatrische Informationen and a member of the scientific advisory board of the journal Psychiatrische Praxis. All other authors have no relevant financial or non-financial interests to disclose. Supplementary Files suppl.mediacoveragedepressionvs.schizophrenia20102020.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4125072","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":281398319,"identity":"9b417a01-b0b5-460a-81d4-2e5313e6190b","order_by":0,"name":"Madeleine Sittner","email":"data:image/png;base64,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","orcid":"","institution":"University Hospital Leipzig","correspondingAuthor":true,"prefix":"","firstName":"Madeleine","middleName":"","lastName":"Sittner","suffix":""},{"id":281398320,"identity":"129c8200-8964-4ebb-bb72-05ca96b52229","order_by":1,"name":"Theresia Rechenberg","email":"","orcid":"","institution":"University Hospital Leipzig","correspondingAuthor":false,"prefix":"","firstName":"Theresia","middleName":"","lastName":"Rechenberg","suffix":""},{"id":281398321,"identity":"24793ab5-d126-48d2-841d-8f00861d60fc","order_by":2,"name":"Sven Speerforck","email":"","orcid":"","institution":"University Hospital Leipzig","correspondingAuthor":false,"prefix":"","firstName":"Sven","middleName":"","lastName":"Speerforck","suffix":""},{"id":281398322,"identity":"21dc629e-7715-4d5f-9e86-9f7ad8f01a77","order_by":3,"name":"Matthias Claus Angermeyer","email":"","orcid":"","institution":"Center for Public Mental Health, Gösing am Wagram, Gösing, Austria","correspondingAuthor":false,"prefix":"","firstName":"Matthias","middleName":"Claus","lastName":"Angermeyer","suffix":""},{"id":281398323,"identity":"41131b86-48d3-4b92-a6e2-e447034164b0","order_by":4,"name":"Georg Schomerus","email":"","orcid":"","institution":"University Hospital Leipzig","correspondingAuthor":false,"prefix":"","firstName":"Georg","middleName":"","lastName":"Schomerus","suffix":""}],"badges":[],"createdAt":"2024-03-18 17:29:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4125072/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4125072/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53153224,"identity":"a271cbad-6404-43b0-a54f-676ada1e9ffa","added_by":"auto","created_at":"2024-03-21 09:03:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38979,"visible":true,"origin":"","legend":"\u003cp\u003eDevelopment of the stereotypical portrayal of schizophrenia and depression between 2010 and 2020 (main results)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4125072/v1/d8fa74c56d40ba28ea90bc5e.png"},{"id":54844620,"identity":"ddc6ebd6-5b5a-4992-94db-bbfe8996fd0e","added_by":"auto","created_at":"2024-04-17 14:43:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":438370,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4125072/v1/d46f9fa2-9230-468d-9cea-3946fff3abc0.pdf"},{"id":53153225,"identity":"18629656-462d-4538-a468-b41796ecd9ae","added_by":"auto","created_at":"2024-03-21 09:03:52","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":14345,"visible":true,"origin":"","legend":"","description":"","filename":"suppl.mediacoveragedepressionvs.schizophrenia20102020.docx","url":"https://assets-eu.researchsquare.com/files/rs-4125072/v1/2c113dc890feaaf792ac6d91.docx"}],"financialInterests":"Competing interest reported. Georg Schomerus is an editorial board member of the journal Psychiatrische Praxis and Associate Editor of Stigma and Health. Sven Speerforck is an editorial board member of the journal Sozialpsychiatrische Informationen and a member of the scientific advisory board of the journal Psychiatrische Praxis. All other authors have no relevant financial or non-financial interests to disclose.","formattedTitle":"“Broken souls” vs. “mad ax man” – The portrayal of depression and schizophrenia in the German media. A comparison between 2010 and 2020","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThere appears to be a widening gap in the stigmatization in the general public between depression and schizophrenia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This has been shown for the desire for social distance, pro-social actions and emotional reactions as an ongoing trend over the past 30 years [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and does not only occur in Germany, but has also been observed in the USA [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The widening gap has most recently become visible when comparing public attitudes towards continuum beliefs for the two disorders in 2011 and 2020 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Schomerus et al. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] found that more people subscribed to continuum beliefs for depression between 2011 and 2020, while support for continuum beliefs in schizophrenia declined. Furthermore, the study showed a decrease in the perceived \u0026ldquo;otherness\u0026rdquo; for depression, whereas it remained at a high level for schizophrenia. Continuum beliefs are associated with less stigmatizing attitudes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], correlating with reduced fear and social distance, decreased perception of dangerousness and unpredictability, and stronger pro-social responses [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Moreover, according to Link \u0026amp; Phelan, the perception of \u0026ldquo;otherness\u0026rdquo; is the centerpiece in the stigma process [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt has been suggested that differences in media coverage could be one of the reasons for the widening gap in stigmatization [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Analyses of print media in the U.S. have already revealed an emphasis on portraying individuals with mental illnesses as dangerous, often utilizing stigmatizing language. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In both US-American and English print media, \"schizophrenic\" was found to be often used as a metaphor rather than a term for illness [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A content analysis conducted in 2018 on three German newspapers similarly shed light on the divergence in the media coverage of depression and schizophrenia [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. First of all, depression received the highest media coverage among all psychiatric disorders, considerably surpassing schizophrenia [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Second, there was a greater emphasis on medical information for depressive disorders, while schizophrenia was most often reported in relation to crime and criminality [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the past, a correlation between print media coverage and attitudes was suspected, but so far, it has not been demonstrated in temporal conjunction with studies of public attitudes and to our knowledge, there has been no comparative study exclusively focusing on depression and schizophrenia in the German media.\u003c/p\u003e \u003cp\u003eThis paper aims to address this gap of knowledge. Therefore, we conducted a qualitative content analysis of all articles mentioning depression or schizophrenia in three nationwide German newspapers for the years 2010 and 2020. We aimed to examine the evolving differences in media coverage of depression and schizophrenia between 2010 and 2020. This involved assessing the overall connotation of articles, the share in reporting, professional contributions, article sections and the quantity and type of reported stereotypes, causes and treatment options.\u003c/p\u003e \u003cp\u003eGiven the results of the previous studies, we hypothesize that there will be a greater emphasis on depression in media coverage compared to schizophrenia. We expect a more qualitative and less stereotypical portrayal of depression, with greater focus on providing medical information and discussion of treatment options. Furthermore, we anticipate that this difference will intensify between 2010 and 2020.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cu\u003eSelection of articles\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eWe decided to analyze three newspapers that are considered influential in shaping public opinion, according to the criteria of Wilke [12]. These newspapers are \u003cem\u003eBILD Zeitung\u003c/em\u003e, which had the highest daily sales in Germany in both 2010 and 2020 [13, 14], \u003cem\u003eS\u0026uuml;ddeutsche Zeitung\u003c/em\u003e, which is particularly popular among journalists [12], and \u003cem\u003eSpiegel\u003c/em\u003e, which was the most frequently cited newspaper overall in 2010 and 2020 [15, 16]. We received access to the archived material of the three newspapers via online archives. We included all regional issues, online articles and also extra issues like \u003cem\u003eBild am Sonntag, BILD Plus\u0026nbsp;\u003c/em\u003eand \u003cem\u003eBILD Sport.\u0026nbsp;\u003c/em\u003eTo filter suitable articles, we conducted a keyword search with the root words \u0026ldquo;depress\u0026rdquo; and \u0026ldquo;schizophr\u0026rdquo;. Unfortunately, in the case of the \u003cem\u003eSpiegel\u003c/em\u003e archive, we couldn\u0026rsquo;t perform a search using root words, so we had to conduct separate searches for each keyword, namely \u0026ldquo;Depression\u0026rdquo;, \u0026ldquo;depressiv\u0026rdquo;, \u0026ldquo;Schizophrenie\u0026rdquo;, \u0026ldquo;schizophren\u0026rdquo;. To limit the number of articles, we narrowed the search period to the second quarter of 2010 and 2020. Our inclusion criteria were as follows: articles had to be in German, could be either printed or online, and search results could also include captions of pictures, headlines, announcements or advertisements. Additionally, we also accounted for articles where the terms \u0026ldquo;depress\u0026rdquo; or \u0026ldquo;schizophr\u0026rdquo; were used metaphorically, since we recognize that this figurative usage also shapes the readers\u0026rsquo; understanding and view of the disorders. This way, a total number of 854 articles could be taken into account. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAnalyzing the articles\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eIn order to comprehensively analyze articles and extract valuable information, we employed two coding units. First, an Excel spreadsheet was created to capture details about the entire article, such as its overall connotation or the section in which it was published.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSecond, we had a closer look at the text passages within the articles. These text passages were selected based on their inclusion of the root words \u0026ldquo;depress\u0026rdquo; or \u0026ldquo;schizophr\u0026rdquo; or their relevance to the meaning of these keywords and were treated as coding units. To evaluate these coding units, we used a qualitative content analysis, which is a systematic, rule-based, data-reducing procedure [17]. Specifically, the summative approach defined by Mayring suited our project best. Initially, a text passage was paraphrased by removing irrelevant text components or repetitive phrases that did not contribute to the core content. Subsequently, the paraphrased statements were generalized to a defined level of abstraction, ensuring that the original meaning was preserved in the new statement. Finally, redundant statements were eliminated, and the generalized information could now be assigned to a category based on predefined coding guidelines [17]. To assist in this process, we utilized MaxQDA (version 22.2.0) as computer-assisted coding tool. Examples of our approach can be seen in Table 1. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e: Examples of the\u0026nbsp;summative approach in qualitative content analysis by Mayring\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003etext passage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eparaphrase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003egeneralization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003ecategory\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e\u0026quot;According to media reports, the single mother suffered from depression after her divorce.\u0026quot;\u003ca href=\"#_ftn1\" name=\"_ftnref1\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e1\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eAfter the divorce, the woman suffered from depression.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eDivorce can be a trigger for depression.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003ecauses - psychosocial stress factors\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eThe depressed man made a confession: he had stabbed the oldest of his three children.\u003ca href=\"#_ftn2\" name=\"_ftnref2\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eThe depressed man stabbed his child.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003ePeople with depression may become violent.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003estereotypes \u0026ndash; dangerousness\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e\u0026quot;However, the trial is solely about whether the defendant, who suffers from schizophrenia, needs to be detained in a psychiatric hospital on a long-term basis.\u0026quot;\u003ca href=\"#_ftn3\" name=\"_ftnref3\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eThe defendant, who suffers from schizophrenia, may be detained in a psychiatric hospital on a long-term basis.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003ePeople with schizophrenia may be detained in psychiatric care.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003etherapy \u0026ndash; detention\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cu\u003eCreating a category system\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eTo establish our category system, we used a mixed deductive-inductive approach. The deductive aspect drew upon previous research studies that had analyzed print media. Consequently, main categories were formulated, encompassing aspects that apply to both schizophrenia and depression in a comparable manner (e.g. \u0026ldquo;treatment\u0026rdquo; or \u0026ldquo;causes\u0026rdquo;). After reviewing 10% of the articles, these main categories were extended and supplemented with subcategories. While making sure the main categories stayed the same for schizophrenia and depression, subcategories could vary between the disorders, thereby indicating distinctions in news coverage for each disorder. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eOperationalization of the research questions\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eBased on previous media analyses of the portrayal of mental illness in print media\u0026nbsp;[18\u0026ndash;23], we used the following operationalization:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe overall connotation of the article:\u003c/em\u003e After an initial reading of each article, we determined whether the connotation appeared appreciative, neutral or pejorative. For instance, if \u0026ldquo;depression\u0026rdquo; was depicted within the context of crime or racism or if \u0026ldquo;schizophrenic\u0026rdquo; was used metaphorically to describe something contradictory or demonic, it would be categorized as having a \u0026ldquo;pejorative connotation\u0026rdquo;. To assess the overall impression conveyed to readers, we also identified appreciative or pejorative text passages. We also took into account implicit evaluations, such as the use of terms like \u0026ldquo;psycho-clinic\u0026rdquo; instead of \u0026ldquo;psychiatry\u0026rdquo; or \u0026ldquo;psycho-prison\u0026rdquo; instead of forensic psychiatry.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe share in reporting for each disorder:\u0026nbsp;\u003c/em\u003eTo measure the interest the media shows for both diseases, we compared the total number of articles about one disorder. Furthermore, we evaluated how many times the root words \u0026ldquo;depress\u0026rdquo; and \u0026ldquo;schizophr\u0026rdquo; appeared within one article (single or multiple references). We noted whether depression and schizophrenia were the main topics of the article, side topics, marginal notes or used metaphorically. Drawing from the approach of Hoffmann-Richter and other researchers\u0026nbsp;[18\u0026ndash;20], we designated articles as \u0026ldquo;main topic\u0026rdquo; when the focus was on one of the disorders, and as \u0026ldquo;side topic\u0026rdquo; when the focus was on another subject, but \u0026ldquo;schizophr\u0026rdquo; or \u0026ldquo;depress\u0026rdquo; were used to explain or influence a significant part of the article. When the root words were mentioned without significantly altering the article, we categorized it as a \u0026ldquo;marginal note\u0026rdquo;. Finally, metaphorical usage was considered as a transfer of meaning detached from the actual concept of the disorder.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe number of times professionals get to speak in an article:\u003c/em\u003e This category is intended to provide an indication of the professionally accurate portrayal of disorders in the media. The term \u0026ldquo;professionals\u0026rdquo; refers to psychiatrists, psychologists, psychotherapists, alternative practitioners for psychotherapy, or researchers in psychiatry-related areas. Non-specialist occupations and non-psychiatric researchers were categorized as \u0026ldquo;others\u0026rdquo;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe section an article is published in:\u003c/em\u003e By evaluating the sections in which articles are published, we determined how the media portrays disorders, whether it leans towards a scientific, political or cultural perspective, and how often those affected had an opportunity to voice their views. We assigned our own names for the sections, as the wording varied among the newspapers. The section \u0026ldquo;Medicine \u0026amp; Health\u0026rdquo; included articles with specialized medical information, excluding the latest research findings, which were categorized under \u0026nbsp;\u0026ldquo;science, technology \u0026amp; research\u0026rdquo;. \u0026ldquo;Reports from affected people\u0026rdquo; presented direct quotes from individuals, while journalistic discussions of affected individuals in the third person were categorized under \u0026ldquo;individual life stories\u0026rdquo;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe number and type of stereotypes the disorders are linked to\u003c/em\u003e: Link \u0026amp; Phelan [4] defined stereotypes as crucial in the process of stigmatization. We decided to analyze our articles based on the stereotypes initially defined by Hayward \u0026amp; Bright\u0026nbsp;[23]\u0026nbsp;and subsequently used in other studies\u0026nbsp;[21, 22]\u0026nbsp;to be able to compare our results. We examined possible stereotypical portrayals in both coding units: text passages and whole articles. Coding units were labeled as \u0026ldquo;dangerousness\u0026rdquo; when an affected person was portrayed as a threat to others, \u0026ldquo;unpredictability\u0026rdquo; when a general inability to control oneself was implied, \u0026ldquo;personal negligence\u0026rdquo; when a (partial) self-inflicted guilt of the affected person was suggested, and \u0026ldquo;incurability\u0026rdquo; when depression or schizophrenia were presented as chronic disorders without effective cures. The only positive stereotype,\u0026nbsp;\u0026ldquo;creativity and brilliancy\u0026rdquo;, referred to cases where affected individuals were depicted as exceptionally creative or ingenious.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe number and type of reported causes of the disorders:\u003c/em\u003e To capture the reported causes of the disorders, we built upon categories previously defined by other researchers [19, 24]. These included \u0026ldquo;biological factors\u0026rdquo; (e.g., heredity or neurotransmitter imbalances), \u0026ldquo;influences from socialization\u0026rdquo; (e.g., violence in childhood, parental conflicts), \u0026ldquo;psychosocial stress factors\u0026rdquo; (e.g., performance pressure, social isolation), \u0026nbsp; \u0026ldquo;intrapsychic factors\u0026rdquo; (e.g., unconscious conflicts) and other (e.g., fate, misfortune) [19]. We inductively expanded these categories to include \u0026ldquo;combination of biological factors and environmental factors\u0026rdquo; and \u0026ldquo;consumption of alcohol or drugs\u0026rdquo;. In 2020, we observed several phrases suggesting a pandemic-related origin of the disorders, leading us to add the subcategory \u0026ldquo;COVID-related stress\u0026rdquo; within the \u0026ldquo;psychosocial stress factors\u0026rdquo; category. This subcategory included persistent stress, anxiety, social isolation, and loneliness triggered by the COVID-19 pandemic and associated mobility restrictions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe number and type of reported treatment options for the disorders:\u003c/em\u003e To evaluate the reported treatments we distinguished between established psychiatric methods (e.g., psychotherapy, psychopharmacotherapy or psychosocial rehabilitation) and other methods (e.g., music, arts and sports therapy, as well as self-healing, retribution, telephone counselling). In the top-level category \u0026ldquo;treatment\u0026rdquo;, we also included the subcategories \u0026ldquo;start, course and outcome of treatment\u0026rdquo; (e.g., passages discussing treatment duration), \u0026ldquo;detention\u0026rdquo; (related to a crime) and \u0026ldquo;prevention\u0026rdquo; of the disorders.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eProof of reliability\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eFor reliability testing, a sample of 10% of the articles was randomly selected and re-coded by TR. Consistency was determined by considering it a match when both coding persons assigned the same code an equal number of times in an article. After discussing non-agreements, some categories were renamed, defined more precisely and distinguished better from other categories. Reliability for the coding unit \u0026ldquo;article\u0026rdquo; was evaluated using kappa and interpreted following Landis \u0026amp; Koch [25], resulting in kappas from 0.644 (substantial) to 0.959 (almost perfect, for details, see \u0026nbsp; table S1). For the coding unit \u0026ldquo;text passage\u0026rdquo;, an interrater agreement of 80,19% was calculated with the assistance of MaxQDA.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAfter creating the final version of this paper, English language editing was carried out with the help of ChatGPT.\u003c/p\u003e\n\u003cdiv id=\"ftn3\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn the following section, we give an overview of our main findings. For detailed data, please refer to table 2 for coding unit \u0026ldquo;article\u0026rdquo; and table 3 for coding unit \u0026ldquo;text passage\u0026rdquo;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAddressing the first research question provides a valuable starting point for understanding the subsequent results, as it examines the differential portrayal of schizophrenia and depression in media reporting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe found that articles on schizophrenia generally leave a more negative impression than those on depression. In 2020, the \u003cem\u003eoverall connotation\u003c/em\u003e of these articles is even more pejorative compared to 2010 and additionally we found more derogatory text passages, which degrade sufferers for example as \u0026ldquo;mad\u0026rdquo;\u003ca href=\"#_ftn1\" name=\"_ftnref1\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e4\u003c/sup\u003e or \u0026ldquo;being nuts\u0026rdquo;\u003ca href=\"#_ftn2\" name=\"_ftnref2\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e5\u003c/sup\u003e. In contrast to this, the reporting on depression is perceived as predominantly neutral. Between 2010 and 2020, the number of articles with negative connotation and the number of text passages categorized as pejorative decreases. Nevertheless, also in reports about depression we find attention-grabbing headlines, miscalling psychiatrist institutions for instance as \u0026ldquo;island of broken souls\u0026rdquo;\u003ca href=\"#_ftn3\" name=\"_ftnref3\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e6\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe share in reporting\u003c/em\u003e for depression is higher than for schizophrenia in both years. Between 2010 and 2020 the priority in news coverage increased for depression, while it decreased for schizophrenia. In fact, the number of articles about depression is more than ten times higher in 2020 than about schizophrenia, while it was only about six times higher in 2010. But not only does the reader get more information about depression, the information is also given more often by \u003cem\u003eprofessionals\u003c/em\u003e. Whereas in 2010 more professionals had their say in the news coverage on schizophrenia than on depression, in 2020 the opposite presents.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUpon reviewing the \u003cem\u003esections\u003c/em\u003e in which articles were published, more noticeable changes between the two compared years become apparent. News on schizophrenia remain mainly in the department \u0026ldquo;individual life stories\u0026rdquo;, in which \u0026ndash; for schizophrenia - only criminal cases are reported. Here, the number of articles in this section rises in 2020. The articles captivate readers with striking headlines, unveiling the most bizarre and brutal crimes committed by individuals with schizophrenia, as later revealed within the pages. \u003cem\u003eBILD Zeitung\u003c/em\u003e for example published a report titled \u0026ldquo;mad ax man attacks pensioner\u0026rdquo;\u003ca href=\"#_ftn4\" name=\"_ftnref4\" title=\"\"\u003e5\u003c/a\u003e or \u003cem\u003eS\u0026uuml;ddeutsche Zeitung\u003c/em\u003e informs about an \u0026ldquo;attack with potato peeler\u0026rdquo; planned by a person with schizophrenia\u003ca href=\"#_ftn5\" name=\"_ftnref5\" title=\"\"\u003e\u003c/a\u003e\u003csup\u003e7\u003c/sup\u003e. In contrast, coverage of depression in the same category of individual life stories is comparatively lower overall and declined further in 2020 compared to 2010. Here, alongside a few criminal cases, the section holds various reports on people who overcame the disorder or prevention tips from affected celebrities. In 2020, news reports on depression are most commonly part of the section \u0026ldquo;society\u0026rdquo;. For both disorders, there are few reports in the \u0026ldquo;medicine \u0026amp; health\u0026rdquo; section.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn exploring the \u003cem\u003estereotypical portrayal\u003c/em\u003e in the media coverage, we observed similar trends in both coding units, articles and text passages (see figure 1). Both disorders are most frequently associated with the stereotype of \u0026ldquo;dangerousness\u0026rdquo;, with individuals with schizophrenia being portrayed as significantly more dangerous overall than those with depression, and this portrayal increased further in 2020 compared to 2010. The same applies to the stereotype \u0026quot;unpredictability,\u0026quot; which is also often used. This results in 40% of all articles reporting on schizophrenia in 2020 describing sufferers as dangerous and 15% describing them as unpredictable. Taking into consideration that in another 30% of all articles \u0026ldquo;schizophr\u0026rdquo; is only used metaphorically, this leaves very little room for informative content. Furthermore, the only positively connoted stereotype of \u0026quot;creativity \u0026amp; brilliancy \u0026quot; is used more often for schizophrenia than for depression. However, this positive representation decreases from 8,9% to 2,5% of all articles between 2010 and 2020.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eShifting our focus to the reported \u003cem\u003ecauses\u003c/em\u003e of depression and schizophrenia, we also found notable variations between the compared years. In 2010, there are more text passages about the causes of schizophrenia than those of depression. In 2020, the opposite occurs and causes for depression take the lead, while the percentage of text passages on causes for schizophrenia decline drastically from 19,2% to 5,9%. But not only the number, but also the type of reported causes differs: For schizophrenia, biological factors are predominantly mentioned in both years. In 2010, a combination of biological factors and environmental factors is also frequently brought up, which is in line with the current professional opinion. In 2020 on the other hand, next to biological factors, the consumption of alcohol or drugs is presented as a prominent factor contributing to schizophrenia. In articles addressing depression on the other hand, psychosocial stress factors are seen as the main cause for the disorder, increasing in-between 2010 and 2020 from 9,2% to 15% of all text passages. In 2020, the stress due to the COVID pandemic and the associated limitations thereby play the most important role, covering a noteworthy 9,3% of all analyzed text passages. In contrast to that, not a single article mentions schizophrenia in relation to COVID.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe category of \u0026ldquo;\u003cem\u003etreatment\u003c/em\u003e\u0026rdquo; aligns with the previously described trend. The proportion of text passages about treatment options for depression increases from 11,3% to 20,8%, while the numbers stay approximately the same for schizophrenia. Notably, there is a clear emphasis on the detention of individuals with schizophrenia in psychiatric institutions, particularly in 2020 compared to 2010. In fact, media reports on detention is four times more than about established psychiatric treatment in 2020. In the reporting on depression, established psychiatric procedures such as medications or psychotherapy are prominent in both years. Lastly, discussions on prevention are exclusively found in the news coverage on depression, and only in the year 2020.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e: Results of the categories with coding unit \u0026quot;article\u0026rdquo;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e\u003cstrong\u003edepression 2010\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003epercent (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e\u003cstrong\u003edepression 2020\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003epercent (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e\u003cstrong\u003eschizo-phrenia 2010\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003epercent (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e\u003cstrong\u003eschizo-phrenia\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2020\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003epercent (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal number of articles\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e100 (326)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e100 (432)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e100 (56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e100 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eoverall connotation of the article\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; pejorative\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; neutral\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; appreciative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44,3 (144)\u003c/p\u003e\n \u003cp\u003e55,2 (180)\u003c/p\u003e\n \u003cp\u003e0,6 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18,3 (79)\u003c/p\u003e\n \u003cp\u003e79,9 (345)\u003c/p\u003e\n \u003cp\u003e1,9 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e66,1 (37)\u003c/p\u003e\n \u003cp\u003e30,4 (17)\u003c/p\u003e\n \u003cp\u003e3,6 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e77,5 (31)\u003c/p\u003e\n \u003cp\u003e20,0 (8)\u003c/p\u003e\n \u003cp\u003e2,5 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of reporting\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;depress\u0026rdquo;/\u0026rdquo;schizophr\u0026rdquo; used as\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; single reference \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; multiple references\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; main topic\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; side topic\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; marginal note\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; metaphor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e81,9 (267)\u003c/p\u003e\n \u003cp\u003e17,5 (57)\u003c/p\u003e\n \u003cp\u003e7,7 (25)\u003c/p\u003e\n \u003cp\u003e34,7 (113)\u003c/p\u003e\n \u003cp\u003e23,0 (75)\u003c/p\u003e\n \u003cp\u003e34,7 (113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76,6 (331)\u003c/p\u003e\n \u003cp\u003e23,4 (101)\u003c/p\u003e\n \u003cp\u003e4,9 (21)\u003c/p\u003e\n \u003cp\u003e38,4 (166)\u003c/p\u003e\n \u003cp\u003e27,6 (119)\u003c/p\u003e\n \u003cp\u003e29,2 (126)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e85,7 (48)\u003c/p\u003e\n \u003cp\u003e14,3 (8)\u003c/p\u003e\n \u003cp\u003e5,4 (3)\u003c/p\u003e\n \u003cp\u003e39,3 (22)\u003c/p\u003e\n \u003cp\u003e23,2 (13)\u003c/p\u003e\n \u003cp\u003e32,1 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e87,5 (35)\u003c/p\u003e\n \u003cp\u003e12,5 (5)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e50 (20)\u003c/p\u003e\n \u003cp\u003e20 (8)\u003c/p\u003e\n \u003cp\u003e30 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessionalism in reporting\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;depress\u0026rdquo;/\u0026rdquo;schizophr\u0026rdquo; used by\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;professionals\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; others\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12,0 (39)\u003c/p\u003e\n \u003cp\u003e88,0 (287)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23,8 (103)\u003c/p\u003e\n \u003cp\u003e76,2 (329)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19,6 (11)\u003c/p\u003e\n \u003cp\u003e80,4 (45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12,5 (5)\u003c/p\u003e\n \u003cp\u003e87,5 (35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003esections\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; medicine \u0026amp; health\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; science, technology \u0026amp; research\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; economy \u0026amp; finances\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; culture \u0026amp; arts\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; sports\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; politics\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; reports from affected people\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; individual life stories\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; society\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8,9 (29)\u003c/p\u003e\n \u003cp\u003e5,5 (18)\u003c/p\u003e\n \u003cp\u003e12,0 (39)\u003c/p\u003e\n \u003cp\u003e22,1 (72)\u003c/p\u003e\n \u003cp\u003e9,2 (30)\u003c/p\u003e\n \u003cp\u003e8,0 (26)\u003c/p\u003e\n \u003cp\u003e4,6 (15)\u003c/p\u003e\n \u003cp\u003e19,0 (62)\u003c/p\u003e\n \u003cp\u003e10,7 (35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14,8 (64)\u003c/p\u003e\n \u003cp\u003e2,8 (12)\u003c/p\u003e\n \u003cp\u003e19,4 (84)\u003c/p\u003e\n \u003cp\u003e15,3 (66)\u003c/p\u003e\n \u003cp\u003e1,2 (5)\u003c/p\u003e\n \u003cp\u003e6,0 (26)\u003c/p\u003e\n \u003cp\u003e5,1 (22)\u003c/p\u003e\n \u003cp\u003e8,6 (37)\u003c/p\u003e\n \u003cp\u003e26,9 (116)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1,8 (1)\u003c/p\u003e\n \u003cp\u003e21,4 (12)\u003c/p\u003e\n \u003cp\u003e3,6 (2)\u003c/p\u003e\n \u003cp\u003e23,2 (13)\u003c/p\u003e\n \u003cp\u003e10,7 (6)\u003c/p\u003e\n \u003cp\u003e3,6 (2)\u003c/p\u003e\n \u003cp\u003e1,8 (1)\u003c/p\u003e\n \u003cp\u003e25,0 (14)\u003c/p\u003e\n \u003cp\u003e8,9 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7,5 (3)\u003c/p\u003e\n \u003cp\u003e2,5 (1)\u003c/p\u003e\n \u003cp\u003e2,5 (1)\u003c/p\u003e\n \u003cp\u003e27,5 (11)\u003c/p\u003e\n \u003cp\u003e2,5 (1)\u003c/p\u003e\n \u003cp\u003e15 (6)\u003c/p\u003e\n \u003cp\u003e2,5 (1)\u003c/p\u003e\n \u003cp\u003e37,5 (15)\u003c/p\u003e\n \u003cp\u003e2,5 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003estereotypical portrayal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;dangerousness\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;unpredictability\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; creativity \u0026amp; brilliancy\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; incurability\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; personal negligence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8,3 (27)\u003c/p\u003e\n \u003cp\u003e3,1 (10)\u003c/p\u003e\n \u003cp\u003e1,2 (4)\u003c/p\u003e\n \u003cp\u003e0,3 (1)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5,3 (23)\u003c/p\u003e\n \u003cp\u003e1,2 (5)\u003c/p\u003e\n \u003cp\u003e0,5 (2)\u003c/p\u003e\n \u003cp\u003e0,2 (1)\u003c/p\u003e\n \u003cp\u003e0,2 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26,8 (15)\u003c/p\u003e\n \u003cp\u003e12,5 (7)\u003c/p\u003e\n \u003cp\u003e8,9 (5)\u003c/p\u003e\n \u003cp\u003e7,1 (4)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40,0 (16)\u003c/p\u003e\n \u003cp\u003e15,0 (6)\u003c/p\u003e\n \u003cp\u003e2,5 (1)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e: Results of the categories with coding unit \u0026quot;text passages\u0026rdquo;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e\u003cstrong\u003edepression 2010\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003epercent (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e\u003cstrong\u003edepression 2020\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003epercent (n)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\"\u003e\n \u003cp\u003e\u003cstrong\u003eschizo-phrenia 2010\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003epercent (n)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\"\u003e\n \u003cp\u003e\u003cstrong\u003eschizo-phrenia 2020\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003epercent (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTotal number of text passages\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\" valign=\"top\"\u003e\n \u003cp\u003e100 (764)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\" valign=\"top\"\u003e\n \u003cp\u003e100 (1081)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\" valign=\"top\"\u003e\n \u003cp\u003e100 (271)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\" valign=\"top\"\u003e\n \u003cp\u003e100 (119)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003etext passages with evaluative tone \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; appreciative\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; pejorative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,9 (7)\u003c/p\u003e\n \u003cp\u003e8,5 (65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,3 (3)\u003c/p\u003e\n \u003cp\u003e3,5 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e7,7 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e12,6 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003estereotypical portrayal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;dangerousness\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;unpredictability\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; creativity \u0026amp; brilliancy\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; incurability\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; personal negligence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3,7 (28)\u003c/p\u003e\n \u003cp\u003e1,6 (12)\u003c/p\u003e\n \u003cp\u003e0,7 (5)\u003c/p\u003e\n \u003cp\u003e0,1 (1)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2,4 (26)\u003c/p\u003e\n \u003cp\u003e0,5 (5)\u003c/p\u003e\n \u003cp\u003e0,1 (1)\u003c/p\u003e\n \u003cp\u003e0,1 (1)\u003c/p\u003e\n \u003cp\u003e0,1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6,6 (18)\u003c/p\u003e\n \u003cp\u003e3,3 (9)\u003c/p\u003e\n \u003cp\u003e2,6 (7)\u003c/p\u003e\n \u003cp\u003e1,5 (4)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13,4 (16)\u003c/p\u003e\n \u003cp\u003e5,0 (6)\u003c/p\u003e\n \u003cp\u003e1,7 (2)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ecauses\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; biological factors\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; combination of biological factors \u0026amp;\u003cbr\u003e\u0026nbsp; \u0026nbsp;environmental factors\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; influences from socialization\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; psychosocial stress factors\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; COVID-related stress\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; consumption of alcohol or drugs\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; intrapsychic factors\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; other\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1,0 (8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,9 (7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 9,2 (70)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e0,9 (7)\u003c/p\u003e\n \u003cp\u003e0,3 (2)\u003c/p\u003e\n \u003cp\u003e2,4 (18)\u003c/p\u003e\n \u003cp\u003e14,7 (118)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,7 (8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,1 (1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1,9 (20)\u003c/p\u003e\n \u003cp\u003e5,7 (62)\u003c/p\u003e\n \u003cp\u003e9,3 (101)\u003c/p\u003e\n \u003cp\u003e0,3 (3)\u003c/p\u003e\n \u003cp\u003e0,1 (1)\u003c/p\u003e\n \u003cp\u003e2,9 (31)\u003c/p\u003e\n \u003cp\u003e21,0 (227)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10,3 (28)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3,7 (10)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,4 (1)\u003c/p\u003e\n \u003cp\u003e2,2 (6)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e2,6 (7)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e19,2 (52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1,7 (2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,8 (1)\u003c/p\u003e\n \u003cp\u003e0,8 (1)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e1,7 (2)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e0,8 (1)\u003c/p\u003e\n \u003cp\u003e5,9 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.43648208469055%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003etreatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; established psychiatric methods\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; other methods\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; start, course and outcome of\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; treatment\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; detention\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; prevention\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7,5 (57)\u003c/p\u003e\n \u003cp\u003e2,0 (15)\u003c/p\u003e\n \u003cp\u003e1,4 (11)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,4 (3)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e11,3 (86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9,4 (102)\u003c/p\u003e\n \u003cp\u003e5,8 (63)\u003c/p\u003e\n \u003cp\u003e3,5 (38)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,1 (1)\u003c/p\u003e\n \u003cp\u003e1,9 (21)\u003c/p\u003e\n \u003cp\u003e20,8 (225)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.309446254071661%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8,1 (22)\u003c/p\u003e\n \u003cp\u003e2,2 (6)\u003c/p\u003e\n \u003cp\u003e2,6 (4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1,5 (7)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e14,4 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.472312703583063%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2,5 (3)\u003c/p\u003e\n \u003cp\u003e0,8 (1)\u003c/p\u003e\n \u003cp\u003e1,7 (2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10,1 (12)\u003c/p\u003e\n \u003cp\u003e0,0 (0)\u003c/p\u003e\n \u003cp\u003e15,1 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv id=\"ftn5\"\u003e\u003cbr\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur qualitative content analysis of newspaper articles showed a widening gap between both disorders in all examined research questions. Depression got covered more often and there is a more \u003cem\u003eprofessional\u003c/em\u003e picture drawn, while schizophrenia got covered less and with less reference to professional care between 2010 and 2020. The trend towards reporting more about depression, which Kroll et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] already noted in German print media between 1990 and 2000, thus seems to be continuing.\u003c/p\u003e \u003cp\u003eWhile for both disorders we found very little reports in sections dedicated to the medicine and health, there is a big interest in crimes, especially when committed by people with schizophrenia. In 2010, there were a number of articles about new research about schizophrenia and its causes, but this scientific interest was nearly completely non-existent in 2020. For depression, in 2020 we found most articles in the section \u0026ldquo;society\u0026rdquo;, which we see strongly connected to the COVID-19 pandemic. The worsening of a preexisting depression seems to be the prime example to show negative side effects of establishing too many restrictive rules, while there is not a single mention of schizophrenia in this context. Also, the media begin to talk about prevention of depression \u0026ndash; but never of schizophrenia.\u003c/p\u003e \u003cp\u003eIn 2020, individuals with symptoms of schizophrenia are portrayed as more dangerous and unpredictable. The frequent reproduction of the stereotype \"dangerousness\" corresponds to the research results of Schlier \u0026amp; Lincoln [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] from an analysis of German print media in 2011. On the other hand, every single \u003cem\u003estereotype\u003c/em\u003e is used less frequently for individuals with depression in 2020. Also, the German newspapers draw a picture of a close relationship between \u0026ldquo;genius\u0026rdquo; and \u0026ldquo;madness\u0026rdquo; only for schizophrenia [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], but vanishingly little for depression. But the use of this one positive stereotype of creativity also decreases for schizophrenia between 2010 and 2020. Altogether, the reader is prone to an understanding of people with schizophrenia as a threat to society. \u003cem\u003eStereotypes\u003c/em\u003e are a key component of theoretical models of stigma, as they are believed to instigate adverse emotional reactions and discriminatory behavior [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Therefore, it is even more concerning that the widening gap also enlarges for the stereotypical portrayal of depression and schizophrenia in the German media.\u003c/p\u003e \u003cp\u003eThe media views biological factors as the predominant \u003cem\u003ecause\u003c/em\u003e for schizophrenia in both years. This corresponds with the stereotypical portrayal of persons with schizophrenia as dangerous or unpredictable, even more so since several studies have linked biogenetic causal theories and the perception of dangerousness and unpredictability [\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Also, we assume that the increased mention of drugs and alcohol as the cause of schizophrenia in 2020 contributes to the increasingly negative image about the disorder.\u003c/p\u003e \u003cp\u003eThe media\u0026rsquo;s emphasis on psychosocial factors as the primary cause for depression aligns with previous analyses of German print media [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and the beliefs held by patients themselves [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. There exists substantial evidence of reduced discrimination, fear and distance if psychiatric symptoms are viewed as understandable responses to life events [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Therefore, increased media coverage on psychosocial causes for depression might be part of the explanation why we see less stigmatization on depression over the past decades in Germany and the USA [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs highlighted in the study introduction, various international cross-sectional studies have reported similar findings regarding the depiction of stereotypes or metaphorical usage, aligning with our study [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A longitudinal study conducted in England also revealed an improvement in reporting on depression over time, but negative portrayals persisted for schizophrenia in a comparison between 1992 and 2008 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Hence, one can reasonably infer that our study findings may be applicable in other nations as well.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eAlthough this study has substantial findings, it is essential to consider the broader context of media consumption in Germany. Given that television and radio remain the most widely used media [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], it is important to acknowledge that newspapers may not be the most important influence on the public\u0026rsquo;s opinion about psychiatric disorders. In fact, newspapers and magazines, including online articles, account for only 3.3% of daily media consumption [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and their reach continues to slowly decline [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Consequently, further studies should prioritize moving image and audio media, with particular attention to emerging social media platforms like Instagram and TikTok, since their frequency of usage has been increasing especially among younger people [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother limitation of this study may be the late reliability check. Ideally, a second intercoder could have conducted an analysis of a subset of articles during the category system's development to detect potential weaknesses earlier in the project. Conducting the reliability check after completing the coding of all articles, we later realized that certain coding instructions lacked the requisite specificity. Consequently, we made minor adjustments to our category system towards the project's conclusion.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis research was conducted to understand the interrelations between media portrayal and the widening gap in public stigmatization between depression and schizophrenia observed between 2010 and 2020 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. We found a widening gap in all investigated categories. The study\u0026rsquo;s main findings reveal an intensifying negative and less professional portrayal of schizophrenia as well as an increasing prominence of depression, its treatment and prevention in media coverage. Although these findings are in line with the changes in continuum beliefs, we must consider that the portrayal of schizophrenia and depression in German media can be both a result and a cause of a stigmatizing image of society regarding these conditions.\u003c/p\u003e \u003cp\u003eBased on these findings, we recommend a balanced coverage including accurate professional information about causes, treatment and prevention of \u003cem\u003eall\u003c/em\u003e mental illnesses. One could argue, it is not the media\u0026rsquo;s responsibility to educate about disorders, but the primary emphasis should not center on the exploitation of individual life narratives or the pursuit of unusual or sensational narrative. The media should let affected persons have their say more often instead of writing about them from an evaluative outside perspective and reduce the proportion of the metaphorical use of \u0026ldquo;schizophrenic\u0026rdquo;, as this often reinforces the image of a split personality [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This way, we may be able to combat stigma and promote understanding.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used internal funds only.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGeorg Schomerus is an editorial board member of the journal \u003cem\u003ePsychiatrische Praxis\u0026nbsp;\u003c/em\u003eand Associate Editor of \u003cem\u003eStigma and Health\u003c/em\u003e. Sven Speerforck is an editorial board member of the journal \u003cem\u003eSozialpsychiatrische Informationen\u003c/em\u003e and a member of the scientific advisory board of the journal \u003cem\u003ePsychiatrische Praxis\u003c/em\u003e. All other authors have no relevant financial or non-financial interests to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. GS, SS, MCA and MS conceptualized the study. MS conducted the article preparation and analysis under the guidance of TR. TR performed the re-coding for reliability testing. The first draft of this paper was written by MS and all authors provided feedback on previous drafts. All authors read and approved the final version of the manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that lead to the findings of this study are available on request from Madeleine Sittner.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSchomerus G, Baumann E, Schindler S, Angermeyer MC (2021) Changes in continuum beliefs for depression and schizophrenia in the general population 2011\u0026ndash;2020: a widening gap. 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Soc Psychiat Epidemiol 42:780\u0026ndash;786. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00127-007-0235-7\u003c/span\u003e\u003cspan address=\"10.1007/s00127-007-0235-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e S\u0026uuml;ddeutsche Zeitung (11.05.2010) Frau t\u0026ouml;tet Spielkameradin ihrer Tochter.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e S\u0026uuml;ddeutsche Zeitung (09.04.2010) Karlsruhe \u0026uuml;berpr\u0026uuml;ft Urteil im Mordfall B\u0026uuml;sra.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Bildzeitung (10.06.2020) Prozess um t\u0026ouml;dliche Gartenzwerg-Attacke.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e DER SPIEGEL (03.04.2020) Zum Gefechtstraining in die Slowakei.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e BILD Deutschland (25.06.2020) Irrer Axtschl\u0026auml;ger greift Rentnerin an.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e SPIEGEL Wissen (03.05.2010) Insel der kaputten Seelen.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e S\u0026uuml;ddeutsche Zeitung M\u0026uuml;nchen (17.06.2010) Attacke mit dem Kartoffelsch\u0026auml;ler.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"media coverage, stigma, depression, schizophrenia, German print media, comparison","lastPublishedDoi":"10.21203/rs.3.rs-4125072/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4125072/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003ePopulation studies show the stigma of depression to diminish, while the stigma of schizophrenia increases. To find out whether this widening gap is reflected in media portrayal of both disorders, this study compares the portrayal of depression and schizophrenia in German print media in 2010 vs. 2020.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a qualitative content analysis using a mixed deductive-inductive approach to establish a category system. In total, we analyzed 854 articles with the summative approach by Mayring.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study found a widening gap in the portrayal of schizophrenia and depression in German media between 2010 and 2020. Schizophrenia was depicted increasingly negative between 2010 and 2020, covering more negative stereotypes and focusing on its biological causes. Depression received increased attention and more neutral und professional coverage, with a greater emphasis on psychosocial causes and discussion of treatment options.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBy showing a widening gap the study highlights how media may shape public views on mental illnesses and reflects public attitudes at the same time. It emphasizes the need for responsible reporting to combat stigma and promote understanding. Therefore, the authors recommend a balanced coverage that includes accurate professional information about all mental illnesses.\u003c/p\u003e","manuscriptTitle":"“Broken souls” vs. “mad ax man” – The portrayal of depression and schizophrenia in the German media. A comparison between 2010 and 2020","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-21 09:03:47","doi":"10.21203/rs.3.rs-4125072/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"db6e5eda-7d19-4263-82d9-55e723b102de","owner":[],"postedDate":"March 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-17T14:35:06+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-21 09:03:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4125072","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4125072","identity":"rs-4125072","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}