MentaI IIIness and the Media: Part II.
Content Analysis of Press Coverage of
Mental Health Topics*
M. MATAS, M.D'! N. el-GuEBALY, M.D.2, D. HARPER, Ph.D), M. GREEN, B.sc. 4 AND A. PETERKIN, B.Sc.5
The public image ofpsychiatry has been tarnished in
recent years.' In order to determine the extent to which
press coverage has contributed to negative attitudes
towards psychiatry, we conducted a content analysis ofa
random selection of newspaper articles which appeared
over a twenty-year period in two different newspapers.
We found that although there had been some minor,
cosmetic changes over the years, such as more
appropriate headlines and more direct quotes from
psychiatric experts, on the whole, content and attitudes
had changed very little. An accuracy check of media
reporting offorensic cases over a 20-yearperiod revealed
that when reporters have access to written material, the
accuracy levels are greatly improved.
Ito anna systematic
Part I ofthis study(1), we reported on the results of
attitudinal questionnaire which was administered
sample of 20 reporters, 20 psychiatrists, 20
medical outpatients with no psychiatric history, and 40
psychiatric inpatients. The results of the questionnaire
survey showed that media reporters were no less
accepting of mental illness than the other groups;
however, reporters suggested that time and cost factors,
as well as the demands of the market place ("sensational-
ism sells newspapers') contributed to a somewhat less
than desirable presentation of mental health topics. The
coverage was rated as mostly negative by all four groups,
with the psychiatrists tending to be the most critical.
Part II of our study looks at whether or not there has
been a change over time in the reporting of mental health
topics. To what extent has the public perception of
*Manuscript received April 1985; revised August 1985.
'Associate Professor. Department of Psychiatry, University of
Manitoba.
2Professor, Department of Psychiatry, University of Manitoba.
3Associate Professor, Department of Psychiatry, University of
Manitoba.
4Faculty of Medicine, University of Manitoba.
5Faculty of Medicine, University of Manitoba.
Address reprint requests to: Dr. M. Matas, Department of Psychiatry,
M5 - McEwen I3Idg., 81. Boniface General Hospital, 409 Tache Avenue,
Winnipeg, Manitoba R2H 2A6
Can. J. Psychiatry Vol. 31, June 1986
431
psychiatry changed over the past twenty years? In the
sixties, the leaders of the anti-psychiatry movement,
Thomas Szasz (2) and ~.D. Laing (3), were lionized by
the media, with frequent radio and television interviews,
magazine and newspaper articles, and widely-reported
public appearances. There followed a spate of anti-
psychiatry movies, including Shock Treatment (1964)
and One Flew Over the! Cuckoo's Nest (1975), where
psychiatrists were portrayed as incompetent, if not
malevolent, figures of ridicule. Thirty years ago,
Nunnally (4,5), after extensive content analysis of media
reports, concluded that "the media of mass communica-
tion generally present a distorted picture of mental health
problems." A search of the relevant literature since
Nunnally's original work revealed no comprehensive
studies dealing with content analysis of press coverage of
mental health topics. The following study tests our
hypothesis that little relevant change in attitudes toward
mental illness occurred in the press over the 20-year
period studied between 1961 and 1981. A rating of the
coverage of a subpopulation of mentally ill patients who
receive the largest amount of publicity, "the criminally
insane," is also attempted.
Methodology
Newspaper Article Rating Instrument - Following a
review of the relevant literature, six a priori content
categories were identified as being important to journalists
and scientists alike: i) Newspaper Article Profile, ii) Article
Content, iii) Article Attitudes, iv) Quality of Journalism, v)
Scientific Accuracy, and vi) Tone of the Article. Questions
were derived from a series of studies (5-12) resulting in a
total of 25 questions including identifying data.
Newspaper Search - Subject headings were selected
from the complete list of headings in the Canadian News
Index (1981) which indexes seven Canadian daily
newspapers. Seven topics were selecfed: a) Alcoholism, b)
Drug Abuse or Addiction, c) Mental Health, d) Psychiatry,
e) Psychology, f) Suicide, and g) Criminal Insanity. A
random selection of articles was carried out for two
newspapers (the Winnipeg Free Press andthe Globe and
Mail) resulting in 45 articles from each newspaper, with 15
articles per sample year (1961, 1971, 1981). It was found that
this procedure resulted in a distribution by subject heading
comparable to the one found in the overall pool of
newspaper articles.
432 CANADIAN JOURNALOF PSYCHIATRY
Rater Selection - Six raters were selected from three
different populations: two psychiatrists, two science
reporters and two patients from a Family Medical Centre
with completed high school education and no psychiatric
history. Kappa analysis to determine the degree of inter-
rater reliability was performed.
Article Rating - A package was given to each rater
containing the following: printed directions, a consent form,
a rater identification form, 90 newspaper articles and 90
questionnaires. The raters were instructed to complete one
25-question form for each of the 90 articles.
Coverage of the "criminally insane" - A listing of 128
names filed by the Winnipeg Free Press under Murder!
Manslaughter in Manitoba, and Criminal Insanity was
retrieved for the last 20 years. Of the 128 names, 22 were
identified as having been assessed by Forensic Services of
Manitoba. For each of the 22 cases identified, the Summary
Court Report (defining the sentence) and the Initial
Coverage 'by the newspaper were rated by two medical
students using the Newspaper Article Rating Instrument
previously described. The raters were also given verbal
instructions to read the Forensic Assessment and to
compare it with the corresponding newspaper article for
accuracy on the following: i) demographic data, ii)
diagnosis, iii) treatment, and iv) prognosis.
Results
When considering the changes in newspaper coverage
over a 20-year period, the following results were obtained
using an analysis of variance followed by post hoc testing
where significant differences were identified. The data
obtained from six raters rating 90 articles over three
sample years (covering a 2Q-year span) yielded the
following: ' promotion of social distance where the ratings were
1. Article Profile - (defined as a combination of page
number, length of article, title, and overall visual
appearance). More articles were rated as being long in
1961 than in the other two sample years. Article titles
were rated as more appropriate in 1981 than in earlier
years.
2. Article Content - (including causes, treatment and
prognosis) was not rated as significantly different over
the 20-year span.
3. Article Attitudes - (authoritarianism: favouring
submission to authority; benevolence: disposition to do
good or be kind; or equation of mental illness with
dangerousness) were not rated as significantly different
over the 20-year span.
4. Quality of Journalism - indicated improvements
over time in two areas: clarity (that is, lack of jargon,
correct definition and usage of terms, adequate detail
given) and interest (that is, does it educate, entertain,
inform the average public?) Articles in 1981 were rated
both more clear in their wording and more interesting
than articles from 1961. Other factors such as structure
(example: Does this article have a beginning/
introduction, middle and end/ summary?), anecdotes/
illustrations/ cases/ examples used, and purpose of the
article were not rated as significantly different in our
Vol. 31, No.5
three-year sample.
5. Scientific Accuracy - More direct quotes from
psychiatric experts were identified in 1981 than in earlier
years. The scientific viewpoint and statistics identified in
the sample articles were not rated as significantly
different over time. More derogatory words were used in
1971 articles, for example, lunatic, berserk, crazy,
maniac, etc.
Further analysis of variance was performed to decide
the importance of page number, newspaper source,
article length and subject heading. It was found that front
page articles were rated as having a more appropriate
profile but tended to cover items portraying the mentally
ill as more dangerous than others in the population. The
length of the article was significant. Short newspaper
articles were rated as less clear in their wording and more
negative in their tone. They were also rated as less
interesting and less clear in their purpose.
The mean kappa scores (13) over all 90 articles,
averaged over all questions using simple kappa for
dichotomous variables and weighted kappa for 1-10
scaled variables were: between media raters K = +.45,
psychiatrists K = +.54, comparison group K = +.62. The
mean overall possible pairs K =+.50 (where K =+1.0 is
perfect agreement).
Regarding the coverage of the 22 cases of criminal
insanity, on a scale of 1-10 with one being the most
negative and 10 most positive each of the following
categories - 1. Article Profile; 2. Article Attitudes; 3.
Quality of Journalism; 4. Scientific Accuracy, and 5.
Tone of the Article - was rated between six and seven,
except for the subcategories of dangerousness and
respectively 4.9 and 4.1. The following items were
compared with the Forensic Assessment to determine
straight agreement/ disagreement in demographic. data,
diagnosis, treatment and prognosis. In all cases (n = 22),
the demographic data given in the newspaper article
agreed with that given in the Forensic Assessment. In
59% of the cases (13/22), the diagnosis was mentioned in
the newspaper article and in all cases it agreed with the
Forensic Assessment. Only in one case was a spelling
error detected. In regard to treatment, 41% of the cases
(9/22) described the treatment received or planned for
the patient. In eight of nine cases this agreed with the
Forensic Assessment. Prognosis was indicated in 36% of
the cases (8/22). Of these eight cases, seven agreed with
the Forensic Assessment regarding the degree of security
and caution required in dealing with the patients.
Discussion
From the results of the relevant data analysis, it is
difficult to determine an overall attitudinal change in the
coverage of mental illness topics in the press over the
sample years - 1961, 1971, and 1981. Various items have
identifiably improved (examples: titles are more
appropriate, articles are more clear and more interesting,
more direct quotes are used); however, numerous areas
June, 1986 MENTAL ILLNESS AND THE MEDIA: PART II
showed no significant change over time (suitability of
article profile; scores for attitudes regarding authoritar-
ianism/ benevolence, dangerousness and social distance;
article structure; use of illustrations and examples; clarity
of article purpose; scientific viewpoint; use of statistics;
tone of the article).
All the categories that were rated as having no
significant change over time show scores that are average
or lower than average, therefore, room for improvement
exists in the press coverage of these items.
Kappa analysis over all 90 articles indicated that fairly
good agreement was obtained no matter how the raters
were paired and that in general, like-occupation pairings
did not result in much better agreement.
As the reliability of the rating instrument plus high
inter-rater reliability had been positively identified, two
raters were involved in rating the 22 forensic newspaper
articles. The results obtained clearly indicate that overall,
the Summary Court Reports are rated above average.
The accuracy of these articles indicates the benefit of
providing reporters with written material.
References
I. Matas M, et al. Mental illness and the media: an assessment
of attitudes and communication. Can J Psychiatry 1985;
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2. Laing RD: The politics of experience. London: Penguin,
1967.
3. Szasz TS. The myth of mental illness. Hoeber Medical
Division. New York: Harper and Row, 1961.
4. Nunnally J. Mental illness: what the media present. In:
Cohen S, Young J, eds. The manufacture of news: social
problems, deviance and the mass media. London:
Constable & Co. Ltd., 1973.
5. Nunnally JC. Popular conceptions of mental health. New
York: Holt, Rinehart & Winston, 1961.
6. Borman SC. Communication accuracy in magazine
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433
7. Pulford DL. Follow-up of study of science news accuracy.
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. Resume
Depuis quelques annees, l'image de lapsychiatrie dans
Ie grand public s'est vue quelque peu ternie. Pour savoir
jusqu'a quel point les medias ont contribue a renforcer
certaines attitudes negatives envers la psychiatrie, nous
avons precede a /'analyse de contenu d'articles de
journaux choisis au hasard, parus depuis vingt ans dans
deux journaux differents. Nous nous sommes rendu
compte que malgre les quelques changements mineurs de
formulation qui ont prts place au cours des annees,
comme Ie choix de manchettes plus appropriees et la
publication d'un plus grand nombre de citations
empruntees ades experts en psychiatrie, le contenu et les
attitudes n'avaient dans l'ensemble n'ont que tres peu
change. Apres avoir verifie I'exactitude des rapports faits
par la presse sur les cas de psychiatrie medico-legale sur
cette periode de vingt ans, nous avons constate que
a
lorsque les journalistes ont acces de la documentation
ecrite, l'exactitude de leurs articles s'ameliore beaucoup.