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Abo Shereda HM, Alqhtani SS, ALYami AH, ALGhamdi HM, Ahmed MIO, ALSalah NA, Selim A. Exploring the relationship between compassion fatigue, stigma, and moral distress among psychiatric nurses: a structural equation modeling study. BMC Nurs 2025; 24:163. [PMID: 39939960 PMCID: PMC11823185 DOI: 10.1186/s12912-025-02802-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 02/04/2025] [Indexed: 02/14/2025] Open
Abstract
BACKGROUND Psychiatric nurses experience unique emotional and ethical challenges, including moral distress, associative stigma, and compassion fatigue, that can negatively affect their mental health and clinical performance. The complex relationship among these variables has not been clearly defined. Thus, this study aimed to determine the levels of compassion fatigue, associative stigma, and moral distress and to investigate how these factors interact with an emphasis on the role of compassion fatigue in mediating the relationship between associative stigma and moral distress. METHODS A convenient sampling technique was used to recruit nurses from Erada Mental Health Complex in Riyadh. In addition to sociodemographic data, three validated tools were used to collect data: the Compassion Fatigue Scale, Clinician Associative Stigma Scale, and Moral Distress for Healthcare Professionals Scale. The structural equation modeling was used to examine the relationship among the three variables using the 'lavaan' package. RESULTS Mediation analysis revealed that compassion fatigue significantly mediates the relationship between associative stigma and moral distress, with 80% of the total effect mediated (β = 6.38, p < 0.001). Direct and indirect effects were confirmed, with associative stigma impacting moral distress both directly (β = 1.64, p < 0.001) and through compassion fatigue (84% of the effect). Structural equation modeling showed a satisfactory model fit (χ²/df = 2.84, CFI = 0.90, RMSEA = 0.075) and supported the central role of compassion fatigue in this relationship. CONCLUSIONS Our findings underscore the importance of addressing compassion fatigue and associative stigma to alleviate moral distress among psychiatric nurses. To ensure nurses' well-being and the delivery of high-quality mental health care, interventions such as peer support groups, resilience training, and organizational initiatives to decrease stigma and compassion fatigue should be considered for all nurses working in psychiatric mental health settings. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Hanaa M Abo Shereda
- Department of Psychiatric Mental Health Nursing, Faculty of Nursing, Menoufia University, Shibin El Kom, Egypt.
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.
| | - Samirh Said Alqhtani
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Abdullah Hamoud ALYami
- Senior Nurse Specialist in Erada complex and mental health, Riyadh, Saudi Arabia
- Eradah Complex for Mental Health, Riyadh, Saudi Arabia
| | - Hani Mohammed ALGhamdi
- Senior Nurse Specialist in Erada complex and mental health, Riyadh, Saudi Arabia
- Director of Clinical Nursing Administration at Erada complex and mental health, Riyadh, Saudi Arabia
| | | | - Norah Abdulrahman ALSalah
- Senior Nurse Specialist in Erada complex and mental health, Riyadh, Saudi Arabia
- Director of Nursing Continuous Education in Executive Nursing R3, Riyadh, Saudi Arabia
| | - Abeer Selim
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
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Chukwuma OV, Ezeani EI, Fatoye EO, Benjamin J, Okobi OE, Nwume CG, Egberuare EN. A Systematic Review of the Effect of Stigmatization on Psychiatric Illness Outcomes. Cureus 2024; 16:e62642. [PMID: 39036187 PMCID: PMC11258934 DOI: 10.7759/cureus.62642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/23/2024] Open
Abstract
A significant proportion of individuals with psychiatric disorders face dual challenges such as managing the symptoms and disabilities of their conditions and enduring stigma arising from misconceptions about mental illness. This stigma denies them quality-of-life opportunities, such as access to satisfactory healthcare services, better employment, safer housing, and social affiliations. This systematic review aims to evaluate the effect of stigmatization on psychiatric illness outcomes, particularly its influence on treatment adherence, treatment-seeking behavior, and care outcomes. We conducted a systematic review of 39 studies published between 2010 and 2024, focusing on the effects of stigmatization on psychiatric illness outcomes. The review utilized robust methodology following Cochrane guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies from 2010 to 2024 obtained from databases such as PubMed, Embase, Google Scholar, Web of Science, and SCOPUS. The quality of the included studies was assessed using the Appraisal Tool for Cross-Sectional Studies, with most studies rated as moderate to high quality. The findings indicate that stigma in psychiatric illness is closely associated with several factors, including illness duration (mean effect size = 0.42, p < 0.05), frequency of clinic visits (mean reduction = 2.3 visits/year), and diagnosis of psychotic disorders (OR = 1.78, 95% CI: 1.20-2.65). Stigma manifests through misinformation, prejudice, and discrimination, leading to significant barriers to accessing and adhering to psychiatric treatment, thereby worsening health outcomes. It leads to delays in accessing healthcare, poor adherence to medication and follow-up, and negative psychiatric health outcomes, including disempowerment, reduced self-efficacy, increased psychiatric symptoms, and decreased quality of life. Also, stigma extends to caregivers and healthcare professionals, complicating care delivery. This review highlights the need for effective interventions and strategies to address stigma, emphasizing the importance of educational interventions to mitigate the adverse effects of public stigma. Understanding the multifaceted nature of stigma is crucial for developing targeted approaches to improve psychiatric care outcomes and ensure better mental health services for individuals with mental illnesses.
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Affiliation(s)
| | - Esther I Ezeani
- Family Medicine, Indiana Regional Medical Center (IRMC), Indiana, USA
- Primary Care, Lifebridge Health, Baltimore, USA
| | | | - Janet Benjamin
- Internal Medicine, Ross University School of Medicine, Miramar, USA
| | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Chuka G Nwume
- Family Medicine, University of Port Harcourt, Port Harcourt, NGA
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Őri D, Szocsics P, Molnár T, Motlova LB, Kazakova O, Mörkl S, Wallies M, Abdulhakim M, Boivin S, Bruna K, Cabaços C, Carbone EA, Dashi E, Grech G, Greguras S, Ivanovic I, Guevara K, Kakar S, Kotsis K, Ingeholm Klinkby IM, Maslak J, Matheiken S, Mirkovic A, Nechepurenko N, Panayi A, Pereira AT, Pomarol-Clotet E, Raaj S, Prelog PR, Soler-Vidal J, Strumila R, Schuster F, Kisand H, Reim A, Ahmadova G, Vircik M, Kafali HY, Grinko N, Győrffy Z, Rózsa S. Attitudes of psychiatrists towards people with mental illness: a cross-sectional, multicentre study of stigma in 32 European countries. EClinicalMedicine 2023; 66:102342. [PMID: 38149261 PMCID: PMC10749877 DOI: 10.1016/j.eclinm.2023.102342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/28/2023] Open
Abstract
Background Mental health-related stigma occurs among the public and professionals alike. The lived experience of mental illness has been linked to less stigmatising attitudes. However, data on psychiatrists and the relationship between stigmatising attitudes and psychotherapeutic activity or case discussion groups remains scarce. Methods A cross-sectional multicentre study was performed in 32 European countries to investigate the lived experiences and attitudes of psychiatrists toward patients with mental illness as well as the relationship between stigma, psychosocial and professional factors. The self-reported, anonymous, internet-based Opening Minds Stigma Scale for Health Care Providers was used to measure the stigmatising attitudes. The survey was translated into the local language of each participating country. All participants were practising specialists and trainees in general adult or child and adolescent psychiatry. The study took place between 2nd October, 2019 and 9th July, 2021 and was preregistered at ClinicalTrial.gov (NCT04644978). Findings A total of 4245 psychiatrists completed the survey. The majority, 2797 (66%), had completed training in psychiatry, and 3320 (78%) worked in adult psychiatry. The final regression model showed that across European countries more favourable attitudes toward people with mental illness were statistically significantly associated with the lived experience of participants (including seeking help for their own mental health conditions (d = -0.92, 95% confidence interval (CI) = -1.68 to -0.15, p = 0.019), receiving medical treatment for a mental illness (d = -0.88, 95% CI = -1.71 to -0.04, p = 0.040), as well as having a friend or a family member similarly affected (d = -0.68, 95% CI = -1.14 to -0.22, p = 0.004)), being surrounded by colleagues who are less stigmatising (d = -0.98, 95% CI = -1.26 to -0.70, p < 0.001), providing psychotherapy to patients (d = -1.14, 95% CI = -1.63 to -0.65 p < 0.001), and being open to (d = -1.69, 95% CI = -2.53 to -0.85, p < 0.001) and actively participating in (d = -0.94, 95% CI = -1.45 to -0.42, p < 0.001) case discussion, supervision, or Balint groups. Interpretation Our study highlights the importance of psychotherapy training, supervision, case discussions and Balint groups in reducing the stigmatising attitudes of psychiatrists toward patients. As the findings represent cross-national predictors, Europe-wide policy interventions, national psychiatric education systems and the management of psychiatric institutions should take these findings into consideration. Funding National Youth Talent Award (Ministry of Human Resources, Hungary, (NTP-NFTÖ-20-B-0134). All authors received no funding for their contribution.
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Affiliation(s)
- Dorottya Őri
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Department of Mental Health, Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Péter Szocsics
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Tamás Molnár
- Department of Psychiatry, Aladar Petz County Teaching Hospital, Győr, Hungary
| | - Lucie Bankovska Motlova
- Division of Medical Psychology, 3rd Faculty of Medicine, Charles University, Prague, The Czech Republic
| | - Olga Kazakova
- Inpatient Psychiatric Department #2, Psychiatric Clinic of Minsk City, Minsk, Belarus
| | - Sabrina Mörkl
- Division of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Sylvie Boivin
- Department of Child and Adolescent Psychiatry, EPSM du Finistère Sud, Quimper, France
| | - Krista Bruna
- Admission Ward, State Psychiatric Hospital Gintermuiza, Jelgava, Latvia
| | - Carolina Cabaços
- Psychiatry Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Institute of Psychological Medicine, Faculty of Medicine, Coimbra University, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Elvira Anna Carbone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Elona Dashi
- Department of Neuroscience, University Hospital Center “Mother Theresa”, Tirane, Albania
| | - Giovanni Grech
- Mental Health Services, Mount Carmel Hospital, Attard, Malta
| | - Stjepan Greguras
- Division of Child and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Iva Ivanovic
- Department for Child Psychiatry, Institute for Children's Diseases, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Kaloyan Guevara
- Acute Detoxification Ward, State Psychiatric Hospital for Treatment of Drug Addiction and Alcoholism, Sofia, Bulgaria
| | - Selay Kakar
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | | | - Ana Mirkovic
- Child Psychiatry Unit, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nikita Nechepurenko
- The Serbsky State Scientific Center for Social and Forensic Psychiatry, Moscow, Russian Federation
| | | | - Ana Telma Pereira
- Institute of Psychological Medicine, Faculty of Medicine, Coimbra University, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
| | - Shaeraine Raaj
- Department of General Adult Psychiatry, South Meath Mental Health Service, Co.Meath, Ireland
| | - Polona Rus Prelog
- Centre for Clinical Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia
| | - Joan Soler-Vidal
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
- Hospital Benito Menni, Complex Assistencial Salut Mental, Sant Boi de Llobregat, Spain
| | - Robertas Strumila
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Psychiatric Clinic, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Florian Schuster
- Klinikum Rechts der Isar der Technischen Universität München: Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Munich, Germany
| | | | - Ann Reim
- University of Tartu, Tartu, Estonia
| | - Gumru Ahmadova
- Department of Psychiatry, United City Hospital N15, Baku, Azerbaijan
| | - Matus Vircik
- Acute Psychiatric Department 1, Psychiatric Hospital Michalovce, Michalovce, Slovak Republic
| | - Helin Yilmaz Kafali
- Department of Psychology, Fevziye School Fundatitions, Işık University, Istanbul, Turkey
| | - Natalia Grinko
- Department of Clinical Psychology, Ukrainian Catholic University, Lviv, Ukraine
| | - Zsuzsa Győrffy
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Sándor Rózsa
- Department of Personality and Health Psychology, Károli Gáspár University of the Reformed Church, Budapest, Hungary
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Shi XL, Li LY, Fan ZG. Psychiatrists’ occupational stigma conceptualization, measurement, and intervention: A literature review. World J Psychiatry 2023; 13:298-318. [PMID: 37383285 PMCID: PMC10294130 DOI: 10.5498/wjp.v13.i6.298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 06/19/2023] Open
Abstract
Psychiatrists require frequent contact with and treatment of patients with mental illnesses. Due to the influence of associative stigma, psychiatrists may also be targets of stigma. Occupational stigma warrants special consideration because it significantly affects psychiatrists' career advancement, well-being, and their patients’ health. Given that there is no complete summary of this issue, this study reviewed the existing literature on psychiatrists' occupational stigma to clearly synthesize its concepts, measurement tools, and intervention strategies. Herein, we emphasize that psychiatrists’ occupational stigma is a multifaceted concept that simultaneously encompasses physically, socially, and morally tainted aspects. Currently, standardized methods to specifically measure psychiatrists’ occupational stigma are lacking. Interventions for psychiatrists’ occupational stigma may consider the use of protest, contact, education, comprehensive and systematic methods, as well as the use of psychotherapeutic approaches. This review provides a theoretical basis for the development of relevant measurement tools and intervention practices. Overall, this review seeks to raise public awareness of psychiatrists' occupational stigma, thereby promoting psychiatric professionalism and reducing its stigma.
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Affiliation(s)
- Xiao-Li Shi
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| | - Lu-Yao Li
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| | - Zhi-Guang Fan
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
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Liu X, Zhu H. Influencing factors of humanistic care ability and its dimensions among mental health workers during the COVID-19 pandemic: an online cross-sectional study. BMC Psychiatry 2023; 23:186. [PMID: 36944933 PMCID: PMC10029794 DOI: 10.1186/s12888-023-04656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 03/06/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND In psychiatric services, humanistic care ability significantly affects the quality of the therapeutic relationship and thus affects the therapeutic outcomes for patients. Mental health workers may be confronted with more obstacles in humanistic care during the COVID-19 pandemic wherethe authors aimed to explore the capacity level of humanistic care among mental health workers and its potential influencing factors. METHOD(S) An online cross-sectional survey was conducted among 262 mental health workers working in Chongqing, China, from December 2020 to January 2021. Data were collected by the Caring Ability Inventory (CAI), the Psychological Capital Questionnaire (PCQ-24), the Eysenck Personality Questionnaire-Revised, and the Short Scale for Chinese (EPQ-RSC). Multiple linear regression analysis was used to explore the influencing factors of humanistic care ability. RESULTS Mental health workers' humanistic care ability is at a low level, with a score of 186.47 ± 21.34. Psychological capital is positively associated with humanistic care ability (β[95%CI] = 0.41 [0.46-0.77], p < 0.001), and its two dimensions (cognition: β[95%CI] = 0.51 [0.30-0.47], p < 0.001; patience: β[95%CI] = 0.48 [0.17-0.28], p < 0.001). Psychoticism is negatively associated with humanistic care ability (β[95%CI] = -0.28 [-5.18 - -2.51], p < 0.001) and its three dimensions (cognition: β[95%CI] = -0.12 [-1.57 - -0.17], p < 0.05; courage: β[95%CI] = -0.17 [-1.7 - -0.32], p < 0.01; patience: β[95%CI] = -0.19 [-1.33 - -0.36], p < 0.01). Extroversion is positively associated with humanistic care ability (β[95%CI] = 0.19 [0.69-2.08], p < 0.001), and its two dimensions (cognition: β[95%CI] = 0.19 [0.32-1.05], p < 0.001; courage: β[95%CI] = 0.27 [0.5-1.23], p < 0.001). Neuroticism is negatively associated with humanistic care ability (β[95%CI] = -0.13[-1.37 - -0.19], p < 0.01) and its one dimension (courage: β[95%CI] = -0.25 [-0.98 - -0.35], p < 0.001). CONCLUSION(S) The research has found that the humanistic care ability of mental health workers is at a low level, and the psychological capital and personality traits are significant factors influencing the humanistic care ability and its sub-dimensions. Interventions to improve the psychological capital of mental health workers or to promote the change of personality traits they want are recommended, thereby to promote humanistic practice.
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Affiliation(s)
- Xiaolin Liu
- Rehabilitation Department, Jinzi Mountain Hospital of Chongqing Mental Health Center, No.102, Jinzi Mountain, Jiangbei District, Chongqing, 401147, China.
| | - Hongjin Zhu
- Nursing College of Chongqing Medical University, Chongqing, China
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Matshabane OP, Campbell MM, Faure MC, Marshall PA, Mayosi BM, Stein DJ, Appelbaum PS, de Vries J. Exploring how a genetic attribution to disease relates to stigma experiences of Xhosa patients with schizophrenia in South Africa. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1679-1686. [PMID: 32409883 DOI: 10.1007/s00127-020-01875-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/02/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Over the past three decades, a range of international stakeholders have highlighted the possibility that genomic research may impact stigma associated with psychiatric disorders. Limited research has been conducted in Africa to investigate this relation. METHOD In the present study, using focus group discussions, we explored the relation between genetic attribution and stigma among 36 Xhosa people with schizophrenia. We addressed three main questions: (1) What causal beliefs do Xhosa people with schizophrenia use to explain their illness and to what extent do genetic explanations play a role in these beliefs? (2) What are the internalised stigma experiences of Xhosa people with schizophrenia? (3) How do genetic explanations relate to stigma experiences, if at all? RESULTS Most participants were able to define genetics and some linked genetics to disease causation. Despite adequate knowledge of genetics and an emphasis on genetic explanations of schizophrenia in the study, most participants held a multitude of causal explanations including: psychosocial, environmental, and cultural. Moreover, participants rarely mentioned disease cause when describing their stigma experiences. DISCUSSION For this population group, there was no straight-forward relation between a genetic attribution and stigma. Therefore, we did not find evidence that genetic attribution may significantly increase stigma. Although North American and European literature provides conflicting evidence regarding this relation, there is increased consensus that biomedical explanations for psychiatric disorders may reduce blame. This study found evidence supporting that consensus. This study provides an empirical foundation to inform ongoing work on the psychosocial implications of psychiatric genomics research in non-Western contexts.
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Affiliation(s)
- Olivia P Matshabane
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Megan M Campbell
- Department of Psychology, Rhodes University, Grahamstown, South Africa
| | - Marlyn C Faure
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Bongani M Mayosi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, USA
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Chang S, Picco L, Abdin E, Yuan Q, Chong SA, Subramaniam M. Resilience and associative stigma among mental health professionals in a tertiary psychiatric hospital: a cross-sectional study in Singapore. BMJ Open 2019; 9:e033762. [PMID: 31888942 PMCID: PMC6937006 DOI: 10.1136/bmjopen-2019-033762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The mental health profession exposes healthcare workers to unique stressors such as associative stigma (stigmatisation that is extended from the stigmatised patients to psychiatric professionals and is based on affiliation with an individual with mental illness). Enhancing resilience, or the ability to 'bounce back' from adversity, is found to be useful in reducing occupational stress and its negative effects. In view of the high burnout rates reported among mental health professionals, this study aimed to examine resilience in this group of professionals and to explore the association between resilience and associative stigma. DESIGN Observational study-cross-sectional design. SETTING Tertiary psychiatry hospital in Singapore. PARTICIPANTS The study was conducted among 470 mental health professionals (doctors, nurses and allied health professionals) working in the hospital. MEASURES Resilience was assessed using the Brief Resilience Scale (BRS) and participants completed questionnaires that examined associative stigma. Participants provided their sociodemographic information, length of service, and information on whether they knew of a close friend or family member who had a mental illness. RESULTS Mean resilience score for the overall sample was 3.59 (SD=0.64). Older age (β=0.012, 95% CI 0.004 to 0.019, p=0.003) and having known a family member or close friend with a mental illness (β=0.155, 95% CI 0.019 to 0.290, p=0.025) predicted higher BRS score. Associative stigma remained significantly associated with resilience score after controlling for sociodemographic factors whereby higher associative stigma predicted lower resilience scores. CONCLUSION The present finding suggests that resilience building programmes among mental health workers should target those of the younger age group, and that addressing the issue of associative stigma is essential.
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Affiliation(s)
- Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Picco L, Chang S, Abdin E, Chua BY, Yuan Q, Vaingankar JA, Ong S, Yow KL, Chua HC, Chong SA, Subramaniam M. Associative stigma among mental health professionals in Singapore: a cross-sectional study. BMJ Open 2019; 9:e028179. [PMID: 31300500 PMCID: PMC6629392 DOI: 10.1136/bmjopen-2018-028179] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES (1) Investigate and explore whether different classes of associative stigma (the process by which a person experiences stigmatisation as a result of an association with another stigmatised person) could be identified using latent class analysis; (2) determine the sociodemographic and employment-related correlates of associative stigma and (3) examine the relationship between associative stigma and job satisfaction, among mental health professionals. DESIGN Cross-sectional online survey. PARTICIPANTS Doctors, nurses and allied health staff, working in Singapore. METHODS Staff (n=462) completed an online survey, which comprised 11 associative stigma items and also captured sociodemographic and job satisfaction-related information. Latent class analysis was used to classify associative stigma on patterns of observed categorical variables. Multinomial logistic regression was used to examine associations between sociodemographic and employment-related factors and the different classes, while multiple linear regression analyses were used to examine the relationship between associative stigma and job satisfaction. RESULTS The latent class analysis revealed that items formed a three-class model where the classes were classified as 'no/low associative stigma', 'moderate associative stigma' and 'high associative stigma'. 48.7%, 40.5% and 10.8% of the population comprised no/low, moderate and high associative stigma classes, respectively. Multinomial logistic regression showed that years of service and occupation were significantly associated with moderate associative stigma, while factors associated with high associative stigma were education, ethnicity and occupation. Multiple linear regression analyses revealed that high associative stigma was significantly associated with lower job satisfaction scores. CONCLUSION Associative stigma was not uncommon among mental health professionals and was associated with sociodemographic factors and poorer job satisfaction. Associative stigma has received comparatively little attention from empirical researchers and continued efforts to address this understudied yet important construct in conjunction with future efforts to dispel misconceptions related to mental illnesses are needed.
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Affiliation(s)
- Louisa Picco
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Qi Yuan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Samantha Ong
- Nursing, Institute of Mental Health, Singapore, Singapore
| | - Kah Lai Yow
- Allied Health, Institute of Mental Health, Singapore, Singapore
| | - Hong Choon Chua
- Chief Executive Office, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Sathur Raghuraman B, Nataraj M, Shiva L. Psychiatry trainee stressors in a postgraduate psychiatry training centre in India. BJPsych Int 2018; 16:53-55. [PMID: 31385952 PMCID: PMC6646846 DOI: 10.1192/bji.2018.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Stress and burnout are major issues affecting medical trainees, especially psychiatry trainees, throughout the world. Stress and burnout were studied using an online survey among psychiatry trainees of the National Institute of Mental Health and Neurosciences (NIMHANS) which is one of the oldest and largest training centers in India. Postgraduate training in academic institutions like NIMHANS, while offering excellent teaching experience, may impact the mental and physical health of trainees due to complex clinical challenges and academic pressure. Measures need to be taken to enhance trainee well-being by ensuring support from colleagues and seniors, allowing for an adequate work-life balance, introducing departmental level committees to address grievances and providing therapy and mentorship. Providing safe and non-stigmatizing spaces to seek help in workplace promotes whole-person growth and well being.
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Affiliation(s)
| | - Manamohan Nataraj
- Senior Resident Doctor, Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
| | - Lakshmi Shiva
- Senior Resident Doctor, Department of Psychiatry, National Institute of Mental Health and Neurosciences, India.
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Zieger A, Mungee A, Schomerus G, Ta TMT, Weyers A, Böge K, Dettling M, Bajbouj M, von Lersner U, Angermeyer MC, Tandon A, Hahn E. Attitude toward psychiatrists and psychiatric medication: A survey from five metropolitan cities in India. Indian J Psychiatry 2017; 59:341-346. [PMID: 29085094 PMCID: PMC5659085 DOI: 10.4103/psychiatry.indianjpsychiatry_190_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Stigmatization and overall scarcity of psychiatrists and other mental health-care professionals remain a huge public health challenge in low- and middle-income countries, more specifically in India. Most patients seek help from faith healers, and awareness about psychiatrists and treatment methods is often lacking. Our study aims to explore public attitudes toward psychiatrists and psychiatric medication in five Indian metropolitan cities and to identify factors that could influence these attitudes. MATERIALS AND METHODS Explorative surveys in the context of public attitudes toward psychiatrists and psychiatric medication were conducted using five convenience samples from the general population in Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). We used a quota sample with respect to age, gender, and religion using the census data from India as a reference. RESULTS Mean scores indicate that attitudes toward psychiatrists and psychiatric medication are overall negative in urban India. Negative attitudes toward psychiatrists were associated with lower age, lower education, and strong religious beliefs. Negative attitudes toward psychotropic medication were associated with lower age, male gender, lower education, and religion. CONCLUSION In line with the National Mental Health Policy of India, our results support the perception that stigma is widespread. Innovative public health strategies are needed to improve the image of psychiatrists and psychiatric treatment in society and ultimately fill the treatment gap in mental health.
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Affiliation(s)
- Aron Zieger
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Aditya Mungee
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Aino Weyers
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Michael Dettling
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Ulrike von Lersner
- Department of Psychiatry, Ernst Moritz Arndt University, Greifswald, Germany
| | | | - Abhinav Tandon
- AKT Neuropsychiatric Centre, Allahabad, Uttar Pradesh, India
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Campus Benjamin Franklin, Berlin, Germany
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11
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Zhong J, Zheng L, Chen X, Gao Q, Zhang B, Wang W. Influencing Factors on Choosing Psychiatry as a Career: An Exploration in Chinese University Students. Psychiatr Q 2016; 87:739-748. [PMID: 26875102 DOI: 10.1007/s11126-016-9427-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is a consistent need of psychiatric professionals in the world including China, and a consistent challenge to recruit more medical students into the psychiatric careers. We aimed to look for factors which have an impact on career-choosing of psychiatry in Chinese university students. We invited 508 non-medical students (NM), 304 medical students without (MO) and 123 medical students with clinical internship experience (MW), to answer a matrix of 43 questions regarding factors influencing career-choosing of psychiatry. Answers to these questions were analyzed through exploratory and confirmatory factor analyses, once the latent factors were identified and structurally-validated, their mean scores in three groups of students were calculated. Five factors with five items each were identified, namely social status inferiority, career importance, practice reward, career preference, and practice stress. NM scored lower than MO and MW did on Social Status Inferiority; NM group scored higher than MO and MW groups did on Career Importance; MW scored lower than NM and MO did on Practice Reward and on Career Preference; Regarding Practice Stress, NM scored higher than MO did, who then in turn, scored higher than MW did. In addition, Practice Stress was positively correlated with advice of the medical educators; and Social Status Inferiority and Career Preference were positively correlated with the psychiatry teaching of the medical educators. Raising career rewards, improving social status, and reinforcing psychiatric education might help to recruit more medical students to specialize in psychiatry practicing.
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Affiliation(s)
- Jiawei Zhong
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, 310058, Zhejiang, China
| | - Luna Zheng
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, 310058, Zhejiang, China
| | - Xiaoling Chen
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, 310058, Zhejiang, China
| | - Qianqian Gao
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, 310058, Zhejiang, China
| | - Bingren Zhang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, 310058, Zhejiang, China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Yuhangtang Road 866, Hangzhou, 310058, Zhejiang, China.
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Attitude towards psychiatrists: A comparison between two metropolitan cities in India. Asian J Psychiatr 2016; 22:140-4. [PMID: 27520916 DOI: 10.1016/j.ajp.2016.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/10/2016] [Accepted: 06/19/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Few patients in need of mental health care have access to psychiatric care in low and middle income countries. Public attitudes towards psychiatrists have not been adequately studied in most developing countries and especially in India, where on average one trained psychiatrist is available for 300,000 people. The aim of our study was to explore attitudes towards psychiatrists in the general population in two Indian metropolitan cities (Chennai and Kolkata) and to identify factors that could influence these attitudes. SUBJECTS AND METHODS Explorative surveys in the context of public attitudes towards psychiatrists were conducted in a convenience sample from the general population in Chennai (n=166) and Kolkata (n=158). Sampling was balanced for age, gender and school education. RESULTS Comparing the two samples using a multivariate analysis, we found more negative attitudes towards psychiatrists in Chennai compared to Kolkata (p<0.0001). Negative attitudes correlated with lower education levels (p<0.001) and stronger religious beliefs (p<0.05) in both cities. CONCLUSION Attitudes towards psychiatrists differed widely between two large metropolitan cities in India. In line with previous studies, negative attitudes correlated with lower level of education and stronger religious beliefs across both cities. Future studies may identify finer cultural and social factors that play an important role in attitudes towards psychiatrists in a diverse country like India.
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Möller-Leimkühler AM, Möller HJ, Maier W, Gaebel W, Falkai P. EPA guidance on improving the image of psychiatry. Eur Arch Psychiatry Clin Neurosci 2016; 266:139-54. [PMID: 26874959 DOI: 10.1007/s00406-016-0678-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
This paper explores causes, explanations and consequences of the negative image of psychiatry and develops recommendations for improvement. It is primarily based on a WPA guidance paper on how to combat the stigmatization of psychiatry and psychiatrists and a Medline search on related publications since 2010. Furthermore, focussing on potential causes and explanations, the authors performed a selective literature search regarding additional image-related issues such as mental health literacy and diagnostic and treatment issues. Underestimation of psychiatry results from both unjustified prejudices of the general public, mass media and healthcare professionals and psychiatry's own unfavourable coping with external and internal concerns. Issues related to unjustified devaluation of psychiatry include overestimation of coercion, associative stigma, lack of public knowledge, need to simplify complex mental issues, problem of the continuum between normality and psychopathology, competition with medical and non-medical disciplines and psychopharmacological treatment. Issues related to psychiatry's own contribution to being underestimated include lack of a clear professional identity, lack of biomarkers supporting clinical diagnoses, limited consensus about best treatment options, lack of collaboration with other medical disciplines and low recruitment rates among medical students. Recommendations are proposed for creating and representing a positive self-concept with different components. The negative image of psychiatry is not only due to unfavourable communication with the media, but is basically a problem of self-conceptualization. Much can be improved. However, psychiatry will remain a profession with an exceptional position among the medical disciplines, which should be seen as its specific strength.
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Affiliation(s)
- A M Möller-Leimkühler
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, 80336, Munich, Germany.
| | - H-J Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, 80336, Munich, Germany.
| | - W Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine-University Düsseldorf, Bergische Landstraße 2, 40629, Düsseldorf, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, 80336, Munich, Germany
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Agyapong VIO, Osei A, Farren CK, McAuliffe E. Factors influencing the career choice and retention of community mental health workers in Ghana. HUMAN RESOURCES FOR HEALTH 2015; 13:56. [PMID: 26156234 PMCID: PMC4496922 DOI: 10.1186/s12960-015-0050-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 06/27/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Whilst there have been several studies exploring retention in health workers, little is known about health workers engaged in the provision of mental health services and the factors that affect their recruitment and retention. AIMS The objective of this research was to examine the views of stakeholders about the factors which influence career choices and retention of community mental health workers (CMHWs) in Ghana. METHODS We administered three separate, self-administered, semi-structured questionnaires to 11 psychiatrists, 29 health policy directors and 164 CMHWs across Ghana, including 71 (43.3%) community psychiatric nurses (CPNs), 19 (11.6%) clinical psychiatric officers (CPOs) and 74 (45.1%) community mental health officers (CMHOs). RESULTS Overall, 34 (20.7%) of all CMHWs chose to work in mental health because of the job prospects in mental healthcare. Overall, 12 (16.2%) CMHOs, 1 (5.3%) CPO and 20 (28.2%) CPNs reported they had considered leaving the mental health profession because of the stigma, with 4 (36.4%) psychiatrists and 12 (41.4%) health policy coordinators also reporting that they knew some CMHWs who had considered leaving the mental health profession because of stigma. Similarly, 16 (21.6%) CMHOs, 4 (22.1%) CPOs and 38 (53.5%) CPNs said they had considered leaving the mental health profession because of concerns about risk. Furthermore, 6 (54.5%) psychiatrists and 3 (10.3%) health policy directors said they knew some CMHWs who had considered leaving the mental health profession because of concerns about risk. Overall, 61 (37.2%) of CMHWs reported that they have considered leaving the mental health profession for other reasons other than stigma and risk including the following: the lack of support, respect and recognition from healthcare managers, lack of opportunities for professional development and poor conditions of service including low salaries, lack of office and personal accommodation and lack of risk allowance and transportation as well as poor inter-professional relationships. CONCLUSIONS Several factors affect the recruitment and retention of CMHWs in Ghana, including the prospects of easy employment, stigma, risk, lack of opportunities for career progression and low salaries.
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Affiliation(s)
- Vincent I O Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
- Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- Centre for Global Health, University of Dublin, Trinity College, Dublin, Ireland.
| | - Akwasi Osei
- Ghana Mental Health Authority and Accra Psychiatric Hospital, Accra, Ghana.
| | - Conor K Farren
- Department of Psychiatry, University of Dublin, Trinity College Dublin, Dublin, Ireland.
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
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Balon R, Tait GR, Coverdale JH, Beresin EV, Louie AK, Roberts LW. Stigma and empathy: sex workers as educators of medical students. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:239-41. [PMID: 25854454 DOI: 10.1007/s40596-015-0338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/17/2015] [Indexed: 05/14/2023]
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Catthoor K, Schrijvers D, Hutsebaut J, Feenstra D, Persoons P, Hert MD, Peuskens J, Sabbe B. Associative stigma in family members of psychotic patients in Flanders: An exploratory study. World J Psychiatry 2015; 5:118-125. [PMID: 25815261 PMCID: PMC4369541 DOI: 10.5498/wjp.v5.i1.118] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 12/18/2014] [Accepted: 01/12/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess presence and severity of associative stigma in family members of psychotic patients and factors for higher associative stigma.
METHODS: Standardized semi-structured interview of 150 family members of psychotic patients receiving full time treatment. This study on associative stigma in family members of psychotic patients was part of a larger research program on the burden of the family, using “Interview for the Burden of the Family” and the chapters stigma, treatment and attribution from the “Family interview Schedule”. The respondents were relatives, one per patient, either partner or parent. The patients had been diagnosed with schizophrenia or schizo-affective disorder. All contacts with patients and relatives were in Dutch. Relatives were deemed suitable to participate in this research if they saw the patient at least once a week. Recruitment took place in a standardized way: after obtaining the patient’s consent, the relatives were approached to participate. The results were analyzed using SPSS Version 18.0.
RESULTS: The prevalence of associative stigma in this sample is 86%. Feelings of depression in the majority of family members are prominent. Twenty-one point three percent experienced guilt more or less frequent, while shame was less pronounced. Also, 18.6% of all respondents indicated that they tried to hide the illness of their family member for others regularly or more. Three six point seven percent really kept secret about it in certain circumstances and 29.3% made efforts to explain what the situation or psychiatric condition of their family member really is like. Factors with marked significance towards higher associative stigma are a worsened relationship between the patient and the family member, conduct problems to family members, the patients’ residence in a residential care setting, and hereditary attributional factors like genetic hereditability and character. The level of associative stigma has significantly been predicted by the burden of aggressive disruptions to family housemates of the psychotic patient.
CONCLUSION: Family members of psychotic patients in Flanders experience higher associative stigma compared to previous international research. Disruptive behavior by the patient towards in-housing family members is the most accurate predictor of higher associative stigma.
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