Psychiatrists׳ fear of death is associated with negative emotions toward borderline personality disorder patients

Structural stigma and its impact on healthcare for borderline personality disorder: a scoping review

BACKGROUND

People with Borderline Personality Disorder (BPD) and their carers/families continue to experience structural stigma when accessing health services. Structural stigma involves societal-level conditions, cultural norms, and organizational policies that inhibit the opportunities, resources, and wellbeing of people living with attributes that are the object of stigma. BPD is a serious mental illness characterized by pervasive psychosocial dysfunction including, problems regulating emotions and suicidality. This scoping review aimed to identify, map, and explore the international literature on structural stigma associated with BPD and its impact on healthcare for consumers with BPD, their carers/families, and health practitioners.

METHODS

A comprehensive search of the literature encompassed MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI Evidence-Based databases (from inception to February 28th 2022). The search strategy also included grey literature searches and handsearching the references of included studies. Eligibility criteria included citations relevant to structural stigma associated with BPD and health and crisis care services. Quality appraisal of included citations were completed using the Mixed Methods Appraisal Tool 2018 version (MMAT v.18), the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Research Syntheses Tool, and the AGREE II: advancing guideline development, reporting, and evaluation in health care tool. Thematic Analysis was used to inform data extraction, analysis, interpretation, and synthesis of the data.

RESULTS

A total of 57 citations were included in the review comprising empirical peer-reviewed articles (n = 55), and reports (n = 2). Studies included quantitative, qualitative, mixed methods, and systematic review designs. Review findings identified several extant macro- and micro-level structural mechanisms, challenges, and barriers contributing to BPD-related stigma in health systems. These structural factors have a substantial impact on health service access and care for BPD. Key themes that emerged from the data comprised: structural stigma and the BPD diagnosis and BPD-related stigma surrounding health and crisis care services.

CONCLUSION

Narrative synthesis of the findings provide evidence about the impact of structural stigma on healthcare for BPD. It is anticipated that results of this review will inform future research, policy, and practice to address BPD-related stigma in health systems, as well as approaches for improving the delivery of responsive health services and care for consumers with BPD and their carers/families.

REVIEW REGISTRATION

Open Science Framework ( https://osf.io/bhpg4 ).

The impact of educational interventions on modifying health practitioners' attitudes and practice in treating people with borderline personality disorder: an integrative review

BACKGROUND

The rising prevalence of Borderline Personality Disorder (BPD) and suicidality represents substantial health burden worldwide. People with BPD experience high rates of crisis presentations and stigma when accessing health services. Educational interventions designed to modify health practitioners' attitudes and practice in treating people with BPD may assist in addressing this stigma. The current review aimed to identify and explore existing educational interventions designed to modify health practitioners' attitudes and practice in BPD; and determine what impact educational interventions have on improving health practitioners' responses towards people with BPD.

METHODS

A comprehensive search of the literature was undertaken in MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI Evidence-Based databases (from inception to February 2022). Secondary sources of literature included grey literature searches and handsearching the references of included studies as part of the comprehensive search strategy. The eligibility criteria included peer-reviewed empirical studies examining BPD-related educational interventions aimed at modifying health practitioners' attitudes and practice in treating people with BPD. Quality appraisal of the included studies were completed using the Mixed Methods Appraisal Tool 2018 version (MMAT v.18) or the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Research Syntheses Tool. Thematic Analysis informed data extraction, analysis, interpretation, and narrative synthesis of the data.

RESULTS

A total of nine papers containing 991 participants across a diverse range of studies including, quantitative, qualitative, mixed methods, and a systematic review were included in this integrative review. Several BPD-related educational interventions designed to modify health practitioners' attitudes and practice in BPD exist. Findings suggest that training health practitioners in BPD-related educational interventions can enhance positive attitudes and change practice towards people with BPD; however, more high-quality studies are needed to confirm these conclusions.

CONCLUSIONS

This review collated and summarized findings from studies examining the impact of BPD-related educational interventions on changing health practitioners' attitudes and practice in treating this population. Results from this review may help inform future research, policy, and practice in stigma-reduction strategies which would improve the delivery of responsive health services and care for people with BPD.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework ( https://osf.io/7p6ez/ ).

Ageist Attitudes Are Associated with Will-to-Live and Moderated by Age, Medical Conditions and Attitudes toward Aging

The extent to which older adults’ ageist attitudes associate with their will-to-live has barely been studied. Moreover, whether this effect is moderated by older adults’ age, medical conditions, and attitudes toward their own aging has not been investigated. These associations were examined by two studies. Study 1 examined the relationship between ageist attitudes and will-to-live among individuals aged 48–97, and the moderating roles of age and medical conditions on this connection. Study 2 reassessed this connection in a new sample of older adults (people aged 60–94 years) and examined the moderating role of their attitudes toward aging in this regard. In line with the hypothesis of the first study, ageist attitudes and will-to-live were negatively associated among older adults with more medical conditions. In accordance with the hypotheses of study 2, the ageist attitudes and will-to-live connection was reconstructed, and when regressed on the ageist attitudes × attitudes toward aging interaction, it remained significant only among those with increased ageist attitudes. These findings demonstrate the negative effect that ageist attitudes may have on will-to-live, especially among the very old, and particularly when their health deteriorates, and support the utility of interventions aimed at increasing their will-to-live.

What we know - and want to know - about Family Connections: a review from the perspective of lived experience

Family Connections is a peer-led education, skills, and support program for family members of individuals with borderline personality disorder. Extant literature on Family Connections is limited but consistent in regard to methodology and outcomes, allowing for meaningful cross-study comparison. Despite evidence across studies regarding the program's efficacy, a number of questions remain to be answered. Three possible future research directions were identified from the perspective of family members with lived experience who are also Family Connections peer leaders; examining Family Connections when led by peers, gathering qualitative data about family member's experiences of Family Connections to illuminate additional program benefits, and studying the efficacy of Family Connections for family members of those with other mental health disorders.

Stigma perpetuation at the interface of mental health care: a review to compare patient and clinician perspectives of stigma and borderline personality disorder

BACKGROUND

People with borderline personality disorder (BPD) experience significant stigma, particularly at the interface of care delivery.

AIMS

To compare and contrast what stigma looks like within mental health care contexts, from the perspective of patients and mental health professionals (MHPs) and how it is perpetuated at the interface of care.

METHOD

A review of the literature was undertaken to compare the experiences of stigma towards BPD from the patient and MHP perspective by thematically analysing the results from empirical studies exploring their experiences.

RESULTS

Thirty studies were found; 12 on patients perspectives and 18 on clinicians perspectives. Six themes arose from the thematic synthesis: (1) stigma related to diagnosis and disclosure; (2) perceived un-treatability; (3) stigma as a response to feeling powerless; (4) stigma due to preconceptions of patients; (5) low BPD health literacy and (6) overcoming stigma through enhanced empathy. A conceptual framework for explaining the perpetuation of stigma and BPD is proposed.

CONCLUSION

Stigma towards people with BPD is perpetuated through poor BPD health literacy by patients and MHPs that stalls effective treatment and engagement, and disempowers all concerned, deferring responsibility to others. Addressing this stigma requires multiple strategies that include more targeted education, advocacy and leadership.

'Old and ill': death anxiety and coping strategies influencing health professionals' well-being and dementia care

OBJECTIVES

This paper examined the psychological factors that influence the well-being of health professionals who work with people with dementia and the types of care (person-centred or task-oriented) provided to these patients.

METHODS

The literature was reviewed to identify the factors influencing the well-being of, and types of care provided by, health professionals working with people experiencing dementia.

RESULTS

Based on our review of the literature, we propose that approaches to care and the well-being of health professionals working with dementia patients are influenced by the characterisation of dementia as a terminal illness that typically occurs in older people. Drawing upon terror management theory, we argue that exposure to dementia patients is likely to promote awareness of one's own mortality and death-related anxiety. A theoretical model is presented which posits that health professionals working in dementia care draw on experiential avoidance to manage this anxiety. Both death anxiety, and coping strategies, such as experiential avoidance, used to manage this anxiety may influence health professionals' approaches to care of, and attitudes towards, dementia patients. We also suggest a bi-directional relationship between health professionals' approaches to care and well-being.

CONCLUSION

Recommendations are made regarding future directions for research and implications for training of health professionals providing direct service or consultation in dementia care.