Health theory of coping

A systematic review of the factors associated with the psychological wellbeing of people with Parkinson's in the COVID-19 pandemic

PURPOSE

The lockdown and social distancing measures introduced as a result of the COVID-19 pandemic impacted the ability of people with Parkinson's to engage in normal health management practices. This led to documented reductions in psychological wellbeing. The aim of the present review was to identify factors associated with the psychological wellbeing of people with Parkinson's during the acute stage of the pandemic.

MATERIALS AND METHODS

Five academic databases (PsycINFO, MEDLINE, Embase, CINAHL, and Web of Science) were searched and 23 articles were identified using pre-defined inclusion and exclusion criteria. The findings are stratified by risk factor and analysed using a narrative synthesis.

RESULTS

Worsening of motor symptoms, poor motor-related daily living experiences and motor symptoms during "off time" (when symptom suppressing medication has worn off) as well as less physical activity emerged as the most consistent risk factors of worsened or poorer psychological wellbeing. A deviation from pre-pandemic risk factors was identified, with age and gender not identified as consistent risk factors.

CONCLUSIONS

The implications of this review are not limited to preparing for future pandemics but can also be applied to more common concerns with comparable contextual characteristics such as yearly flu outbreaks, social isolation, and economic uncertainty.

Nonsuicidal self-injury among Chinese university students during the post-COVID-19 era: analysis of sex differences and the impact of gender role conflict

Background

Global centers of epidemic prevention and control have entered a new stage of normalization, namely, the "post-COVID-19 era." During the post-COVID-19 era, which is characterized by the time period following that with the most serious medical consequences, the psychosocial consequences of the COVID-19 pandemic began to receive worldwide attention, especially the degree of psychological distress it caused.

Aim

This study explored the differential impact of gender role conflict on Chinese university students' engagement in nonsuicidal self-injury (NSSI) as a function of biological sex following the global COVID-19 pandemic.

Methods

Participants were 1,600 university students in northwestern China (M age = 21.3 years; 50.8% women) who completed online measures of demographic variables (including biological sex, gender role conflict, and NSSI engagement).

Results

Women reported significantly more gender role conflicts than men did, while engagement in NSSI was significantly more prevalent among men than women. A total of 262 men reported engaging in at least one NSSI behavior, resulting in a prevalence rate of 33.25%. In comparison, a total of 106 individuals reported engaging in at least one NSSI behavior, resulting in a prevalence rate of 13.05% among women. Gender role conflict was found to significantly predict university students' NSSI engagement, regardless of biological sex.

Conclusion

This is the first empirical study to identify sex differences in both gender role conflict and engagement in NSSI among university students in Northwestern China during the post-COVID-19 era. In addition, the present study is the first to demonstrate how gender role conflict predicts engagement in NSSI across sexes. These findings will inform the literature on gender role conflict and NSSI, particularly the close relationship between gender role conflict and engagement in NSSI among Chinese university students, and they emphasize the need for continued efforts to explore NSSI cross-culturally.

A systematic review of post-traumatic growth in ambulance personnel: facilitators and prevalence rates

Introduction

Ambulance personnel are exposed to traumatic and stressful situations, which can increase the risk of mental health conditions, such as post-traumatic stress disorder (PTSD). High rates of PTSD have been found in ambulance personnel (Petrie et al., 2018), but no review is available to examine post-traumatic growth (PTG - positive psychological change following a trauma) in this population. This literature review provides an overview of the prevalence rates and facilitators that may contribute to PTG in ambulance personnel.

Methods

A systematic search was conducted on EBSCOhost in January 2024 across the following six databases: Academic Search Ultimate, PsycINFO, PsycARTICLES, MEDLINE, ERIC and Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ultimate.

Results

Eleven papers were identified for this review. Pooled prevalence of PTG was moderate (52%), and facilitators for PTG were grouped into five categories: coping style/strategies, resilience, personality traits, gender and incident characteristics.

Conclusions

Numerous facilitators contributed to the development of PTG, although these did not arise in all papers. The quality of research ranged from satisfactory to excellent. Evidence suggested that adaptive coping style, high levels of resilience, the absence of a personality trait (neuroticism) and being female may facilitate PTG. Further research is needed to support the reliability of findings.

Family System and Gender as Predictors of Religious Coping in Pakistani Patients with Hepatitis C

Pakistan has the second-largest number of HCV infections in the world with homogeneity across provinces and no evidence of decline over the past 30 years (Mahmud et al. in BMC Infect Dis 19(1):1-11, 2019). Currently, one in every 20 Pakistanis is suffering from HCV (Haqqi et al. in Viral Immunol 32(9):402-413, 2019). The disease significantly interferes with the everyday life of the patient (Silberbogen et al. in Psychosomatics 50(2):114-122, 2009; Foster in Viral Hepat 16(9):605-611, 2009). The present research aimed to find the role of gender, family system, and social support in predicting coping in patients with hepatitis C (HCV). A sample of 100 HCV patients was taken using purposive sampling from different public and private hospitals in Lahore, Pakistan. For assessment, the Multidimensional Scale of Perceived Social Support and Brief Cope Inventory were used. Results showed that male hepatitis C patients used a higher level of religious coping. Hepatitis C patients living in a joint family system used a higher level of religious coping. It also showed that there was no significant relationship between social support and coping. Patients suffering from hepatitis C for 2 years or more adopted avoidant coping strategies as compared to the patients diagnosed for 1 year or more. This research has important implications for psychologists, paramedical staff, doctors, social workers, caregivers, peers, and families of patients suffering from HCV. It would help in formulating effective therapeutic interventions. It would also add to the literature in the field of health psychology.

The Role of Mental Health Stigma in University Students' Satisfaction With Web-Based Stress Management Resources: Intervention Study

BACKGROUND

University students frequently report elevated levels of stress and mental health difficulties. Thus, the need to build coping capacity on university campuses has been highlighted as critical to mitigating the negative effects of prolonged stress and distress among students. Since the COVID-19 pandemic, web-based stress management resources such as infographics and web-based workshops have been central to supporting university students' mental health and well-being. However, there is a lack of research on students' satisfaction with and uptake of these approaches. Furthermore, mental health stigma has been suggested to have not only fueled the emergence of these web-based approaches to stress management but may also influence students' help-seeking behaviors and their satisfaction with and uptake of these resources.

OBJECTIVE

This study explored potential differences in students' satisfaction and strategy use in response to an interactive infographic (an emerging resource delivery modality) presenting stress management strategies and a web-based workshop (a more common modality) presenting identical strategies. This study also examined the relative contribution of students' strategy use and family-based mental health stigma in predicting their sustained satisfaction with the 2 web-based stress management approaches.

METHODS

University students (N=113; mean age 20.93, SD 1.53 years; 100/113, 88.5% women) completed our web-based self-report measure of family-based mental health stigma at baseline and were randomly assigned to either independently review an interactive infographic (n=60) or attend a synchronous web-based workshop (n=53). All participants reported their satisfaction with their assigned modality at postintervention (T1) and follow-up (T2) and their strategy use at T2.

RESULTS

Interestingly, a 2-way mixed ANOVA revealed no significant group × time interaction or main effect of group on satisfaction. However, there was a significant decrease in satisfaction from T1 to T2, despite relatively high levels of satisfaction being reported at both time points. In addition, a 1-way ANOVA revealed no significant difference in strategy use between groups. Results from a hierarchical multiple regression revealed that students' strategy use positively predicted T2 satisfaction in both groups. However, only in the web-based workshop group did family-based mental health stigma predict T2 satisfaction over and above strategy use.

CONCLUSIONS

While both approaches were highly satisfactory over time, findings highlight the potential utility of interactive infographics since they are less resource-intensive than web-based workshops and students' satisfaction with them is not impacted by family-based mental health stigma. Moreover, although numerous intervention studies measure satisfaction at a single time point, this study highlights the need for tracking satisfaction over time following intervention delivery. These findings have implications for student service units in the higher education context, emphasizing the need to consider student perceptions of family-based mental health stigma and preferences regarding delivery format when designing programming aimed at bolstering students' coping capacity.

Mediating effect of psychological capital on the relationship between mental health literacy and coping styles among newly recruited nurses

BACKGROUND

Newly recruited nurses face multiple sources of stress and their coping styles need to be focused on to ensure good mental health. This study aimed to examine the relationship among mental health literacy, psychological capital and coping styles in newly recruited nurses.

METHODS

A cross-sectional study was conducted in August and September 2022. A total of 315 newly recruited nurses were recruited in a tertiary hospital in Henan Province, central China, employing the convenience sampling method. The self-reported questionnaires were sent through a QR code, including the Mental Health Literacy Scale for Healthcare Students, Psychological Capital Questionnaire, and Simplified Coping Style Questionnaire. Pearson correlation analysis was used to evaluate the relationships among the variables. Mediation analysis was performed to identify the mediating effect of psychological capital on the relationship between mental health literacy and coping styles.

RESULTS

Positive coping showed a positive relationship with psychological capital and mental health literacy, while negative coping showed a negative relationship with psychological capital and mental health literacy. For positive coping, psychological capital was a partial mediator with an effect of 0.140, accounting for 62.8%. For negative coping, a full mediating effect was shown by psychological capital between mental health literacy and negative coping, with an indirect effect of -0.048.

CONCLUSION

Psychological capital plays a partial and complete mediating role between mental health literacy and different coping styles among newly recruited nurses. Diversified training and personalized guidance in improving mental health literacy and increasing psychological capital simultaneously can be provided to newly recruited nurses continuously to adjust their coping styles.

Understanding the pathway between work and health outcomes for women during the preconception, pregnancy, and postpartum periods through the framing of maternal obesity

The link between work and health outcomes for preconception, pregnant, and postpartum (PPP) working women is complex. Further, innovation and enhanced understanding are required to address the work-related determinants of maternal obesity. However, workplace health promotion is not typically systems-based nor attuned to the specific needs and context of individual PPP women. We propose that to improve health outcomes for PPP women, we must understand the pathways between paid work and health for the individual woman by taking a systems-thinking approach. In this paper, we (a) outline the rationale for why the oversimplification or "dilution" of individual context may occur; (b) present a systems-informed pathway model (the "Context-Exposure-Response" Model) and overview of potential work-related impacts on health and wellbeing outcomes for PPP women using maternal obesity to provide context examples; (c) further investigate the role of motivational factors from a systems perspective; and (d) briefly examine the implications for policy, practice, and intervention design. It is anticipated that this research may act as a starting point to assist program developers, researchers, and policymakers to adopt a systems-focused perspective while contributing to the health improvement and obesity prevention of PPP women.

Coping with depression: a narrative study of an online depression community in China

PURPOSE

The goal of this study was to explore the coping strategies of depression sufferers that have worked for them based on the study of an online depression community.

METHODS

We conducted a thematic narrative analysis of 120 stories posted by the members in the largest online depression community in China. MaxQDA version 18 was used to code the data, and the analytic approach was consistent with the category-centred approach of grounded theory.

RESULTS

The study found that the coping strategies mainly include self-reconciliation (e.g., perceiving/accepting feelings, accepting the present self, and holding hope for the future), actions (recreational activities, physical exercise, and engaging in volunteer work), addressing the stressors and symptoms (e.g., staying away from stressors, seeing the doctor), and seeking interpersonal support (e.g., seeking support from family, friends, and peers).

CONCLUSION

The findings revealed the coping strategies that were helpful and examined how they functioned for the affected members, which make up for the lack of attention to the individual experiences of depression sufferers in coping research. The findings also have practical implications for the related education and consultation, providing useful insights for doctors and patients. These ways of coping are based on depression sufferer' anonymous narratives, which can be convincing to clients.

Correlations between weight perception and overt risk-taking among Canadian adolescents

OBJECTIVE

Perceptions of body weight represent an important health issue for Canadian adolescents. While associations between weight perception and mental health concerns like eating disorder symptomatology are well established, there is need for more Canadian evidence about how weight perception is associated with overt risk-taking among adolescents, and further how such associations differ by biological sex.

METHODS

We conducted a national analysis of grade 9-10 students participating in the 2017-2018 cycle of the Health Behaviour in School-aged Children (HBSC) study in Canada. This analysis described contemporary patterns of alternate weight perception and then examined the strength and statistical significance of such associations by biological sex, with tobacco, alcohol, and cannabis use, binge drinking, fighting, and illicit drug use as outcomes. Behaviours were considered both individually and in combination. Analyses were descriptive and analytical, with regression models accounting for the nested and clustered nature of the sampling approach.

RESULTS

Responses from 2135 males and 2519 females were available for a complete case series analysis. A total of 26% and 35% of males and females, respectively, perceived themselves as "too fat" while 20% and 9% identified as "too thin". Females perceiving themselves as "too fat" reported higher likelihoods of engaging in individual and scaled indicators of overt risk-taking. Conversely, among males, alternate weight perception was associated with lower levels of such behaviours.

CONCLUSION

As males and females perceive and react to weight perception differently, clinical and health promotion strategies should be developed and uniquely targeted to groups of adolescents in regards to weight perception and risk-taking.

Workplace sense of belonging and paramedic wellbeing using network analysis: A cross-sectional study

BACKGROUND

Workplace sense of belonging is an important contributor to health and wellbeing. It may be even more important for paramedics to buffer against distress inherent in the workplace. To date, however, there has been no research on paramedic workplace sense of belonging and wellbeing.

METHODS

Using network analysis, this study aimed to identify the dynamic relationships of workplace sense of belonging in paramedics with variables associated with wellbeing and ill-being-identity, coping self-efficacy and unhealthy coping. Participants were a convenience sample of 72 employed paramedics.

RESULTS

The results showed workplace sense of belonging linked to other variables through distress, distinguishable by the relationship with unhealthy coping for wellbeing and ill-being. The relationships between identity (perfectionism and sense of self) as well as the relationship between perfectionism and unhealthy coping were stronger for those with ill-being than observed for those with wellbeing.

CONCLUSIONS

These results identified the mechanisms by which the paramedicine workplace can contribute to distress and unhealthy coping strategies, which can lead to mental illnesses. They also highlight contributions of individual components of sense of belonging highlighting potential targets for interventions to reduce the risk of psychological distress and unhealthy coping amongst paramedics in the workplace.

Mental Health Workers' Knowledge and Attitude Towards Borderline Personality Disorder: A Saudi Multicenter Study

Background Borderline personality disorder (BPD) is a mental illness characterized by emotional instability. Its prevalence can be as high as 1.8% among the general population. Poor knowledge and negative perceptions of the disorder by mental health workers (MHWs) can affect patients' care and their help-seeking behavior. This study aims to explore MHW's knowledge and attitudes toward BPD. Method A cross-sectional study was conducted on MHWs across the five regions of Saudi Arabia (SA) using a questionnaire that assessed knowledge, attitude, and training regarding BPD. Results  Data collected from 1028 MHWs showed a good knowledge level. Superior knowledge was observed among females, residents in the central region, physicians, those who received specific BPD training, and MHWs who had more experience and frequent interactions with BPD patients. Participants had moderate to high levels of perceived knowledge and confidence regarding the identification, assessment, and management of BPD patients. Undergraduate training programs were the most reported source of information on the disorder. While 66% of participants admitted that they find dealing with BPD patients more difficult and thought patient management was inadequate, 71% were willing to attend further BPD training. Conclusion MHWs in SA have moderate knowledge of but negative perceptions of BPD; specific training is needed to improve the care provided for BPD patients.

Understanding the Needs of Primary School Teachers in Supporting Their Students' Emotion Regulation

BACKGROUND

Accumulating evidence has underscored the importance of fostering children's emotion regulation (ER) within primary school settings and the role of teachers in such efforts. This study sought to assess the needs of teachers in supporting students' ER, through a better understanding of teachers' perceptions and use of healthy versus unhealthy ER strategies in the classroom.

METHODS

Primary school teachers (n = 212; 91% female) completed an online, researcher-developed needs assessment survey assessing their perceptions regarding the importance of ER instruction and challenges surrounding children's ER, as well as the perceived effectiveness and reported use of healthy and unhealthy ER strategies in the classroom.

RESULTS

Cochran's Q and chi-square analyses revealed misperceptions regarding the effectiveness of healthy and unhealthy strategies, as well as discrepancies between teachers' perceptions regarding the effectiveness of specific healthy strategies (eg, meditation) and their reported use of them.

CONCLUSIONS

While teachers recognize the growing importance of fostering ER in the classroom, the present findings suggest that there is a need for more professional development regarding the effectiveness and implementation of ER strategies in the primary school context. Efforts should be made to provide teachers with concrete recommendations for the implementation of ER strategies in the classroom.

A Qualitative Study of Self and Caregiver Perspectives on How Autistic Individuals Cope With Trauma

Background

Coping can moderate the relationship between trauma exposure and trauma symptoms. There are many conceptualisations of coping in the general population, but limited research has considered how autistic individuals cope, despite their above-average rates of traumatic exposure.

Objectives

To describe the range of coping strategies autistic individuals use following traumatic events.

Methods

Fourteen autistic adults and 15 caregivers of autistic individuals, recruited via stratified purposive sampling, completed semi-structured interviews. Participants were asked to describe how they/their child attempted to cope with events they perceived as traumatic. Using an existing theoretical framework and reflexive thematic analysis, coping strategies were identified, described, and organized into themes.

Results

Coping strategies used by autistic individuals could be organized into 3 main themes: (1) Engaging with Trauma, (2) Disengaging from Trauma, and (3) Self-Regulatory Coping. After the three main themes were developed, a fourth integrative theme, Diagnostic Overshadowing, was created to capture participants' reports of the overlap or confusion between coping and autism-related behaviors.

Conclusions

Autistic individuals use many strategies to cope with trauma, many of which are traditionally recognized as coping, but some of which may be less easily recognized given their overlap with autism-related behaviors. Findings highlight considerations for conceptualizing coping in autism, including factors influencing how individuals cope with trauma, and how aspects of autism may shape or overlap with coping behavior. Research building on these findings may inform a more nuanced understanding of how autistic people respond to adversity, and how to support coping strategies that promote recovery from trauma.

Perceived Work Ability: A Constant Comparative Analysis of Workers’ Perspectives

Perceived work ability, or one’s perceived ability to continue working in their current job, is important to understand in order to inform efforts to retain talent and promote worker well-being. The current study offers a unique contribution by taking an inductive approach, giving participants voice to describe their own work ability experiences. Participants (N = 301) who were working at least 30 h a week in the U.S. and reported one or more hindrances to work ability responded to four open-ended questions about hindrances to work ability, individual strategies for maintaining work ability, and employer supports for maintaining work ability. Using constant comparative analysis, we corroborated existing work ability research and theory, along with unique contributions that enhance our understanding of perceived work ability. Notably, non-work demands, such as family obligations and lack of financial resources are under-examined, yet emerged as important work ability hindrances in this study. We also uncovered several personal strategies to help maintain WA (e.g., maintaining health and using work strategies to optimize functionality) that are dependent upon available job resources (e.g., support, autonomy, and flexibility). Ultimately, job resources of support, job control, and flexibility emerged as the most powerful leverage points for organizations to help workers maintain WA. Findings suggest that future efforts to support workers’ work ability should include these resources.

How do paramedics and student paramedics cope? A cross-sectional study

Despite threats to wellbeing inherent in paramedicine, little is known about how paramedics cope. This study explored the breadth of healthy and unhealthy coping strategies used by paramedics and student paramedics. A convenience sample of 198 paramedics and student paramedics completed an online survey. Wellbeing was measured using WHO-5 and coping using the Coping Index. Primary outcomes were summarised using descriptive statistics. Most of the sample had wellbeing (68%); student paramedics had significantly better wellbeing than paramedics. There was no significant difference between paramedics and student paramedics on healthy or unhealthy coping. Participants with ill-being had significantly fewer healthy and more unhealthy coping strategies than those with wellbeing, and relatively few used professional support (28%). Internationally, few studies have reported coping strategies in paramedics. This study expands our understanding of healthy and unhealthy coping strategies used by paramedics and student paramedics. The results support research that shows paramedic work affects wellbeing, however not that paramedics are at greater risk of unhealthy coping than students or the general population. The results have implications for both the prevention of overwhelming distress in the workplace and the need to increase the use of professional support to prevent unhealthy coping, including suicidality.

The modifiable biopsychosocial drivers of psychological distress for adolescents with asthma: Implications for Clinical Care

PURPOSE

Overwhelming distress exceeds the capacity of healthy coping strategies to feel better using healthy coping strategies alone, resulting in the use of unhealthy coping strategies. Unhealthy coping strategies may exacerbate asthma symptoms and asthma can contribute to overwhelming distress. This study aimed to review the modifiable drivers of overwhelming distress in adolescents with asthma.

METHODS

The biopsychosocial drivers of psychological distress for adolescents with asthma were explored within the domains of the modifiable biopsychosocial model of health and wellbeing.

RESULTS

Asthma in adolescents is associated with problems in the domains of environment, developmental outcomes, sense of belonging, health behaviours, coping, and treatment of illness.

CONCLUSIONS

The relationship between asthma and psychological distress highlights the need for holistic treatment of asthma. Further research is needed to establish causation between variables and to investigate whether interventions that address either asthma symptoms or biopsychosocial drivers of distress can improve both factors.

How do paramedics cope? A scoping review

Exposure to repeated trauma is an inherent component of paramedicine. Additionally, paramedics are exposed to threats that can undermine healthy workplaces, social connectedness, and health behaviour, predisposing them to overwhelming distress and unhealthy coping, including suicidality and psychiatric disorders. This scoping review aimed to identify how paramedics cope. PubMed, PsycINFO and CINAHL were searched between January 1, 2010, to April 21, 2021. Studies were included if they used any research design to identify specific coping strategies used by paramedics. Three studies met the inclusion criteria-two qualitative and one cross-sectional survey design. There was a high risk of bias across all studies. Studies were conducted in Israel, Poland, and the UK, primarily with males. Two studies only identified healthy coping strategies-self-soothing and social and professional support. Unhealthy strategies identified in the third study were limited to negative self-talk and alcohol use, with no mention of other harmful behaviours, social withdrawal, or suicidality. There is limited research describing how paramedics cope, and in particular, how female paramedics cope. Further research exploring the breadth of coping strategies used by paramedics is needed to understand the impact of the work paramedics undertake on coping and inform prevention and support activities.

Mental health and coping strategies during the COVID-19 pandemic: A qualitative study of unemployed and employed people in Nigeria

The coronavirus disease 2019 (COVID-19) significantly disrupted human activities all over the world. Despite this, little or nothing is known about mental health and coping strategies during the COVID-19 pandemic among the unemployed and employed people in Nigeria. Therefore, this study was an effort towards bridging this knowledge gap. We employed a qualitative design with 66 participants (age range = 18-62 years) who described how the COVID-19 pandemic affected their mental health and how they coped during the COVID-19 pandemic. The data were analyzed using thematic analysis. Our findings revealed distressing impacts (e.g., depressive and anxious impacts, stress, loss of job, financial challenges, loneliness, etc.) for the unemployed and employed groups. Further, the unemployed group utilized more positive coping strategies (e.g., engaging in activities, hope, relaxation, connecting with others, etc.) than the employed group; whereas, only the employed group utilized a maladaptive coping strategy (alcohol consumption). These data have practical implications for protecting mental health and fostering positive coping in these groups during and beyond the COVID-19 pandemic.

The Experiences of Mid-career and Seasoned Orchestral Musicians in the UK During the First COVID-19 Lockdown

The introduction of social distancing, as part of efforts to try and curb the spread of the COVID-19 pandemic, has brought about drastic disruption to the world of the performing arts. In the UK the majority of professional orchestral musicians are freelance and therefore self-employed. These players, previously engaged in enjoyable, busy, successful, portfolio careers, are currently unable to earn a living carrying out their everyday work of performing music, and their future working lives are surrounded by great uncertainty. The aim of the present study was to examine how established professional musicians are experiencing this period, and to look for similarities and differences between the experiences of musicians in the middle of their performing careers (aged 35-45), with those of older players (aged 53 and over). Single semi-structured interviews were carried out over Zoom with 24 freelance, self-employed orchestral musicians; 12 mid-career musicians aged 35-45, and 12 seasoned musicians aged 53 and over. Thematic analysis identified themes common to both groups: the loss of a much-loved performing career, missing music making and colleagues, and anxiety about the future of the music profession. It also identified differences between the two groups: challenges to their identity as a musician, the extent of their anxiety about finances, the extent of their emotional distress, attitudes toward practicing and engaging in collaborative music making, and confusion over future career plans. Findings are discussed with reference to lifespan models of musicians' career development, the PERMA model of wellbeing, and the concept of resilience.

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

BACKGROUND

Structural stigma in health systems experienced by consumers diagnosed with Borderline Personality Disorder (BPD) is a widespread phenomenon that causes major health inequities and harm for this population. Structural stigma in this context relates to institutional policies, cultural norms, and organizational practices that limit consumers' access to health services, quality of care, and capacity to achieve optimal health and well-being. BPD is a serious mental illness with high morbidity and mortality, characterized by instability in interpersonal relationships, self-image, and emotional and behavioral deregulation, which stem from significant traumatic childhood/life events, and/or biological etiologies. The objectives of this scoping review are to explore the international literature on structural stigma in healthcare systems specific to BPD, and to provide an overview of the impact of structural stigma on health services for BPD consumers and their carers/families.

METHODS

This scoping review will follow the Joanna Briggs Institute (JBI) scoping review guidelines. We will search the following electronic databases (from inception onwards): MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI-Evidence databases. Grey literature will be identified through the Google search engine. We will include all types of literature in English, published and unpublished, including any study design, reviews, clinical practice guidelines, policy reports, and other documents. No restrictions on publication date of sources of evidence will be applied. International literature should examine structural stigma associated with BPD in any healthcare setting such as, outpatients, inpatients, primary health care, or community-based facilities. Two reviewers will independently screen all titles, abstracts, and full-text citations. Quality appraisal of the included sources of evidence will be assessed using the Mixed Methods Appraisal Tool (MMAT) 2018 version. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., thematic analysis) methods.

DISCUSSION

This review is anticipated to enhance both identification and understanding of those structures in health systems (i.e., institutional policies, cultural norms, and practices) that manifest and perpetuate stigma experienced by consumers with BPD and their carers/families. The findings can be used to inform future research, policy, and practice relating to stigma reduction strategies that can be adopted to improve the provision of BPD-responsive services and care for this population.

SYSTEMATIC REVIEW REGISTRATION

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