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Moxham L, Tapsell A, Perlman D, Al Mutair A, Al-Sagarat AY, Alsaraireh FA, Chung MH, Jose TT, Kuo SY, Liu MF, Nayak AK, Shamsan A, Sudhakar C, Tsai HT, Velayudhan B, Yang CY, Roberts MM, Yeh PM, Patterson C. Nursing students' attitudes towards mental illness: A multi-national comparison. J Psychiatr Ment Health Nurs 2024. [PMID: 38532682 DOI: 10.1111/jpm.13048] [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: 08/16/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
Accessible Summary What is known on the subject Health professionals, including nurses, are shown to have stigmatizing attitudes towards mental illness. For nursing students who are in their formative years of professional development, mental illness stigma can severely impact the care they provide. Little research has investigated multi-national comparisons of nursing students' attitudes towards mental illness. What this paper adds to existing knowledge This study shows that between countries, there were substantial differences amongst nursing students in stigmatizing attitudes towards mental illness. Cultural perspectives may explain some of these differences. What are the implications for practice Regardless of location, stigmatizing attitudes are present at varying levels. Each nation can take steps to reduce these by acknowledging the presence of stigmatizing attitudes amongst nurses, educating nurses regarding the negative impacts of stigma on patient outcomes, and decrease stigmatizing attitudes by facilitating opportunities for nurses (particularly student nurses) to have direct contact with people with lived experiences of mental illness. ABSTRACT INTRODUCTION: Stigmatizing attitudes perpetuated by nursing professionals are a pervasive problem for people experiencing mental health issues. This global issue has detrimental consequences; inhibiting one's life chances and help-seeking behaviours. To date, few studies have compared nursing students' attitudes towards mental illness from a multi-national perspective. AIM To compare undergraduate nursing students' attitudes towards mental illness across six countries: Australia, India, Jordan, Saudi Arabia, Taiwan and USA. METHOD In a cross-sectional design, data were collected from undergraduate nursing students (N = 426) using the Social Distance Scale. A one-way analysis of variance was used to compare differences between countries. RESULTS Nursing students' attitudes to mental illness differed between countries. Social Distance Scores were highest amongst nursing students from Jordan and Saudi Arabia. Students from Taiwan and India possessed moderate stigma scores. Social Distance Scores from the USA and Australia were lowest. DISCUSSION Clear differences in stigmatizing attitudes emerged between countries; these are discussed in relation to possible cultural influences. IMPLICATIONS FOR PRACTICE It is suggested that educating nurses, combined with direct contact with people with lived experiences of mental illness, can reduce stigmatizing attitudes regardless of country, location or educational institution.
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Affiliation(s)
- Lorna Moxham
- School of Nursing, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Amy Tapsell
- University of Sydney Business School, University of Sydney, Sydney, New South Wales, Australia
| | - Dana Perlman
- School of Education, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Abbas Al Mutair
- Dr Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
- College of Health Sciences, University of Sharjah, University City - Sharjah, Sharjah, United Arab Emirates
| | - Ahmad Yahya Al-Sagarat
- Community and Mental Health Nursing Department, Faculty of Nursing, Mutah University, AL-Karak, Jordan
| | - Faris A Alsaraireh
- Community and Mental Health Nursing Department, Faculty of Nursing, Mutah University, AL-Karak, Jordan
| | - Min-Huey Chung
- College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Tessy Treesa Jose
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Karnataka, India
| | - Shu-Yu Kuo
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Megan F Liu
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Asha K Nayak
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Karnataka, India
| | - Abbas Shamsan
- Dr Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Christopher Sudhakar
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Karnataka, India
| | - Hsiu-Ting Tsai
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Binil Velayudhan
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Karnataka, India
| | - Chyn-Yng Yang
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Michelle M Roberts
- School of Nursing, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pi-Ming Yeh
- College of Nursing, East Tennessee State University, Johnson City, Tennessee, USA
| | - Christopher Patterson
- School of Nursing, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Francis-Oliviero F, Driollet B, Alla F. Pediatric health professionals' perceptions of social health inequalities and proportionate universalism in a French academic hospital: a qualitative study. Eur J Pediatr 2023:10.1007/s00431-023-05005-0. [PMID: 37171520 PMCID: PMC10176283 DOI: 10.1007/s00431-023-05005-0] [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: 11/24/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
To describe healthcare professionals' perceptions of social health inequalities in the context of pediatric chronic disease and their insights regarding proportionate universalism as a potential solution to reduce them. Semi-directive interviews were conducted with healthcare professionals from different pediatric chronic disease departments of a single French academic hospital. This qualitative study was based on an inductive thematic analysis; an interview topic guide was used for the interviews and the analysis. In this study, we highlighted three main themes: the healthcare professionals' perceptions of social health inequalities in their practices, their beliefs regarding the causality of those inequalities, and potential solutions proposed by healthcare professionals to reduce them. Healthcare professionals very often associated inequalities with socio-economic precariousness or geographical disparities but were not familiar with the notion of a social gradient. Paradoxically, while they claimed not to differentiate among patients in their practice, they did report adapting care, depending on the social situation. For healthcare professionals, inequalities were the result of misunderstood problems, a lack of family support, a failure of the prevention system, and a lack of financial resources. CONCLUSION We still need to develop solutions to tackle those inequalities at every level of the healthcare system, and healthcare professionals must be more actively involved in this effort. One approach is to adapt public health principles such as proportionate universalism to individual care. WHAT IS KNOWN • Social health inequalities exist in pediatric care and a social gradient has been shown in many clinical situations. • Exploring health professionals' perceptions of social health inequalities can lead to solutions to tackle them. WHAT IS NEW • Pediatricians and pediatric nurses were not fully aware of the social gradient of health. • Although they claimed not to differentiate between patients in their practice, healthcare professionals did adapt care when complicated social situations arose.
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Affiliation(s)
- Florence Francis-Oliviero
- Centre INSERM U1219, University of Bordeaux, ISPED, Bordeaux Population Health, Bordeaux, France.
- Pôle de Santé Publique, Service d'Information Médicale, CHU de Bordeaux, Bordeaux, France.
| | - Bénédicte Driollet
- Centre INSERM U1219, University of Bordeaux, ISPED, Bordeaux Population Health, Bordeaux, France
| | - François Alla
- Centre INSERM U1219, University of Bordeaux, ISPED, Bordeaux Population Health, Bordeaux, France
- Pôle de Santé Publique, Service de Soutien Méthodologique et d'Innovation en Prévention, CHU de Bordeaux, Bordeaux, France
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Martínez-Martínez C, Esteve-Claramunt F, Prieto-Callejero B, Ramos-Pichardo JD. Stigma towards Mental Disorders among Nursing Students and Professionals: A Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031839. [PMID: 35162862 PMCID: PMC8835101 DOI: 10.3390/ijerph19031839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 01/25/2023]
Abstract
Stigma is one of the main barriers to prevention, treatment and recovery from mental illness. However, bibliometric studies in this area are still scarce. Therefore, our aim was to quantify and analyze the scientific literature on the stigma of nursing students and professionals towards mental disorders. To this purpose, bibliometric indicators of scientific production, impact and collaboration were used. Among our results, it stands out that only 14.3% of the total number of studies analyzed measure the efficacy of the interventions carried out to reduce stigma. Furthermore, with exceptions such as Happell B and Byrne L, collaborations between authors and institutions are limited. “Service user involvement” appeared as a prominent keyword in 2018, coinciding with the increase in publications on the effectiveness of interventions. Interventions based on the involvement of people with psychiatric diagnoses in the design of nursing curricula seem to become a promising line of research. More studies measuring the efficacy of such interventions are needed. Knowledge of the lines of research that are being developed and of the researchers and institutions involved can contribute to creating synergy between the different researchers and to continue adding projects to the existing ones, thus contributing to the generation of more robust results that show the most indicated interventions to reduce the still present stigma and improve care for people with psychiatric diagnoses.
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Affiliation(s)
| | - Francisca Esteve-Claramunt
- Department of Nursing, Faculty of Health Sciences, Universidad Europea de Valencia, 46010 Valencia, Spain;
- Correspondence:
| | - Blanca Prieto-Callejero
- Nursing Department, University of Huelva, 21004 Huelva, Spain; (B.P.-C.); (J.D.R.-P.)
- Hospital Virgen de la Bella (Lepe), 21440 Huelva, Spain
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Sølvhøj IN, Kusier AO, Pedersen PV, Nielsen MBD. Somatic health care professionals' stigmatization of patients with mental disorder: a scoping review. BMC Psychiatry 2021; 21:443. [PMID: 34493245 PMCID: PMC8424966 DOI: 10.1186/s12888-021-03415-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/06/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals' stigmatization toward patients with mental disorders. METHODS We conducted a scoping review using Arksey and O'Malley's framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May-June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008-2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo. RESULTS A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions. CONCLUSIONS The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.
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Affiliation(s)
- Ida Nielsen Sølvhøj
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Denmark.
| | - Amalie Oxholm Kusier
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Pia Vivian Pedersen
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Maj Britt Dahl Nielsen
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
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Martínez-Martínez C, Sánchez-Martínez V, Ballester-Martínez J, Richart-Martínez M, Ramos-Pichardo JD. A qualitative emancipatory inquiry into relationships between people with mental disorders and health professionals. J Psychiatr Ment Health Nurs 2021; 28:721-737. [PMID: 33351223 DOI: 10.1111/jpm.12727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/27/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: A therapeutic alliance with people with mental disorders could help increase the efficacy of treatment. The paradigm shift from a paternalistic model to one that respects the person's autonomy has led to professionals accepting the active role of people with mental disorders making decisions that affect their treatment. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: People with mental disorders perceive paternalistic and stigmatizing attitudes from health professionals, and they do not feel involved in decisions about their health, which can render effective therapeutic alliances difficult. The findings reveal that although people in Mediterranean countries are used to paternalistic treatment from health professionals due to cultural factors, people with mental disorders are increasingly critical of how they are treated and demand greater autonomy and respect in the decision to undergo drug therapy. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: In their interactions with people with mental disorders, health professionals should include efforts aimed at improving shared decision-making capabilities and avoiding paternalistic or stigmatizing attitudes. ABSTRACT: Introduction A therapeutic alliance with people is essential for the efficacy of treatments. However, the traditional paternalistic values of the Mediterranean society may be incompatible with patient autonomy. Aim To explore the therapeutic relationship from the perspective of people diagnosed with mental disorders with health professionals, including nurses. Methods This emancipatory research was performed through focus groups, with people with mental disorders who had a variety of diagnoses and experiences of acute and community-based mental health services and other healthcare services. Data were analysed using the content analysis method. Results Four main themes emerged: stereotypes and prejudice; quality of interactions and treatment; emotional and behavioural impacts; and demands. Discussion According to the participants' descriptions, health professionals are not exempt from prejudice against persons with psychiatric diagnoses. They reported experiencing abuse of power, malpractice, and overmedication. Thus, in the Mediterranean culture, professional attitudes may represent a barrier for an appropriate therapeutic alliance, and people with mental disorders do not feel involved in making decisions about their health. Implications for practice Knowing how people with mental disorders perceive their interactions with health professionals and the effects is necessary to move the care model towards more symmetric relationships that facilitate a therapeutic alliance.
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Affiliation(s)
- Concepción Martínez-Martínez
- Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad Europea, Valencia, Spain.,Faculty of Nursing and Podiatry University of Valencia, Valencia, Spain
| | | | | | - Miguel Richart-Martínez
- Nursing Department, Health Sciences Faculty, University of Alicante, San Vicente del Raspeig, Spain
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Patterson C, Perlman D, Moxham L, Sudhakar C, Nayak AK, Velayudhan B, Jose TT, Tapsell A. Australian and Indian nursing students' skills and attitudes surrounding mental illness: Preparing for a transnational nursing education collaboration. Nurse Educ Pract 2020; 50:102909. [PMID: 33285402 DOI: 10.1016/j.nepr.2020.102909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/11/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022]
Abstract
Cultural competence is a viewed as a necessary set of skills within nursing, and there is a need for student support in this area. This is particularly important in mental health care, with two skills considered crucial for providing quality care: therapeutic relationship skills and positive attitudes. With the objective of initiating an educational collaboration between two educational institutions, this study examined Australian and Indian undergraduate nursing student's perceived therapeutic relationship skills and stigma attitudes associated with mental illness. Participants were five hundred and fifty-five (n = 555) undergraduate nursing students from two different universities in Indian and Australia. The modified version of the Scale To Assess Therapeutic Relationship (STAR-C) and the Social Distance Scale (SDS) were both used to examine student's perceived therapeutic relationship skills and stigma attitudes. Australian nursing students indicated lower levels of stigma with lower levels of self-reported therapeutic relationships skills, as compared with the Indian nursing student cohort. However, Indian nursing students indicated higher levels of stigma with higher self-reported therapeutic relationship skills. The results of this study may reflect cultural differences and meanings attached to mental illness.
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Affiliation(s)
- Christopher Patterson
- School of Nursing, Faculty of Science Medicine and Health, University of Wollongong Northfields Avenue, NSW, 2522, Australia.
| | - Dana Perlman
- School of Education, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Lorna Moxham
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Christopher Sudhakar
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Karnataka, 576104, India
| | - Asha K Nayak
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Karnataka, 576104, India
| | - Binil Velayudhan
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Karnataka, 576104, India
| | - Tessy Treesa Jose
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Karnataka, 576104, India
| | - Amy Tapsell
- Global Challenges Program, Research and Innovation Division, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
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da Silva AG, Baldaçara L, Cavalcante DA, Fasanella NA, Palha AP. The Impact of Mental Illness Stigma on Psychiatric Emergencies. Front Psychiatry 2020; 11:573. [PMID: 32636773 PMCID: PMC7319091 DOI: 10.3389/fpsyt.2020.00573] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/03/2020] [Indexed: 01/06/2023] Open
Abstract
Psychiatric emergencies are severe behavioral changes secondary to worsening mental illness. Such situations present a risk to the patient and other people, so they need immediate therapeutic intervention. They are associated with feelings of fear, anger, prejudice, and even exclusion. The attitudes of professionals and factors related to the workplace culture in health can help to perpetuate stereotypes and interfere with the quality of care. Stigma has undesirable consequences in patients with mental disorders. Certain measures can reduce stigma and provide a more dignified way for patients to recover from the crisis. This article aims to discuss the causes of stigma, ways of dealing with it, and achievements that have been made in psychiatric emergency care settings.
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Affiliation(s)
- Antônio Geraldo da Silva
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Associação Brasileira de Psiquiatria, Rio de Janeiro, Brazil.,Asociación Psiquiátrica de América Latina
| | - Leonardo Baldaçara
- Associação Brasileira de Psiquiatria, Rio de Janeiro, Brazil.,Asociación Psiquiátrica de América Latina.,Medicine, Universidade Federal do Tocantins, Palmas, Brazil
| | - Daniel A Cavalcante
- Department of Psychiatry, Interdisciplinary Laboratory in Clinical Neuroscience (LiNC), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,GAPi (Early Psychosis Group), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Martínez-Martínez C, Sánchez-Martínez V, Sales-Orts R, Dinca A, Richart-Martínez M, Ramos-Pichardo JD. Effectiveness of direct contact intervention with people with mental illness to reduce stigma in nursing students. Int J Ment Health Nurs 2019; 28:735-743. [PMID: 30693628 DOI: 10.1111/inm.12578] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Abstract
People with mental illnesses are at a higher risk than the general population of suffering from somatic diseases. However, they receive less attention from healthcare services. Some studies have indicated that this situation can be partially explained by the stigmatizing attitudes of health professionals, including nurses. With the objective to improve future nursing professionals' attitudes towards people with mental illnesses, an intervention involving direct contact with people who had lived experience with mental illnesses was designed and its effectiveness was measured. It consisted of a single 90-min session involving a mental health professional, a person with a mental illness, and a family member of someone with a mental illness. The intervention was based on a structured script where they described their experiences with the illness and their history of recovery, and then, they had a discussion with the attendees. The effectiveness of this approach was measured through a quasi-experimental study with a pretest-post-test design. The differences in the scores obtained in the AQ-27-E questionnaire before and after the intervention indicated that there was a decrease in fear, feelings of danger, avoidance, segregation, and coercive attitudes, while positive feelings increased, including a tendency to help and compassion. These results are important for clinical practice because this intervention could improve the quality of care provided to people with mental illnesses.
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Affiliation(s)
| | | | | | - Andra Dinca
- Técnico de Integración Social de ASIEM (Association for the Integral Health of People with M.D.), Spain
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FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 2017; 18:19. [PMID: 28249596 PMCID: PMC5333436 DOI: 10.1186/s12910-017-0179-8] [Citation(s) in RCA: 1125] [Impact Index Per Article: 160.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/14/2017] [Indexed: 02/06/2023] Open
Abstract
Background Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. Methods PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were examined to identify further eligible studies. Results Forty two articles were identified as eligible. Seventeen used an implicit measure (Implicit Association Test in fifteen and subliminal priming in two), to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. Discussion The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Conclusions Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed.
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Affiliation(s)
- Chloë FitzGerald
- Institute for Ethics, History, and the Humanities, Faculty of Medicine University of Geneva, Genève, Switzerland.
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, Faculty of Medicine University of Geneva, Genève, Switzerland
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Henderson C, Noblett J, Parke H, Clement S, Caffrey A, Gale-Grant O, Schulze B, Druss B, Thornicroft G. Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry 2014; 1:467-82. [PMID: 26361202 DOI: 10.1016/s2215-0366(14)00023-6] [Citation(s) in RCA: 350] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This Review considers the evidence for mental-health-related stigma in health-care and mental-health-care settings. Do mental-health-care and other health-care professionals stigmatise people using their services? If so, what are the effects on quality of mental and physical health care? How can stigma and discrimination in the context of health care be reduced? We show that the contact mental-health-care professionals have with people with mental illness is associated with positive attitudes about civil rights, but does not reduce stigma as does social contact such as with friends or family members with mental illness. Some evidence suggests educational interventions are effective in decreasing stigma especially for general health-care professionals with little or no formal mental health training. Intervention studies are needed to underpin policy; for instance, to decrease disparity in mortality associated with poor access to physical health care for people with mental illness compared with people without mental illness.
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Affiliation(s)
- Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Jo Noblett
- Springfield Hospital, South West London and St George's NHS Mental Health Trust, London, UK
| | - Hannah Parke
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sarah Clement
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alison Caffrey
- Springfield Hospital, South West London and St George's NHS Mental Health Trust, London, UK
| | | | - Beate Schulze
- Institute of Social Medicine, Occupational Medicine and Public Health, University of Leipzig, Atlanta, GA, USA
| | - Benjamin Druss
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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James BO, Omoaregba JO, Okogbenin EO. Stigmatising attitudes towards persons with mental illness: a survey of medical students and interns from southern Nigeria. Ment Illn 2012; 4:e8. [PMID: 25478110 PMCID: PMC4253366 DOI: 10.4081/mi.2012.e8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 02/13/2012] [Accepted: 03/21/2012] [Indexed: 11/25/2022] Open
Abstract
Stigmatising attitudes towards persons with mental illness are commonly reported among health professionals. Familiarity with mental illness has been reported to improve these attitudes. Very few studies have compared future medical doctors’ attitudes toward types of mental illness, substance use disorders and physical illness. A cross-sectional survey of 5th and 6th year medical students as well as recently graduated medical doctors was conducted in April 2011. The 12-item level of contact report and the Attitude towards Mental Illness Questionnaire were administered. Participants endorsed stigmatising attitudes towards mental illness; with attitudes more adverse for schizophrenia compared to depression. Stigmatising attitudes were similarly endorsed for substance use disorders. Paradoxically, attitudes towards HIV/AIDS were positive and similar to diabetes mellitus. Increasing familiarity with mental illness was weakly associated with better attitudes towards depression and schizophrenia. Stigmatising attitudes towards depression and schizophrenia are common among future doctors. Efforts to combat stigma are urgently needed and should be promoted among medical students and recent medical graduates.
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