Stigmatizing attitudes of tertiary hospital physicians towards people with mental disorders in Saudi Arabia

Mental health stigma: a conundrum for healthcare practitioners in conservative communities

This paper presents perspectives on the stigma and shame around mental health in conservative communities, and some of the issues faced by health systems in those communities. The various causes of stigma are explored, and how these are often more pronounced in culturally reserved, conservative communities. While health systems are supposed to provide support for mental health sufferers, this stigma sometimes even extends to healthcare workers, which can discourage patients from asking for assistance. Solutions and reforms are needed, for example education programs; addressing gender norms, and the consideration of culture and religion, to form effective solutions. It is also suggested that alternative therapies and support mechanisms, including digital solutions such as artificial intelligence chatbots, may be useful to provide much needed support to individuals with poor mental health. Along with integrating options such as CBT (cognitive behavioral therapy), it may be useful to draw on indigenous psychologies, such as Islamic psychology, as a way of decolonizing approaches. Therefore, when considering solutions, cultural and religious norms must be considered to ensure their efficacy and acceptance.

Mental illness attitudes, service provision interest and further training preferences of clinical associates

BACKGROUND

 Non-specialist health professionals are required to provide mental health services given the burden of disease due to mental illness. The study aimed to explore the attitudes of clinical associates towards those with mental illness as well as their interest in mental health work and additional mental health training.

METHODS

 A cross-sectional study design was utilised. The study population consisted of clinical associates based in South Africa. An electronic questionnaire was developed that incorporated the 16-item Mental Illness Clinicians' Attitudes version 4 scale (MICA-4), which is scored out of 96 with higher scores indicating more stigmatising attitudes. Multivariate linear regression was used to determine factors associated with the MICA-4 score.

RESULTS

 The mean MICA-4 score for the 166 participants who completed all 16 questions was 37.55 (standard deviation 7.33). In multivariate analysis, the factors associated with significantly lower MICA-4 scores were falling in the 25- to 29-year-old age category and indicating that a mental health rotation formed part of the undergraduate degree. More than 80% of the participants (140/167, 83.8%) indicated an interest in mental health work. Two-thirds of the participants (111/167, 66.5%) indicated an interest in a specialisation in mental health.

CONCLUSION

 The mean MICA-4 score recorded for clinical associates indicates low stigma levels towards those with mental illness. Additionally, there is significant interest in working and training in mental health.Contribution: Training programmes should take note of the contribution of a mental health rotation to a positive attitude to mental health patients. Clinical associates' attitudes towards mental illness together with their interest in working and training in mental health suggest that they could be more widely utilised in mental health service provision.

Attitudes of Emergency Nurses toward Clients with Mental Illness: A Descriptive Correlational Study in a Nationwide U.S. Sample

Introduction: Individuals with mental illness often experience stigma from healthcare professionals, including emergency nurses. The purpose of this study was to identify personal and professional attributes of emergency nurses that may be related to their level of stigma toward people with mental illness in the U.S. Methods: Secondary analysis of a cross-sectional study to analyze emergency nurses' characteristics against their perceptions of stigma toward mental illness as measured by the Mental Illness: Clinicians' Attitudes Scale-4 (MICA v4). Data analyses consisted of descriptive statistics; stepwise linear regression; and analysis of the internal consistency of the MICA v4 in the current sample. Results: The mean MICA v4 scores for this sample were 53.4. The linear regression analysis revealed a significant model explaining 23.5% of the variance of MICA v4 scores (F[34] = 6.4, p < 0.001, R2 = 0.235). Many attributes were found to have a strong association with lower stigmatizing attitudes. Discussion: The results of this study indicated high levels of stigma toward individuals with mental illness. Findings from this study can inform nursing education and research, and ultimately improve the health outcomes of individuals with mental illness.

Stigmatizing attitudes toward mental disorders among non-mental health nurses in general hospitals of China: a national survey

Background

Negative attitudes of nurses toward mental disorders have been reported in various countries. Nurses' stigmatizing attitudes can harm patients with mental disorders (PWMD), thereby delaying the provision of help to patients and leading to decreased quality of care. In this study, we aimed to assess Chinese nurses' stigmatizing attitudes toward patients with mental illness and provide a basis for future development and testing of appropriate and culturally adapted interventions to reduce it.

Objective

This study aimed to assess the attitudes of Non-mental Health Nurses (NMHNs) in general hospitals in China toward the stigma of PWMD and determine the factors influencing them.

Methods

A cross-sectional survey of NMHNs in general hospitals were conducted. A self-designed WeChat-based questionnaire was used that included demographic information about the need for training on mental health issues. Participants were provided with a vignette of a depression case with suicidal thoughts. The Depression Stigma Scale (DSS) and Social Distance Scale (SDS) were used to assess attitudes toward mental disorders. Nine questions on the adequacy of knowledge about anxiety and depression and the current status of scale use were used to assess the current status of training needs for mental disorders. Descriptive analysis, chi-square test, and multivariate logistic regression were used for the table.

Results

A total of 8,254 nurses in non-mental health professions participated in this study. The mean DSS score of NMHNs was (17.24 ± 6.700), and the SDS score was (10.34 ± 3.154). The total detection rate of stigma among the survey respondents was 13.40% (1,107/8254). Multivariate logistic regression showed that age between 30 and 39 years [p = 0.001, OR = 1.427 (1.154-1.764)], 4 years of work experience and above [p = 0.018, OR = 1.377 (1.056-1.796)], having a bachelor's degree [p < 0.001, OR = 0.742 (0.647-0.851)], adequate psychological knowledge [p < 0.001, OR = 1.567 (1.364-1.799)], full knowledge of communication with patients with anxiety and depression [p < 0.001, OR = 1.848 (1.389-2.459)], and the need to acquire skills to identify anxiety and depression were the influencing factors associated with stigma [p < 0.001, OR = 0.343 (0.236-0.499)].

Conclusion

Stigmatizing attitudes toward PWMD exist among NMHNs in general hospitals in China. Thus, more mental health education programs for NMHNs are needed. Factors associated with higher morbidity stigma can be used to develop appropriate interventions to improve NMHNs' stigmatizing attitudes and provide better quality care to PWMD.

A Case of Panic Disorder Misdiagnosed as Epilepsy for 9 Years in a Young Male

Panic disorder can be misdiagnosed as epilepsy and vice versa, which, in turn, can impact the patient, their family, and the healthcare system. Here, we describe a rare case of a 22-year-old male with a 9-year history of misdiagnosed drug-resistant epilepsy. On presentation to our hospital, the patient's physical examination and other investigations were unremarkable. The attacks were reported to last for about 5-10 minutes and were related to interfamilial distress. He reported feeling anxious about having an attack, experiencing palpitations and sweating before and during episodes, feeling chest tightness, derealization, and fearing loss of control, based on which a diagnosis of panic disorder was made. The patient was treated with 12 sessions of cognitive behavioral therapy, following which all his antiepileptic medications were stopped over 8 weeks. The dose of sertraline was increased and maintained at 200 mg once daily and was gradually stopped after 6 months of remission. This case highlights that panic disorder should be considered as a differential diagnosis of epilepsy. This can be done through a cross-specialty referral, especially given that the clinical manifestations of hyperventilation syndrome can be diagnosed differently by neurologists, psychiatrists, and other specialists.

The comparative importance of mental and physical disorders for health-related days out of role in the general population of Saudi Arabia

Background

A major component of illness burden is role impairment. As part of the recently-completed Saudi National Mental Health Survey (SNMHS), we compare the number of days out of role in the Saudi population associated with ten core mental disorders assessed in the survey to those associated with ten commonly occurring chronic physical disorders.

Methods

The SNMHS was a household survey that assessed prevalence of ten common anxiety, mood, disruptive behavior, and eating disorders in a nationally representative sample of n = 1981 citizens of the Kingdom of Saudi Arabia (KSA) ages 15–65. Comparison information was obtained on prevalence of ten common chronic physical disorders and number of health-related days out of role (DOR) in the 30 days before interview. Generalized linear models were used to examine univariate and multivariable associations of disorders with DOR and to calculate population attributable risk (PAR) separately and overall for the disorders controlling for socio-demographics.

Results

19.9% of respondents had one or more of the selected mental disorders and 47.1% had one or more of the selected physical disorders. Nine mental disorders and two physical disorders were associated with increased DOR. PAR was 32.9% for mental disorders, 27.0% for physical disorders, and 59.9% for both combined.

Conclusions

Mental disorders are associated with a substantial proportion of all health-related DOR in the Kingdom of Saudi Arabia. Programs to detect and treat mental disorders might lead to substantially decreased role impairment in the Kingdom.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12721-z.

Healthcare Professionals' Attitudes Toward Patients With Mental Illness: A Cross-Sectional Study in Qatar

BACKGROUND

Negative attitudes toward mental illness by Health Care Professionals (HCP) have been reported in many countries across the world. Stigmatizing attitudes by HCP can have adverse consequences on people with mental illness from delays in seeking help to decreased quality of care provided. Assessing such attitudes is an essential step in understanding such stigma and, if needed, developing and testing appropriate and culturally adapted interventions to reduce it.

AIMS

To assess physicians and nurses attitudes toward mental illness and to determine associated factors with different levels of stigma.

METHODS

A cross-sectional survey was conducted among Physicians and Nurses. The Mental Illness Clinician's Attitudes (MICA) scale was used to assess attitudes toward mental illness. MICA scores range between 1 and 6 with higher values indicating higher stigmatizing attitudes. Demographic and work related information were also gathered. Descriptive statistics along with multivariate linear and multivariate logistic regression models were used.

RESULTS

A total of 406 nurses and 92 doctors participated in the study. The nurses' mean MICA score was significantly higher than that of the physicians. Among nurses, being Asian and working in a geriatric, rehabilitation and long-term care facility were associated with lower MICA scores. Among physicians, being female or graduating more than 1 year ago were also associated with lower MICA scores.

CONCLUSION

Stigmatizing attitudes toward people with mental illness by healthcare workers are present in Qatar. They are higher among nurses as compared to physicians. Factors associated with higher stigmatizing attitudes could be used in creating appropriate intervention to reduce the magnitude of the problem.

The Assessment of Attitudes of Medical Doctors towards Psychiatric Patients-A Cross-Sectional Online Survey in Poland

(1) Introduction: Stigmatization is a multi-level process leading to depreciation of particular social groups. It is particularly visible among people suffering from mental illnesses. Patient stigmatization is a serious problem in psychiatric care; thus, a reliable assessment of its level is important in the context of effective medical interventions. The aim of this paper is to assess the level of stigmatization of psychiatric patients among doctors. (2) Methods: An online, quantitative, CAWI (Computer Assisted Web Interview) study was conducted in the form of an anonymous, voluntary survey addressed to doctors working in Poland. The questionnaire questions included a socio-geographic assessment and questions assessing the level of stigmatization. A standardized psychometric tool, the MICA-4 Scale for doctors, was also used. The results obtained were compared with the evaluation of the existing reports on stigmatization among Polish society. (3) Results: 501 doctors of various specialties and at various stages of career participated in the study. Most of the respondents were women (75%). The average score of MICA-4 obtained by the respondents was 40.26 (minimum 17; maximum 67; SD 8.93). The women’s score was lower than the men’s (p = 0.034). (4) Conclusions: Stigmatization of psychiatric patients is a common phenomenon among doctors. The type of performed work and career stage has an impact on the perception of psychiatric patients. Specialists scored highest in the MICA-4 Scale, similarly to physicians of surgical fields. Due to the prevalence of the phenomenon of stigmatization, especially among people who are meant to provide patients with help, there is an urgent need to implement anti-stigma programs.