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Őri D, Szocsics P, Molnár T, Motlova LB, Kazakova O, Mörkl S, Wallies M, Abdulhakim M, Boivin S, Bruna K, Cabaços C, Carbone EA, Dashi E, Grech G, Greguras S, Ivanovic I, Guevara K, Kakar S, Kotsis K, Ingeholm Klinkby IM, Maslak J, Matheiken S, Mirkovic A, Nechepurenko N, Panayi A, Pereira AT, Pomarol-Clotet E, Raaj S, Prelog PR, Soler-Vidal J, Strumila R, Schuster F, Kisand H, Reim A, Ahmadova G, Vircik M, Kafali HY, Grinko N, Győrffy Z, Rózsa S. Attitudes of psychiatrists towards people with mental illness: a cross-sectional, multicentre study of stigma in 32 European countries. EClinicalMedicine 2023; 66:102342. [PMID: 38149261 PMCID: PMC10749877 DOI: 10.1016/j.eclinm.2023.102342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/28/2023] Open
Abstract
Background Mental health-related stigma occurs among the public and professionals alike. The lived experience of mental illness has been linked to less stigmatising attitudes. However, data on psychiatrists and the relationship between stigmatising attitudes and psychotherapeutic activity or case discussion groups remains scarce. Methods A cross-sectional multicentre study was performed in 32 European countries to investigate the lived experiences and attitudes of psychiatrists toward patients with mental illness as well as the relationship between stigma, psychosocial and professional factors. The self-reported, anonymous, internet-based Opening Minds Stigma Scale for Health Care Providers was used to measure the stigmatising attitudes. The survey was translated into the local language of each participating country. All participants were practising specialists and trainees in general adult or child and adolescent psychiatry. The study took place between 2nd October, 2019 and 9th July, 2021 and was preregistered at ClinicalTrial.gov (NCT04644978). Findings A total of 4245 psychiatrists completed the survey. The majority, 2797 (66%), had completed training in psychiatry, and 3320 (78%) worked in adult psychiatry. The final regression model showed that across European countries more favourable attitudes toward people with mental illness were statistically significantly associated with the lived experience of participants (including seeking help for their own mental health conditions (d = -0.92, 95% confidence interval (CI) = -1.68 to -0.15, p = 0.019), receiving medical treatment for a mental illness (d = -0.88, 95% CI = -1.71 to -0.04, p = 0.040), as well as having a friend or a family member similarly affected (d = -0.68, 95% CI = -1.14 to -0.22, p = 0.004)), being surrounded by colleagues who are less stigmatising (d = -0.98, 95% CI = -1.26 to -0.70, p < 0.001), providing psychotherapy to patients (d = -1.14, 95% CI = -1.63 to -0.65 p < 0.001), and being open to (d = -1.69, 95% CI = -2.53 to -0.85, p < 0.001) and actively participating in (d = -0.94, 95% CI = -1.45 to -0.42, p < 0.001) case discussion, supervision, or Balint groups. Interpretation Our study highlights the importance of psychotherapy training, supervision, case discussions and Balint groups in reducing the stigmatising attitudes of psychiatrists toward patients. As the findings represent cross-national predictors, Europe-wide policy interventions, national psychiatric education systems and the management of psychiatric institutions should take these findings into consideration. Funding National Youth Talent Award (Ministry of Human Resources, Hungary, (NTP-NFTÖ-20-B-0134). All authors received no funding for their contribution.
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Affiliation(s)
- Dorottya Őri
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Department of Mental Health, Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Péter Szocsics
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Tamás Molnár
- Department of Psychiatry, Aladar Petz County Teaching Hospital, Győr, Hungary
| | - Lucie Bankovska Motlova
- Division of Medical Psychology, 3rd Faculty of Medicine, Charles University, Prague, The Czech Republic
| | - Olga Kazakova
- Inpatient Psychiatric Department #2, Psychiatric Clinic of Minsk City, Minsk, Belarus
| | - Sabrina Mörkl
- Division of Medical Psychology, Psychosomatics and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Sylvie Boivin
- Department of Child and Adolescent Psychiatry, EPSM du Finistère Sud, Quimper, France
| | - Krista Bruna
- Admission Ward, State Psychiatric Hospital Gintermuiza, Jelgava, Latvia
| | - Carolina Cabaços
- Psychiatry Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Institute of Psychological Medicine, Faculty of Medicine, Coimbra University, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Elvira Anna Carbone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Elona Dashi
- Department of Neuroscience, University Hospital Center “Mother Theresa”, Tirane, Albania
| | - Giovanni Grech
- Mental Health Services, Mount Carmel Hospital, Attard, Malta
| | - Stjepan Greguras
- Division of Child and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Iva Ivanovic
- Department for Child Psychiatry, Institute for Children's Diseases, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Kaloyan Guevara
- Acute Detoxification Ward, State Psychiatric Hospital for Treatment of Drug Addiction and Alcoholism, Sofia, Bulgaria
| | - Selay Kakar
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | | | - Ana Mirkovic
- Child Psychiatry Unit, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nikita Nechepurenko
- The Serbsky State Scientific Center for Social and Forensic Psychiatry, Moscow, Russian Federation
| | | | - Ana Telma Pereira
- Institute of Psychological Medicine, Faculty of Medicine, Coimbra University, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
| | - Shaeraine Raaj
- Department of General Adult Psychiatry, South Meath Mental Health Service, Co.Meath, Ireland
| | - Polona Rus Prelog
- Centre for Clinical Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia
| | - Joan Soler-Vidal
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
- Hospital Benito Menni, Complex Assistencial Salut Mental, Sant Boi de Llobregat, Spain
| | - Robertas Strumila
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Psychiatric Clinic, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Florian Schuster
- Klinikum Rechts der Isar der Technischen Universität München: Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Munich, Germany
| | | | - Ann Reim
- University of Tartu, Tartu, Estonia
| | - Gumru Ahmadova
- Department of Psychiatry, United City Hospital N15, Baku, Azerbaijan
| | - Matus Vircik
- Acute Psychiatric Department 1, Psychiatric Hospital Michalovce, Michalovce, Slovak Republic
| | - Helin Yilmaz Kafali
- Department of Psychology, Fevziye School Fundatitions, Işık University, Istanbul, Turkey
| | - Natalia Grinko
- Department of Clinical Psychology, Ukrainian Catholic University, Lviv, Ukraine
| | - Zsuzsa Győrffy
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Sándor Rózsa
- Department of Personality and Health Psychology, Károli Gáspár University of the Reformed Church, Budapest, Hungary
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Klinkby IMI, Hastrup LH, Bo S, Storebø OJ, Simonsen E, Kongerslev MT. Prevalence and incidence of personality disorders among children and adolescents in Danish mental health services: a nationwide register study. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02274-w. [PMID: 37566164 DOI: 10.1007/s00787-023-02274-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
A few epidemiological studies have examined personality disorders (PDs) among children and adolescents in secondary mental health services. This study aims to describe the prevalence and incidence of PDs among children and adolescents who have attended Danish child and adolescent psychiatric services (CAPS). Using register-based data, we studied all patients under the age of 18 years who were admitted to in- and outpatient CAPS (N = 115,121) in Denmark from 2007 to 2017. A total of 4952 patients were diagnosed with a PD during the study period. The mean prevalence was 859 patients per year, and the mean incidence was 274 patients per year, including an increased incidence and prevalence of borderline, anxious, and unspecified PDs over the decade. The number of patients diagnosed with PDs increased from 700 to 851 per year, but the proportion of patients with PDs compared to all psychiatric diagnoses decreased from 4.2% to 2.8% over the study period. The PD population had an older age (14.8 years vs. 11.3 years; p < 0.001), a higher likelihood of being female (74% vs. 44%; p < 0.001), and four times more contacts with the psychiatric emergency departments than other patients with a psychiatric diagnosis. Future studies should focus on (a) implementing further epidemiological studies in different countries; (b) tracking diagnostic practices to facilitate comparisons and provide feedback for training clinicians and raising awareness; and (c) estimating trajectories of PDs, including costs within the CAPS, to facilitate informed decision-making regarding the future organization and provision of services to these children, adolescents, and their families.
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Affiliation(s)
| | - Lene Halling Hastrup
- Psychiatric Research Unit, Mental Health Services Region Zealand, Slagelse, Denmark
- Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - Sune Bo
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Mental Health Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Erik Simonsen
- Research Unit, Region Zealand Mental Health Services East, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mickey T Kongerslev
- Department of Psychology, University of Southern Denmark, Odense, Denmark.
- Research Unit, Region Zealand Mental Health Services East, Roskilde, Denmark.
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Őri D, Szocsics P, Molnár T, Bankovska Motlova L, Kazakova O, Mörkl S, Wallies M, Abdulhakim M, Boivin S, Bruna K, Cabacos C, Carbone EA, Dashi E, Grech G, Greguras S, Ivanovic I, Guevara K, Kakar S, Kotsis K, Klinkby IMI, Maslak J, Matheiken S, Mirkovic A, Nechepurenko N, Panayi A, Pereira AT, Pomarol-Clotet E, Raaj S, Rus Prelog P, Soler-Vidal J, Strumila R, Schuster F, Kisand H, Hargi A, Ahmadova G, Vircik M, Yilmaz Kafali H, Grinko N, Győrffy Z, Rózsa S. Psychometric properties of the Opening Minds Stigma Scale for Health Care Providers in 32 European countries - A bifactor ESEM representation. Front Public Health 2023; 11:1168929. [PMID: 37361150 PMCID: PMC10285467 DOI: 10.3389/fpubh.2023.1168929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/17/2023] [Indexed: 06/28/2023] Open
Abstract
Aims To measure the stigma of healthcare providers toward people suffering from mental illness, the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a commonly applied instrument. However, this scale has not been thoroughly validated in many European countries, its psychometric properties are still unknown and data on practicing psychiatrists is lacking. Therefore, this multicenter study aimed to assess the psychometric characteristics of the 15-item OMS-HC in trainees and specialists in adult and child psychiatry in 32 countries across Europe. Materials and methods The OMS-HC was conducted as an anonymous online survey and sent via Email to European adult and child psychiatrists. Parallel analysis was used to estimate the number of OMS-HC dimensions. Separate for each country, the bifactor ESEM, a bifactor exploratory structural equation modeling approach, was applied to investigate the factor structure of the scale. Cross-cultural validation was done based on multigroup confirmatory factor analyses and reliability measures. Results A total of 4,245 practitioners were included, 2,826 (67%) female, 1,389 (33%) male. The majority (66%) of participants were specialists, with 78% working in adult psychiatry. When country data were analyzed separately, the bifactor model (higher-order factor solution with a general factor and three specific factors) showed the best model fit (for the total sample χ2/df = 9.760, RMSEA = 0.045 (0.042-0.049), CFI = 0.981; TLI = 0.960, WRMR = 1.200). The average proportion of variance explained by the general factor was high (ECV = 0.682). This suggests that the aspects of 'attitude,' 'disclosure and help-seeking,' and 'social distance' could be treated as a single dimension of stigma. Among the specific factors, the 'disclosure and help-seeking' factor explained a considerable unique proportion of variance in the observed scores. Conclusion This international study has led to cross-cultural analysis of the OMS-HC on a large sample of practicing psychiatrists. The bifactor structure displayed the best overall model fit in each country. Rather than using the subscales, we recommend the total score to quantify the overall stigmatizing attitudes. Further studies are required to strengthen our findings in countries where the proposed model was found to be weak.
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Affiliation(s)
- Dorottya Őri
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
- Department of Mental Health, Heim Pál National Pediatric Institute, Budapest, Hungary
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, United States
| | - Péter Szocsics
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Tamás Molnár
- Department of Psychiatry, Aladar Petz County Teaching Hospital, Győr, Hungary
| | - Lucie Bankovska Motlova
- Division of Medical Psychology, 3rd Faculty of Medicine, Charles University, Prague, Czechia
| | - Olga Kazakova
- Inpatient Psychiatric Department #2, Psychiatric Clinic of Minsk City, Minsk, Belarus
| | - Sabrina Mörkl
- Division of Medical Psychology, Psychosomatics and Psychotherapy, Medical University of Graz, Graz, Austria
| | | | | | - Sylvie Boivin
- Department of Child and Adolescent Psychiatry, EPSM du Finistère Sud, Quimper, France
| | - Krista Bruna
- Admission Ward, State Psychiatric Hospital Gintermuiza, Jelgava, Latvia
| | - Carolina Cabacos
- Psychiatry Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Elvira Anna Carbone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Elona Dashi
- Department of Neuroscience, University Hospital Center “Mother Theresa”, Tirana, Albania
| | - Giovanni Grech
- Mental Health Services, Mount Carmel Hospital, Attard, Malta
| | - Stjepan Greguras
- Department of Psychiatry and Psychological Medicine, Division of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Iva Ivanovic
- Department for Child Psychiatry, Clinical Centre of Montenegro, Institute for Children’s Diseases, Podgorica, Montenegro
| | - Kaloyan Guevara
- Acute Detoxification Ward, State Psychiatric Hospital for Treatment of Drug Addiction and Alcoholism, Sofia, Bulgaria
| | - Selay Kakar
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | | | | | - Ana Mirkovic
- Child Psychiatry Unit, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nikita Nechepurenko
- The Serbsky State Scientific Center for Social and Forensic Psychiatry, Moscow, Russia
| | | | - Ana Telma Pereira
- Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra, Portugal
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
| | - Shaeraine Raaj
- Department of General Adult Psychiatry, South Meath Mental Health Service, Meath, Ireland
| | - Polona Rus Prelog
- Centre for Clinical Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia
| | - Joan Soler-Vidal
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Salud Mental, Instituto de Salud Carlos III, Barcelona, Spain
- Hospital Benito Menni, Complex Assistencial Salut Mental, Sant Boi de Llobregat, Spain
| | - Robertas Strumila
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
- Psychiatric Clinic, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Florian Schuster
- Klinikum rechts der Isar der Technischen Universität München: Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Munich, Germany
| | | | | | - Gumru Ahmadova
- Department of Psychiatry, United City Hospital N15, Baku, Azerbaijan
| | - Matus Vircik
- Acute Psychiatric Department 1, Psychiatric Hospital Michalovce, Michalovce, Slovakia
| | - Helin Yilmaz Kafali
- Child and Adolescent Psychiatry, Sultanbeyli State Hospital, Istanbul, Türkiye
| | - Natalia Grinko
- Department of Clinical Psychology, Ukrainian Catholic University, Lviv, Ukraine
| | - Zsuzsa Győrffy
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Sandor Rózsa
- Department of Personality and Health Psychology, Károli Gáspár University of the Reformed Church, Budapest, Hungary
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