Experiences of stigma, discrimination and violence and their impact on the mental health of health care workers during the COVID-19 pandemic

Health care workers have been exposed to COVID-19 more than people in other professions, which may have led to stigmatization, discrimination, and violence toward them, possibly impacting their mental health. We investigated (1) factors associated with stigma, discrimination, and violence, (2) the association of stigma, discrimination, and violence with mental health, (3) everyday experiences of stigmatization, discrimination, and violence. We chose a combination of a quantitative approach and qualitative content analysis to analyze data collected at three time points: in 2020, 2021 and 2022. A higher age was associated with lower odds of experiencing stigma, discrimination, and violence, whereas female gender was related to more negative experiences. The intensity of exposure to COVID-19 was associated with greater experience with stigmatization, discrimination, and violence across all three years (for example in 2022: odds ratio, 95% confidence interval: 1.74, 1.18-2.55 for mild exposure; 2.82, 1.95-4.09 for moderate exposure; and 5.74, 3.55-9.26 for severe exposure, when compared to no exposure). Stigma, discrimination, and violence were most strongly associated with psychological distress in 2020 (odds ratio = 2.97, 95% confidence interval 2.27-3.88) and with depressive symptoms in 2021 (odds ratio = 2.78, 95% confidence interval 2.12-3.64). Attention should be given to the destigmatization of contagious diseases and the prevention of discrimination, violence, and mental health problems, both within workplaces and among the public.

"I Didn't Expect to Be So Caught Up in It": a Qualitative Study of Experiences of Medical Students' Volunteering for Ukrainian Refugees

OBJECTIVE

Russia's invasion of Ukraine in February 2022 triggered a huge wave of migration, with thousands of refugees arriving at Prague's Central Station. With no medical service available, medical students started to volunteer and were running an infirmary available around the clock. The research aimed to explore medical students' professional experiences, emotionally challenging situations, and coping strategies in this demanding setting.

METHODS

The authors used a qualitative analysis of semi-structured in-depth interviews with 19 participants recruited through purposive sampling. Interviews took place between April and May 2022. Data were recorded, transcribed, and processed by using thematic qualitative analysis.

RESULTS

The research identified five emotionally challenging situations: caring for traumatized refugees, refusal of treatment, disruption of everyday life, independent decision-making, and complexity of voluntary work. Students adopted both adaptive and maladaptive coping strategies for dealing with stress and trauma. Almost half the students reported signs of secondary traumatization and moral distress; however, no one asked for psychological help.

CONCLUSIONS

Medical school curricula should cover trauma-informed approaches, healthy coping strategies, and destigmatization of psychological problems.

Depression in healthcare workers during COVID-19 pandemic: results from Czech arm of HEROES Study

The pandemic due to COVID-19 brought new risks for depression of health care workers, which may have differently influenced men and women. We aimed to investigate (1) whether health care workers in Czechia experienced an increase in depression during the COVID-19 pandemic, (2) which factors contributed the most to this change, and (3) whether the magnitude of the associations differed by gender. We studied 2564 participants of the Czech arm of the international COVID-19 HEalth caRe wOrkErS (HEROES) Study. Online questionnaire was administered to health care workers in summer 2020 (wave 0) and spring 2021 (wave 1). Depression was defined by reaching 10 or more points on the Patient Health Questionnaire. Logistic regression investigated the association of participant´s characteristics with depression and multivariable decomposition for non-linear models assessed, to what extent the characteristic explained the change in depression occurrence. The prevalence of depression increased twice during the pandemic (11% in wave 0 and 22% in wave 1). Stress accounted for 50% of the difference, experience of death due to COVID-19 for 15% and contact with COVID-19 patients for 14%. Greater resilience and sufficient personal protective equipment were strongly associated with lower occurrence of depression. The protective association of resilience with depression was stronger in men than in women. We conclude that interventions to promote mental health of health care workers in future health crisis should aim at decreasing stress and enhancing resilience. They should be delivered especially to individuals who have contact with the affected patients and may face their death.

The Challenges of Inter-role Conflicts for Peer Support Workers

The definitions of the roles of peer support workers (PSWs) are unclear, creating one of the main challenges to PSWs' successful involvement in mental health care. In this empirical qualitative study conducted in the Czech Republic, four common roles of PSWs (N=15) were identified: friend, professional, staff member, and expert-by-experience. Conflicts were observed between the roles of friend and professional and between staff member and expert-by-experience. These conflicts may have a detrimental effect on the PSWs' well-being. The authors therefore call on organizations to prioritize regular supervision, team education, clear definition of the PSW position within an organization, and the destigmatization of people with mental illness in mental health services.

Medical Students' Career Choice and Attitudes Toward Psychiatry: Case of the Czech Republic

OBJECTIVE

A survey among medical students of all medical schools in the Czech Republic was conducted to investigate attitudes and views of psychiatry and career choice of psychiatry.

METHODS

A Czech version of the Attitudes to Psychiatry Scale (APS) and a questionnaire surveying demographic characteristics and choices of future specialty were distributed to all medical students of eight medical schools in the Czech Republic via the schools' internal communication systems in the form of an anonymous online questionnaire.

RESULTS

Out of a total of 10,147 medical students in the Czech Republic (academic year 2019/2020), 2418 students participated in the survey (response rate 23.8%). Psychiatry as a non-exclusive career choice was considered by 31.3% respondents; child and adolescent psychiatry was considered by 15.4% respondents. Psychiatry as the only choice was considered by 1.6%, and child and adolescent psychiatry was not considered at all. The interest in both specialties was declining since the first year of study. The status of psychiatry among other medical specialties was perceived as low; students were rather discouraged from entering psychiatry by their families. They did not feel encouraged by their teachers to pursue career in psychiatry despite the fact that they were interested in psychiatry. They also felt uncomfortable with patients with mental illness.

CONCLUSIONS

Despite high enthusiasm for psychiatry in the first year of medical school, only a small proportion of medical students consider to choose psychiatry, and especially child and adolescent psychiatry, as a career at the end of medical school.

Correlates of internalized stigma levels in people with psychosis in the Czech Republic

BACKGROUND

Internalized stigma negatively affects lives and prognosis of individuals with psychosis.

AIM

This study aimed to identify correlates of internalized stigma among individuals with psychosis in a sample of community care users in the Czech Republic.

METHODS

A cross-sectional study was conducted among 133 community service users with psychosis. A shortened version of the Internalized Stigma of Mental Illness (ISMI-10) scale was used alongside the 5-level EQ-5D version (EQ-5D-5L), assessing health-related quality of life. Descriptive and linear regression analyses were performed in order to determine levels of internalized stigma and its correlates.

RESULTS

High levels of internalized stigma were reported in 25% of participants. Lower internalized stigma levels were associated with better self-reported health status and being married, and higher internalized stigma with a longer period of time since initial contact with psychiatric care.

CONCLUSION

Lower internalized stigma levels are associated with better self-reported health-related quality of life. In addition, clients having used psychiatric care for longer periods of time reported significantly higher internalized stigma levels. Therefore, authors suggest self-stigma reduction interventions based in a community setting with an emphasis on targeting clients with chronic psychosis.

How to reduce stigmatization of people with mental illness in medical education: READ intervention

Stigmatization of people with mental illness in health care is a serious problem contributing to poor provision of health care and preventive medicine, it decreases their willingness to seek help and reduces quality of their life and life expectancy. The aim of this study is to evaluate the impact of the anti-stigma training READ on medical students during their psychiatric module. The training was held by a psychiatrist and a peer lecturer. This study is a part of the international project INDIGO. A total of 53 medical students participated in this study (32 in intervention group, 21 in control group). Participants completed questionnaire at baseline and at immediate follow-up. It contained scales measuring attitudes, knowledge, empathy and intergroup anxiety. The intervention group demonstrated reductions in stigma-related attitudes, improvements in mental illness knowledge and reductions in intergroup anxiety. At immediate follow-up the control group demonstrated improvements in mental illness knowledge and reductions in intergroup anxiety. Based on the results of this study common psychiatric module at the medical school (including theoretical and practical education) does not contribute to the sufficient reduction of stigma. The training READ with an involvement of peer lecturers appears to be a convenient instrument how to reduce stigmatization of people with mental illness at medical schools. The contact with people who are not in the acute state of the illness is crucial for destigmatization.

Short video interventions to reduce mental health stigma: a multi-centre randomised controlled trial in nursing high schools

BACKGROUND

We aimed to assess whether short video interventions could reduce stigma among nursing students.

METHODS

A multi-centre, randomised controlled trial was conducted. Participating schools were randomly selected and randomly assigned to receive: (1) an informational leaflet, (2) a short video intervention or (3) a seminar involving direct contact with a service user. The Community Attitudes towards Mental Illness (CAMI) and Reported and Intended Behaviour Scale (RIBS) were selected as primary outcome measures. SPANOVA models were built and Cohen's d calculated to assess the overall effects in each of the trial arms.

RESULTS

Compared to the baseline, effect sizes immediately after the intervention were small in the flyer arm (CAMI: d = 0.25; RIBS: d = 0.07), medium in the seminar arm (CAMI: d = 0.61; RIBS: d = 0.58), and medium in the video arm (CAMI: d = 0.49 RIBS: d = 0.26; n = 237). Effect sizes at the follow-up were vanishing in the flyer arm (CAMI: d = 0.05; RIBS: d = 0.04), medium in the seminar arm (CAMI: d = 0.43; RIBS: d = 0.26; n = 254), and small in the video arm (CAMI: d = 0.22 RIBS: d = 0.21; n = 237).

CONCLUSION

Seminar had the strongest and relatively stable effect on students' attitudes and intended behaviour, but the effect of short video interventions was also considerable and stable over time. Since short effective video interventions are relatively cheap, conveniently accessible and easy to disseminate globally, we recommend them for further research and development.

Mental illness stigma among medical students and teachers

BACKGROUND

Medical school curriculum contributes to future doctors' attitude formation towards people with mental illness.

AIM

The purpose of this study was to compare stigmatizing attitudes between medical students and faculty, analyse stigmatizing attitudes among students from different years of study and identify factors predicting stigma.

METHODS

A cross-sectional study with the use of scales measuring attitudes and social distance was designed. Online questionnaires were distributed to all students and teachers at a medical faculty in the Czech Republic.

RESULTS

The response rate was 32.1% ( n = 308) among students and 26.7% ( n = 149) among teachers. Teachers had a greater prevalence of stigmatizing attitudes than students. Increased tolerant attitudes in students were detected after the fourth year, that is, following introduction to psychiatry. Preferred specialization in psychiatry and attending two psychiatry courses predicted more tolerant attitudes. Among both students and teachers, men possessed more stigmatizing attitudes towards people with mental illness. Age was an important predictor of stigmatizing attitudes among teachers.

CONCLUSION

Educators should pay closer attention to the role of medical psychology and communication training implementation, which may be beneficial to improving skills and increasing medical students' self-esteem and feeling of competence throughout their psychiatry rotation.

Can video interventions be used to effectively destigmatize mental illness among young people? A systematic review

Video is considered to be an effective, easy to use tool employed in anti-stigma interventions among young people. Mass media has been shown to be effective for reducing stigma; however, there is insufficient evidence to determine the destigmatization effects of videos specifically. This article systematically reviews the effectiveness of video intervention in reducing stigma among young people between 13 and 25 years. We searched 13 electronic databases including randomized controlled trials, cluster randomized controlled trials, and controlled before and after studies. Of the 1426 abstracts identified, 23 studies (reported in 22 papers) met the inclusion criteria. Video interventions led to improvements in stigmatising attitudes. Video was found to be more effective than other interventions, such as classical face-to-face educational sessions or simulation of hallucinations. According to results of two studies, social contact delivered via video achieved similar destigmatization effect to that delivered via a live intervention. Although the quality of studies as well as the form of video interventions varied, the findings suggest that video is a promising destigmatization tool among young people; however, more studies in this area are needed. There was a lack of evidence for interventions outside of school environments, in low- and middle-income countries, and studies, which looked at long-term outcomes or measured impact on actual behaviour and implicit attitudes. The review generates recommendations for video interventions targeted at young people.

Attitudes towards the people with mental illness: comparison between Czech medical doctors and general population

PURPOSE

Stigma among health care professionals is detrimental to the life of those with mental health problems. In the region of post-communist Europe, the level of stigma among health care providers remains understudied. We aimed to compare attitudes towards people with mental illness between Czech medical doctors and the general population.

METHODS

The Community Attitudes towards Mentally Ill (CAMI) scale was used to measure stigmatizing attitudes among a nationally representative sample of (1) adults residing in the Czech Republic (n = 1810) and (2) Czech medical doctors (n = 1200). Descriptive statistics and multivariable linear regression were used to assess differences between both samples.

RESULTS

Compared to the general adult population in the Czech Republic, Czech medical doctors demonstrated less stigmatizing attitudes toward people with mental illness in 26 of the 27 CAMI items as well as in the total CAMI score. Medical doctors, however, were more likely to consider mental hospitals as an up-to-date method of treating people with mental illness.

CONCLUSIONS

Our findings demonstrate more favourable attitudes towards people with mental illness among Czech medical doctors when compared to the Czech general population. Stigma, however, is high among both these groups.

Reported and Intended Behaviour Towards Those With Mental Health Problems in the Czech Republic and England

This is one of the first studies, which compares the level of stigmatizing behaviour in countries that used to be on the opposite sides of the Iron Curtain. The aim was to identify the prevalence of reported and intended stigmatizing behaviour towards those with mental health problems in the Czech Republic and to compare these findings with the findings from England. The 8-item Reported and Intended Behaviour Scale (RIBS) was used to assess stigmatising behaviour among a representative sample of the Czech population (n = 1797). Results were compared with the findings of an analogous survey from England (n = 1720), which also used the RIBS. The extent of reported behaviour (i.e., past and present experiences with those with mental health problems) was lower in the Czech Republic than in England. While 12.7% of Czechs reported that they lived, 12.9% that they worked, and 15.3% that they were acquainted with someone who had mental health problems, the respective numbers for England were 18.5%, 26.3% and 32.5% (P < 0.001 in each of these items). On the other hand, the extent of intended stigmatizing behaviour towards those with mental health problems is considerably higher in the Czech Republic. Out of maximum 20 points attached to possible responses to the RIBS items 5–8, Czechs had a lower total score (x = 11.0, SD = 4.0) compared to English respondents (x = 16.1, SD = 3.6), indicating lower willingness to accept a person with mental health problems (P < 0.001). The prevalence of stigmatizing behaviour in the Czech Republic is worrying. Both, further research and evidence based anti-stigma interventions, should be pursued in order to better understand and decrease stigmatizing behaviour in the Czech Republic and possibly across the post-communist countries in Central and Eastern Europe.