European study on the stigma of mental illness in clinical practice reveals first results
The study, conducted in collaboration with the University of Coimbra, offers key recommendations for creating a stigma-free environment among mental health professionals.
A European study of 4,245 adult and child psychiatrists in 32 countries, including Portugal, offers key recommendations for promoting a workplace culture that includes anti-stigma initiatives and their integration into psychiatry and child psychiatry training programmes, as well as the importance of psychotherapy and peer-to-peer case discussions.
The study's primary goal was to measure stigma among these mental health professionals and is part of ongoing research in 32 European countries aimed at implementing interventions to reduce the stigma of mental illness in clinical practice.
The research, titled 'Attitudes of Psychiatrists Towards People with Mental Illness: A Cross-Sectional, Multicentre Study of Stigma in 32 European Countries,' was published in The Lancet's eClinicalMedicine journal and led by Dorottya Őri, a psychiatrist at the Child and Adolescent Psychiatric Hospital in Vadaskert, Hungary.
Ana Telma Pereira and Carolina Cabaços, researchers from the Institute of Medical Psychology of the Faculty of Medicine of the University of Coimbra (IPM - FMUC), are the national coordinators of this European project, and explain that "the main objective of the study was to analyse the relationship between the first-person experiences of the participating psychiatrists and child psychiatrists and their stigmatising attitudes towards people with mental illness".
The researchers provide further context: "According to the social scientist Erving Goffman, stigma refers to any social characteristic that, in our minds, devalues someone from a normal, whole person to one who is discredited, damaged, or tainted. In the health sector, stigma can lead to, among other things, barriers to access to healthcare, overly paternalistic or condescending treatment, or the devaluation of patients' complaints, and is an undeniable driver of social inequality".
Pereira and Cabaços also note that "people with mental illness are most likely to be stigmatised, which, together with negative expectations of discriminatory experiences, leads them to avoid seeking help and thus to be less compliant with treatment. From a broader perspective, stigma is also considered one of the main barriers to adequate funding for technical and scientific advances in the field of psychiatry," they add.
The research team used the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) to measure mental illness-related stigma in 32 European countries (Hungary, Portugal, Denmark, Lithuania, Austria, Turkey, Albania, Azerbaijan, Ukraine, Slovenia, Croatia, Serbia, Russia, Estonia, France, Czechia, Ireland, Greece, Montenegro, Slovakia, Latvia, Malta, Bulgaria, Belarus, Italy, Switzerland, Germany, the Netherlands, the United Kingdom, Belgium, Spain and Cyprus).
The OMS-HC is a widely used self-report tool developed to assess stigmatising attitudes among health care workers. Its psychometric properties in the 32 participating countries were evaluated in a previous study published by the same research team.
"This scale, which ranges from 15 to 75 points — with the highest scores indicating the most stigmatising attitudes — consists of 15 self-report items divided into three subscales that assess the following dimensions: attitude towards people with mental illness; disclosure and help-seeking; and social distance," the researchers explain.
"Overall, the average score for the total sample was relatively low: 30.47, corresponding to about 40% of the total scale, indicating that the majority of psychiatrists participating in the study had a generally positive attitude towards mental illness," Ana Telma Pereira and Carolina Cabaços add.
Regarding Portugal, the researchers point out that "the country had a mean score of 32.47 on the total stigma score, slightly above the mean for all participants, and ranked as the sixth country with the highest mean score on the OMS-HC, following Latvia (35.98), Ukraine (35.02), Belarus (35.01), Bulgaria (33.09), and Czechia (32.82)." A total of 148 Portuguese adult, child, and adolescent psychiatrists from all regions of the country participated in the survey, with the majority being adult psychiatrists (82.4%).
"Across the 32 participating countries, professionals who scored lower on the stigma scale (i.e. who had more positive attitudes towards mental illness) tended to be those who were "surrounded by positive attitudes from colleagues, who participated in case discussion groups, were actively involved in psychotherapeutic practice, or had personal experience of mental illness,”, they conclude.
The participation of the researchers from the University of Coimbra in the study stems from their interest in the topic of stigma associated with mental illness, which is the subject of the doctoral thesis of Carolina Cabaços, also a psychiatrist at the Coimbra Hospital and University Centre and a visiting researcher at FMUC. Her thesis is supervised by António Macedo, Professor at the UC Faculty of Medicine and Director of the FMUC Institute of Medical Psychology; Miguel Castelo-Branco, Professor at FMUC and Scientific Coordinator of the UC Coimbra Institute for Biomedical Imaging and Translational Research; and Ana Telma Pereira.
The scientific article is available here.