Understanding Stigma - A study on mental health related stigma by Portuguese health care professionals

Abstract Purpose Studies are increasingly showing that health related stigma is a barrier to employment, but it is not known how. The aim of this systematic review is to identify, appraise and analyse studies that have directly or indirectly addressed ways in which stigma affects sustainable employment and well-being at work of people with disabilities. Methods Using a multiphase screening process, this review is based on a comprehensive literature search (2000–2019) carried out in six electronic databases: Embase, Web of Science, Medline Ovid, Cochrane CENTRAL, PsycINFO and Google Scholar. Results 7.263 publications were identified; 96 studies were found eligible to be included in the review. 72% of the studies were conducted in North America or Europe. Few studies directly assessed how stigma affects the employment of people with disabilities. Most studies highlighted that attitudes and behaviour of employers formed a barrier to employment, as well as anticipated stigma and self-stigma in people with health problems. However, the findings also showed that the attitudes and behaviour of co-workers, health care professionals, reintegration professionals, customers, and family and friends could act as a barrier to employment although these influences are under-researched. Although many similarities were seen in the relevant findings of studies about both physical and mental disabilities, several nuances were found. Conclusion Stigma hampers sustainable employment and well-being in multiple ways. Whereas the number of publications on this topic is rapidly increasing, the roles of health care professionals, reintegration professionals, co-workers, customers, and family and friends particularly warrant more attention.

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Reducing mental health-related stigma in primary health care settings in low- and middle-income countries: a systematic review – CORRIGENDUM

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796019000349 ◽

2019 ◽

Vol 29 ◽

Author(s):

E. Heim ◽

B. A. Kohrt ◽

M. Koschorke ◽

M. Milenova ◽

G. Thornicroft

Keyword(s):

Mental Health ◽

Systematic Review ◽

Health Care ◽

Middle Income ◽

Health Care Settings ◽

Middle Income Countries ◽

Primary Health ◽

Related Stigma ◽

Health Related ◽

Primary Health Care Settings

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Mental health-related stigma in health care and mental health-care settings

The Lancet Psychiatry ◽

10.1016/s2215-0366(14)00023-6 ◽

2014 ◽

Vol 1 (6) ◽

pp. 467-482 ◽

Cited By ~ 183

Author(s):

Claire Henderson ◽

Jo Noblett ◽

Hannah Parke ◽

Sarah Clement ◽

Alison Caffrey ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Health Care Settings ◽

Related Stigma ◽

Health Related

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Understanding Supporting and Hindering Factors in Community-Based Psychotherapy for Refugees: A Realist-Informed Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17134618 ◽

2020 ◽

Vol 17 (13) ◽

pp. 4618 ◽

Cited By ~ 4

Author(s):

Douglas Gruner ◽

Olivia Magwood ◽

Lissa Bair ◽

Liezl Duff ◽

Shiva Adel ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Mental Health Care ◽

Global Mental Health ◽

Community Based ◽

Cultural Constructs ◽

Related Stigma ◽

Health Related ◽

And Gender

Culture, tradition, structural violence, and mental health-related stigma play a major role in global mental health for refugees. Our aim was to understand what factors determine the success or failure of community-based psychotherapy for trauma-affected refugees and discuss implications for primary health care programs. Using a systematic realist-informed approach, we searched five databases from 2000 to 2018. Two reviewers independently selected RCTs for inclusion, and we contacted authors to obtain therapy training manuals. Fifteen articles and 11 training manuals met our inclusion criteria. Factors that improved symptoms of depression, anxiety, and PTSD included providing culturally adapted care in a migrant-sensitive setting, giving a role to other clinical staff (task-shifting), and intervention intensity. Precarious asylum status, constraining program monitoring requirements, and diverse socio-cultural and gender needs within a setting may reduce the effectiveness of the program. Primary care programs may enable community based mental health care and may reduce mental health-related stigma for refugees and other migrants. More research is needed on the cultural constructs of distress, programs delivered in primary care, and the role of cultural and language interpretation services in mental health care.

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Disaster Management in Rural and Remote Primary Health Care: A Scoping Review

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000200 ◽

2021 ◽

Vol 36 (3) ◽

pp. 362-369

Author(s):

Katie A. Willson ◽

Gerard J. FitzGerald ◽

David Lim

Keyword(s):

Mental Health ◽

Health Care ◽

Primary Health Care ◽

Mental Health Care ◽

Disaster Management ◽

Scoping Review ◽

Health Care Professionals ◽

Disaster Preparedness ◽

Rural And Remote ◽

Primary Health

AbstractObjective:This scoping review aims to map the roles of rural and remote primary health care professionals (PHCPs) during disasters.Introduction:Disasters can have catastrophic impacts on society and are broadly classified into natural events, man-made incidents, or a mixture of both. The PHCPs working in rural and remote communities face additional challenges when dealing with disasters and have significant roles during the Prevention, Preparedness, Response, and Recovery (PPRR) stages of disaster management.Methods:A Johanna Briggs Institute (JBI) scoping review methodology was utilized, and the search was conducted over seven electronic databases according to a priori protocol.Results:Forty-one papers were included and sixty-one roles were identified across the four stages of disaster management. The majority of disasters described within the literature were natural events and pandemics. Before a disaster occurs, PHCPs can build individual resilience through education. As recognized and respected leaders within their community, PHCPs are invaluable in assisting with disaster preparedness through being involved in organizations’ planning policies and contributing to natural disaster and pandemic surveillance. Key roles during the response stage include accommodating patient surge, triage, maintaining the health of the remaining population, instituting infection control, and ensuring a team-based approach to mental health care during the disaster. In the aftermath and recovery stage, rural and remote PHCPs provide long-term follow up, assisting patients in accessing post-disaster support including delivery of mental health care.Conclusion:Rural and remote PHCPs play significant roles within their community throughout the continuum of disaster management. As a consequence of their flexible scope of practice, PHCPs are well-placed to be involved during all stages of disaster, from building of community resilience and contributing to early alert of pandemics, to participating in the direct response when a disaster occurs and leading the way to recovery.

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Prescribing stigma in mental disorders: A comparative study of Portuguese psychiatrists and general practitioners

International Journal of Social Psychiatry ◽

10.1177/00207640211002558 ◽

2021 ◽

pp. 002076402110025

Author(s):

Bárbara Almeida ◽

Ana Samouco ◽

Filipe Grilo ◽

Sónia Pimenta ◽

Ana Maria Moreira

Keyword(s):

Mental Health ◽

Mental Disorder ◽

General Practitioners ◽

Psychiatric Patients ◽

Self Report ◽

Cross Sectional ◽

Medical Speciality ◽

Diagnostic Overshadowing ◽

Related Stigma ◽

Health Related

Background: Physicians, including psychiatrists and general practitioners (GPs), have been reported as essential sources of stigma towards people diagnosed with a mental disorder (PDMDs), which constitutes an important barrier to recovery and is associated with poorer clinical outcomes. Therefore, psychiatrists and GPs are key populations where it is crucial to examine stigma, improve attitudes and reduce discrimination towards psychiatric patients. Aims: This study is the first to explore mental health-related stigma among Portuguese psychiatrists and GPs, examining the differences between these two specialities and assessing whether sociodemographic and professional variables are associated with stigma. Method: A cross-sectional study was performed between June 2018 and August 2019. A consecutive sample of 55 Psychiatrists and 67 GPs working in Porto (Portugal) filled a 25-item self-report questionnaire to assess their attitudes towards PDMDs in clinical practice. The instrument was designed by the authors, based on previous mental health-related stigma studies and validated scales. The questionnaire includes 12 stigma dimensions ( Autonomy, Coercion, Incompetence, Dangerousness, Permanence, Pity, Responsibility, Segregation, Labelling, Diagnostic Overshadowing, Shame and Parental Incompetence), and its total score was used to measure Overall Stigma (OS). Sample characteristics were examined using descriptive statistics, and the factors affecting stigma were assessed through regression analysis. Results: GPs exhibit significantly higher OS levels than psychiatrists, and present higher scores in the dimensions of dangerousness, parental incompetence, diagnostic overshadowing and responsibility. Besides medical speciality, several other sociodemographic variables were associated with sigma, including age, gender, having a friend with a mental disorder, professional category, agreement that Psychiatry diverges from core medicine and physician’s interest in mental health topics. Conclusions: Our data suggest that both psychiatrists and GPs hold some degree of stigmatizing attitudes towards PDMDs. Overall, these results bring new light to stigma research, and provide information to tailor anti-stigma interventions to Portuguese psychiatrists and GPs.

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