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

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.

Parents provide their perspective on the crossroads of autism and deafness

Often “diagnostic overshadowing” takes place — whereby autism might mask hearing loss or intellectual disability, and vice versa — is a real concern in children affected by both conditions.

Physical health in mental health: considerations for paramedics

Life expectancy for people with a mental illness diagnosis is 15–20 years less than those without, mainly because of poor physical health. Mental ill health affects a significant proportion of paramedics' patients, and practitioners could assess and promote their physical health even though contact time is limited. Factors affecting physical health include substandard and disjointed care, stigma and diagnostic overshadowing—where physical symptoms are dismissed as a feature of mental illness. Diagnostic overshadowing is not discussed in key paramedic literature, although patients with mental health problems are at risk of not having their physical needs being taken seriously. The paramedic's role in health promotion is receiving more attention. Making Every Contact Count (MECC)—a behaviour change model using brief interaction—could be adopted by paramedics to promote physical health, especially when linked to campaigns and local services. Health promotion is in its early days in paramedicine, and paramedics could learn from the experiences of other professions.