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February 2011
WPA Study: Stigmatization of Psychiatry and Psychiatrists

One of the goals of the WPA Action Plan 2008-2011, adopted by the WPA General Assembly, is to enhance the image of psychiatry and psychiatrists worldwide among the general public, health professionals, policy makers and students of health professions.

In the pursuance of this goal, WPA funded the international control group study "Stigmatization of Psychiatry and Psychiatrists" (2010-2011), which is conducted jointly by the WPA Sections on Schizophrenia, Stigma and Mental Illness, Forensic Psychiatry, and international collaborating centers. Additional funding was received by the German foundation for Mental Health. The project assesses the stigmatization and discrimination of psychiatry and psychia-trists employing a comparative approach with primary care physicians.

The steering group of the study is chaired by W. Gaebel (Principal Investigator, Chair, WPA Section on Schizophrenia), H. Stuart (Co-Principal Investigator, Chair, WPA  Section on Stigma and Mental Illness), J. Arboleda-Flórez (Co-Investigator, chair Section on Forensic Psychiatry), and N. Sartorius (Consultant). Collaborating centers are situated in Belarus, Brazil, Chile, Denmark, Egypt, Japan, Kenya, New Zealand, Nigeria, Poland and the U.S.A.

Background

The stigma of mental illness constitutes a major problem worldwide. Past research on this issue has often focused on the perception of people with mental illness in the lay population or on the stigmatizing experiences of people who suffer from mental illness. Not only does stigma affect people who experience a mental illness, it can also affect those around them, such as family members, mental health professionals, mental health programs, psychiatric treatment methods, and even psychiatry as a medical discipline. However, research documenting the scope and magnitude of stigma experienced by psychiatrists is scarce.

The present study focuses on the stigma of psychiatry and psychiatrists. Psychiatrists are often perceived as unscientific, manipulative or lacking therapeutic success, and psychiatry has frequently a lower status in comparison to other medical specialties. Stigma is considered to be an occupational stressor for psychiatrists, diminishing job satisfaction and reducing the readiness to stay in the field of psychiatry.

Objectives

The main objective is to describe the international scope and magnitude of the stigma and discrimination of psychiatry and psychiatrists and compare the stigmatization experienced by psychiatrists with the stigmatization experienced by a control-group of primary care physi-cians. International experiences in this field were addressed using a systematic literature review. Personal experiences of psychiatrists and primary care physicians were to be as-sessed by a questionnaire survey. Structural data about national mental healthcare systems were also assessed.

The following research questions are tested:

(1) Can the stigma of psychiatry and psychiatr-ists be measured empirically across countries?

(2) Do psychiatrists report higher levels of stigma compared to primary care physicians?

(3) Is this stigmatization experience - if any is found - associated with higher levels of feelings of burnout and job dissatisfaction?

Methods

(1) Systematic literature review about the stigma and discrimination of psychiatry and psy-chiatrists.

(2) Target-group specific questionnaire survey to assess stigmatization and discrimination experienced by psychiatrists and primary care physicians. The study examines three aspects of stigma: perceived stigma as perception of societal stereotypes, self-stigmatization, and concrete discrimination experiences. Additionally, the questionnaire contains a section on the frequency of burnout experiences and job satisfaction.

Data collection and sample size
The survey was performed using a web-based questionnaire, if required, additional a paper - and - pencil questionnaire were used. The intended case numbers for each collaborating center are n=200 psychiatrists and n=200 primary care physicians.

Survey instrument
The questionnaire was newly developed by the research group. The majority of the items have been adapted from existing questionnaires. Additional items were generated from self-reports of a focus group of psychiatrists at the PI‘s study site and further items were gener-ated based on the results of the literature review. The questionnaire was translated into the languages of the various collaborating countries.

(3) Data about structural indicators of national mental health care systems were assessed by analyzing WHO data on national mental health care systems.

Project Status, Preliminary Results and Outlook

1. Systematic Literature Review
This part has been accomplished and the results were published in World Psychiatry (Sartorius N, Gaebel W, et al., 2010). The literature was reviewed concerning the image of psychiatry and psychiatrists in the media and the opinions about psychiatry and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. Interventions that have been undertaken to combat stigma and consequent discrimination were also reviewed and a series of recommendations to the national psychiatric societies and to individual psychiatrists were made.

2. Survey
The survey is conducted between September 2010 and February 2011 in twelve countries. The questionnaire was completed as yet by 1.328 psychiatrists and 726 primary care physicians.

3. Preliminary Results
Initial analyses showed that perceived stigma is still a considerable factor and that this mainly pertains to income-related concerns and to a negative image of the specialty. Almost 90% of the psychiatrist respondents think that there is a need for specific interventions to combat the stigma of psychiatry. A vast majority of respondents are of the opinion that the importance of psychiatrists' work for society is underestimated. Psychiatrists perceive the public opinion towards psychiatry and psychiatrists less favourable than they perceive themselves and psychiatry.

4. Outlook
Data analysis will be finalized by March 20, 2011. Results will be published and presented on occasion of the WPA World Congress in Buenos Aires, Argentina, September, 18-22, 2011.

Reference:

Sartorius N, Gaebel W, Cleveland HR, Stuart H, Akiyama T, Arboleda-Flórez J, Baumann AE, Gureje O, Jorge MR, Kastrup M, Suzuki Y, Tasman A. WPA guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatry. 2010 Oct;9(3):131-44.

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