Levels of stigma among community mental health staff in Guangzhou, China

BMC Psychiatry

Yuanguang Huang¹  Graham Thornicroft²  Juan Li¹  Jie Li¹ 

[1] Guangzhou Psychiatric Hospital, Guangzhou Medical University, 36# Mingxin Road, Liwan, Guangzhou 510370, China;Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigny, London SE5 8AF, UK

关键词: Psychometric properties;    Mental health staff;    Stigma;   

Others  :  1123394
DOI  :  10.1186/s12888-014-0231-x

 received in 2014-01-17, accepted in 2014-08-05,  发布年份 2014

【 摘 要 】

Background

Stigma and discrimination are widely experienced by people with mental illness, even in healthcare settings. The purposes of this study were to assess mental health stigma among community mental health staff in Guangzhou, China and in doing so also to assess the psychometric properties of the Reported and Intended Behaviour Scale (RIBS) - Chinese version.

Methods

A cross-sectional survey was undertaken among 214 community mental health staff in Guangzhou from September to November, 2013. The Mental Health Knowledge Schedule (MAKS) and RIBS were administered together with the Mental Illness: Clinicians’ Attitudes Scale (MICA) to evaluate staff stigma from the perspective of knowledge, attitudes and behaviour.

Results

The total scores of RIBS, MAKS and MICA were (11.97 ± 3.41), (16.80 ± 5.39) and (51.69 ± 6.94) respectively. Female staff members were more willing to contact people with mental illness than males (t(212) = −2.85,P = 0.005) and had more knowledge about mental illness (t(212) = −2.28,P = 0.024). The Chinese version of RIBS had good internal consistency (alpha = 0.82), test-retest reliability (r = 0.68,P < 0.001) and adequate convergent validity, as indicated by a significant negative correlation with the Chinese version of MICA(r = −0.43, P < 0.001).

Conclusions

Our results show relatively high levels of stigma toward people with mental illness among community mental health staff in Guangzhou, China. There are slightly gender differences in discriminatory behaviours and stigma related knowledge of mental illness among community mental health staff, with female staff in general less stigmatising. Accordingly, anti-stigma programmes should be established among healthcare staff. In addition, the Chinese version of RIBS is a reliable, valid and acceptable measure which can be used to assess the willingness of participants to contact people with mental illness in future anti-stigma campaigns.

【 授权许可】

   
2014 Li et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Sartorius N: Stigma and mental health. Lancet 2007, 370:810-811.
• [2]Sartorius N: Time to change, time to evaluate. Invited commentary on…Evaluation of England’s Time to Change programme. Br J Psychiatry Suppl 2013, 55:s108-s109.
• [3]Ehrlich-Ben OS, Hasson-Ohayon I, Feingold D, Vahab K, Amiaz R, Weiser M, Lysaker PH: Meaning in life, insight and self-stigma among people with severe mental illness. Compr Psychiatry 2013, 54(2):195-200.
• [4]Lasalvia A, Zoppei S, Van Bortel T, Bonetto C, Cristofalo D, Wahlbeck K, Bacle SV, Van Audenhove C, van Weeghel J, Reneses B, Germanavicius A, Economou M, Lanfredi M, Ando S, Sartorius N, Lopez-Ibor JJ, Thornicroft G: Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet 2013, 381(9860):55-62.
• [5]Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M: Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 2009, 373(9661):408-415.
• [6]Park SG, Bennett ME, Couture SM, Blanchard JJ: Internalized stigma in schizophrenia: relations with dysfunctional attitudes, symptoms, and quality of life. Psychiatry Res 2013, 205(1–2):43-47.
• [7]Brohan E, Elgie R, Sartorius N, Thornicroft G: Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophr Res 2010, 122(1–3):232-238.
• [8]Acosta FJ, Aguilar EJ, Cejas MR, Gracia R: Beliefs about illness and their relationship with hopelessness, depression, insight and suicide attempts in schizophrenia. Psychiatr Danub 2013, 25(1):49-54.
• [9]Ucok A, Karadayi G, Emiroglu B, Sartorius N: Anticipated discrimination is related to symptom severity, functionality and quality of life in schizophrenia. Psychiatry Res 2013, 209(3):333-339.
• [10]Hill K, Startup M: The relationship between internalized stigma, negative symptoms and social functioning in schizophrenia: the mediating role of self-efficacy. Psychiatry Res 2013, 206(2–3):151-157.
• [11]Rusch N, Corrigan PW, Wassel A, Michaels P, Larson JE, Olschewski M, Wilkniss S, Batia K: Self-stigma, group identification, perceived legitimacy of discrimination and mental health service use. Br J Psychiatry 2009, 195(6):551-552.
• [12]Yap MB, Reavley NJ, Jorm AF: Associations between stigma and help-seeking intentions and beliefs: findings from an Australian national survey of young people. Psychiatry Res 2013, 210(3):1154-1160.
• [13]Henderson C, Evans-Lacko S, Thornicroft G: Mental illness stigma, help seeking, and public health programs. Am J Public Health 2013, 103(5):777-780.
• [14]Mojtabai R: Mental illness stigma and willingness to seek mental health care in the European Union. Soc Psychiatry Psychiatr Epidemiol 2010, 45(7):705-712.
• [15]Bruce G, Link JCP: Stigma and its public health implications. Lancet 2006, 367:528-529.
• [16]Sarisoy G, Kacar OF, Pazvantoglu O, Korkmaz IZ, Ozturk A, Akkaya D, Yilmaz S, Boke O, Sahin AR: Internalized stigma and intimate relations in bipolar and schizophrenic patients: a comparative study. Compr Psychiatry 2013, 54(6):665-672.
• [17]Cerit C, Filizer A, Tural U, Tufan AE: Stigma: a core factor on predicting functionality in bipolar disorder. Compr Psychiatry 2012, 53(5):484-489.
• [18]Vazquez GH, Kapczinski F, Magalhaes PV, Cordoba R, Lopez JC, Rosa AR, Sanchez DCM, Tohen M: Stigma and functioning in patients with bipolar disorder. J Affect Disord 2011, 130(1–2):323-327.
• [19]Perlick DA, Rosenheck RA, Clarkin JF, Sirey JA, Salahi J, Struening EL, Link BG: Stigma as a barrier to recovery: adverse effects of perceived stigma on social adaptation of persons diagnosed with bipolar affective disorder. Psychiatr Serv 2001, 52(12):1627-1632.
• [20]Thornicroft G: Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry 2011, 199(6):441-442.
• [21]Eaton J, McCay L, Semrau M, Chatterjee S, Baingana F, Araya R, Ntulo C, Thornicroft G, Saxena S: Scale up of services for mental health in low-income and middle-income countries. Lancet 2011, 378(9802):1592-1603.
• [22]Corrigan PW, Watson AC, Warpinski AC, Gracia G: Stigmatizing attitudes about mental illness and allocation of resources to mental health services. Community Ment Health J 2004, 40(4):297-307.
• [23]Corrigan PW, Watson AC: Factors that explain how policy makers distribute resources to mental health services. Psychiatr Serv 2003, 54(4):501-507.
• [24]Corrigan PW, Watson AC, Heyrman ML, Warpinski A, Gracia G, Slopen N, Hall LL: Structural stigma in state legislation. Psychiatr Serv 2005, 56(5):557-563.
• [25]Corrigan PW, Markowitz FE, Watson AC: Structural levels of mental illness stigma and discrimination. Schizophr Bull 2004, 30(3):481-491.
• [26]Evans-Lacko S, London J, Japhet S, Rusch N, Flach C, Corker E, Henderson C, Thornicroft G: Mass social contact interventions and their effect on mental health related stigma and intended discrimination. BMC Public Health 2012, 12:489.
• [27]Clement S, van Nieuwenhuizen A, Kassam A, Flach C, Lazarus A, de Castro M, McCrone P, Norman I: Filmed v. live social contact interventions to reduce stigma: randomised controlled trial. Br J Psychiatry 2012, 201(1):57-64.
• [28]Michaels PJ, Corrigan PW, Buchholz B, Brown J, Arthur T, Netter C, Macdonald-Wilson KL: Changing stigma through a consumer-based stigma reduction program. Community Ment Health J 2013, 50(4):395-401.
• [29]Beldie A, den Boer JA, Brain C, Constant E, Figueira ML, Filipcic I, Gillain B, Jakovljevic M, Jarema M, Jelenova D, Karamustafalioglu O, Kores Plesnicar B, Kovacsova A, Latalova K, Marksteiner J, Palha F, Pecenak J, Prasko J, Prelipceanu D, Ringen PA, Sartorius N, Seifritz E, Svestka J, Tyszkowska M, Wancata J: Fighting stigma of mental illness in midsize European countries. Soc Psychiatry Psychiatr Epidemiol 2012, 47(Suppl 1):1-38.
• [30]Lauber C, Nordt C, Braunschweig C, Rossler W: Do mental health professionals stigmatize their patients? Acta Psychiatr Scand Suppl 2006, 429:51-59.
• [31]Beales D: Continuing stigmatisation by psychiatrists. Br J Psychiatry 2001, 178:475.
• [32]Corker E: Stigma caused by psychiatrists. Br J Psychiatry 2001, 178:379.
• [33]Harangozo J, Reneses B, Brohan E, Sebes J, Csukly G, Lopez-Ibor J, Sartorius N, Rose D, Thornicroft G: Stigma and discrimination against people with schizophrenia related to medical services. Int J Soc Psychiatry 2013, 60(4):359-366.
• [34]Schulze B: Stigma and mental health professionals: a review of the evidence on an intricate relationship. Int Rev Psychiatry 2007, 19(2):137-155.
• [35]Adewuya AO, Oguntade AA: Doctors’ attitude towards people with mental illness in Western Nigeria. Soc Psychiatry Psychiatr Epidemiol 2007, 42(11):931-936.
• [36]Xiang YT, Yu X, Sartorius N, Ungvari GS, Chiu HF: Mental health in China: challenges and progress. Lancet 2012, 380(9855):1715-1716.
• [37]Thornicroft G, Rose D, Kassam A, Sartorius N: Stigma: ignorance, prejudice or discrimination? Br J Psychiatry 2007, 190:192-193.
• [38]Rong Y, Glozier N, Luscombe GM, Davenport TA, Huang Y, Hickie IB: Improving knowledge and attitudes towards depression: a controlled trial among Chinese medical students. BMC Psychiatry 2011, 11:36.
• [39]Phillips MR, Pearson V, Li F, Xu M, Yang L: Stigma and expressed emotion: a study of people with schizophrenia and their family members in China. Br J Psychiatry 2002, 181:488-493.
• [40]Lv Y, Wolf A, Wang X: Experienced stigma and self-stigma in Chinese patients with schizophrenia. Gen Hosp Psychiatry 2013, 35(1):83-88.
• [41]Evans-Lacko S, Rose D, Little K, Flach C, Rhydderch D, Henderson C, Thornicroft G: Development and psychometric properties of the reported and intended behaviour scale (RIBS): a stigma-related behaviour measure. Epidemiol Psychiatr Sci 2011, 20(3):263-271.
• [42]Angermeyer MC, Dietrich S: Public beliefs about and attitudes towards people with mental illness: a review of population studies. Acta Psychiatr Scand 2006, 113(3):163-179.
• [43]Angermeyer MC, Matschinger H, Holzinger A: Gender and attitudes towards people with schizophrenia. Results of a representative survey in the Federal Republic of Germany. Int J Soc Psychiatry 1998, 44(2):107-116.
• [44]Angermeyer MC, Matschinger H: Public beliefs about schizophrenia and depression: similarities and differences. Soc Psychiatry Psychiatr Epidemiol 2003, 38(9):526-534.
• [45]Evans-Lacko S, Little K, Meltzer H, Rose D, Rhydderch D, Henderson C, Thornicroft G: Development and psychometric properties of the Mental Health Knowledge Schedule. Can J Psychiatry 2010, 55(7):440-448.
• [46]Kassam A, Glozier N, Leese M, Henderson C, Thornicroft G: Development and responsiveness of a scale to measure clinicians’ attitudes to people with mental illness (medical student version). Acta Psychiatr Scand 2010, 122(2):153-161.
• [47]Henderson C, Evans-Lacko S, Flach C, Thornicroft G: Responses to mental health stigma questions: the importance of social desirability and data collection method. Can J Psychiatry 2012, 57(3):152-160.
• [48]Chandra A, Minkovitz CS: Stigma starts early: gender differences in teen willingness to use mental health services. J Adolesc Health 2006, 38(6):751-754.
• [49]Martinez-Zambrano F, Garcia-Morales E, Garcia-Franco M, Miguel J, Villellas R, Pascual G, Arenas O, Ochoa S: Intervention for reducing stigma: assessing the influence of gender and knowledge. World J Psychiatry 2013, 3(2):18-24.
• [50]Nosek BA, Hawkins CB, Frazier RS: Implicit social cognition: from measures to mechanisms. Trends Cogn Sci 2011, 15(4):152-159.
• [51]Wang X, Huang X, Jackson T, Chen R: Components of implicit stigma against mental illness among Chinese students. PLoS One 2012, 7(9):e46016.
• [52]Corrigan PW, Morris SB, Michaels PJ, Rafacz JD, Rusch N: Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatr Serv 2012, 63(10):963-973.
• [53]Durand-Zaleski I, Scott J, Rouillon F, Leboyer M: A first national survey of knowledge, attitudes and behaviours towards schizophrenia, bipolar disorders and autism in France. BMC Psychiatry 2012, 12:128.
• [54]Cheon BK, Chiao JY: Cultural variation in implicit mental illness stigma. J Cross Cult Psychol 2012, 14:1058-1062.
• [55]Furnham A, Chan E: Lay theories of schizophrenia. A cross-cultural comparison of British and Hong Kong Chinese attitudes, attributions and beliefs. Soc Psychiatry Psychiatr Epidemiol 2004, 39(7):543-552.
• [56]Yang LH: Application of mental illness stigma theory to Chinese societies: synthesis and new directions. Singapore Med J 2007, 48(11):977-985.