Risk Factors of the Stigma Towards Psychiatric Patients Among Primary Healthcare Workers in China

Abstract

Background:There are over 16 million people with diverse mental illnesses in China. Mental illness has a serious influence on life quality of patients and their families. The attitude held by primary healthcare workers towards patients can have an impact on patients’ seeking of medical treatment and the outcome of treatment. Even further,  public attitudes could be influenced by healthcare workers. However, there are few research studies on the stigma held by primary healthcare workers. This study aimed at investigating the risk factors of stigma among primary healthcare workers in China, providing the basis for the intervention on decreasing stigma level of healthcare workers, and improving the acceptability of patients with mental illness.

Methods:This cross-sectional study randomly investigated 395 primary healthcare workers (101 doctors in township clinics, 94 nurses in township clinics, 59 other staff in township clinics, including pharmaceutical, epidemic prevention and health personnel, and 95 rural doctors) in Mianzhu County, Sichuan Province. This study used Assessment Scale of Discrimination towards Patients with Mental Disorders to measure the stigma level of healthcare workers, the scale of Mental Health Locus of Origin to measure participants’ attribution of mental illness, Quality of Contact to measure contact quality, the level of Contact Report to measure contact frequency. This study also collected participants’ information related to health care occupation: title, years’ work experience, occupation status, income, satisfaction with income, satisfaction with work environment, etc. This study also accounted for the influence of mass media and the attitude of relatives and friends into consideration.

Descriptive data analysis was performed for the demographic characteristics, variables related to health care occupation, the attribution of causes of mental illness, quality of contact, frequency of contact, features of local culture, and the pattern of stigma level. Then linear regression models were built to determine the level of significance  related with stigma level.

Results:The analysis revealed that for healthcare workers, those with a middle level of satisfaction towards income held a lower stigma level than those who were not satisfied with income level (β=-0.187, p=0.007); those with experience in psychiatry/ psychological department held lower stigma level (β=-0.174, p=0.006); those received more positive outcomes from patients held a lower stigma level (β=-0.183, p=0.012); and those who had a higher contact quality held a lower level of stigma (β=-0.313, p=0.000).

Implications:  The findings suggest that it is important to strengthen the communication between healthcare workers of different positions, especially between nurses and other staff. The enhancement of knowledge and skills about mental illness can help healthcare workers to decrease their stigma level. Moreover, healthcare workers should develop their relationship with patients by getting more involved into the treatment and life of patients. Besides, the training of mental illness knowledge is also important in improving healthcare workers’ attitude towards psychiatric patients. Future studies are warranted to evaluate the increased provider knowledge and reduced stigma for mental illness between providers and patients in China.