Understanding Providers Stigmatization of SMI Among Veterans Principal Investigator: Greer Sullivan, MD, MSPH Background: Stigma related to mental disorders is known to be widespread and to have devastating effects on the lives of those diagnosed with mental disorders. A key group who have influence not only in the lives but also in the treatment of persons with SMI are mental health and primary care providers. Researchers have identified interpersonal contact as an effective approach to reducing stigma because interpersonal contact disconfirms stereotypes of those who are mentally ill. Even though providers who treat mental illness often have contact with SMI, research has suggested that providers who treat SMI patients exhibit considerable stigmatizing attitudes and behaviors toward their patients. It is likely that despite their experience and training, the amount and nature of the contact affects disconfirmation of stereotypes, that is, it serves to confirm negative stereotypes of SMI. Objectives:
The aim of this study is the assessment of the stigmatizing beliefs, attitudes and behaviors of health providers towards those diagnosed with SMI. Our study will also provide insight into provider stigmatizing perceptions and attitudes that may have a direct bearing upon the quality of treatment that veterans receive. A better understanding of these factors will aid in designing interventions intended to reduce stigma.
The specific aims of interest are:
Specific Aim 1 : To assess the effect of provider type (primary care, psychiatry,) on stigmatizing attitudes and practice behaviors towards persons with SMI, specifically schizophrenia.
Specific Aim 2 : To examine the relationship of provider characteristics and the amount and nature of contact with SMI (self, non-professional and professional associations) to provider stigmatizing attitudes and appropriate referral behaviors. Methods: The proposed project is based upon social science theories of the cognitive and motivational aspects of stigma and interventions designed and implemented to reduce stigma among marginalized groups including persons with mental illness. Based on Corrigan's work, we have developed a conceptual model that depicts providers'practice behaviors as a function of provider characteristics, type of interpersonal contact and stigmatizing beliefs and attitudes. The populations of interest are primary care physicians and nurse practitioners and psychiatrists and nursing staff who work with SMI patients. A cross sectional factorial design with a vignette experiment and survey measures will be used to assess stigmatizing provider attitudes and practice behaviors towards those with SMI, as a function of provider characteristics and amount and nature of contact with persons with SMI. In this design, the benefits of controlled experiments are combined with sample survey techniques. The proposed study is a 2X2 factorial design. One vignette will be randomized to each participant (N=256). A systematic analysis of the data using appropriate univariate, bivariate and multivariate techniques will be used to analyze the data. Before conducting regressions analysis the data diagnostics will be run to examine departures from normality such as outliers. A series of standard ordinary least squares analysis will be used to examine the outcomes of interest.
. Over the last three years the VA has been actively promoting a change in the culture of mental health services with a move toward a recovery model. A recovery model involves viewing persons with mental illness as capable of functioning in the world and as individuals who should be empowered to be involved in health decision-making. One of the greatest barriers to the adoption of this model may be providers themselves. As members of the general public, providers may share stigmatizing views that can affect their clinical practices. The aim of this study is to better understand providers views of serious mental illness and how these views might influence clinical decision-making. Based on the results of this study, interventions can be developed to address stigma among providers.
