The effectiveness of mental health disorder stigma-reducing interventions in the healthcare setting: An integrative review
Introduction
Mental health disorders (MHDs) are on the rise resulting in a widespread epidemic affecting millions of individuals in the United States (NAMI, 2019). Multiple studies have shown that people with MHDs have increased morbidity and mortality compared to the general population (Nordentoft et al., 2013; Wahlbeck et al., 2011). The World Health Organization estimated that in 2020, about 1.53 million individuals died from suicide, which is one death every 20 s (WHO, 2020). A significant percentage of these individuals suffer from chronic MHDs (Bachmann, 2018; WHO, 2020). This unabated epidemic, which continues to increase, is hitting healthcare organizations exceptionally hard. For the purpose of this integrative review, the phrase ‘healthcare professionals’ refers to those with existing healthcare degrees and those pursuing a career in health care.
The prevalence of MHDs is increasing rapidly in the United States. One in 25 Americans live with a MHD, such as schizophrenia, bipolar disorder, or major depression disorder (CDC, 2018; NAMI, 2019). In 2018, one in five Americans aged 18 or older, or an estimated 47.6 million adults, were diagnosed with a MHD (NAMI, 2019; SAMHSA, 2016). It is predicted that more than 50% of peoples in the United States will be diagnosed with a MHD at some point of their lives (CDC, 2018). Recent data indicates a substantial spike of patients presenting to healthcare settings for the chief complain of MHDs (Tucci et al., 2015), and the healthcare setting is often the initial point of contact for individuals suffering from MHDs (Khenti et al., 2019). In addition, uninsured individuals with MHDs choose the emergency department for treatment knowing that, by law, they cannot be rejected based on their insurance status (Joint Commission, 2015). However, despite this increase and a need for treatment, stigmatization of MHD patients by health care professionals (HCPs) have become a public health crisis (Knaak et al., 2017).
A recent study by Del Olmo-Romero et al. (2019), reports individuals who use mental-health services expressed feeling demeaned and discriminated by HCPs. Stigma towards patients with MHDs undermines the quality of patient-centered care (Schmitt et al., 2014) and adds to a disparity in life expectancy (Henderson et al., 2014). Stigmatization experienced by individuals also causes concealment of symptoms, which can lead to further rage, anxiety, verbal outbursts, and increased suicidal ideation. This stigmatization creates a reluctance in the patient, which increases the likelihood that they may avoid seeking social and/or medical support (Chaudoir & Fisher, 2010). In response to these issues, measures are being taken locally and internationally to decrease the stigma and prejudice faced by individuals who are diagnosed with a MHD.
Section snippets
Problem statement
Mental health disorders have become a leading global disease which cause individuals to seek treatment in the hospital setting. Approximately 16% to 44% of clients being treated in a healthcare setting expressed facing discrimination, such as being treated with disrespect by HCPs (Mötteli et al., 2019). Stigma displayed by HCPs in the healthcare setting can create emotional anguish, anxiety, and diminishes the individual's self-esteem. Furthermore, this can impede HCPs from providing holistic
Significance of the project
The diagnosis of a mental health disorder is particularly and overwhelmingly affected by disease-associated stigma. Universally, the unique aspects of MHDs creates enormous challenges to the quality of health care delivery. This issue demands the attention of conscientious HCPs working in healthcare settings. The negative attitudes attached to MHDs fosters denunciation and condemnation, which leads to suboptimal social interactions (Hinshaw & Stier, 2008). Stigmatizing attitudes towards
Clinical question
Specifically, this integrative review aims to answer the research question: “Do educational interventions and/or other initiatives effectively reduce the stigmatizing attitudes of healthcare professionals toward patients presenting with a chief complaint of mental health disorder in the healthcare setting?”
Methods
An integrative review is the broadest type of research, which warrants a blend of various methodologies, such as experimental and non-experimental research, as well as merged data from theoretical and empirical research, to understand a phenomenon of interest (Hopia et al., 2016; Souza et al., 2010; Whittemore & Knafl, 2005). This method of review can accurately identify evidence-based practice, research, and policy initiatives for healthcare practice (Hopia et al., 2016; Souza et al., 2010;
Conceptual framework and eligible criteria
To sustain the comprehensive framework, this study followed the Preferred Reporting Items for Systematic Reviews and Meta (PRISMA) guidelines (Moher et al., 2009). The synthesized data derived from the primary research is used to provide an understanding of the accuracy of various tests to identify source variability (Welch et al., 2016). The PRISMA consist of a 27-item, diagnostic-test checklist, which is a four-phase flow diagram used to guide comprehensive and transparent reporting of
Global mental health disorder stigma
Stigma is a relentless force. Evidence suggests that stigma leads to guilt, humiliation, low self-esteem, and anxiety resulting in social isolation and increased reluctance towards medical care (Cheon & Chiao, 2012; Rüsch et al., 2014). Mental illness stigma is well documented in different parts of the world. It is a global issue that transcends cultural heritage and raises major concern for individuals with MHDs (Dalky, 2012; Hinshaw & Stier, 2008). Globally, the perception of MHDs are shaped
Selected studies and interventions
The studies in this integrative review consist of various interventions with some studies using multiple methods to address stigma in the healthcare setting. Most of the interventions listed in this review have proven to be effective in reducing the stigma related to MHDs, except for one study by Mittal et al. (2020). The interventions utilized for these studies are listed in Table 2 in the Intervention column. Comprehending the various methods and the effectiveness of each method used within
Discussion
The results of this integrative review suggest that the most effective stigma-reducing interventions are the contact-based interaction between HCPs and individuals who are successfully living life with MHDs (Corrigan et al., 2012). When individuals share their personal experiences living with MHDs, it can reduce anxiety and increase empathy in HCPs (Corrigan et al., 2012). The meta-analysis conducted by Corrigan et al. (2012), found that contact-based interventions helped decreased stigma of
Limitations
Although the integrative review is the broadest type of review used in nursing research, there are some limitations to this methodology. For example, the intricacy of using varied studies has the potential to cause bias and a lack of rigor. Moreover, many of the studies have not been analyzed for the long-term effectiveness of anti-stigma interventions; therefore, the efficacy of the interventions only demonstrates short-term benefits. Additional studies are needed to evaluate if the benefits
Implementations for practice and research
Decreasing mental health stigma should be a top priority of healthcare policies to uphold the rights of individuals with MHDs and ensure healthcare equity. A stigma reduction program should be an ongoing process in healthcare settings, and the approaches must be continually analyzed to ensure its viability. Applying anti-stigma interventions related to MHDs along with recommended strategies, should be included as part of continuing education for all HCPs, and added as an essential criterion for
Conclusion
There is growing evidence which suggests using various initiatives to reduce stigmatization among HCPs and increase the delivery of mental health interventions with fidelity. Developing various techniques for reducing stigma in HCPs perception towards patients with MHDs is coherent with the objectives of the WHO Action Plan 2013–2020 (Saxena et al., 2013) and the objective of the Grand Challenges in Global Mental Health (Collins et al., 2011). Therefore, understanding MHDs and participating in
Human and animal rights
This article does not contain any studies with animals performed.
Informed consent
This is an integrative review, and no informed consent was required.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of competing interest
None.
Acknowledgement
The author would like to express sincere appreciation to Dr. Cynthia Goodrich (Liberty University) and Dr. Anthony Bauer (Liberty University) for their invaluable guidance in completing this project.
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