Retrospective Study
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World J Psychiatr. Sep 22, 2014; 4(3): 62-68
Published online Sep 22, 2014. doi: 10.5498/wjp.v4.i3.62
Preliminary study of associative stigma among trainee psychiatrists in Flanders, Belgium
Kirsten Catthoor, Joost Hutsebaut, Didier Schrijvers, Marc De Hert, Jozef Peuskens, Bernard Sabbe
Kirsten Catthoor, Department of Psychiatry, Psychiatrisch Ziekenhuis Stuivenberg, ZNA Antwerpen, B2060 Antwerp, Belgium
Kirsten Catthoor, Didier Schrijvers, Bernard Sabbe, Collaborative Antwerp Psychiatric Research Institute, Campus Drie Eiken, 2610 Wilrijk, Belgium
Joost Hutsebaut, De Viersprong (Landelijk Centrum voor Persoonlijkheidsproblematiek), 4661 EP Halsteren, The Netherlands
Marc De Hert, Jozef Peuskens, Department Neurosciences KU Leuven, UPC KULeuven, Campus Kortenberg, 3070 Kortenberg, Belgium
Author contributions: Catthoor K designed the study, collected the data, and drafted the article; Hutsebaut J and Schrijvers D participated in the design of the study, performed statistical analysis, and interpreted the results; De Hert M, Peuskens J and Sabbe B revised the paper critically; all authors read and approved the final manuscript.
Correspondence to: Kirsten Catthoor, MD, Department of Psychiatry, Psychiatrisch Ziekenhuis Stuivenberg, ZNA Antwerpen, ZNA Lange Beeldekensstraat 267, B2060 Antwerp, Belgium.
Telephone: +32-478-353957 Fax: +32-3-2177752
Received: March 28, 2014
Revised: June 17, 2014
Accepted: July 12, 2014
Published online: September 22, 2014

AIM: To study the degree of stigmatization among trainee psychiatrists, individual characteristics potentially leading to higher associative stigma, and coping mechanisms.

METHODS: Two hundred and seven trainee psychiatrists in Flanders (Belgium), all member of the Flemish Association of Trainee Psychiatrists, were approached to participate in the survey. A non-demanding questionnaire that was specifically designed for the purpose of the study was sent by mail. The questionnaire consisted of three parts, each emphasizing a different aspect of associative stigma: devaluing and humiliating interactions, the focus on stigma during medical training, and identification with negative stereotypes in the media. Answers were scored on a Likert scale ranging from 0 to 3. The results were analyzed using SPSS Version 18.0.

RESULTS: The response rate of the study was 75.1%. The internal consistency of the questionnaire was good, with a Cronbach’s α of 0.71. Seventy-five percent of all trainee psychiatrists confirmed hearing denigrating or humiliating remarks about the psychiatric profession more than once. Additionally, more than half of them had had remarks about the incompetence of psychiatrists directed at them. Only 1.3% remembered having stigma as a topic during their psychiatric training. Trainees who had been in training for a longer period of time had experienced a significantly higher level of stigmatization than trainees with fewer years of experience (mean total stigma scores of 16.93 ± SD 7.8 vs 14.45 ± SD 6.1, t = -2.179 and P < 0.05). In addition, senior trainees effectively kept quiet about their profession significantly more often than their junior colleagues (mean item score 0.44 ± SD 0.82 vs 0.13 ± SD 0.48, t = 2.874, P < 0.01). Comparable results were found in trainees working in adult psychiatry as were found in those working in child or youth psychiatry (mean item score 0.38 ± SD 0.77 vs 0.15 ± SD 0.53, t = -2.153, P < 0.05). Biologically oriented trainees were more inclined to give preventive explanations about their profession, which can be seen as a coping mechanism used to deal with this stigma (mean item score 2.05 ± SD 1.05 vs 1.34 ± SD 1.1, t = -3.403, P < 0.01).

CONCLUSION: Associative stigma in trainee psychiatrists is underestimated. More attention should be paid to this potentially harmful phenomenon in training.

Keywords: Associative stigma, Trainee psychiatrist, Psychiatry training, Mental health gap, Coping mechanisms

Core tip: Associative stigma is an extension of psychiatric stigma to those who care for patients, including psychiatrists. Scientific evidence on associative stigma among trainee psychiatrists is scarce although theoretical considerations are abundant. This study tried to evaluate the degree to which trainees experience stigmatization related to their profession. The results suggest that associative stigmatization is a marked problem for psychiatrists in training. Trainee psychiatrists in Flanders mention feelings of stigmatization within society in general and the medical environment in particular. A better understanding of this complex phenomenon is certainly warranted, to prevent the further evolution of the mental health gap.