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Health Services Research & Development

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Does Serious Mental Illness Influence Treatment Decisions of Physicians and Nurses?

Mittal D, Sullivan G, Reaves C, Han X, Mukherjee S, Morris S, Corrigan P. Does Serious Mental Illness Influence Treatment Decisions of Physicians and Nurses? Poster session presented at: American Psychiatric Association Annual Meeting; 2013 May 21; San Francisco, CA.

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Introduction: Although at high risk for chronic medical conditions, persons with serious and persistent mental disorders, such as schizophrenia, receive poor care for their physical health problems. Relative to those without mental illness, persons with serious mental disorders receive sub-optimal medical, preventive, and specialty health care. While the reasons for this pattern are multi-factorial and complex, one potential contributor that has received very little attention is providers' stigmatizing attitudes about mental illness. Bias on the part of health care providers has been documented in several areas, including bias related to gender, race, and socioeconomic status. The goal of this project was to assess the influence of serious mental illness on providers' decision-making about treatment; and to compare the effect of mental illness on the decision-making of four different provider types (primary care physicians, primary care nurses, psychiatrists, and mental health nurses). Methods: To investigate provider bias among providers as a result of serious mental illness, we conducted a vignette survey study. The study was informed by a conceptual model based on extensive literature review. The model proposes that providers' practice behaviors (or, more precisely, behavioral intentions) and expectations represent a function of provider characteristics (including provider personality traits [specifically authoritarianism, empathy , and self-awareness], training and specialty) and stigmatizing beliefs and attitudes. The model holds that stigmatizing attitudes and beliefs are associated with hypothetical provider behaviors (defined as "outcomes" in this project), such as intention to refer patients for psychosocial rehabilitation or to weight reduction programs Results: Results reveal that all provider groups (primary care and mental health doctors and nurses) viewed persons with SMI more negatively than they viewed persons without SMI on most attitudinal and behavioral outcome variables, including those related to treatment decisions. This finding suggests that stigma-reduction interventions that target all provider groups are needed.

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