Study Suggests Providers' Endorsement of Stigma Regarding Mental Illness Related to Patient Treatment Options
People with serious mental illness experience serious health challenges and alarming morbidity rates, dying on average, 15 to 30 years younger than their cohorts. In part, this occurs because of health system failures (i.e., absence of integrated care services or insufficient insurance coverage). However, research also suggests that some provider decisions may worsen health outcomes; for example, health providers are less likely to refer patients with mental illness for mammography, inpatient hospitalization after diabetic crisis, or cardiac catheterization. Provider endorsement of stigma might be one possible influence on these healthcare decisions for people with mental illness. This study examined provider response to two treatment options that might be offered to a male patient with schizophrenia who was seeking help for low back pain due to arthritis: 1) referral for specialist consult, or 2) refilling the patient's prescription for Naproxen. In 2011 and 2012, investigators recruited nurses, physicians, and psychologists (total=166) from mental health and primary care clinics in five VA hospitals located in the Southeast and Southwest U.S. Participants were asked to complete one of two mailed vignettes: in one vignette, the patient had schizophrenia; in the other, he did not (results are reported in this paper only for the patient with schizophrenia). Study measures also included assessing participants' attitudes about mental healthcare; for example, if they had a mental health problem, would they go for help, and how embarrassed would they feel if friends knew they'd sought professional help.
- Healthcare providers who endorsed more stigmatizing attitudes about mental illness were likely to be more pessimistic about the patient's adherence to treatment. Stigmatizing attitudes were greater among those providers who were relatively less comfortable with using mental health services themselves.
- Greater perceived treatment adherence was positively associated with both health decisions: referrals and prescription refill. Thus, poor perceived adherence was partly a proxy for stigmatizing attitudes providers held about people with mental illness, which in turn led to different treatment decisions in patients with serious mental illness.
- Providers from mental health backgrounds showed no difference in expectations about treatment response than primary care professionals, suggesting that both primary care and mental health providers should be targets of interventions aimed at decreasing disparities in clinical care.
- Decisions in the model were behavioral intentions and not actual behaviors. Subsequent studies should examine the relationship between providers' attitudes and their actual treatment decisions in patients with mental illness; for example, do provider beliefs about people with mental illness and their response to treatment predict actual treatment decisions?
- The model was correlational and not causational; future research should collect belief and behavior indicators over separate times.
This study was funded by HSR&D (IIR 08-086). Dr. Mittal is part of HSR&D's Center for Mental Healthcare and Outcomes Research and the Central Arkansas Veterans Healthcare System.
Corrigan P, Mittal D, Reaves C, Haynes T, Han X, Morris S, and Sullivan G. Mental Health Stigma and Primary Health Care Decisions. Psychiatry Research. August 15, 2014;218(1-2):35-38.