The Effects of Stigma Toward Mental Illness on

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The Effects of Stigma Toward Mental Illness on Family Physicians Michelle Sipe, MS 4;

The Effects of Stigma Toward Mental Illness on Family Physicians Michelle Sipe, MS 4; Kristine Goto, Ph. D Our predictions: - Family physicians with higher stigma would - Refer to psychiatry more quickly - Feel less comfortable treating mental illness - Take less psychosocial CME Referral Score 1, 47 Depression -1, 9 Anxiety Practice Setting Not Underserved, 63 (47%) Urban 67 (51%) 39 (29%) -3, 3 Immediately Years in Practice Underserved, 70 (53%) -4, 8 1 (1%) 12 (9%) 58 (44%) 60 (46%) 0 -25% 26 -50% 51 -75% 76 -100% -1, 6 Summary of Results - Stigma was related to referral rates to psychiatrists for anxious patients only. - Lower stigma levels were associated with greater amounts of recent psychiatric CME. - Stigma wasn’t related to comfort level treating mental illness. 70 -3, 9 0 2 Limitations - Geographic constraints (Arizona) - AMIQ instrument – self-reporting 43 11 7 3 4 Likert scale (Comfort Level) 5 Figure 3: Comfort level (a higher number indicates more comfort) and average AMIQ scores (more negative numbers indicate higher stigma) -2, 1 -1 -2, 5 61 -5, 3 11 0 hrs Figure 1: Demographics -2, 3 -2, 4 3. Lower stigma levels were significantly related with higher levels of recent psychosocial CME. 10 -20 years 44 (33%) Other Results and Trends - Physicians’ mean overall stigma score was -2. 08 (from -10 to +10, with negative numbers indicating higher stigma) - Family physicians were more likely to treat (vs. refer) anxiety and depression. - Physicians in underserved areas tended to be younger and more comfortable treating mental illness. - Stigma increased with years in practice Discussion and Conclusions 2. There was no significant relationship between stigma levels and comfort levels with treating mental illness. 1 6 -10 years 12 (9%) % of Mental Illness in Practice -3, 5 After 1 -2 meds 1 -5 years 29 (22%) >20 years 48 (36%) -2 Figure 2: Referral scores (higher scores indicate more medication trials before referring) and referral categories correlated to average AMIQ (stigma) scores Results Rural 27 (20%) Schizophrenia -1, 6 -2, 2 -1, 8 -2 -2, 2 1, 11 Bipolar Referral categories; refer: # Respondents Our study had three aims: 1. Compare AMIQ (stigma) ratings and referral rates for anxiety, depression, bipolar, and schizophrenia. 2. Compare AMIQ ratings and selfstated comfort levels with treating mental illness. 3. Compare AMIQ ratings and amount of recent psychosocial CME. 2, 41 2, 37 After 3+ Meds Suburban Aims 1. Stigma and referral rates for anxiety were significantly related, but no other mental illnesses (depression, bipolar disorder, or schizophrenia) were significantly related to stigma levels. AMIQ Scores Prior studies examined referral rates based on perceived confidence level, and how confidence relates to amount of recent psychosocial CME. 5, 6 Few studies have examined whether these factors are related to physician stigma toward mental illness. We administered an email survey to family physicians via a statewide family medicine association. The survey contained demographic questions and a short stigma questionnaire (Attitudes Towards Mental Illness Questionnaire or AMIQ). Respondents were asked about their comfort level, amount of recent mental health-related CME, and how many medications they would try before referring patients to psychiatry. # Respondents AMIQ Scores Almost 91 million Americans live in Mental Health Professional Shortage Areas 1, and PCPs supply about half of mental health services 2. Prior research has demonstrated that physicians frequently hold stigmatized views towards patients with mental illness 3. These views can result in a decline in timely, proper diagnosis and treatment and erosion of the physician-patient relationship 4. Main Results Methods AMIQ Scores Background Importance - Helped clarify relationship between stigma, referral habits, comfort level, and CME amongst family physicians in Arizona. - Stigma-reduction training could result in less unnecessary referrals and improved patient care. References 38 15 4 ≤ 10 hrs 11 -20 hrs 20 -40 hrs Amount of CME >40 hrs Figure 4: Recent psychosocial CME (last 3 years) and average AMIQ (stigma) scores (more negative numbers indicate higher stigma) 1. U. S. Department of Health and Human Services. Shortage designation: Health Professional shortage areas & medically underserved Areas/Populations. http: //bhpr. hrsa. gov/shortage 2. Searight R. Realistic approaches to counseling in the office setting. Am Fam Physician. 2009; 79(4): 277 -284. 3. Shao WA, Williams JW, J r, Lee S, Badgett RG, Aaronson B, Cornell JE. Knowledge and attitudes about depression among non-generalists and generalists. J Fam Pract. 1997; 44(2): 161 -168. 4. van Nieuwenhuizen A, Henderson C, Kassam A, et al. Emergency department staff views and experiences on diagnostic overshadowing related to people with mental illness. Epidemiol Psychiatr Sci. 2012: 1 -8. 5. Verhaak PF. Analysis of referrals of mental health problems by general practitioners. Br J Gen Pract. 1993; 43(370): 203 -208 6. Bethune C, Worrall G, Freake D, Church E. No psychiatry? assessment of family medicine residents' training in mental health issues. Can Fam Physician. 1999; 45: 2636 -2641.