Attitudes of psychiatrists towards people with mental illness: a cross-sectional, multicentre study of stigma in 32 European countries.

Background: Mental health-related stigma occurs among the public and professionals alike. The lived experience of mental illness has been linked to less stigmatising attitudes. However, data on psychiatrists and the relationship between stigmatising attitudes and psychotherapeutic activity or case discussion groups remains scarce. Methods: A cross-sectional multicentre study was performed in 32 European countries to investigate the lived experiences and attitudes of psychiatrists toward patients with mental illness as well as the relationship between stigma, psychosocial and professional factors. The self-reported, anonymous, internet-based Opening Minds Stigma Scale for Health Care Providers was used to measure the stigmatising attitudes. The survey was translated into the local language of each participating country. All participants were practising specialists and trainees in general adult or child and adolescent psychiatry. The study took place between 2nd October, 2019 and 9th July, 2021 and was preregistered at ClinicalTrial.gov (NCT04644978). Findings: A total of 4245 psychiatrists completed the survey. The majority, 2797 (66%), had completed training in psychiatry, and 3320 (78%) worked in adult psychiatry. The final regression model showed that across European countries more favourable attitudes toward people with mental illness were statistically significantly associated with the lived experience of participants (including seeking help for their own mental health conditions (d = -0.92, 95% confidence interval (CI) = -1.68 to -0.15, p = 0.019), receiving medical treatment for a mental illness (d = -0.88, 95% CI = -1.71 to -0.04, p = 0.040), as well as having a friend or a family member similarly affected (d = -0.68, 95% CI = -1.14 to -0.22, p = 0.004)), being surrounded by colleagues who are less stigmatising (d = -0.98, 95% CI = -1.26 to -0.70, p < 0.001), providing psychotherapy to patients (d = -1.14, 95% CI = -1.63 to -0.65 p < 0.001), and being open to (d = -1.69, 95% CI = -2.53 to -0.85, p < 0.001) and actively participating in (d = -0.94, 95% CI = -1.45 to -0.42, p < 0.001) case discussion, supervision, or Balint groups. Interpretation: Our study highlights the importance of psychotherapy training, supervision, case discussions and Balint groups in reducing the stigmatising attitudes of psychiatrists toward patients. As the findings represent cross-national predictors, Europe-wide policy interventions, national psychiatric education systems and the management of psychiatric institutions should take these findings into consideration. Funding: National Youth Talent Award (Ministry of Human Resources, Hungary, (NTP-NFTÖ-20-B-0134). All authors received no funding for their contribution.

Psychometric properties of the Opening Minds Stigma Scale for Health Care Providers in 32 European countries - A bifactor ESEM representation.

Aims: To measure the stigma of healthcare providers toward people suffering from mental illness, the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a commonly applied instrument. However, this scale has not been thoroughly validated in many European countries, its psychometric properties are still unknown and data on practicing psychiatrists is lacking. Therefore, this multicenter study aimed to assess the psychometric characteristics of the 15-item OMS-HC in trainees and specialists in adult and child psychiatry in 32 countries across Europe. Materials and methods: The OMS-HC was conducted as an anonymous online survey and sent via Email to European adult and child psychiatrists. Parallel analysis was used to estimate the number of OMS-HC dimensions. Separate for each country, the bifactor ESEM, a bifactor exploratory structural equation modeling approach, was applied to investigate the factor structure of the scale. Cross-cultural validation was done based on multigroup confirmatory factor analyses and reliability measures. Results: A total of 4,245 practitioners were included, 2,826 (67%) female, 1,389 (33%) male. The majority (66%) of participants were specialists, with 78% working in adult psychiatry. When country data were analyzed separately, the bifactor model (higher-order factor solution with a general factor and three specific factors) showed the best model fit (for the total sample χ2/df = 9.760, RMSEA = 0.045 (0.042-0.049), CFI = 0.981; TLI = 0.960, WRMR = 1.200). The average proportion of variance explained by the general factor was high (ECV = 0.682). This suggests that the aspects of 'attitude,' 'disclosure and help-seeking,' and 'social distance' could be treated as a single dimension of stigma. Among the specific factors, the 'disclosure and help-seeking' factor explained a considerable unique proportion of variance in the observed scores. Conclusion: This international study has led to cross-cultural analysis of the OMS-HC on a large sample of practicing psychiatrists. The bifactor structure displayed the best overall model fit in each country. Rather than using the subscales, we recommend the total score to quantify the overall stigmatizing attitudes. Further studies are required to strengthen our findings in countries where the proposed model was found to be weak.

The Postpartum Obsessive-Compulsive Scale: Psychometric, Operative and Epidemiologic Study in a Portuguese Sample.

BACKGROUND: Although obsessive-compulsive (OC) symptoms are common in the perinatal period, measures to comprehensively assess their presence, frequency, interference and severity are lacking. The Perinatal Obsessive-Compulsive Scale (POCS) is the only self-report questionnaire with context-specific items. It includes items to assess perinatal-specific obsessions and compulsions, a severity scale and an interference scale. OBJECTIVES: (1) to analyze the validity and reliability of the Portuguese version of the POCS; (2) to find Obsessive-Compulsive Disorder (OCD) prevalence in postpartum and determine the POCS cut-off scores and its accuracy (sensitivity, specificity and predictive values) in screening for OCD according to DSM-5 criteria; (3) to describe the prevalence, content, severity, interference and onset of OC symptoms in the postpartum. METHODS: 212 women in postpartum filled in a booklet, including the POCS Portuguese preliminary version, the Perinatal Anxiety Screening Scale and the Postpartum Depression Screening Scale; they were interviewed with the Diagnostic Interview for Psychological Distress-Postpartum. RESULTS: Confirmatory Factor Analysis revealed that POCS presented acceptable fit indexes (χ2/df = 2.2971; CFI= 0.9319; GFI = 0.8574; TLI = 0.9127; RMSEA = 0.860, p < 0.001). The Cronbach's alphas were all > 0.800. The POCS cut-off point that maximized the Youden Index (J = 0.86, 95% CI [0.94-0.99]) was 20, corresponding to an Area Under the Curve of 0.970 (p < 0.001; Standard Error = 0.031; 95% CI: 0.937 to 0.988). The prevalence of postpartum OCD was 3.30%. The severity of thoughts and behaviors was moderate to severe for approximately 15% of women. For thirty-five percent of women, the onset of symptoms was in the first three months postpartum. CONCLUSIONS: The Portuguese version of POCS has good validity, reliability and accuracy and may be considered ready for use in both clinic and research fields. POCS provides specific information regarding symptoms and individual patterns experienced by each woman, which allows normalization, destigmatization and personalized intervention.

The Impact of COVID-19 on Anxious and Depressive Symptomatology in the Postpartum Period.

Background: Women in the postpartum period may be particularly vulnerable to the psychological effects of the COVID-19 pandemic. The aim of our study was to evaluate the impact of the coronavirus pandemic on postpartum depression and anxiety levels and the role of the fear of COVID-19 in its development. Methods: Women who delivered at the Bissaya Barreto Maternity Hospital, between 16 March and 16 June 2020 (Group 1: Birth in COVID-19 period, n = 207), recruited in the postpartum period, filled in a set of self-reported validated questionnaires: Perinatal Depression Screening Scale, Perinatal Anxiety Screening Scale, Profile of Mood States, Perseverative Thinking Questionnaire, Dysfunctional Beliefs Towards Maternity Scale, and the Fear of COVID-19 Scale. Levels of depressive and anxious symptomatology, negative affect, negative repetitive thinking, and the dysfunctional beliefs towards motherhood of these women were compared with data from samples of previous studies that included women whose delivery had occurred at the same Maternity Hospital before the COVID-19 pandemic period (Group 2: Birth before the COVID-19 period, n = 212). Results: Based on the cutoff points of the screening scales, the prevalence of clinically relevant depressive and anxious symptoms in Group 1 was 40.1% and 36.2%, respectively. Women in Group 1 had significantly higher levels of anxious and depressive symptoms, negative affect, negative repetitive thinking, and dysfunctional beliefs towards motherhood than women in Group 2 (p < 0.05). Fear of COVID-19 in the postpartum period was a predictor of depressive (ß = 0.262) and anxious (ß = 0.371) symptoms, explaining 6.9% and 13.7% of their variability, respectively (p < 0.001). Conclusion: During the COVID-19 pandemic, women in the postpartum period present greater depressive and anxious symptomatology, as well as increased risk factors.

Portuguese Version of the Stigma Scale: Preliminary Psychometric Characteristics.

INTRODUCTION: Stigma is associated with poor prognosis of illness and reduced help-seeking behavior, self-esteem and treatment compliance. The aims of this study were to study the reliability and construct validity of the King's et al Stigma Scale, and its association with Illness and Help-Seeking Behaviors scale (IHSBS) scores. MATERIAL AND METHODS: One hundred and forty mental health patients filled out the Stigma scale and the Illness and Help-Seeking Behaviors scale. The exploratory factor analysis of the stigma scale was performed, and its reliability studied. The correlation analysis was used and mean differences in Stigma Scale scores among IHSBS groups were explored. RESULTS: The exploratory factor analysis indicated four factors (F): F1-Disclosure, F2-Discrimination, F3-Acceptance and F4-Personal Growth, which showed acceptable/good internal consistency (α from 0.70 to 0.91). Help-seeking behaviors were not associated with stigma. The levels of Discrimination were high in the group with global high-IHSB and in patients with medium/high illness behavior (IB) and health-related worries (HW). Additionally, Disclosure and overall stigma levels were higher in groups with high-HW and with medium-IB scores (when compared with the group with low-IB). The group with low-IB also had lower levels of Acceptance and Personal Growth when compared with the groups with medium-IB and high-IB, respectively. CONCLUSION: The Stigma Scale (27 items) is a valid, reliable instrument and useful tool to assess stigma in mental health patients.

Introdução: O estigma está associado a pior prognóstico de doença e redução da procura de ajuda, autoestima e adesão ao tratamento. Os objetivos deste estudo foram estudar a fidedignidade a validade de construto da Escala de Estigma de King et al e a sua associação com as pontuações da Escala de Comportamento de Procura de Ajuda e de Doença (ECPAD). Material e Métodos: Cento e quarenta doentes psiquiátricos preencheram a Escala de Estigma e a ECPAD. Foi realizada a análise fatorial exploratória da escala de estigma e a sua fidelidade estudada. Foram realizadas análises de correlação e exploradas as diferenças nas médias das pontuações da escala de estigma nos grupos de ECPAD. Resultados: A análise fatorial exploratória indicou quatro fatores (F): F1-Divulgação, F2-Discriminação, F3-Aceitação e F4-Crescimento Pessoal (α de 0.70 a 0.91). Os comportamentos de procura de ajuda não se associaram ao estigma. Os níveis de Discriminação foram altos no grupo com CPAD total-elevado e nos grupos com comportamentos de doença (CD) e com preocupações com a saúde (PS) médios/elevados. Adicionalmente, os níveis de Divulgação e Estigma total foram superiores no grupo com PS-elevado e no grupo com CD-médio (quando comparado com o grupo CD-baixo). O grupo com CD-baixo também revelou níveis inferiores de Aceitação e Crescimento Pessoal em comparação com os grupos com CD-médio e CD-elevado, respectivamente. Conclusão: A escala de estigma (27 itens) é um instrumento válido, fidedigno e útil para avaliar o estigma em doentes psiquiátricos.

The Protective Role of Self-Compassion in the Relationship between Perfectionism and Burnout in Portuguese Medicine and Dentistry Students.

Recent studies have documented the high prevalence of burnout among medicine and dentistry students, with potentially catastrophic consequences for both students and patients. Both environmental and personality factors play a part in burnout; perfectionism, a common trait in medicine students' personalities, has been linked to psychological distress and increasing students' vulnerability to burnout. Self-compassion, i.e., treating oneself kindly through hardship, has recently emerged as a buffer between perfectionism and psychological distress. While using a novel three-factor conceptualization of perfectionism (BIG3), this study aims to analyze if self-compassion has a protective role in the relationship between perfectionism and burnout, in a sample of medicine and dentistry students, through mediation analysis. We found that self-compassion significantly mediated the relationship between all three forms of perfectionism and burnout: as a partial mediator in self-critical and rigid perfectionism, as well as a full mediator in narcissistic perfectionism. Our findings underline self-compassion's relevance in burnout prevention and management, supporting its use as an intervention target in burnout reduction programs and strategies.

COVID-19 psychological impact: The role of perfectionism.

Psychological reactions to pandemics and their constraints depend heavily on personality. Although perfectionism is consistently associated to depression, anxiety and stress, its role in the pandemics' psychological impact has not been yet empirically studied. Our aim was to analyze the role of perfectionism in psychological distress during the pandemic of COVID-19, testing whether it is mediated by fear of COVID-19 and repetitive negative thinking/RNT. Participants (N = 413 adults; 269.2% women) were recruited from September until December 2020, via social networks. They completed self-report validated questionnaires to evaluate perfectionism dimensions (self-critical, rigid and narcissistic perfectionism), fear of COVID-19, RNT and psychological distress (sum of anxiety, depression and stress symptoms). As women had significantly higher levels of self-critical perfectionism, RNT, fear of COVID-19 and psychological distress, gender was controlled in mediation analysis. The three perfectionism dimensions correlated with RNT, fear of COVID-19 and psychological distress. The effect of self-critical perfectionism on psychological distress was partially mediated by fear of COVID-19 and RNT whereas the effect of rigid and narcissistic perfectionism was fully mediated. Perfectionism influences emotional and cognitive responses to the COVID-19 and therefore should be considered both in the prevention and psychological consequences of the pandemic.