The study explored the levels of perceived stigma, devaluation, and discrimination towards people with mental disorders, as well as the influential factors among Chinese psychiatrists. The scores of the PDD scale, along with its two subscales, were negatively associated with professional titles, income satisfaction and job satisfaction. Both the scores of the PDD scale and the Perceived Devaluation subscale were significantly higher among participants with younger age and violence attack experience. In addition, the scores of the Perceived Discrimination subscale were significantly lowers among female psychiatrists.
Our results showed a relatively high level of mental illness stigma among Chinese psychiatrists. The average scores of the PDD scale (3.60), the Perceived Devaluation subscale (3.48), and the Perceived Discrimination subscale (3.69) were higher than the midpoint score (i.e., 3). The average score of the PDD scale in our study was higher than that in some other studies on community residents in Tianjin, China (mean scores of the PDD scale, Perceived Discrimination subscale and Perceived Devaluation subscale were 3.1, 3.2 and 2.8, respectively) (26) and nursing students from a university in north China (mean score of the PDD scale was 2.78) (27). Similarly, studies conducted in Australia (36), Brazil (12) and Italy (11) indicated that psychiatrists had greater stereotypes to people with mental illness than the general population. It might be due to the fact that compared to the general public or medical students, psychiatrists are more exposed to individuals with mental disorders and a heavier workload in providing mental health services. They may foster stigma through different ways consciously or unconsciously, such as demonstrating social distancing, psychiatric labelling, insufficient interpretation on diagnosis, etc. (37, 38). Moreover, the lack of government investment in mental health resources (20) would affect the quality and effectiveness of services, thereby perpetuating the stereotypical view of mental illness as untreatable and deteriorating (12).
This study indicated that psychiatrists with higher professional titles had higher scores in the PDD scale and its two subscales. As psychiatrists progress in their careers and attain higher professional titles, they are more likely to encounter severe mental disorders and complex situations. This may result in a more negative perception of individuals with mental illness or a greater desire to maintain social distance compared to those with lower titles. Moreover, lower income satisfaction and lower job satisfaction were found to be linked with increased levels of perceived stigma. Professional satisfaction can be diminished by unfair payment of wage (39). Low job satisfaction among psychiatrists can lead to a high incidence of burnout (31, 40), a psychological syndrome merging as a long-term response to chronic stressors at work and characterized by three dimensions: emotional exhaustion, depersonalisation, and reduced personal accomplishment (41). Depersonalisation refers to the development of apathetic, pessimistic and dehumanizing attitudes towards patients (42), which is highly correlated with mental illness stigma among psychiatrists (43, 44).
Our study also revealed a negative association between the levels of psychiatrists’ stigma towards mental illness and their age. This finding contrasts with previous research conducted in Australia (45), which suggested that health professionals with older aged held more stigmatising attitudes towards mental illness patients. This may be explained by the fact that their sample involved a wide variety of specialties, whereas our current study focused solely on psychiatrists. In line with our finding, a study conducted on psychiatrists in Brazil discovered that younger age was related to negative stereotype (12). Psychiatrists with older age may have more professional experience in dealing with mental disorders and are more likely to witness the process of treatment, rehabilitation, and reintegration into the society of their patients; this experience, in turn, serves as an agent for reducing stigma (46).
In addition, psychiatrists who had experienced a violent attack within the past year demonstrated significantly higher scores in the PDD scale and the Perceived Devaluation subscale than those who had not experienced such attacks. There is a high prevalence of workplace violence (WPV) against healthcare workers, especially in psychiatric settings (47), where the risk of patients’ violent behaviours is increased by psychiatric disorders such as psychoses and substance dependence (48). WPV against health professionals would cause deleterious consequences such as job dissatisfaction, anxiety, and burnout (48, 49). Psychiatrists may distance themselves from the work (41), perceiving patients as dangerous and potentially harmful to society, which can result in higher levels of mental illness stigma.
Our study found that female psychiatrists had lower scores in perceived devaluation than their male counterparts. This is consistent with prior studies conducted on the general public or medical staff, showing that females reported lower levels of stigma than the males (30, 45, 50). Possible explanations for this observation could include the fact that female psychiatrists tend to have higher levels of empathy than male psychiatrists (51). Additionally, women may be more aware of the detrimental effects of stigmatization (52) and more willing to reach out to people with mental illness (30), thereby becoming more aware of the situation of the mentally ill people and holding a more positive view of their worth.
There are some limitations to our study. First, the representativeness of our findings should be considered with caution since the sample was not randomly selected. Second, as our sampling strategy was cross-sectional, the results could not establish a causal relationship. For future research, we recommend employing a longitudinal design with randomized sampling to address these limitations.