Community Mental Health Journal

, Volume 52, Issue 3, pp 294–301 | Cite as

Patient Perceptions of Prejudice and Discrimination by Health Care Providers and its Relationship with Mental Disorders: Results from the 2012 Canadian Community Health-Mental Health Survey Data

  • Kirsten Marchand
  • Heather Palis
  • Eugenia Oviedo-Joekes
Original Paper


Using data from a nationally representative survey, the Canadian Community Health Survey-Mental Health, this secondary analysis aimed to determine the prevalence of perceived prejudice by health care providers (HCPs) and its relationship with mental disorders. Respondents accessing HCPs in the prior year were asked if they experienced HCP prejudice. A hypothesis driven multivariable logistic regression analysis was conducted to determine the relationship between type of mental disorders and HCP prejudice. Among the 3006 respondents, 10.9 % perceived HCP prejudice, 62.4 % of whom reported a mental disorder. The adjusted odds of prejudice was highest for respondents with anxiety (OR 3.12; 95 % CI 1.60, 6.07), concurrent mood or anxiety and substance disorders (OR 3.08; 95 % CI 1.59, 5.95) and co-occurring mood and anxiety disorders (OR 2.89; 95 % CI 1.68, 4.97) compared to respondents without any mental disorders. These findings are timely for informing discussions regarding policies to address HCP prejudice towards people with mental disorders.


Health care provider prejudice Patient experiences Mental disorders 



The authors wish to acknowledge Dr. Mieke Koehoorn from the University of British Columbia for her contributions to the development of the manuscript. Author support was also received by The Western Regional Training Centre for Health Services Research (KM), Canadian Institutes of Health Research (EOJ) and Michael Smith Foundation for Health Research (EOJ).

Author’s Contribution

All authors take public responsibility for the content and have made substantial contributions to the manuscript. KM, HP and EOJ contributed to the conception and interpretation of the data. KM led data acquisition and analysis and drafted the manuscript. All authors revised the manuscript for intellectual content and approved the final version.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to declare.


  1. Alonso, J., Buron, A., Bruffaerts, R., He, Y., Posada-Villa, J., Lepine, J. P., et al. (2008). Association of perceived stigma and mood and anxiety disorders: results from the World Mental Health Surveys. Acta Psychiatrica Scandinavica, 118(4), 305–314.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Bolster, D., & Manias, E. (2010). Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: Qualitative observation and interview study. International Journal of Nursing Studies, 47(2), 154–165.CrossRefPubMedGoogle Scholar
  3. Brener, L., Horwitz, R., von Hippel, C., Bryant, J., & Treloar, C. (2014). Discrimination by health care workers versus discrimination by others: Countervailing forces on HCV treatment intentions. Psychology, Health & Medicine, 20, 1–6.Google Scholar
  4. Buckley, P. F. (2006). Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness. Journal of Clinical Psychiatry, 67(Suppl 7), 5–9.PubMedGoogle Scholar
  5. Burgess, D. J., Ding, Y., Hargreaves, M., van Ryn, M., & Phelan, S. (2008). The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample. Journal of Health Care for the Poor and Underserved, 19(3), 894–911.CrossRefPubMedGoogle Scholar
  6. Chen, L. Y., Crum, R. M., Martins, S. S., Kaufmann, C. N., Strain, E. C., & Mojtabai, R. (2013). Service use and barriers to mental health care among adults with major depression and comorbid substance dependence. Psychiatric Services, 64(9), 863–870.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614–625.CrossRefPubMedGoogle Scholar
  8. Corrigan, P. W., Mittal, D., Reaves, C. M., Haynes, T. F., Han, X., Morris, S., et al. (2014). Mental health stigma and primary health care decisions. Psychiatry Research, 218(1–2), 35–38.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Gabbidon, J., Farrelly, S., Hatch, S. L., Henderson, C., Williams, P., Bhugra, D., et al. (2014). Discrimination attributed to mental illness or race-ethnicity by users of community psychiatric services. Psychiatric Services, 65, 1360–1366.CrossRefPubMedGoogle Scholar
  10. Gilchrist, G., Moskalewicz, J., Slezakova, S., Okruhlica, L., Torrens, M., Vajd, R., et al. (2011). Staff regard towards working with substance users: a European multi-centre study. Addiction, 106(6), 1114–1125.CrossRefPubMedGoogle Scholar
  11. Hausmann, L. R., Jeong, K., Bost, J. E., & Ibrahim, S. A. (2008). Perceived discrimination in health care and health status in a racially diverse sample. Medical Care, 46(9), 905–914.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Howard, V., & Holmshaw, J. (2010). Inpatient staff perceptions in providing care to individuals with co-occurring mental health problems and illicit substance use. Journal of Psychiatric and Mental Health Nursing, 17(10), 862–872.CrossRefPubMedGoogle Scholar
  13. Kassam, A., Williams, J., & Patten, S. (2012). Perceived discrimination among people with self-reported emotional, psychological, or psychiatric conditions in a population-based sample of Canadians reporting a disability. Canadian Journal of Psychiatry, 57(2), 102–110.PubMedGoogle Scholar
  14. Kessler, R. C., & Ustun, T. B. (2004). The world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93–121.CrossRefPubMedGoogle Scholar
  15. Kinsler, J. J., Wong, M. D., Sayles, J. N., Davis, C., & Cunningham, W. E. (2007). The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care STDS, 21(8), 584–592.CrossRefPubMedGoogle Scholar
  16. Lee, C., Ayers, S. L., & Kronenfeld, J. J. (2009). The association between perceived provider discrimination, healthcare utilization and health status in racial and ethnic minorities. Ethnicity and Disease, 19(3), 330–337.PubMedPubMedCentralGoogle Scholar
  17. Link, B. G., Struening, E. L., Rahav, M., Phelan, J. C., & Nuttbrock, L. (1997). On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. Journal of Health and Social Behavior, 38(2), 177–190.CrossRefPubMedGoogle Scholar
  18. Lovi, R., & Barr, J. (2009). Stigma reported by nurses related to those experiencing drug and alcohol dependency: A phenomenological Giorgi study. Contemporary Nurse, 33(2), 166–178.CrossRefPubMedGoogle Scholar
  19. Mental Health Commission of Canada. (2014). Opening minds initiative. Retrieved December 5, 2014 from
  20. Pascoe, E. A., & Smart Richman, L. (2009). Perceived discrimination and health: a meta-analytic review. Psychological Bulletin, 135(4), 531–554.CrossRefPubMedPubMedCentralGoogle Scholar
  21. SAS. (2012). SAS 9.4 (Version 9.4). NC, USA: SAS.Google Scholar
  22. Shavers, V. L., Fagan, P., Jones, D., Klein, W. M., Boyington, J., Moten, C., et al. (2012). The state of research on racial/ethnic discrimination in the receipt of health care. American Journal of Public Health, 102(5), 953–966.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Skosireva, A., O’Campo, P., Zerger, S., Chambers, C., Gapka, S., & Stergiopoulos, V. (2014). Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings. BMC Health Services Research, 14, 376.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Statistics Canada. (2013, 2013-09-10). Canadian Community Health Survey-Mental health. Retrieved October 10, 2014 from
  25. Thornicroft, G. (2008). Stigma and discrimination limit access to mental health care. Epidemiologia e psichiatria sociale, 17(1), 14–19.CrossRefPubMedGoogle Scholar
  26. Thornicroft, G., Rose, D., & Kassam, A. (2007). Discrimination in health care against people with mental illness. International Review of Psychiatry, 19(2), 113–122.CrossRefPubMedGoogle Scholar
  27. Trujols, J., Sinol, N., Iraurgi, I., Batlle, F., Guardia, J., de Los, Perez, & Cobos, J. (2011). Patient and clinician’s ratings of improvement in methadone-maintained patients: Differing perspectives? Harm Reduction Journal, 8, 23.CrossRefPubMedPubMedCentralGoogle Scholar
  28. University of British Columbia. (2012, June 2012). Research involving human participants. Retrieved 12-Oct-2014 from
  29. van Boekel, L. C., Brouwers, E. P., van Weeghel, J., & Garretsen, H. F. (2014). Healthcare professionals’ regard towards working with patients with substance use disorders: comparison of primary care, general psychiatry and specialist addiction services. Drug and Alcohol Dependence, 134, 92–98.CrossRefPubMedGoogle Scholar
  30. Wen, C. K., Hudak, P. L., & Hwang, S. W. (2007). Homeless people’s perceptions of welcomeness and unwelcomeness in healthcare encounters. Journal of General Internal Medicine, 22(7), 1011–1017.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Zhao, J., Stockwell, T., & Macdonald, S. (2009). Non-response bias in alcohol and drug population surveys. Drug Alcohol Rev, 28(6), 648–657.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Centre for Health Evaluation and Outcome Sciences, Providence Health CareSt. Paul’s HospitalVancouverCanada
  2. 2.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada

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