Skip to main content

Advertisement

SpringerLink
Log in

Associative stigma experienced by mental health professionals in China and the United States

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

“Associative stigma” is the negative stereotyping of mental health service providers who treat people with serious mental illness. The Clinician Associative Stigma Scale (CASS) has been validated in a US sample but not in other nations, e.g., in China which has been found to have substantially higher levels of stigma towards people with mental illness than the US.

Methods

The 19-item CASS was translated into Chinese and administrated to 665 mental health professionals working in psychiatric hospitals in Southern China. Confirmatory factor analysis (CFA) was used to compare the factor structure with that found in the US sample. Socio-demographic correlates of CASS scores and comparison with US data were conducted using regression models and t test.

Results

CFA showed a good model fit (GFI = 0.911 and RMSEA = 0.068) for the four factors found in the US study: (1) discomfort with disclosing about working with serious mental illness, (2) stereotypes about professionals’ own poor mental health, (3) stereotypes about unpleasantness of working with people with serious mental illness, and (4) stereotypes about lack of treatment effectiveness. Total CASS score and subscales concerning stereotypes about providers’ mental health and about unpleasantness of working with such patients were significantly lower in China than in the US (both P < 0.001), but stereotypes concerning professional ineffectiveness were higher in China.

Conclusion

Associative stigma was lower in China than in the US, possibly reflecting the cultural dominance of respect for educated professionals over stigma towards people with serious mental illness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Goffman E. Stigma (1969) Notes on the management of spoiled identity[J]. Am J Sociol 45(527):642

    Google Scholar 

  2. Haugen PT, Mccrillis AM, Smid GE et al (2017) Mental health stigma and barriers to mental health care for first responders: a systematic review and meta-analysis[J]. J Psychiatr Res 94:218

    Article  PubMed  Google Scholar 

  3. Crowe A, Averett P, Glass JS (2016) Mental illness stigma, psychological resilience, and help seeking: what are the relationships?[J]. Mental Health Prevent 4(2):63–68

    Article  Google Scholar 

  4. Xu Z, Rüsch N, Huang F et al (2017) Challenging mental health related stigma in China: Systematic review and meta-analysis. I. Interventions among the general public[J]. Psychiatry Res 255:449

    Article  PubMed  Google Scholar 

  5. Corrigan PW (2004) Target-specific stigma change: a strategy for impacting mental illness stigma.[J]. Psychiatr Rehabil J 28(2):113–121

    Article  PubMed  Google Scholar 

  6. Carrara BS, Caa V (2018) Self-stigma, mentally ill persons and health services: an integrative review of literature[J]. Arch Psychiatr Nurs 32(2):317

    Article  PubMed  Google Scholar 

  7. Wang K, Link BG, Corrigan PW et al (2018) Perceived provider stigma as a predictor of mental health service users’ internalized stigma and disempowerment[J]. Psychiatry Res 259:526–531

    Article  PubMed  Google Scholar 

  8. Gabbidon J, Clement S, Nieuwenhuizen AV et al (2013) Mental Illness: Clinicians’ Attitudes (MICA) Scale—psychometric properties of a version for healthcare students and professionals[J]. Psychiatry Res 206(1):81–87

    Article  PubMed  Google Scholar 

  9. Park K, Seo M (2016) Care burden of parents of adult children with mental illness: the role of associative stigma[J]. Compr Psychiatry 70:159

    Article  PubMed  Google Scholar 

  10. Kopera M, Suszek H, Bonar E et al (2015) Evaluating explicit and implicit stigma of mental illness in mental health professionals and medical students[J]. Community Ment Health J 51(5):628

    Article  PubMed  Google Scholar 

  11. Björkman T, Angelman T, Jönsson M (2008) Attitudes towards people with mental illness: a cross-sectional study among nursing staff in psychiatric and somatic care.[J]. Scand J Caring Sci 22(2):170–177

    Article  PubMed  Google Scholar 

  12. Hori H, Richards M, Kunugi H (2011) Attitudes toward schizophrenia in the general population, psychiatric staff, physicians, and psychiatrists: a web-based survey in Japan.[J]. Psychiatry Res 186(2–3):183–189

    Article  PubMed  Google Scholar 

  13. Nordt C, Rössler W, Lauber C (2006) Attitudes of mental health professionals toward people with schizophrenia and major depression.[J]. Schizophr Bull 32(4):709–714

    Article  PubMed  PubMed Central  Google Scholar 

  14. Jorm AF, Korten AE, Jacomb PA et al (1999) Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals[J]. Aust N Z J Psychiatry 33(1):77–83

    Article  CAS  PubMed  Google Scholar 

  15. Feret H, Conway L, Austin JC (2011) Genetic counselors’ attitudes towards individuals with schizophrenia: desire for social distance and endorsement of stereotypes[J]. Patient Educ Couns 82(1):69

    Article  PubMed  Google Scholar 

  16. Lauber C, Anthony M, Ajdacicgross V et al (2004) What about psychiatrists’ attitude to mentally ill people?[J]. Eur Psychiatry 19(7):423–427

    Article  PubMed  Google Scholar 

  17. Yanos PT, Vayshenker B, Deluca JS et al (2017) Development and Validation of a Scale assessing mental health clinicians’ experiences of associative stigma.[J]. Psychiatr Serv 68(10):appips201600553

    Article  Google Scholar 

  18. Stefanovics EA, He H, Cavalcanti M et al (2016) Witchcraft and biopsychosocial causes of mental illness: attitudes and beliefs about mental illness among health professionals in five countries[J]. J Nerv Ment Dis 204(3):169–174

    Article  PubMed  Google Scholar 

  19. Zhu Y, Zhang H, Yang G et al. Attitudes towards mental illness among medical students in China: impact of medical education on stigma.[J]. Asia-Pacific Psychiatry 2017(10063):e12294

  20. Luo A, He H, Mohamed S et al (2018) Medical student attitudes towards people with mental illness in China: a qualitative study[J]. Culture Med Psychiatry 6:1–17

    Google Scholar 

  21. Li-tze Hu, Peter M (1999) Bentler. cutoff criteria for fit indexes in covariance structure anaysis: conventional criteria versus new alternatives[J]. Struct Equ Model 6(1):1–55

    Article  Google Scholar 

  22. Stevens JP (1992) Applied multivariate statistics for the social sciences. 2nd ed. Erlbaum, Hillsdale

  23. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Earlbaum Associates, Hillsdale, NJ

    Google Scholar 

  24. Schuman MA (2015) Confucius–and the world he created. Basic Books, New York

  25. Billioud S, Thoraval J (2015) The Sage and the people: the confucian revival in China. Oxford University Press, New York

    Book  Google Scholar 

  26. Lee JA, Soutar GN, Daly TM et al (2011) Schwartz values clusters in the United States and China[J]. J Cross Cult Psychol 42(2):234–252

    Article  Google Scholar 

  27. Ho DY (1976) On the concept of face[J]. Am J Soc 81(4):867–884

    Article  Google Scholar 

  28. Blendon RJ, Benson JM, Hero JO (2014) Public trust in physicians–US medicine in international perspective.[J]. N Engl J Med 371(17):1570–1572

    Article  PubMed  Google Scholar 

  29. Khullar D, Do You Trust the Medical Profession? A growing distrust could be dangerous to public health and safety. New York Times, Jan. 23 (2018) https://www.nytimes.com/2018/01/23/upshot/do-you-trust-the-medical-profession.html

  30. Hu X (2017) Expanding the mental health workforce in China: narrowing the mental health service gap. Psychiatr Serv 68(10):987–989

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Philip Yanos provided unpublished subscale scores from his study of the CASS. Dr. Jie Zhang gave important opinions in discussion.

Funding

This study was supported from funding to H H from the Guangzhou Municipal Psychiatric Diseases Clinical Transformation Laboratory (no: 201805010009), Key Laboratory for Innovation platform Plan, Science and Technology Program of Guangzhou, China and from the Guangzhou Municipal key discipline in psychiatry. The funding source had no role in the study design, analysis or interpretation of data or in the preparation of the report or decision to publish the results.

Author information

Authors and Affiliations

  1. The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China

    Xiaoming Lin, Bin Sun, Min Yu & Hongbo He

  2. Yale Medical School, New Haven, CT, USA

    Robert Rosenheck

  3. Foshan Third People’s Hospital, Foshan, China

    Guojun Xie

  4. Jiangmen Third People’s Hospital, Jiangmen, China

    Guhua Zhong

  5. Zhaoqing Third People’s Hospital, Zhaoqing, China

    Changzan Tan

  6. Dongguan Mental Health Center (Dongguan Xinchung Hospital), Dongguan, China

    Zhupei Li

Authors
  1. Xiaoming Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert Rosenheck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bin Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guojun Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guhua Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Changzan Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhupei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Min Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hongbo He
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hongbo He.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, X., Rosenheck, R., Sun, B. et al. Associative stigma experienced by mental health professionals in China and the United States. Soc Psychiatry Psychiatr Epidemiol 54, 745–753 (2019). https://doi.org/10.1007/s00127-018-1643-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-018-1643-6

Keywords

Search

Navigation