Reducing mental health-related stigma in primary health care settings in low- and middle-income countries: a systematic review

Heim, Eva; Kohrt, Brandon A.; Koschorke, Mirja; Milenova, Maria; Thornicroft, Graham

doi:10.1017/s2045796018000458

Cited by 48 publications

(53 citation statements)

References 37 publications

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“…The same result was found in a previous systematic review on anti-stigma interventions with health professionals in LMICs (Heim et al ., 2018). Measuring behavioural outcomes is a challenge, particularly in resource-strained contexts, because it requires time and human resources to assess students’ skills in their contact with patients (Nortje and Seedat, 2013).…”

Section: Discussionsupporting

confidence: 90%

Reducing mental health-related stigma among medical and nursing students in low- and middle-income countries: a systematic review

Heim

Henderson

Kohrt

et al. 2019

Epidemiol Psychiatr Sci

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Aims This systematic review compiled evidence on interventions to reduce mental health-related stigma among medical and nursing students in low- and middle-income countries (LMICs). Primary outcomes were stigmatising attitudes and discriminatory behaviours. Methods Data collection included two strategies. First, previous systematic reviews were searched for studies that met the inclusion criteria of the current review. Second, a new search was done, covering the time since the previous reviews, i.e. January 2013 to May 2017. Five search concepts were combined in order to capture relevant literature: stigma, mental health, intervention, professional students in medicine and nursing, and LMICs. A qualitative analysis of all included full texts was done with the software MAXQDA. Full texts were analysed with regard to the content of interventions, didactic methods, mental disorders, cultural adaptation, type of outcome measure and primary outcomes. Furthermore, a methodological quality assessment was undertaken. Results A total of nine studies from six countries (Brazil, China, Malaysia, Nigeria, Somaliland and Turkey) were included. All studies reported significant results in at least one outcome measure. However, from the available literature, it is difficult to draw conclusions on the most effective interventions. No meta-analysis could be calculated due to the large heterogeneity of intervention content, evaluation design and outcome measures. Studies with contact interventions (either face-to-face or video) demonstrated attitudinal change. There was a clear lack of studies focusing on discriminatory behaviours. Accordingly, training of specific communication and clinical skills was lacking in most studies, with the exception of one study that showed a positive effect of training interview skills on attitudes. Methods for cultural adaptation of interventions were rarely documented. The methodological quality of most studies was relatively low, with the exception of two studies. Conclusions There is an increase in studies on anti-stigma interventions among professional students in LMICs. Some of these studies used contact interventions and showed positive effects. A stronger focus on clinical and communication skills and behaviour-related outcomes is needed in future studies.

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Section: Discussionsupporting

confidence: 90%

Reducing mental health-related stigma among medical and nursing students in low- and middle-income countries: a systematic review

Heim

Henderson

Kohrt

et al. 2019

Epidemiol Psychiatr Sci

Self Cite

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“…Our findings are consistent with those which have shown that attitudes can be improved following education aimed at reducing stigma [39,40]. A systematic review of reducing mental health stigma among primary health care settings in LMICs demonstrated that education could have important impacts on stigma such as reducing stigmatizing attitudes [41]. Additional evidence indicates that education can positively change attitude, while there is less evidence for improving knowledge [42].…”

Section: Discussionsupporting

confidence: 90%

Effectiveness of an anti-stigma training on improving attitudes and decreasing discrimination towards people with mental disorders among care assistant workers in Guangzhou, China

Fan

Zhong

et al. 2019

Int J Ment Health Syst

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Background: Care assistant workers as a new pattern of care providers in China play an important role in bridging the mental health treatment gap. Stigma and discrimination against people with mental disorders among care assistant workers is a barrier which adversely influences mental health service delivery. However, programs aimed at reducing stigma among care assistant workers are rare in China. Methods: A total of 293 care assistant workers from four districts of Guangzhou, China were randomly divided into an intervention group (n = 139) and a control group (n = 154). The intervention group received anti-stigma training and the control group received traditional mental health training. Both trainings lasted for 3 h. Participants were measured before and after training using Perceived Devaluation and Discrimination Scale (PDD), Mental illness: Clinicians' Attitudes (MICA) and Mental Health Knowledge Schedule (MAKS). Data were analyzed by descriptive statistics, t-test, Chi square test or Fisher's exact test. Multilinear regression models were performed to calculate adjusted regression coefficient of the intervention on PPD, MAKS, and MICA. Results: There were significant lower scores on PDD and MICA in the intervention group after training when compared with the control group (both P < 0.001). No significant difference was found on MAKS total score between the two groups after training (P = 0.118). Both groups had better correct identification of schizophrenia, depression and bipolar disorder before and after training. Conclusions: These findings suggest that anti-stigma training may be effective in reducing the perception of devaluation-discrimination against people with mental illness and decreasing the level of negative stigma-related mental health attitudes among care assistant workers.

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“…27 In China, mental disorders are also associated with stigma, and patients with mental disorders are likely to have negative experiences and discrimination when receiving health services. 49,50 However, statistical differences of expectations between patients from the MHD and ED were only detected in two domains in our study. Potential explanations for that could be that almost half of the patients from the MHD in this study were diagnosed with depression and/or anxiety.…”

Section: Discussioncontrasting

confidence: 78%

<p>Comparison Of Expectations For Health Services Between Inpatients From Mental Health Department And Endocrinology Department In China</p>

Liu¹,

Zhou²,

Niu³

et al. 2019

PPA

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Background: Patient expectations for health services refer to the anticipation or the belief about what should be encountered in the healthcare system. Understanding patient expectations can improve patient satisfaction and healthcare compliance. It is particularly important for patients with mental disorders, as greater healthcare compliance is required for them due to the chronic and relapsing nature of their diseases. However, little is known about expectations among Chinese patients with mental disorders. Objective: To examine expectations for healthcare among patients with mental disorders and to compare them with those of patients with chronic physical diseases. Patients and methods: A cross-sectional survey was conducted among two inpatient groups, consecutively recruited from the Mental Health Department (MHD) and Endocrinology Department (ED) in one tertiary general hospital in Changsha, China. Patient expectations were measured by eight translated and modified vignettes of health system responsiveness. Group differences were compared using Chi-square tests for sociodemographic and clinical characteristics and Z-test for expectation rating. Logistic regression was performed to test whether group differences of expectations remained statistically significant after controlling for socio-demographic and clinical variables. Results: Most patients from MHD rated scenarios in vignettes on communication, choice of provider, autonomy, and social support as "meeting expectations", and rated scenarios in vignettes on prompt attention, dignity, confidentiality, and quality of basic amenities as "below expectations". In comparison, patients from MHD had similar expectations with their counterparts from ED, for prompt attention, dignity, confidentiality, communication, choice of provider, and social support; however, patients from MHD had significantly lower expectations in quality of basic amenities and higher expectations in autonomy, after adjusting for socio-demographic and clinical factors. Conclusion: Like their counterparts with physical diseases, patients with mental disorders also expect prompt attention, dignity, confidentiality, communication, choice of provider, and social support in their interaction with the healthcare system. Moreover, extra attention to autonomy is needed for patients with mental disorders to meet their expectations and improve patient satisfaction.

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Reducing mental health-related stigma in primary health care settings in low- and middle-income countries: a systematic review

Abstract: More rigorous trials are needed in LMICs to test interventions that target discriminatory behaviours in relationship with patients. Cultural adaptation of stigma interventions and structural/institutional factors should be more explicitly addressed in such trials.

Cited by 48 publications

References 37 publications

Reducing mental health-related stigma among medical and nursing students in low- and middle-income countries: a systematic review

Reducing mental health-related stigma among medical and nursing students in low- and middle-income countries: a systematic review

Effectiveness of an anti-stigma training on improving attitudes and decreasing discrimination towards people with mental disorders among care assistant workers in Guangzhou, China

<p>Comparison Of Expectations For Health Services Between Inpatients From Mental Health Department And Endocrinology Department In China</p>

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