Psychiatrists’ occupational stigma conceptualization, measurement, and intervention: A literature review

Table 1 Measurement tool of psychiatrists’ occupational stigma

Scale title	Target	Content	Item	Dimension
[89]THCT	Public	Measure public trust in medical professionals and health care team	29	7 dimensions: Stigma-based discrimination; communication skills; system trust; loyalty; confidentiality; fairness; general trust
[90]PPOSS	Patients	Measure the cognitive, affective, and behavioral components of occupational stigma	19	3 dimensions: Stereotype (6 items); prejudice (7 items); discrimination (6 items)
[94]SDS	Public	Measure stigmatizing public perceptions of and behavioral inclinations toward the physicians	8	Single dimension
[97]Public attitudes towards psychiatrists’ questionnaire	Public	Measure the public's unfavorable views and impressions of psychiatrists' professionalism, mental health, occupational authority and ethical standards	8	Single dimension
[98]OSCS	Practitioners	Measure the stigma awareness of practitioners in the service industry	6	Single dimension
[100]E16-COVID19-S	Practitioners	Measure specific aspects of physician occupational stigma	16	3 dimensions: Personalized stigma (8 items); concerns of disclosure and public attitudes (5 items); negative experiences (3 items)
[101]PSCP	Physicians	Measure perception of COVID-19-induced stigma in healthcare workers	10	2 dimensions: Environmental stigmatization; the perception of personal stigmatization
[103]Self-designed stigma questionnaire	Physicians	Measure mental health stigma	12	Single dimension
[104]DAQ	Medical students	Measure stigmatization of physicians suffering from mental disorders	3	Single dimension
[105]SOSS-D	Doctors	Measure the stigma of occupational stress and burnout among physicians	11	3 dimensions: Perceived structural stigma (5 items); perceived individual stigma (3 items); perceived other related stigma (3 items)
[106]MHPSS	Mental Health Professionals	Measure occupational stress and burnout stigma in mental health professionals	13	4 dimensions: Perceived other stigma (3 items); perceived structural stigma (4 items); personal stigma (3 items);self-stigma (3 items)
[107]PIOSS	Physicians	Measure physicians' identification with negative labels, perceptions of devaluation and discrimination, as well as the denial and disapproval of their own profession	19	3 dimensions: Label identification (5 items); status loss (8 items); career denial (6 items)
[108]FSS	Forensic	Measure internalized occupational stigma	12	2 dimensions: Dangerousness/unpredictability (7 items); responsibility/blame (5 items)
[13]Mental health professionals’ questionnaire	Mental health professionals	Measure the perceived associative stigma	4	Single dimension
[110]Measuring Psychiatrist occupational stigma scale (the scale a)	Psychiatrists	Measure perceived stigma in terms of the perception of societal stereotypes	16	Single dimension
[110]Measuring Psychiatrist occupational stigma scale (the scale b)	Psychiatrists	Measure self-stigma in terms of stereotype agreement	16	Single dimension
[110]Measuring Psychiatrist occupational stigma scale (the scale c)	Psychiatrists	Measure perceived stigma in terms of structural discrimination	5	Single dimension
[110]Measuring Psychiatrist occupational stigma scale (the scale d)	Psychiatrists	Measure discrimination experiences	13	Single dimension
[110]Measuring Psychiatrist occupational stigma scale (the scale e)	Psychiatrists	Measure stigma outcomes	5	Single dimension

COVID-19: Coronavirus disease 2019; DAQ: Discriminative attitude questionnaire; FSS: Forensic Stigma Scale; OSCS: Occupational Stigma Consciousness Scale; PIOSS: Physician Internalized Occupational Stigma Scale; PPOSS: Patient Toward Physician Occupational Stigma Scale; PSCP: Perception of Stigma due to COVID-19 in Physicians; SDS: Social Distance Scale; SOSS-D: Stigma of Occupational Stress Scale for Doctors; THCT: Trust in doctors in general and Trust in the health care team scales.

Table 2 Intervention of education

Strategy	Target	Content	Objective
[119]Education training	Family caregivers of patients with schizophrenia	Teaching related knowledge and skills (90 min/8 sessions)	Reduce stigma toward patients with schizophrenia
[120]Anti-stigma training	Care assistant workers	Financial assistance policy of care assistant workers + mental health knowledge (2 h) + stigma related to mental illness (1 h)	Reduce stigma toward patients with mental illness
[121]Anti-stigma training	Community mental health staff	Two parts: Knowledge introduction + stigma related to mental illness (1 d)	Increase mental health knowledge; Reduce stigma toward patients with mental illness and social distance
[122]Anti-stigma training	Probation officers	Six modules in PPT about overview of severe and persistent mental illnesses; information about key diagnoses and the medications; services associated with those diagnoses	Increase mental health knowledge; Reduce stigma toward mental illness and behavior tendency
[123]NECT	Persons with severe mental illness	20 sessions (1 h): (1) Introduction (1 wk); (2) Psychoeducation (3 wk); (3) Cognitive restructuring (8 wk); and (4) Narrative enhancement (8 wk)	Reduce stigma toward mental illness
[124]Educational workshop	High School Students	Classroom-based workshop: (1) Introduction: Mental illness and public stigma; (2) Education; and (3) Treatment of mental illness and available community resources (1 h)	Reduce stigma toward mental illness
[125]Educational videos	High school students and college students	Educational film (10 min): (1) BMM about mental illness; or (2) RCM advocated by experts	Reduce more stigma in BMM than RCM
[126]END	Medical students	Short lecture; testimonies about the experiences and stigma; role-plays	Increase mental health knowledge; Reduce stigma toward mental illness and behavior tendency
[127]Mental health first aid training	Pharmacy and non-pharmacy students	Identify, understand, and respond to signs of mental illnesses and substance use disorders (8 h); Methods: Videos, role play sessions, action plan creation, discussion, and other interactive activities	Reduce stigma toward mental illness

BMM: Biomedical messages; END: Education not discrimination project; NECT: Narrative enhancement cognitive therapy; PPT: Power point; RCM: Recommended messages.

Table 3 Intervention of comprehensive strategies

Strategy	Type	Content	Target	Objective
[143]Lecture	Education + direct contact	Video + personal experience + questions and answers (50 min)	Undergraduate	Increase knowledge of depression and help-seeking willingness
[144]Three-stage intervention paradigm	Education + direct contact + indirect contact	Dance-drama + lectures + direct contact (2 h)	Undergraduate	Increase understanding and tolerance toward patients with mental illness; Decrease negative review, negative labels and social distance toward patients with mental illness
[145]Filmed theatrical intervention based on a personal narrative	Education + indirect contact	Filmed version of a one-woman stage play performed by a recognized educator and speaker on the lived experience of mental illness and recovery (50-min)	Health-care service providers, university students in a health-care-related course, people with BD and their friends and family members and the general public	Decrease stigma toward people with BD among health-care service provider (significant/sustainable); others (more limited)
[146]Course	Education + direct contact + indirect contact	Lecture + watch videos/movie + in-class discussion + direct contact + roleplay + action project (18 wk)	Occupational therapy students	Decrease stigma toward mental illness and social distance
[147]Course	Education + direct contact + indirect contact	Teaching (42 h) + movie (3/4 h) + contact + presentations (2 h) + clinical correlations (6 h)	Medical students	Increase student confidence; Decrease stigma toward mental illness
[148]Course	Education + direct contact + indirect contact	Face-to-face (45 min) + video-based contact (40 min) + educational lecture (90-min)	Medical students	Decrease stigma toward mental illness
[149]Case discussion	Education + direct contact + indirect contact	Document patient strengths and treatment recommendations; Group presentation discussion (10 wk)	Primary care providers	Increase willingness to help and hope for recovery; Decrease negative stereotypes
[150]Course	Education + direct contact	Personal experience + questions and answers (69-90 min)	Pharmacy students	Decrease stigma toward mental illness
[151]Workshop	Education + direct contact	Workshop (4 d): Knowledge teaching + personal experience + questions and answers	Public Health Services administrators	Decrease stigma toward patients with mental illness
[152]Workshop	Education + direct contact	Workshop (1 h): Knowledge teaching + personal experience	Social work students	Decrease stigma toward mental illness
[153]Course	Education + direct contact	Panel discussion (2 h) + visit rehabilitation center + Small group discussion (20 min)	Medical students	Decrease stigma toward patients with mental illness and psychiatry
[154]Curriculum	Education + direct contact	Courses + clinical practice + stigma views and policy (14 d)	Community mental health staff	Increase related knowledge; Decrease stigma
[155]Education program	Education + direct contact	Enhancing contact model: Psychoeducational training (4 wk) + single and group family contact (8 wk)	Family caregivers of persons with schizophrenia	Decrease stigma toward mental illness
[156]Education program	Education + direct contact	Lectures (2 h) + contact with people with lived experience of mental illness (1 h)	Community health and care staff	Decrease stigma toward mental illness
[157]Course	Education + indirect contact	Teaching + videos (3 h)	Psychology students	Improve attitude toward schizophrenia
[158]Virtual program	Education + indirect contact	Three consecutive interventions (14 h/2 d): 2 sessions (2.5 h) + e-contact (3.5 h) + project-based learning (5.5 h)	University students	Decrease stigma toward mental disorders
[159]Educational video	Education + indirect contact	Social contact film with general mental health education (30 min/2 mo intervals in 1 year)	University students	Decrease mental illness-related stigma
[160]Course	Education + indirect contact	Interactive workshop-style sessions (3.5 h/15 wk)	Primary care physicians	Increase skill and confidence; Decrease stigma toward mental illness
[161]Educational Video	Education + indirect contact	Video-based contact intervention (VBCI): Elements of psychoeducation and interviews (5 min)	Primary care nurses	Improve attitude toward patients with mental illness in short term
[163]Educational video	Education + indirect contact	YouTube videos (5-10 min)	Muslin adults aged 18 and over	Decrease stigma toward mental illness
[164]Lecture	Education + direct contact	Personal experience + Interaction	High school students	Decrease stigma toward mental illness
[165]Education program	Education + direct contact	Educational program (1 d)	Adolescents	Education decreases stigma toward mental illness; Direct contact fails
[166]Course	Education + direct contact	Education with PBL: Problem-based learning model + direct contact	Nursing students	Improve positive attitude toward mental illness
[167]Online focus group	Education + direct contact + indirect contact	Education + relationship strategies + media contact	Senior undergraduate nursing students	Minimize the negative impact on the people they take care of
[168]Sessions	Education + direct contact	Five sessions (3 d)	Caregivers of mental health service users	Improve family relations and understanding of mental illness

BD: Bipolar disorder.

Table 4 Other intervention strategies

Strategy	Objective
[171]Positive thinking training	Intervene with self-stigma in depressed patients
[172]Positive empathy intervention	Establish a positive emotional connection with stigmatized person to reduce stigma
[173]Cognitive-behavioral intervention	Reduce self-stigma associated with mental illness
[174]Wise intervention	Increase perceived social support; Reduce personal discrimination
[175]Visual information image intervention	Increase sense of support and engagement; Reduce stigma
[176]Work integration	Reduce perceived stigma of workers with serious mental illness
[177-180]Art therapy	Reduce mental illness stigma of adolescents
ACT	Reduce weight stigma[182], substance use disorder stigma[183], and homosexuality stigma[181]
[184]Narrative Therapy	Reduce the level of stigma for patients with permanent enterostomies
[185]Written expression-based emotional intervention	Reduce negative emotion
[186]Sand tray therapy	Improve the development of self-esteem in sexually abused adolescents
[187]CBGT	Reduce the level of stigma in the population of people living with HIV
[188]Intergenerational choir	Reduce the stigma of Alzheimer's patients and increasing positive attitudes
[189]FSM	Reduce stigma and promote mental health help-seeking behavior

ACT: Acceptance and commitment therapy; CBGT: Compassion-based group therapy; FSM: Fresh start mindset framing.