Explicit and Implicit Attitudes of Canadian Psychiatrists toward People with Mental Illness

Abstract

Objective: People with mental illness suffer stigma and discrimination across various contexts, including the health care setting, and clinicians' attitudes play an important role in perpetuating stigma. Effective stigma-reduction interventions for physicians require a better understanding of explicit (that is, conscious and controllable) and implicit (that is, subconscious and automatic) forms of bias, and of predictors and moderators of stigma. Methods: Members of a Canadian university psychiatry department and of the Canadian Psychiatric Association (CPA) were invited to participate in a web-based study consisting of 2 measures of explicit attitudes, the Social Distance Scale (SDS) and the Opening Minds Scale for Health Care Providers (OMS-HC), and 1 measure of implicit attitudes, the Implicit Association Test (IAT). Results: Thirty-five psychiatry residents and 68 psychiatrists completed the study (response rates of 12.1% for the university sample and 3.3% for the CPA sample). Participants desired greater social distance from the vignette patient with schizophrenia. Mean IAT scores, although negative, did not reach the threshold for a meaningful effect size. Patient contact positively predicted IAT scores, while age, sex, and level of training (resident, compared with psychiatrist) did not. Neither patient contact nor implicit attitudes predicted SDS or OMS-HC scores. Conclusion: Psychiatrists did not differ from psychiatry residents on any measures of explicit or implicit attitudes toward mental illness. Explicit attitudes toward people with mental illness were relatively negative; implicit attitudes were neither negative nor positive; and implicit and explicit attitudes were not correlated. Greater patient contact predicted more positive implicit attitudes, but did not predict explicit attitudes.