DSN Stigma Survey 2014

DSN Stigma Survey 2014

Assessing the Impact of Stigma on Doctors with Mental Illness
​
Dr L J Freeman FRCEM and Dr R Sykes MB ChB (hons)

AIMS
​Mental health problems are under-reported among doctors, and may be associated with stigma and self-perception issues. This study aimed to examine the experiences of doctors with mental illnesses when transitioning from the doctor to the patient role.
METHODS
​This qualitative, survey-based study was conducted among members of the Doctors' Support Network (DSN) for three weeks in January 2014. The DSN is a charity that provides peer support to doctors with mental health problems in the United Kingdom. An online anonymous survey was distributed to DSN members to collect basic demographic data and personal experiences of stigma related to mental health diagnoses. The participants were asked whether stigma had affected : 
  • ​how they felt about their illness
  • their willingness to seek help
  • how non-medical friends or colleagues interacted with them
  • how medical colleagues interacted with them
  • how the doctors providing them with treatment interacted with them.
RESULTS
​Where stigma is experienced

Doctors' Support Network 2016 DSN stigma survey 2014 chart mental health
Self stigma
67 respondents (53%) felt that stigma had affected how they felt about their illness. The prevalent themes in the comments were 'failure' and 'the perception of the illness as a choice.'
Sample quote
'It took me a very long time to get over feeling ashamed and profoundly guilty for my illness (depression). And in the earliest stages it took me a long time to accept what I knew logically the diagnosis was because of these feelings.'
Stigma affecting willingness to seek help
70 respondents (55%) reported that stigma had affected their willingness to seek help, and that this had delayed accessing support.
Sample quote
'I experienced two years of pretty florid physical symptoms of anxiety / depression (weight loss, early morning wakening, panic attacks) before attending my GP for help, mainly because I really wanted to be able to cope, and everyone around me seemed to be coping fine. I didn't want to admit to failing.'
Stigma affecting interactions with non-medical colleagues and friends
64 doctors (50%) reported difficult interactions with non-medical colleagues. Thematic analysis revealed 'denial' and 'shunning' as common issues.
Sample quote
'Whilst an in-patient suffering an episode of depression I was allocated a new CPN (Community Psychiatric Nurse). I was visited on the ward by this CPN and the CMHT (Community Mental Health Team) manager. They told me that as I had previously worked in psychiatry I should know better than to allow myself to become unwell, and that I should know the tightness of reserve in the NHS, so should not be wasting peoples' time or taking up a valuable bed space.'
Stigma affecting interactions with medical colleagues and friends
Most respondents (79/127 ; 62%) reported problematic interactions with medical colleagues. Themes included 'avoidance', 'lack of recognition of skills', 'problems returning to work' and 'dismissing legitimate concerns'.

Sample quote
​'Most medical colleagues were unaware of my history - BUT if they are aware then our relationship becomes markedly different.'
Stigma affecting interactions with doctors providing treatment
A minority (43/127 ; 34%) reported that stigma was an issue when seeking treatment from a doctor, with common themes identified as 'dismissing symptoms' and 'role confusion'.

Sample quote
'I vividly remember seeing a hospital physician, who noticed that I had cut my arms, & responded with the disgusted remark 'you've been at yourself'. I felt very stigmatised!'

CONCLUSIONS
  • Mental health stigma is a significant issue among doctors.
  • ​Interactions with medical colleagues are the most problematic.
  • The survey was limited by the use of a small self-selected sample.​
  • The high incidence of perceived stigma underscores the need for further action.

The survey was presented as a poster at the International Conference on Physician Health, London 2014.
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