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

Psychiatrists require frequent contact with and treatment of patients with mental illnesses.Due to the influence of associative stigma,psychiatrists may also be targets of stigma.Occupational stigma warrants special consideration because it significantly affects psychiatrists'career advancement,well-being,and their patients’health.Given that there is no complete summary of this issue,this study reviewed the existing literature on psychiatrists'occupational stigma to clearly synthesize its concepts,measurement tools,and intervention strategies.Herein,we emphasize that psychiatrists’occupational stigma is a multifaceted concept that simultaneously encompasses physically,socially,and morally tainted aspects.Currently,standardized methods to specifically measure psychiatrists’occupational stigma are lacking.Interventions for psychiatrists’occupational stigma may consider the use of protest,contact,education,comprehensive and systematic methods,as well as the use of psychotherapeutic approaches.This review provides a theoretical basis for the development of relevant measurement tools and intervention practices.Overall,this review seeks to raise public awareness of psychiatrists'occupational stigma,thereby promoting psychiatric professionalism and reducing its stigma.

Preliminary study of associative stigma among trainee psychiatrists in Flanders, Belgium

AIM: To study the degree of stigmatization among trainee psychiatrists, individual characteristics potentially leading to higher associative stigma, and coping mechanisms.METHODS: Two hundred and seven trainee psychiatrists in Flanders(Belgium), all member of the Flemish Association of Trainee Psychiatrists, were approached to participate in the survey. A non-demanding questionnaire that was specifically designed for the purpose of the study was sent by mail. The questionnaire consisted of three parts, each emphasizing a different aspect of associative stigma: devaluing and humiliating interactions, the focus on stigma during medical train-ing, and identification with negative stereotypes in the media. Answers were scored on a Likert scale ranging from 0 to 3. The results were analyzed using SPSS Version 18.0. RESULTS: The response rate of the study was 75.1%. The internal consistency of the questionnaire was good, with a Cronbach's α of 0.71. Seventy-five percent of all trainee psychiatrists confirmed hearing denigrating or humiliating remarks about the psychiatric profession more than once. Additionally, more than half of them had had remarks about the incompetence of psychiatrists directed at them. Only 1.3% remembered having stigma as a topic during their psychiatric training. Trainees who had been in training for a longer period of time had experienced a significantly higher level of stigmatization than trainees with fewer years of experience(mean total stigma scores of 16.93 ± SD 7.8 vs 14.45 ± SD 6.1, t =-2.179 and P < 0.05). In addition, senior trainees effectively kept quiet about their profession significantly more often than their junior colleagues(mean item score 0.44 ± SD 0.82 vs 0.13 ± SD 0.48, t = 2.874, P < 0.01). Comparable results were found in trainees working in adult psychiatry as were found in those working in child or youth psychiatry(mean item score 0.38 ± SD 0.77 vs 0.15 ± SD 0.53, t =-2.153, P < 0.05). Biologically oriented trainees were more inclined to give preventive explanations about their profession, which can be seen as a coping mechanism used to deal with this stigma(mean item score 2.05 ± SD 1.05 vs 1.34 ± SD 1.1, t =-3.403, P < 0.01).CONCLUSION: Associative stigma in trainee psychiatrists is underestimated. More attention should be paid to this potentially harmful phenomenon in training.

Autism spectrum disorders: The collaborative roles of the psychiatrists, educators and parents

Autism is a complex disability that requires collaboration, consultation and communication for provision of optimum treatment and intervention. Both psychiatrists and educators are key to the well-being of children and their families and can work together successfully in a comprehensive framework. This article provides information and recommendations in order to bridge both disciplinary fields so that this framework can be established.

Assessment of Psychiatrists and Nurses’ Attitudes toward Suicide Behaviour

Background: Psychiatrists and nurses are anticipated to prevent suicide behaviour, but their limited experience and lack of knowledge of patients with suicidal attempts have influenced their perception. A significant association between health care providers’ attitudes and the course of suicidal behaviour treatment. Purpose: current scientific paper aimed to assess Psychiatrists’ and nurses’ attitudes towards suicide and suicide attempters in Saudi Arabia. Method: Cross-sectional investigation was conducted in a Psychiatric hospital in North Saudi Arabia. A convenience sample of psychiatrists and nurses (N = 132). The response rate was 88%. The Modified Suicide Opinion Questionnaire (SOQ) was employed to evaluate psychiatrists’ and nurses’ attitudes toward suicide. Results: attitudes toward suicide behaviour among psychiatrists and nurses were positive. The findings of these studies demonstrate that psychiatrists and nurses held positive attitudes toward suicide in the categories of professional role, beliefs, communication and seeking attention. Also, the evidence revealed in the current paper demonstrates that psychiatrists expressed more positive attitudes toward suicidal behaviour than nursing staff. Moreover, psychiatrists and nurses who have a higher level of education recorded higher scores on the positive attitudes scale towards suicidal behaviour. Furthermore, a statistically significant difference between respondents’ attitudes toward suicide behaviour and their years of experience. Finally, psychiatrists and nurses who have a personal history of suicide behaviour have more positive attitudes toward suicide ideation. Conclusion/Implication for Future Practice: Psychiatrists and nurses had favourable attitudes towards suicide attempters. Health care organizations need to provide support to professionals by exposing them to suicide prevention programs and it was expected to improve and enhance the attitudes toward suicidal behaviour. In addition, psychiatrists and nurses, when they are aware of their opinions and attitudes toward suicide behaviour, can help their patients through the expression of their own thoughts and fears, which can lead to increased communication and trust.

Relationship between Social Support and Self-efficacy in Women Psychiatrists

Objective： To explore the relationship between social support and self-efficacy in women psychiatrists. Methods： A survey was conducted in four hospitals in Shandong province using the Social Support Scale and the General Self-efficacy Scale （GSE）. A total of 140 women psychiatrists participated in the study. Results： Women psychiatrists of different ages or with different qualifications experience significant differences in objective support, subjective support, the utilization of support, and total scores on the social support and self-efficacy questionnaires （P〈0.05）. There were also significant differences in self-efficacy between different groups （P〈0.05）. Subjective support, objective support and the utilization of support have a positive correlation with the self-efficacy of women psychiatrists. Women psychiatrists in different education level have significant differences in objective support, utilization of support and total score of social support （P〈0.01）. Conclusions： Ages and educational backgrounds affect social support and self-efficacy, and self-efficacy had a significant positive correlation with the various dimensions of social support.

心理医生诊疗话语中评价资源的生态语言学分析

文章采用实证研究方法,基于心理咨询与治疗会话小型语料库,综合运用评价系统、生态语言学等理论,尝试探讨心理医生诊疗话语中评价资源的使用分布情况。结果显示,借助消极判断、鉴赏等资源,医患之间形成相同的价值联盟和态度站位;借助二声、道义型情态、让步等介入资源,医生拓展了医患话语之间的对话性、协商性和主体间性;借助大量锐化聚焦等资源,医生强化了态度和介入的干预,引发患者积极情感与价值取向的心理共鸣。这种基于“评价言语行为-积极情感/价值取向传递-诊疗干预”动态模型的探讨,有助于揭示评价系统资源的社会服务功能和社会治理功能。

Being a Father of a Premature Newborn: The Parental Experience and the Father/Premature Newborn Relationship: A Study Carried out in the Department of Neonatology Intensive Care Unit of Mohammed VI University Hospital

Introduction: Despite advances in obstetrics and pediatrics over the past 20 years, premature birth remains an unpredictable event that can have a devastating impact on parenthood. This study aimed to analyze the psycho-affective experiences of fathers of premature newborns. Methods: This was a descriptive cross-sectional study, carried out in the department of neonatology and neonatal intensive care unit of the CHU Mohamed VI in OUJDA, over 6 months from March 2022 to August 2022. It focused on 30 fathers of premature newborns hospitalized in our department. Results: The majority of fathers described a state of fear and stress, and attributed their negative experience to the unexpected nature of the premature birth. At the first meeting, half the fathers had a positive image of their newborn’s physical appearance, while 22% of fathers reported feeling uncomfortable about their newborn’s low weight. Most fathers reported that they appreciated the welcome they received, the skill with which they cared for their newborn, and the availability of the pediatrician to provide information on their child’s state of health. Two fathers enjoyed skin-to-skin contact with their newborns. None of the fathers met a psychologist. When they returned home, half the fathers had a positive outlook, marked by happiness at being able to fully invest in their role as fathers, the other half reported being torn between the desire to see their child integrated into the family cocoon and the fear of not being able to manage delicate situations properly without a medical team. Conclusion: Bringing a premature baby into the world can be a difficult experience, leading to the development of even minor psychological distress in some fathers, and hence the need for specific psychological care.

精神科医生职业认同问卷的构建及其信效度检验

背景目前,我国针对精神科医生职业认同的研究相对较少,且缺乏有效的评价工具。目的编制具有良好信效度的精神科医生职业认同问卷,为精神科医生职业认同的评估提供有效工具。方法采用自编精神科医生职业认同问卷,经过筛选与专家咨询,整理条目后,形成精神科医生职业认同初始问卷,并对400名精神科医生施测。采用项目分析、信度分析和效度分析对问卷的信效度进行检验。结果最终版问卷的Cronbach’sα系数为0.930,各维度Cronbach’sα系数为0.817~0.920;KMO=0.904,χ^(2)=2931.652(P<0.01),探索性因子分析的累积方差贡献率为68.306%。验证性因子分析结果显示,χ^(2)/df=1.234,GFI=0.905,NFI=0.916,RMSEA=0.036,CFI=0.983,IFI=0.983。精神科医生职业认同问卷最终版由职业认知、职业行为、职业情感、职业价值观4个维度构成,共23个条目。结论精神科医生职业认同问卷具有较好的信效度,可作为评估精神科医生职业认同的有效工具。

基于SCL―90量表的中职学生心理健康现状研究与建议

本项目基于《症状自评量表SCL-90》5年时间里通过对福建省福清卫生学校3725名学生的心理测试研究,以此来分析目前中职学生的心理健康情况,为中职学校心理健康教育与咨询工作提供客观依据;在同类研究中首次探讨精神心理科医生的药物治疗在中职学生心理问题治疗中的必要性,旨在探索解决中职学生心理问题的正确方法,让更多的学生得到正确的治疗,以此减轻学生的身心痛苦。

精神科医生职业倦怠与人格特质的关系

目的:探讨精神科医生职业倦怠与人格特质的关系,为预防精神科医生的职业倦怠提出根据。方法:选取精神科医生225名作为研究对象[男89人,女136人;平均年龄(36±8)岁]。采用Maslach倦怠量表-服务行业版(MBI-HSS)测量职业倦怠水平,简版大五人格量表(GBFS)评估人格特质。结果:女性精神科医生MBI-HSS的3个维度得分均高于男性(均P <0. 05);工作6～10年的精神科医生的情感耗竭和个人成就感维度的得分高于其他工作年限的精神科医生,工作≤5年的精神科医生的去个性化维度的得分高于其他工作年限的精神科医生(均P <0. 05)。回归分析结果显示,GBFS的稳定性得分与MBI-HSS的情感耗竭得分负向关联(β=-0. 19),GBFS宜人性得分和与MBI-HSS去个性化得分负向关联(β=-0. 34),GBFS严谨性得分与MBI-HSS成就感得分正向关联(β=0. 18),性别与MBI-HSS成就感得分负向关联(β=-0. 16)。结论:精神科医生的职业倦怠与人格特质关系密切。男性精神科医生和工作6～10年的精神科医生更容易出现职业倦怠,预防精神科医生的职业倦怠应考虑到性格和工作年限等因素。

精神科医护人员睡眠质量与心理健康状况的关系

目的了解精神科医护人员睡眠质量与心理状况的关系。方法运用匹茨堡睡眠质量指数量表(PSQI)和症状自评量表(SCL 90),对浦东新区精神卫生中心的86名临床医护人员的睡眠质量及其心理状况进行调查。结果精神科医护人员PSQI总分为5. 63±4. 12,有54. 65%的精神科医护人员存在睡眠质量问题, 22. 09%的医护人员睡眠质量较差。精神科组PSQI睡眠效率因子分、睡眠障碍因子分显著高于内科组。除入睡时间外,PSQI各成分与SCL 90各因子及总分呈正相关关系。结论精神科医护人员睡眠质量较差,且睡眠质量与心理健康状况是互为影响的因素。

精神科医师述情障碍与工作倦怠的关系

目的：分析精神科医师述情障碍与工作倦怠的关系,探讨影响精神科医师工作倦怠的因素。方法：对4所精神专科医院的112名从业1～31年的精神科医师进行问卷调查,采用Maslach工作倦怠量表通用版（MBI-GS）和多伦多述情障碍20项量表（TAS-20）评估工作倦怠和述情障碍水平,按照芬兰“健康2000”系列研究界定倦怠标准,应用多重线性回归分析评价述情障碍对工作倦怠的预测作用。结果：13.4%（15/112）的精神科医师存在重度工作倦怠。相关分析显示,TAS-20总分（r=0.22,P〈0.05）和“情感辨别不能”得分（r=0.23,P〈0.05）与MBI-GS总分呈正相关,TAS-20总分（r=0.30,P〈0.01）及“情感辨别不能”（r=0.33,P〈0.01）、“情感描述不能”得分（r=0.27,P〈0.01）与MBI-GS“成就感降低”因子分呈正相关。多重线性回归分析显示,“情感辨别不能”因子得分与“成就感降低”因子得分呈正向关联（β=0.36,P〈0.05）。结论：精神科医师倦怠问题突出,情感辨别不能可能是成就感低落的预测因素。

精神科医师在灾难心理救援工作中的角色定位——天津港爆炸事故后心理救援工作的思考

灾难后的心理救援工作需要心理咨询师、志愿者、精神科医师等多种角色。其中,精神科医师以其自身的身份优势、有医学背景、组织结构统一性好等特点,适合充当灾难后心理救援工作的领导角色。

精神分裂症患者及家属、医生对知情同意具体程序态度的初步分析

目的分析精神科医生、精神分裂症患者及其家属对知情同意具体程序的态度,以指导今后知情同意的实施。方法所有样本均来自中南大学湘雅二医院,共计55名患者,46名家属,61名医生。采用知情同意态度问卷,来调查精神科医生、精神分裂症患者及其家属对知情同意具体程序的态度。结果患者、家属、精神科医生非参数检验结果表明,共计有17项条目存在显著性差异。比如条目4“签写一份接受医疗服务的知情同意书,其目的是”,67．4%的家属,59．2%的患者,90．2%的医生选择第3项“既保护医生又保护患者”,仅21．7%的家属,26．5%的患者,1．6%的医生选择第2项“保护患者”。结论目前精神分裂症患者、家属以及精神科医生对知情同意具体程序的态度存在明显差异。

保定、上海精神科医生对情感性精神障碍治疗的比较

目的 了解不同区域精神科医生对情感性精神障碍不同亚型的治疗情况及疗效不佳时的进一步处理方法。方法 采用随机分层法抽取保定、上海两市不同职称的精神科医生各 60名进行问卷调查。问卷内容包括医生对 6个不同亚型的情感性精神障碍病例的治疗及医生的一般情况。结果 ( 1)在抑郁发作时 ,选用频度较高的药物为氟西汀、阿米替林。上海医生多选用氟西汀 ,而保定医生多选用阿米替林。在双相轻中度抑郁发作时 ,有 93 3 %的医生合用碳酸锂。在重度抑郁及其伴精神病性症状时电休克是首选治疗 ,两种亚型首选该治疗的医生分别占 2 9 2 %、2 0 9%。 ( 2 )双相躁狂发作及快速循环发作选用频度较高的药物是碳酸锂 ,分别为 89 2 %、 5 7 5 %。 ( 3 )首选治疗疗效不佳时 ,轻中度抑郁发作多改用另一种抗抑郁药 ,而重度抑郁发作多选用电休克治疗。结论 不同区域经济水平不同 。

精神科专科医院与综合医院医师工作倦怠及相关因素分析

目的调查精神科专科医院及综合医院医务人员工作压力状况，并探讨不同专科医师工作压力与功能性躯体不适及健康相关行为的关系。方法应用Maslach工作倦怠量表通用版（MBI—GS）、患者健康问卷（PHQ-15），对112名精神科医师（专科组）和121名非精神科医师（非专科组）进行抽样测试研究。结果专科组倦怠率为89．3％，非专科组倦怠率为99．2％；非专科组MBI—GS总分及情感衰竭、成就感低落维度分显著高于专科组（P〈0．001）；专科组体育锻炼参与度显著优于非专科组，吸烟行为少于非专科组，饮食规律优于非专科组（P〈0．05，P〈0．001）；非专科组PHQ-15总分及胃病、四肢或关节痛、胸痛、心悸、气促、性生活异常、大便异常、消化系不适、疲劳感和睡眠困难症状分均高于专科组（P〈0．05，P〈0．001）；体育锻炼与MBI总分及情感衰竭维度呈负相关，PHQ总分与情感衰竭维度呈正相关；多元线性回归分析显示，MBI总分（β=0．375，95％CI：2．85—3．09）、情感衰竭（β=0．273，95％CI：3．11～3．47）和性别（β=0．218，=95％CI：1．38～1．51）进入回归模型，为功能性躯体不适的预测因素（R2=0．102）。结论综合医院医师较精神科专科医院医师有更高程度的工作倦怠及功能性躯体不适症状，情感衰竭维度是功能性躯体不适症状的预测因素，健康的生活方式可能对减轻倦怠程度有一定作用。

精神科医生的职业倦怠与防御方式的相关性研究

目的了解精神科医生的职业倦怠程度,了解精神科医生的防御方式以及职业倦怠与防御方式的相关性,为精神科医生职业倦怠的干预提供理论依据。方法采用问卷调查法,对四川省成都市某医院75名精神科医生的职业倦怠状况和防御方式进行调查分析。结果情绪衰竭与被动攻击、潜意显现呈正相关。玩世不恭与投射、被动攻击、隔离和消耗倾向呈正相关。成就感低与投射、被动攻击和同一化呈负相关(P<0.05)。结论临床精神科医生的职业倦怠与个体的特定防御方式有关,可采取针对性的干预措施。

精神科医师职业倦怠的状况及其对精神医学教育的启示

目的:研究精神科医师职业倦怠的发生和影响因素。方法:使用问卷法对住院精神科医师倦怠情况进行调查。结果:精神科医师的工作倦怠总体情况比较严重;职业倦怠存在显著的性别差异;31￣35岁年龄段者的人容易产生职业倦怠,中年员工的倦怠水平比较高;精神科医师的职业倦怠水平与社会支持水平呈现显著相关;精神科医师的应对与工作倦怠有显著相关。结论:精神科医师是职业倦怠的高发人群;为更好地提升其职业稳定性,需要从综合化的角度关注精神科医师的心理健康,不断提升其社会支持水平,并从医学教育的角度进行早期预防。

精神科医生对迟发性运动障碍的认知及临床实践状况调查

目的探讨精神科医生对迟发性运动障碍(TD)的认知及临床实践状况。方法应用自行设计的TD知识及态度问卷对106名临沂市精神科医生进行调查。结果精神科医生对TD临床表现项目掌握情况最好(86.79%),发病机制项目掌握情况最差(56.60%)。市级精神科医生对TD基础知识的掌握情况好于县区级精神科医生(P<0.01)。98.11%的精神科医生认为有必要进行TD诊断和治疗的培训,81.13%的医生接受过TD诊断和治疗的培训,其中,仅62.79%的医生接受过正规课程培训,34.92%的医生对TD的诊断和治疗没有信心。91.51%的医生认为在应用抗精神病药物前,应与患者及家属讨论TD发生的危险性,但仅76.42%的医生在临床实践中常规执行。98.11%的医生认为在应用抗精神病药物期间,应监测异常不自主运动,但仅74.52%的医生常规监测,53.77%的医生作监测结果记录。65.10%的医生认为TD是造成医疗纠纷及诉讼的原因之一,76.41%的医生认为没有患者的同意,抗精神病药物不得长期超适应证使用。结论应加强对精神科医生TD知识的培训,在临床工作中,应严格执行知情告知并常规监测TD的发生。

我国部分精神科医生对赌博成瘾认知程度的调查

目的:为了调查我国精神科医生对赌博成瘾的认识、经验和态度,以便做好今后的教育或培训工作,为促进我国精神科医生对于赌博成瘾的认知而提出更多建设性的建议。方法:采用自行设计的问卷来调查我国部分地区精神科医生对赌博成瘾的认识、诊断和治疗经验、接受培训的经历及有关态度。结果:共收回有效问卷110份,其中45%的精神科医生在临床实践中没有见过赌博成瘾病人,见过者中有67%的人见过病人不超过5个。所有110名被调查者中只有1人接受过赌博成瘾治疗的教育/培训,尽管有83%的人愿意接受该障碍识别与治疗方面的培训。90%以上的被调查者能认识到赌博成瘾的不良后果,80%者同意该障碍是一个公共卫生问题并且为一种成瘾障碍,70%者同意该障碍易共患其他重要的精神障碍,但仅有41%者知道精神病人赌博问题发生率比一般人群高。36%者表示能够评估并诊断赌博障碍,同时,23%者表示能够治疗该障碍。缺少知识、培训、资源及政府的支持是妨碍精神科医生参与治疗该障碍的主要因素,这些因素也是导致赌博成瘾在精神卫生场所未被识别的主要原因。结论:大多数精神科医生对赌博成瘾仅有很少的认识,几乎没有人接受过这方面的教育/培训。我国大多数精神科医生不仅对赌博成瘾的临床经验很少,也没有能力诊治该障碍。