title: Preliminary study of associative stigma among trainee psychiatrists in Flanders, Belgium.
abstract: OBJECTIVE
  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 training, 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).
  
  
  CONCLUSIONS
  Associative stigma in trainee psychiatrists is underestimated. More attention should be paid to this potentially harmful phenomenon in training.
authors.affiliation: Kirsten Catthoor, Department of Psychiatry, Psychiatrisch Ziekenhuis Stuivenberg, ZNA Antwerpen, B2060 Antwerp, Belgium.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Catthoor
authors.affiliation: Kirsten Catthoor, Department of Psychiatry, Psychiatrisch Ziekenhuis Stuivenberg, ZNA Antwerpen, B2060 Antwerp, Belgium.
authors.forename: Joost
authors.initials: J
authors.lastname: Hutsebaut
authors.affiliation: Kirsten Catthoor, Department of Psychiatry, Psychiatrisch Ziekenhuis Stuivenberg, ZNA Antwerpen, B2060 Antwerp, Belgium.
authors.forename: Didier
authors.initials: D
authors.lastname: Schrijvers
authors.affiliation: Kirsten Catthoor, Department of Psychiatry, Psychiatrisch Ziekenhuis Stuivenberg, ZNA Antwerpen, B2060 Antwerp, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: De Hert
authors.affiliation: Kirsten Catthoor, Department of Psychiatry, Psychiatrisch Ziekenhuis Stuivenberg, ZNA Antwerpen, B2060 Antwerp, Belgium.
authors.forename: Jozef
authors.initials: J
authors.lastname: Peuskens
authors.affiliation: Kirsten Catthoor, Department of Psychiatry, Psychiatrisch Ziekenhuis Stuivenberg, ZNA Antwerpen, B2060 Antwerp, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: Sabbe
keywords: Associative stigma; Coping mechanisms; Mental health gap; Psychiatry training; Trainee psychiatrist