Providers' Personal and Professional Contact With Persons With Mental Illness: Relationship to Clinical Expectations.
OBJECTIVE
Providers share many stigmatizing attitudes with the general public regarding persons with mental illness. These attitudes may contribute to suboptimal general medical care for patients with schizophrenia. This study tested the hypothesis that provider contact (personal and professional) with persons with mental illness would be associated with clinical expectations and that this relationship would be mediated by provider stigmatizing attitudes.


METHODS
Between August 2011 and April 2012, 192 health care providers from five Veterans Affairs medical centers responded to a clinical vignette describing a patient with schizophrenia who is seeking treatment for back pain. Providers completed a survey to determine their expectations regarding the vignette patient's treatment adherence, ability to read and understand health education materials, and social and vocational functioning. Self-report data on the amount of contact each provider had with persons with mental illness in their practices and in their personal lives were also collected.


RESULTS
Structural equation modeling showed that providers with greater professional contact with patients with mental illness in their clinical practice and greater personal contact with individuals with mental illness exhibited significantly lower stigmatizing attitudes toward the patient with schizophrenia in the vignette and were more likely to expect the vignette patient to have better treatment adherence, a better understanding of educational material, and higher social and vocational functioning.


CONCLUSIONS
Greater personal and professional contact with persons with mental illness was associated with lower provider stigma and higher expectations of patient adherence, increased ability to understand educational material, and higher social and vocational functioning. It is possible that interventions involving contact with persons with mental illness could reduce providers' stigma.
Dr. Mittal is with the Department of Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, North Little Rock, Arkansas (e-mail: dinesh.mittal@va.gov ). He is also with the Department of Psychiatry, University of Arkansas for Medical Sciences (UAMS), Little Rock, where Dr. Chekuri and Ms. Han are affiliated. Dr. Ounpraseuth is with the Department of Biostatistics at UAMS. Ms. Reaves and Dr. Sullivan are with the School of Medicine, University of California, Riverside. Dr. Corrigan is with Department of Psychology, Illinois Institute of Technology, Chicago.
Dinesh
D
Mittal
Dr. Mittal is with the Department of Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, North Little Rock, Arkansas (e-mail: dinesh.mittal@va.gov ). He is also with the Department of Psychiatry, University of Arkansas for Medical Sciences (UAMS), Little Rock, where Dr. Chekuri and Ms. Han are affiliated. Dr. Ounpraseuth is with the Department of Biostatistics at UAMS. Ms. Reaves and Dr. Sullivan are with the School of Medicine, University of California, Riverside. Dr. Corrigan is with Department of Psychology, Illinois Institute of Technology, Chicago.
Songthip T
ST
Ounpraseuth
Dr. Mittal is with the Department of Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, North Little Rock, Arkansas (e-mail: dinesh.mittal@va.gov ). He is also with the Department of Psychiatry, University of Arkansas for Medical Sciences (UAMS), Little Rock, where Dr. Chekuri and Ms. Han are affiliated. Dr. Ounpraseuth is with the Department of Biostatistics at UAMS. Ms. Reaves and Dr. Sullivan are with the School of Medicine, University of California, Riverside. Dr. Corrigan is with Department of Psychology, Illinois Institute of Technology, Chicago.
Christina
C
Reaves
Dr. Mittal is with the Department of Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, North Little Rock, Arkansas (e-mail: dinesh.mittal@va.gov ). He is also with the Department of Psychiatry, University of Arkansas for Medical Sciences (UAMS), Little Rock, where Dr. Chekuri and Ms. Han are affiliated. Dr. Ounpraseuth is with the Department of Biostatistics at UAMS. Ms. Reaves and Dr. Sullivan are with the School of Medicine, University of California, Riverside. Dr. Corrigan is with Department of Psychology, Illinois Institute of Technology, Chicago.
Lakshminarayana
L
Chekuri
Dr. Mittal is with the Department of Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, North Little Rock, Arkansas (e-mail: dinesh.mittal@va.gov ). He is also with the Department of Psychiatry, University of Arkansas for Medical Sciences (UAMS), Little Rock, where Dr. Chekuri and Ms. Han are affiliated. Dr. Ounpraseuth is with the Department of Biostatistics at UAMS. Ms. Reaves and Dr. Sullivan are with the School of Medicine, University of California, Riverside. Dr. Corrigan is with Department of Psychology, Illinois Institute of Technology, Chicago.
Xiaotong
X
Han
Dr. Mittal is with the Department of Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, North Little Rock, Arkansas (e-mail: dinesh.mittal@va.gov ). He is also with the Department of Psychiatry, University of Arkansas for Medical Sciences (UAMS), Little Rock, where Dr. Chekuri and Ms. Han are affiliated. Dr. Ounpraseuth is with the Department of Biostatistics at UAMS. Ms. Reaves and Dr. Sullivan are with the School of Medicine, University of California, Riverside. Dr. Corrigan is with Department of Psychology, Illinois Institute of Technology, Chicago.
Patrick
P
Corrigan
Dr. Mittal is with the Department of Veterans Affairs (VA) South Central Mental Illness Research, Education and Clinical Center, North Little Rock, Arkansas (e-mail: dinesh.mittal@va.gov ). He is also with the Department of Psychiatry, University of Arkansas for Medical Sciences (UAMS), Little Rock, where Dr. Chekuri and Ms. Han are affiliated. Dr. Ounpraseuth is with the Department of Biostatistics at UAMS. Ms. Reaves and Dr. Sullivan are with the School of Medicine, University of California, Riverside. Dr. Corrigan is with Department of Psychology, Illinois Institute of Technology, Chicago.
Greer
G
Sullivan
D000328:Adult; D001291:Attitude of Health Personnel; D001416:Back Pain / Q000628:therapy; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012559:Schizophrenia / Q000150:complications; D057566:Self Report; D057545:Social Stigma; D013240:Stereotyping; D014481:United States