Background
Methods
Participants and sampling
Measures
-
Demographics and work-related characteristicsParticipants offered the information about age, gender, religious belief, education level, and type of residence (hukou). In terms of work-related characteristics, they offered the information of their position, length of service, title, monthly income, satisfaction about income, and satisfaction about working environment. Two questions were about their evaluation of work. “What are the chances for patients to rehabilitate through the work of primary healthcare staff” (1 = large; 2 = general; 3 = small), and “How many patients you know have rehabilitated or stayed well” (1 = most of them; 2 = nearly half of them; 3 = fewer than half of them). Three other questions were about work and education experience: “Do you have work experience in psychiatric/psychological departments” (1 = yes; 2 = no), “Have you received training about mental health since work” (1 = yes; 2 = no), and “Have you received any formal education in medical school” (1 = yes; 2 = no).
-
Stigma levelRespondents’ stigma level towards psychiatric patients was assessed using Assessment Scale of Discrimination against Patients with Mental Disorders [25]. It was developed to assess the stigma level of Chinese healthcare workers in psychiatric and non-psychiatric departments, and relatives and friends of psychiatric patients with high level of reliability and validity [26, 27]. It contains 26 5-point questions, and it assesses the attitude in 3 dimensions: psychiatric patients’ social communication (e.g., “Psychiatric patients can become trustable friends”), psychiatric patients’ danger (e.g., “Many psychiatric patients committed crimes”), and psychiatric patients’ capability (e.g., “Psychiatric patients cannot adapt to school life”). For each item, the participant is required to choose the degree they agreed to. This study used the average score of questions in analyses. Higher scores indicate higher levels of stigma. In this study, its Cronbach’s alpha coefficient was 0.9, indicating a good reliability.
-
Causes of psychiatric illnessEight 6-point questions were extracted from the Mental Health Locus of Origin (MHLO) scale [28]. This instrument has five items that attribute mental issues to “endogenous” factors (e.g., “The cause of most psychological problems is to be found in the brain”), which emphasizes the effect from gene and physiological factors. 3 items attribute it to “interactional” factors (e.g., “The mental illness of some people is caused by abuse or neglect during childhood”), which emphasizes the effect from social environment and interaction between people. The total score of the scale ranges from 0 to 80. A higher total score indicates that the respondent believes that the causes of psychiatric illness are more likely to be “endogenous,” We used the average score of the instrument in analyses. A lower total score of respondents indicates they believed that psychiatric illness was “interactional,” The Cronbach’s alpha coefficient of this instrument was 0.45 in this study, which is relatively low.
-
Quality of contactThe quality of contact between healthcare workers and patients was measured by 6 items. Each of the items uses one word to describe the relationship between participants and patients, and their polar opposites (equal and unequal status, involuntary or voluntary, superficial or intimate, pleasant or unpleasant, cooperative or competitive, and positive or negative). The words are placed as anchors on a 10-point scale. The overall quality is the average score of the scores of the 6 items. We used the average score of the instrument in analyses. A higher average score stands for a higher quality of contact [29]. The Cronbach’s alpha coefficient of this instrument was 0.64 in this study, which is good.
-
Frequency of contactContact Report was employed to measure the contact frequency between respondents and psychiatric patients [30]. This instrument describes 12 relationships that the participant and psychiatric patients may be in, indicating 12 levels of familiarity that the participant has to psychiatric patients. The scores of the 12 statements range from 1 to 12 (e.g., the item “Never observed person with mental illness” scores 1. And the item “I have a serious mental illness” scores 12). Participants choose every statement that fit their situation. The final score is decided by the largest score of the statement that is chosen. A higher final score indicates a more frequent contact with the psychiatric patients. In this study, the coefficient of reproducibility was 0.91, indicating a good reliability.
-
Social interaction and mediaOne question was asked to assess the attitude of their relatives and friends towards psychiatric patients: “What is the attitude of your relatives and friends towards psychiatric patients” (1 = sympathetic; 2 = neutral; 3 = aloof). Another question was asked to assess the attitude of media: “What is the attitude of the mass media towards psychiatric patients” (1 = sympathetic; 2 = neutral; 3 = aloof).
Statistical analysis
Results
Characteristics of subjects
Variables |
n (%) | Score (s.d.) | t/F | Variables |
n (%) | Score (s.d.) | t/F |
---|---|---|---|---|---|---|---|
Basic characteristics
| |||||||
Gender | Type of residence | ||||||
Men | 128 (32.6) | 1.82 (0.587) | −3.417** | Urban | 210 (53.6) | 1.90 (0.587) | 2.491** |
Women | 265 (67.4) | 2.03 (0.562) | Rural | 182 (46.4) | 2.04 (0.560) | ||
Age | Educational level | ||||||
18–27 | 123 (32.8) | 2.07 (0.553) | 3.375** | ≤ High school | 46 (11.9) | 1.96 (0.469) | 0.220 |
28–37 | 129 (34.4) | 1.95 (0.611) | Secondary school | 115 (29.7) | 1.99 (0.581) | ||
≥ 38 | 123 (32.8) | 1.89 (0.525) | ≥ Junior college | 226 (58.4) | 1.95 (0.603) | ||
Buddhist | |||||||
Yes | 84 (21.3) | 2.06 (0.633) | −1.679 | ||||
No | 311 (78.7) | 1.94 (0.558) | |||||
Characteristics about occupations
| |||||||
Occupation | Monthly personal income (RMB, yuan) | ||||||
Doctor | 101 (25.6) | 1.97 (0.565) | 5.826** | ≤ 1000 | 134 (33.9) | 1.99 (0.637) | 6.041** |
Nurse | 94 (23.8) | 2.19 (0.557) | 1001–2000 | 104 (26.3) | 2.05 (0.527) | ||
Other staff in township clinics | 59 (14.9) | 1.89 (0.617) | > 2000 | 64 (16.2) | 1.74 (0.534) | ||
Village doctor | 95 (24.1) | 1.88 (0.563) | |||||
Length of service | Satisfaction about income | ||||||
1–5 years | 116 (29.4) | 2.05 (0.555) | 2.531 | Satisfied | 72 (18.2) | 1.79 (0.516) | 0.422** |
6–15 years | 106 (26.8) | 2.06 (0.590) | General | 185 (46.8) | 1.94 (0.557) | ||
≥ 16 years | 112 (28.4) | 1.90 (0.597) | Unsatisfied | 124 (31.4) | 2.09 (0.629) | ||
Title | Satisfaction about work environment | ||||||
None | 141 (35.7) | 2.02 (0.572) | 2.165 | Satisfied | 124 (31.4) | 1.79 (0.565) | 9.803*** |
Physicians’ assistant | 52 (13.2) | 1.83 (0.537) | General | 241 (61.0) | 2.02 (0.573) | ||
Primary/intermediate/advanced title | 179 (45.3) | 1.97 (0.592) | Unsatisfied | 26 (6.6) | 2.20 (0.445) |
Variables |
n (%) | Score (s.d.) | t/F | Variables |
n (%) | Score (s.d.) | t/F |
---|---|---|---|---|---|---|---|
Evaluation of work
| |||||||
The chances for patients to rehabilitate through the work of primary healthcare staff | Patients known to have rehabilitated or stayed well | ||||||
Large | 173 (43.8) | 1.85 (0.552) | 6.893** | Most of them | 164 (41.5) | 1.83 (0.608) | 14.894*** |
General | 170 (43.0) | 2.03 (0.597) | Nearly half of them | 114 (28.9) | 1.94 (0.551) | ||
Small | 44 (11.1) | 2.15 (0.461) | Fewer than half of them | 108 (27.3) | 2.21 (0.489) | ||
Knowledge of psychiatric illness
| |||||||
Work experience in psychiatric/psychological departments | Training about mental health since work | ||||||
Yes | 33 (8.4) | 1.71 (0.599) | 2.637** | Yes | 230 (58.2) | 1.96 (0.566) | 0.312 |
No | 354 (89.6) | 1.99 (0.575) | No | 157 (39.7) | 1.98 (0.592) | ||
Medical school education | |||||||
Yes | 328 (83.0) | 1.95 (0.600) | 1.045 | ||||
No | 50 (12.7) | 2.04 (0.482) | |||||
Social culture
| |||||||
Attitude of relatives and friends towards patients | Attitude of mass media towards patients | ||||||
Sympathetic | 233 (59.0) | 1.86 (0.601) | 11.227*** | Sympathetic | 283 (71.6) | 1.91 (0.588) | 7.730** |
Neutral | 111 (28.1) | 2.13 (0.462) | Neutral | 72 (18.2) | 2.02 (0.467) | ||
Aloof | 43 (10.9) | 2.13 (0.533) | Aloof | 32 (8.1) | 2.31 (0.516) |
Correlations among other variables
Stigma level | Quality of contact | Quantity of contact | Causes of psychiatric illness | |
---|---|---|---|---|
Stigma level | 1 | |||
Quality of contact | −0.374** | 1 | ||
Quantity of contact | −0.01 | −0.031 | 1 | |
Causes of psychiatric illness | 0.013 | −0.138** | −0.06 | 1 |
Hierarchical linear regression analyses
Model 1 | Model 2 | Model 3 | |||||
---|---|---|---|---|---|---|---|
β |
P
| β |
P
| β |
P
| ||
Gender | Male: Female | −0.161 | 0.018 | −0.055 | 0.432 | −0.055 | 0.425 |
Type of residence | Urban: Rural | −0.044 | 0.507 | −0.053 | 0.426 | −0.051 | 0.445 |
Age | Ref: 18–27 | ||||||
28–37 | −0.013 | 0.869 | −0.060 | 0.399 | −0.082 | 0.245 | |
≥37 | 0.04 | 0.616 | −0.020 | 0.812 | −0.050 | 0.543 | |
Work experience in psychiatric/psychological department | Yes: No | −0.172 | 0.006 | −0.174 | 0.006 | ||
Occupation | Ref: Village doctors | ||||||
Doctors | 0.012 | 0.883 | −0.001 | 0.989 | |||
Nurses | 0.134 | 0.130 | 0.078 | 0.385 | |||
Other staff in township clinics | −0.077 | 0.290 | −0.073 | 0.313 | |||
Monthly personal income (RMB, yuan) | Ref: ≥2000 | ||||||
0–1000 | −0.040 | 0.677 | −0.012 | 0.899 | |||
1001–2000 | −0.026 | 0.774 | −0.002 | 0.979 | |||
Satisfaction about income | Ref: Low | ||||||
High | −0.037 | 0.606 | −0.05 | 0.490 | |||
Medium | −0.207 | 0.003 | −0.187 | 0.007 | |||
Satisfaction about working environment | Ref: Low | ||||||
High | −0.174 | 0.147 | −0.111 | 0.352 | |||
Medium | −0.095 | 0.404 | −0.046 | 0.686 | |||
The chances for patients to rehabilitate through the work of primary healthcare staff | Ref: Low | ||||||
High | −0.036 | 0.734 | 0.046 | 0.667 | |||
Medium | 0.030 | 0.768 | 0.074 | 0.460 | |||
Patients known to have rehabilitated or stayed well | Ref: fewer than half | ||||||
Most | −0.117 | 0.158 | −0.139 | 0.092 | |||
Nearly half | −0.160 | 0.030 | −0.183 | 0.012 | |||
Quality of contact | −0.343 | 0.000 | −0.313 | 0.000 | |||
Attitude of relatives and friends towards patients | Ref: Aloof | ||||||
Sympathetic | −0.182 | 0.061 | |||||
Neutral | −0.050 | 0.603 | |||||
Attitude of mass media towards patients | Ref: Aloof | ||||||
Sympathetic | −0.218 | 0.020 | |||||
Neutral | −0.243 | 0.007 | |||||
R2
| 0.035 | 0.295 | 0.333 | ||||
⊿R2
| 0.035 | 0.260 | 0.038 |