Mental Health Stigma and Perceived Practice Competence Among Nurse Practitioners: A Cross-Sectional Descriptive Study

Purpose: Approximately 50% of Americans will meet the criteria for a mental health disorder sometime during their life, and the majority of these illnesses begin in childhood and adolescence (Merikangas et al., 2010). Significant health disparities exist among those with a major mental illness who die 10 to 32 years earlier than the general population due to largely preventable causes (NIMH, 2011; Walker, McGee, & Druss, 2015). In order to reduce this health disparity, the Centers for Disease Control and Prevention (2011) developed an action plan outlining specific strategies to integrate mental health promotion and mental illness prevention with chronic physical disease prevention from a public health model. The challenge is for health care professionals to respond to these initiatives.

The Institute of Medicine’s report on the future of nursing (2010) identifies the integral role of nurses, particularly advanced practice nurses, in the rapidly evolving healthcare system. Nurse practitioners are ideal providers to reduce health disparities among those with mental illness as they are prepared both philosophically and educationally from a health promotion and disease prevention framework. However, there are multiple barriers to help-seeking that prevent individuals from initiating conversations with their health care provider regarding mental health issues. A primary barrier to help-seeking is perceived stigma regarding those with mental health disorders (Ahmedani, 2011; Calloway, Kelly & Ward-Smith, 2012). Goffman (1963) defines stigma as an “attribute that is deeply discrediting and reduces the bearer from a whole and usual person to a tainted, discounted one (p.3)”

While studies exist describing the attitudes of physicians and other health care providers toward those with mental illness there is a gap in the literature related to stigmatizing attitudes among nurse practitioners. Additionally, it is unknown what facilitators and barriers to effective recognition and management of mental health disorders nurse practitioners experience. Therefore, the purposes of this study are to 1) assess nurse practitioners’ attitudes regarding treating individuals with mental health disorders, and 2) examine perceived competence and factors associated with nurse practitioner recognition and management of mental health disorders in non-psychiatric settings.

Methods:  A cross-sectional descriptive study was conducted via anonymous surveys at a national nurse practitioner conference. Participants provided demographic and practice data and completed the Medical Condition Regard Scale (MCRS; Christison, Haviland, & Riggs, 2002) for three separate mental health diagnoses (anxiety/depression [A/D], attention deficit hyperactivity disorder [ADHD], and substance use disorders [SUD]). Descriptive statistics were calculated to examine demographic and practice pattern data as well as the distribution of scores on the MCRS for all three conditions. Pearson correlation and Spearman’s Rho were used to examine relationships between variables, depending on the level of the data. Student t-tests were utilized to evaluate variation in stigmatizing attitudes based on participants’ demographic, educational, and personal factors.

Results:  The final sample (N=141) were predominantly female (82%), Caucasian (71%), and reported <10 years of experience in advanced practice (62%). Only 33% of participants reported feeling well-prepared by their nurse practitioner education to manage mental health disorders. Mean values on the MCRS (higher scores indicating more positive attitudes) were highest for A/D (M=39.15, SD=5.93), followed by ADHD (M=35.85, SD=7.19), and SUD (M=35.21, SD=7.77). Examination of individual items revealed 42% of participants reported working with patients with anxiety and/or depression as ‘satisfying’ while only 26% and 22.7% of participants rated satisfaction with treating ADHD and SUD, respectively. Participants with a personal or family history of a mental health disorder reported more favorable attitudes towards patients with ADHD (t = -2.3, p = .024) than those without a personal or family history, but no differences were detected with A/D or SUD.

Conclusion: Results suggest stigmatizing attitudes towards individuals with mental health disorders may exist among nurse practitioners, and lack of confidence in managing mental health disorders may contribute to this stigma. The majority of participants did not feel well prepared to manage mental health disorders, yet 70% of mental health care is provided in primary care settings (NAMI, 2015). These findings highlight the need for increased mental health content within nurse practitioner curricula as well as the development and implementation of innovative evidence-based educational strategies to decrease stigmatizing attitudes and beliefs towards those with a mental health disorder.