Construction of Clinical/Practice Question and Literature Review

Construction of Clinical/Practice Question and Literature Review

The hallmark of psychiatric care is improving the quality of life of patients presenting with psychiatric illnesses and enhancing communities’ capacity to seek care. This paper details a practice question for scholarly purposes aimed at exploring aspects of psychiatric care. It will also discuss the literature review centered on the practice question, appraise some pieces of evidence supporting the practice problem, and explore the need for further research.

Introduction and Question

Mental health disorders remain a global health concern. The rising prevalence of these disorders, together with the negative health effects they have on communities, warrants their address. Global efforts to enhance the quality of psychiatric care have fallen short of changing communities’ perceptions of these disorders. Indeed, social stigma and lack of community awareness of these disorders remain an impediment to global success in managing and addressing mental health disorders (Gallego et al., 2020). As evident in some cultures, these illnesses have not been recognized as real illnesses, with many associating them with curses, bad luck, and weaknesses. In these communities, mental health illnesses are the subject of chastisements, name-calling, and ridicule. These, along with social stigma, devalue individuals with these illnesses and considerably affect their health-seeking behavior.

Subsequently, ethnic minority groups are mostly impacted by social stigma and negative perceptions of mental health illnesses. The practice question asks: In ethnic minority groups (P), does changing the social conception of mental health illnesses among members of these group (I), compared to psychiatric conception (C), lower the stigma associated with these disorders (O) after a successful health awareness campaign (T).

The practice question focuses on ethnic minority groups as a population of interest. This is because this group still lags in measures of health-seeking behavior for mental health illnesses. Additionally, they are disproportionately affected by these illnesses compared to other groups. The literature reviewed was obtained from reputable databases such as PubMed, Google Scholar, Cochrane, and CINAHL. The search terms used were social perception of mental health illnesses, stigma associated with mental health disorders, and impacts of health awareness on mental health disorders across ethnic minority groups. Articles used in the review were those that met the criteria of relevancy, purpose, authority, and currency. Consensual findings in these pieces of literature were the impact of social stigma on mental health illnesses, the need to address these illnesses, and the significance of improving awareness and social perception of mental health disorders.

Review of Literature

Literature findings revealed the impact of social stigma and negative perception of mental health illnesses on the level of adoption of mental health services. Stigmatization, poor awareness, socio-cultural influences, and poor acceptability of these illnesses across communities affect the level of utilization of mental health services in ethnic minority groups (Muhorakeye & Biracyaza, 2021). This reveals the low utilization of these services among ethnic minority groups. Notwithstanding, poor adoption of these services considerably affects their overall health and is responsible for the high burden of these illnesses in these communities. da Silva et al. (2020) also detail the impact of mental health stigma on psychiatric emergencies. Per this source, the stigma associated with mental health disorders has undesirable consequences for individuals with these disorders. It affects their health-seeking behavior and lowers their utilization and adoption of the available management strategies.

To follow this, patients with mental health disorders often face discrimination and stigma related to their disease. Pescosolido et al. (2021) report that stigma results in negative social experiences. The discrimination, isolation, and rejection that proceed with mental health stigma affect the ability and willingness of the sufferer to own up to his illness and seek care. There are several types of stigma associated with mental health disorders. Subu et al. (2021) note that the stigma experienced by patients with mental health disorders is mainly public stigma, perceived stigma from the patient’s perspective, family attitude toward mental health disorders, professional stigma, and employment discrimination. Regardless of the type, social stigma still affects patients’ care levels and utilization of mental healthcare services across ethnic minority groups.

While social stigma has traditionally been associated with the public, recent findings report stigma among healthcare providers. Porfyri et al. (2022) note that healthcare professionals are just as susceptible to stigmatizing attitudes as other community members. Of significance in their stigmatizing attitudes is how they handle their patients with these illnesses. Jauch et al. (2023) report that stigmatizing attitudes by healthcare professionals affect how they provide care to patients with mental health disorders. It creates barriers to health seeking and provision through pathways such as delays in healthcare provision, sub-optimal therapeutic relationships, poor mental healthcare, and patient safety concerns. This highlights the need to address this stigma.

Notably, stigma about mental health illness often arises from fear or lack of understanding of these disorders. Al Omari et al. (2021) report that the overarching principle behind the stigmatization of mental health disorders is the misrepresentation of these illnesses across global societies. Inaccurate representation of the pathophysiological features and manifestation of these illnesses leads to misunderstanding and consequent stigmatization of them. Nugent et al. (2020) also detail the impact of religiosity and culture on the stigmatization of mental health disorders. Per these findings, the cultural definition of illness and causative factors in disease and suffering is likely to influence the stigmatization of these disorders. In ethnic minority groups, where a proper definition of mental health disorders is nonexistent, individuals are likely to have a negative perception of these disorders, which further explains the stigmatization of mental health disorders common in these societies.

Subsequently, the findings on the causal factors for stigma, along with the forms of stigma across global societies, point to the need to address them. A lack of understanding of these illnesses as a causal factor for mental health disorders, as posited by Javed et al. (2021), reinforces the need for enhancing community awareness of these disorders. Nyblade et al. (2019) note that educating communities on mental health disorders enhances communities’ understanding of these illnesses and may be valuable in lessening the stigma associated with these disorders. Shim et al. (2022) also report that incorporating an educational framework in health promotional campaigns targeting mental health illnesses may help enhance community awareness of these illnesses and health-seeking behavior.

The impact of these findings in the comprehensive management of mental health disorders, notwithstanding, some studies proposed contrary mechanisms of handling social stigma associated with mental health disorders. Gallego et al. (2020) challenge the significance of educational strategies in enhancing community awareness. Per the findings, community educational approaches provide little impact in lessening the stigma associated with these illnesses. The author further recommends acculturation and modernization as two valuable strategies for lessening the stigmatization of mental health disorders.

Appraisal and Synthesis

The articles used in the literature reviewed detailed several aspects of comprehensive psychiatric care. There is a consensual finding across the literature used on the impacts of social stigma on health-seeking behavior and the overall well-being of individuals with mental health disorders. The articles used can be stratified into qualitative studies, systematic reviews, and quantitative studies. The article by Muhorakeye & Biracyaza (2021), which detailed the target population per the PICOT formatted practical question, utilized qualitative designs. Articles on interventions and comparisons were cross-sectional studies and systematic reviews. The article that addressed the outcome was a systematic review article.

Findings by Muhorakeye & Biracyaza (2021) detailed specific barriers to mental healthcare. This literature detailed the influence of social stigma on the utilization of mental healthcare and other valuable resources used in managing these disorders. The article also introduced social stigma as a problem in mental healthcare and how it affects people with these illnesses. Moreover, it is a qualitative study that adopts a cross-sectional design that explores barriers to mental healthcare among patients seeking healthcare. Its findings informed the basis for addressing the intervention section in the PICOT formatted practice question.

Findings by Al Omari et al. (2021) and Javed et al. (2021) detail the nexus between the stigmatization of mental health disorders and poor or lack of understanding of these disorders. This article is a cross-sectional study that was targeted at exploring the associated factors of stigma toward individuals with mental health disorders. This article maintained relevance as it compared the psychiatric conceptions of mental health disorders and the social conceptions of these illnesses. Per the study findings, stigmatization of mental health disorders is a diversion from the classical psychiatric conceptions to the social factors that inform how communities perceive these illnesses. Poor mental education results in a poor understanding of these illnesses and is likely to inform whether or not an individual stigmatizes these disorders. Findings by (Shim et al., 2022) and Nyblade et al. (2019) reiterate the significance of community education in eliminating social stigma. Through educational strategies, communities get to understand the scientific principles explaining these disorders. This may help in lessening the stigma mounted on these illnesses.

In as much as the literature utilized was explicit in detailing aspects of psychiatric care relevant to answering the PICOT practical question, they fell short of drawing a nexus with the population under scrutiny. The article by Muhorakeye & Biracyaza (2021) that details the population affected only gives findings on select communities and fails to discuss findings in other communities. While this can be reflective of other communities, differences in cultures and religiosity that also influence individuals’ and communities’ perceptions of these illnesses can affect the generalization of these findings. A gap, therefore, exists on the impact of social stigma in ethnic minority groups. This will involve scrutinizing individual factors that are associated with stigma in these groups and doing a cross-analysis to restructure the PICOT question.

Synthesis

There was a consensual finding that poor mental health education is a barrier to mental healthcare and health-seeking behavior. This problem is especially compounded in ethnic minority groups, where cultural diversity exists. Addressing this problem may help lessen the social stigma apparent in these communities.

Further Research

Based on evidence from this literature review, there is a need to identify factors attributed to social stigma across ethnic minority groups. The socio-cultural characteristics that inform social stigma in these communities make generalizing an intervention difficult. Exploring the cultural influences on social stigma may help in giving a perspective of addressing it in ethnic minority groups.

Social stigma remains a barrier to mental healthcare and health-seeking behavior for patients with these illnesses. This problem is especially compounded in ethnic minority groups. Addressing this problem is thus necessary for comprehensive psychiatric care. Research studies that explore the impact of changing the social conception of these disorders in communities on lessening the stigmatization of these disorders are thus necessary. Educational strategies are vital in this regard. This approach, implemented through community outreach programs targeting ethnic minority groups, can broaden their understanding of these illnesses and may help change their perspectives on them.

References

Al Omari, O., Khalaf, A., Al Sabei, S., Wynaden, D., Ballad, C. A., Al Dameery, K., & Al Qadire, M. (2021). Associated factors of stigma toward people with mental illness among university and school students. Perspectives in Psychiatric Care, 58(4), 1736–1743. https://doi.org/10.1111/ppc.12982 

da Silva, A. G., Baldaçara, L., Cavalcante, D. A., Fasanella, N. A., & Palha, A. P. (2020). The impact of mental illness stigma on psychiatric emergencies. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00573

Gallego, J., Cangas, A. J., Aguilar, J. M., Trigueros, R., Navarro, N., Galván, B., Smyshnov, K., & Gregg, M. (2020). Education students’ stigma toward mental health problems: A cross-cultural comparison. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.587321

Jauch, M., Occhipinti, S., & O’Donovan, A. (2023). The stigmatization of mental illness by mental health professionals: A scoping review and Bibliometric analysis. PLOS ONE, 18(1). https://doi.org/10.1371/journal.pone.0280739

Javed, A., Lee, C., Zakaria, H., Buenaventura, R. D., Cetkovich-Bakmas, M., Duailibi, K., Ng, B., Ramy, H., Saha, G., Arifeen, S., Elorza, P. M., Ratnasingham, P., & Azeem, M. W. (2021). Reducing the stigma of mental health disorders with a focus on low- and middle-income countries. Asian Journal of Psychiatry, 58, 102601. https://doi.org/10.1016/j.ajp.2021.102601

Muhorakeye, O., & Biracyaza, E. (2021). Exploring barriers to mental health services utilization at Kabutare District Hospital of Rwanda: Perspectives from patients. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.638377

Nugent, C., Rosato, M., Hughes, L., & Leavey, G. (2020). Risk factors associated with experienced stigma among people diagnosed with mental ill-health: A cross-sectional study. Psychiatric Quarterly, 92(2), 633–643. https://doi.org/10.1007/s11126-020-09827-1

Nyblade, L., Stockton, M. A., Giger, K., Bond, V., Ekstrand, M. L., Lean, R. M., Mitchell, E. M., Nelson, L. R., Sapag, J. C., Siraprapasiri, T., Turan, J., & Wouters, E. (2019). Stigma in health facilities: Why it matters and how we can change it. BMC Medicine, 17(1). https://doi.org/10.1186/s12916-019-1256-2 

Pescosolido, B. A., Halpern-Manners, A., Luo, L., & Perry, B. (2021). Trends in the public stigma of mental illness in the US, 1996-2018. JAMA Network Open, 4(12). https://doi.org/10.1001/jamanetworkopen.2021.40202

Porfyri, G.-N., Athanasiadou, M., Siokas, V., Giannoglou, S., Skarpari, S., Kikis, M., Myroforidou, A., Anoixa, M., Zerakis, N., Bonti, E., Konsta, A., Diakogiannis, I., Rudolf, J., & Deretzi, G. (2022). Mental health-related stigma discrimination and prejudices among Greek healthcare professionals. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.1027304

Shim, Y. R., Eaker, R., & Park, J. (2022). Mental Health Education, awareness and stigma regarding mental illness among college students. Journal of Mental Health & Clinical Psychology, 6(2), 6–15. https://doi.org/10.29245/2578-2959/2022/2.1258

Subu, M. A., Wati, D. F., Netrida, N., Priscilla, V., Dias, J. M., Abraham, M. S., Slewa-Younan, S., & Al-Yateem, N. (2021). Types of stigma experienced by patients with mental illness and mental health nurses in Indonesia: A qualitative content analysis. International Journal of Mental Health Systems, 15(1). https://doi.org/10.1186/s13033-021-00502-x

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The purpose of this assignment is to state your clinical/practice question and explore the literature pertaining to your clinical/practice problem as you described in your Module 3 Discussion Board. According to Moran et al. (2020) when conducting a literature review, the goal is to obtain a representative sample of the literature which describes the concepts related to the phenomenon of interest and the research results applicable to the clinical/practice question and identify what gaps need to be further researched. Your work for this paper may be used to build upon your scholarly project and publishable manuscript—thus it is important that you align your literature review with the topic you have selected (or are considering) for your PICOT question and DNP project.

Instructions:

Please follow the rubric below.
Your work for this paper may be used to build upon your scholarly project and publishable manuscript—thus it is important that you align your literature review with the topic you have selected (or are considering) for your PICOT question and DNP project.