The early recognition and treatment of mental health disorders can improve quality of life outcomes and reduce lifelong disability. However, stigmatizing attitudes have been found among nurse practitioners (NPs) who care for patients with anxiety and/or depression, attention deficit/hyperactivity disorder (ADHD), and substance use disorder (SUD), according to a study published in the Journal of the American Association of Nurse Practitioners.
Researchers conducted an anonymous survey of NPs that contained an 11-item scale to assess biases, emotions, and expectations related to 3 categories of mental health diagnoses: anxiety/depression, SUD, and ADHD. They provided demographic information, educational preparation, and clinical practice setting, along with responses on the Medical Condition Regard Scale (MCRS).
A total of 141 NPs completed the survey; the majority of the respondents were women (82.3%) and were certified as family NPs (71.6%). followed by adult NPs (12.1%) and geriatric NPs (5.7%). Approximately one-third of participants (31.9%) indicated that the education they received covered the diagnosis and management of mental health disorders, yet only 18.4% completed clinical hours in a psychiatric setting.
The researchers noted that most of the respondents (67.3%) reported that their educational program had not adequately prepared them to manage common mental health disorders; however, 49.6% reported feeling confident about their ability to manage these disorders in adults and 46.1% in older patients. A majority of respondents (58%) reported assessing mental health at each visit, and 56% routinely recommended activities such as mindfulness and gratitude practices.
Overall, NP attitudes were most favorable toward working with patients with anxiety/depression and least favorable toward working with patients with SUDs. The group of NPs who reported favorable attitudes toward working with people anxiety/depression, also reported favorable attitudes about working with patients with ADHD and SUDs.
Respondents who had a personal or family history of a mental health disorder reported more favorable attitudes toward those with ADHD compared with those without any personal or family history. No differences were detected in attitudes toward patients with anxiety/depression or SUDs. NPs who spent clinical hours working in a psychiatric setting demonstrated more favorable attitudes toward individuals with SUDs than respondents without clinical hours in the psychiatric setting, but no statistically significant difference was identified for anxiety/depression or ADHD.
Participants responded more favorable to items related to working with patients with anxiety/depression, followed by ADHD and SUDs. Participants reported feeling most frustrated when working with patients with SUDs, followed by anxiety/depression, and ADHD. Just over one-fourth of participants preferred not to work with patients with SUDs. The majority of respondents agreed that insurance plans should provide coverage for these conditions as they do for other medical conditions.
“With primary care settings often being the first point of contact for the patient with a mental health disorder, it is imperative that patients who develop the courage to seek assistance for mental health issues are met by a caring, knowledgeable NP who is free from bias and stigmatizing attitudes,” concluded the authors. “With the current national focus on reducing opioid use, this is particularly relevant for the provision of compassionate, high-quality care to individuals with SUDs.”
Young CC, Calloway SJ. Assessing mental health stigma: Nurse practitioners’ attitudes regarding managing patients with mental health disorders [published online March 16, 2020]. J Am Assoc Nurse Pract. doi: 10.1097/JXX.0000000000000351