This is the first study to analyze psychiatrists’ stigma toward schizophrenia utilizing the LPA technique. To our knowledge, this is also the first time a large sample of mental health professionals has been assessed regarding this issue in such an under-researched area, a Latin American country. We were able to identify three distinct stigma profiles within the group of Brazilian psychiatrist studied.
The “no stigma” profile was the smallest group. The “no stigma” psychiatrists positively stereotyped individuals with schizophrenia, showed the highest disagreement with restrictions, and had the best impression on society’s stigma toward schizophrenia. The “unobtrusive stigma” psychiatrists were significantly younger; they matched individuals with schizophrenia and the general population regarding stereotypes. Although they displayed the lowest level of social distance, they mostly agreed with involuntary admission, showing also the highest perceived prejudice. The majority of psychiatrists in our sample were categorized as belonging to the “great stigma” profile. They negatively stereotyped individuals with schizophrenia, they mostly agreed with restrictions, and they demonstrated the highest level of social distance. They were significantly overrepresented by individuals between 31 and 40 years of age and were significantly less likely to have had only rare contact with a family member with a psychiatric disorder.
Although most of the data in the literature shows that mental health professionals might stigmatize their patients, there have been some reports to the contrary . We argue that an important factor to be put into perspective regarding this issue is the heterogeneity of the professional class, especially of psychiatrists . Previous studies of the same class have demonstrated that, in general, psychiatrists hold stigmatizing beliefs about individuals with schizophrenia . However, further investigation revealed distinct patterns of the psychiatrists’ stigma; not all of them showed negative beliefs, with nearly one quarter of the sample indicating innocuous opinions. Compared with those of the other profiles, the “no stigma” individuals were significantly older; this might illustrate the hypothesis that contact with individuals with mental disorder, here derived from a longer professional experience, diminishes stigma . Lewis et al.  also found that older psychiatrists predicted less violence and a better outcome for someone with psychosis than did their younger colleagues. It might be also possible that this could represent the different settings in which these psychiatrists were trained [35, 36]. Younger psychiatrists have had greater access to the biological basis of mental disorders, a type of knowledge that usually increases the risk of nurturing stigma [37–40].
The “unobtrusive stigma” group comprised individuals with uncertain opinions. Based on the low level of social distance and on the neutral stereotypes attribution, one hypothesis would be that the psychiatrists in this profile truly believe that individuals with schizophrenia are like anyone else. High perceived prejudice would thus represent their genuine impression of society’s stigma. Nevertheless, these answers could also have been influenced by the “social desirability” response bias . Given that “perceived prejudice” is a way of indirect questioning , its high scores could also be an indicator of psychiatrists’ own prejudiced attitudes [4, 28]. Griffiths et al.  also observed that perceived stigma was higher than was personal stigma, hypothesizing that social desirability makes respondents score low on questionnaires directly addressing their own opinions, while causing them to project their personal stigmatizing beliefs onto others through high perceived prejudice. Considering this interpretation, neutral answers on stereotypes would represent a “central tendency bias” , a behaviour often observed while assessing polemic issues [45, 46]. The fact that agreement with involuntary admission was highest for the “unobtrusive stigma” profile raises further suspicion of disguised stigmatizing beliefs on the part of the respondents. Consequently, the overrepresentation of younger individuals in this profile allows us to speculate that either inexperienced psychiatrists truly show less stigma while overestimating society’s stigma or less professional experience increases the willingness to give politically correct answers, the professionals being more concerned with the potential of rejection due to their negative views.
The majority of psychiatrists in our sample were categorized as fitting the “great stigma” profile. They were the ones who showed the worst stigmatizing beliefs in all dimensions, except for perceived prejudice. This is in agreement with previous findings that mental health professionals are often rated as a stigmatizing group by people who seek mental health services . In this profile, there was a significant predominance of individuals 31–40 years of age, a stratum representing psychiatrists that have finished their training an average of 5–10 years prior and are beginning their professional career. We can hypothesise that, compared with older psychiatrists, these subjects lack the contact occasioned by professional experience that could diminish stigma . Conversely, it is possible that they show more stigma than their younger colleagues because they were trained in a decade in which awareness of the stigma issue was not widespread . Data in the literature show that the great majority of stigma studies and anti-stigma campaigns were initiated in the mid-1990s, publications emerging from 2000 onward . One interesting finding was that individuals who were rarely in contact with a family member presenting a psychiatric disorder were significantly underrepresented in this profile. In general, such contact is beneficial against stigma, possibly explaining why people with no such contact show stigma . This might be true as long as contact does not exceed a certain degree; frequent contact was also associated with this high stigma profile. Previous findings report that stigma and desire for social distance increases as situations imply greater social closeness [4, 49, 50]; it turns out that only those with a certain level of contact, i.e. those with rare contact, were protected against membership in the “great stigma” profile.
This study has certain limitations, including the fact that the sample is not necessarily representative of the population of Brazilian psychiatrists. There could be a selection bias relative to those attending the congress. However, because psychiatrists are usually unavailable to surveys in Brazil , interviewing them at the national congress was the best way to gather a large nationwide sample. Nevertheless, as previously mentioned, attrition prior to and during the interview was quite high (37.5%). In addition to underscoring psychiatrists’ low commitment to surveys, this could also represent some resistance to revealing possible personal stigmatizing beliefs. In view of this likely bias, our results should be interpreted with caution. Furthermore, conducting face-to-face interviews could be perceived as less anonymous, thereby leading to a greater response bias toward social desirability. This could hypothetically shift psychiatrist’s scores toward more innocuous opinions and obfuscate true stigmatizing beliefs. Although this was conjectured for the “unobtrusive stigma” profile, the effect might also be present in the other profiles.