Self-stigma of seeking professional psychological help and its influencing factors among high-risk health care workers for depression and anxiety: a multicenter cross-sectional study | BMC Psychiatry

The level of self-stigma of seeking professional psychological help among Chinese HCWs at high risk of depression and anxiety is moderate

The results of this study reveal that the median score for self-stigma of seeking help among these Chinese HCWs is 30.0 (26.0, 30.0). The median score of 30.0 lies within the middle range of the possible scores (10–50), indicating a moderate level of self-stigma in seeking professional psychological help. Furthermore, the interquartile range of 26.0 to 30.0 shows that 50% of HCWs fall within this range, suggesting that self-stigma in seeking professional psychological help is relatively common among Chinese HCWs at high risk of depression and anxiety. This score reflects a complex and paradoxical attitude observed in some HCWs: they may recognize the importance of mental health and the necessity for professional help, yet sociocultural influences, professional identity, or personal beliefs often lead to negative perceptions or apprehensions about seeking such assistance. The results of this study are similar to those of several other studies [27, 29]. In a study comparing the level of self-stigma of seeking professional psychological help between military doctors and other military personnel, Jones et al. [29] found that self-stigma of seeking professional psychological was more prevalent among doctors. Another study [27] indicated that veterinary students at a university in Australia had significantly higher levels of self-stigma of seeking professional psychological help than non-veterinary students. This manifestation may stem from relevant cultural factors. On the one hand, in Chinese sociocultural contexts, seeking psychological help from professionals is often stigmatized by the public as a sign of mental illness [39]. When individuals internalize these stigmatizing views, they tend to develop self-stigmatizing attitudes toward seeking such help, which subsequently leads to behavioral inhibition [12]. Moreover, qualitative studies on the stigma of seeking professional psychological help have shown that the Chinese cultural notion of endurance tends to regard help-seeking behavior as a sign of incompetence, vulnerability, and inadequacy. Influenced by the concept of face, individuals are often reluctant to disclose their weaknesses to strangers, perceiving it as a behavior that undermines their self-esteem and confidence. This perception is internalized as part of the help-seeker’s self-stigma [39]. On the other hand, in Chinese professional culture, healthcare workers are often socially constructed as”angels in white,”an idealized identity that reflects society’s high expectations for the medical profession to save lives and show compassion [40]. However, this role positioning also implies a conflict between the professional image and the personal mental health needs of healthcare workers. This professional identity leads doctors to worry that seeking professional psychological help may be labeled as”unprofessional”or”incompetent,”and that they may be perceived as unable to meet the demands of their job. Consequently, they may equate help-seeking behavior with professional failure, leading to self-stigma and avoidance of psychological interventions [39]. Thus, it is essential to address these influencing factors identified in this study and implement relevant interventions to reduce the self-stigma of seeking professional psychological help among HCWs.

Self-stigma of seeking professional psychological help among Chinese HCWs at high risk of depression and anxiety is influenced by various factors

Sleeping time

Short sleep duration is a prominent issue in the health status of HCWs. This study shows that 39.3% of HCWs sleep less than 6 h per day. HCWs with less than 6 h of sleep who are at high risk of depression and anxiety had a self-stigma score 3.215 units higher than the reference group (B = 3.215, p = 0.006). This indicates a significant link between short sleep duration and self-stigma in seeking psychological help. Consistent with the findings of Birtel et al. [22, 54], poor sleep quality is negatively correlated with self-stigma, with less sleep associated with more severe self-stigma. The possible reasons include individuals with short sleep duration often experiencing anxiety [55] and depressive symptoms [56], leading them to be more introverted, negative, and avoidant in social interactions, making it difficult for them to seek psychological help from others [37, 38]. Additionally, individuals with depression symptoms are more sensitive and tend to amplify negative perceptions and evaluations of seeking professional psychological help from others or society, thereby exacerbating the internalization of stigma [18, 34]. Furthermore, studies have indicated that short sleep duration is associated with reduced self-efficacy among individuals, reflecting their diminished confidence in completing tasks and overcoming challenges [57]. Individuals with lower self-efficacy are more prone to internalizing negative labels in the context of social stigma [58]. This increased susceptibility can be attributed to the fact that low self-efficacy compromises psychological resilience, making it more challenging for individuals to maintain confidence and a sense of control when facing negative evaluations from others. Consequently, short sleep duration indirectly heightens individuals’sensitivity to and internalization of stigma by diminishing their self-efficacy [58]. Therefore, at the hospital level, leaders in relevant departments should pay close attention to the sleep problems of clinical HCWs, strengthen the reserves of frontline personnel, arrange shifts reasonably, ensure adequate sleep time for HCWs working night shifts, provide necessary medical and psychological counseling services to HCWs, and focus on their physical and mental health to alleviate their psychological stress, anxiety, depression, and other negative emotions. At the individual level, HCWs should improve their professional skills, correctly face clinical work pressure and challenges, not neglect their mental health, enhance awareness of actively seeking help and support, and actively seek assistance from professional psychologists.

Level of social support

The results of this study show that the higher the social support level among HCWs, the lower their level of self-stigma in seeking professional psychological help (P < 0.001), consistent with the findings of Karaçar Y et al. [23, 31]. When individuals experience negative emotions, family, friends, or other social networks become their main avenues for seeking help and support [59]. Social support, which encompasses both instrumental and emotional support, provides individuals with guidance and practical assistance, such as sharing valuable information, positive knowledge, and effective coping skills; while also offering emotional encouragement by enhancing feelings of being loved, cared for, respected, and connected to a supportive network [23, 60]. It helps individuals reduce self-stigma associated with seeking psychological help through various pathways and mechanisms, including enhancing individual self-efficacy, improving sleep quality, reducing negative emotions, diminishing the internalization of public stereotypes and discrimination, and promoting social integration [22, 23, 54, 60, 61]. For example, empirical studies have shown that social support not only enhances individuals’self-efficacy and sleep quality but also mediates the relationship between variables such as sleep quality and self-stigma, thereby indirectly reducing self-stigma [22, 54, 61]. Individuals who interact with these social networks exhibit lower levels of self-stigma and are more willing to consider treatment [62, 63]. There have been relevant studies reporting that social support interventions have shown good application effects in reducing self-stigma among women who have experienced domestic violence [64]and patients with hepatitis B [65]. Therefore, it is necessary to further strengthen social support for HCWs and implement intervention measures that are based on social contact to reduce their self-stigma and facilitate their seeking of professional psychological help.

Levels of depression symptoms and anxiety symptoms

The results of the multifactorial analysis in this study show that depression symptoms and anxiety symptoms are positively correlated with self-stigma of seeking professional psychological help, with higher levels of depression symptoms and anxiety symptoms among HCWs associated with more severe self-stigma of seeking professional psychological help (P < 0.05). This is consistent with the findings of Pellet J et al. [24, 28]. Individuals with anxiety symptoms and depression symptoms are more sensitive to topics related to anxiety symptoms or depressive symptoms and tend to amplify negative attitudes and evaluations from others or society. This perception can contribute to self-stigma [34]. Therefore, when considering whether to seek professional psychological assistance, negative stereotypes have a more significant impact on them, potentially leading them to feel discriminated against. Furthermore, individuals with anxiety or depression symptoms are more likely to show inhibited behavior [66], be more introverted, pessimistic, and more likely to avoid situations, and less likely to maintain social interaction [38], resulting in less social support for them. Feelings of self-shame can further exacerbate individual levels of depression. Therefore, paying attention to the mental health status of HCWs and identifying high-risk individuals early is crucial for promoting their seeking of professional psychological assistance.

Strengths and limitations

To the best of our knowledge, this study is the first to investigate self-stigma of seeking professional psychological help, as well as associated factors, among a large sample of Chinese HCWs across multiple centers. The results of this study could guide mental health providers in developing targeted interventions aimed at reducing self-stigma and promoting help-seeking behaviors among HCWs at high risk of depression and anxiety, ultimately enhancing their mental well-being.

This study has several limitations. Firstly, it uses a cross-sectional design, limiting the ability to establish causal relationships between self-stigma of seeking professional psychological help and its influencing factors. Secondly, in our study, the sample was predominantly composed of nurses (87.3% of the total) and female HCWs, which resulted in an underrepresentation of doctors, other healthcare professionals, and male participants. This bias may be attributed to the methods used for questionnaire distribution. Specifically, because the questionnaires were primarily distributed through nursing managers, the majority of the responses were from female nurses, which likely contributed to the insufficient participation from doctors and male HCWs. The underrepresentation of male participants and doctors in our study may limit the generalizability of our findings to these groups. Future research should develop more comprehensive recruitment strategies and strive to recruit a more diverse sample to ensure that the experiences and perspectives of all healthcare professionals, including male participants and doctors, are adequately represented. Thirdly, the lack of data on the distribution of hospital types and grades in this study limits our ability to generalize the findings to different healthcare settings. Future research should consider collecting such data to provide a more comprehensive understanding of the factors influencing self-stigma of seeking professional psychological help among healthcare workers. Fourthly, the limitations of this study include the challenges in using the PHQ-9 and GAD-7 alone to fully differentiate between work-related stress and clinical symptoms. Future research should consider additional tools or questions to better address this distinction.