Stigma and barriers to seeking mental health care among emergency department providers – A mixed methods study

TL;DR

Emergency department providers face significant mental health challenges but avoid seeking care due to stigma and other barriers, which can harm their well-being and performance.

Contribution

This study identifies specific barriers and self-stigma affecting mental health care-seeking behaviors among ED clinicians using mixed methods.

Findings

25.59% of ED providers scored in the moderate to severe depression range.

Self-stigma was higher among male providers compared to female providers.

Common barriers included lack of time, privacy concerns, and worries about professional repercussions.

Abstract

High levels of psychological distress and depression are common among clinicians working in US emergency departments [ED], yet treatment-seeking remains rare, contributing to burnout and negative well-being. Reluctance to seek care often reflects concerns about negative consequences (e.g., stigma, negative professional impact). We sought to characterize the availability of mental health resource availability, beliefs about seeking care, and barriers faced by emergency department healthcare providers. A sequential mixed-method design was employed. Phase 1 included a survey of ED physicians, advanced practice providers (APPs; i.e., nurse practitioners and physician assistants) and medical residents at an academic medical center. The survey assessed demographics, perceptions of support across occupational levels (e.g., institutional, unit/ department, direct supervisor, and peers), and workplace stressors. Phase 2 comprised qualitative interviews to explore survey findings in depth. The survey respondent sample (n = 43; 39% of all ED staff) included 20 physicians, 10 APPs, and 13 residents. Overall, 25.59% scored in the moderate to severe depression range on the PHQ-9. Self-stigma was moderate and significantly higher among males (M = 2.81, SD = 0.54) when compared to female (M = 2.19, SD = 0.52) providers. Common barriers to seeking care included lack of time (72%), privacy concerns (49%), worry about negative impact on licensing (37%), and expectation that treatment would not help (37%). Interviews (n = 16; 88% had completed the survey) reinforced these findings, identifying three commonly endorsed beliefs about 1) the need for occupationally tailored mental health resources, 2) the continued presence and perpetuation of mental health stigma, and 3) barriers to seeking mental health services. In addition to time constraints, many clinicians reported self-stigmatizing beliefs and/or worries about professional repercussions for seeking care for mental health issues. These data underscore pervasive impediments to seeking help in ED, which may negatively influence clinician well-being and performance over time.

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