# Stigma Among Nurses Toward Individuals with Mental Health Conditions: An Integrative Review of Qualitative and Quantitative Studies

## TL;DR

This review finds that nurses in mental health settings have lower stigma toward individuals with mental health conditions, but stigma remains common and is linked to lack of training and contact.

## Contribution

This is the first integrative review to comprehensively analyze nurses' stigma toward individuals with mental health conditions using both qualitative and quantitative studies.

## Key findings

- Stigma among nurses is lower in mental health specialists compared to other clinical areas.
- Insufficient training and limited contact with individuals with mental health conditions are associated with higher stigma.
- Associative stigma is a recurring theme affecting psychiatric nursing identity and development.

## Abstract

Background: Individuals with mental health conditions frequently experience stigmatization and discrimination. Among the primary objectives in the fight against stigma is to examine groups that play a crucial role in addressing it, such as healthcare professionals. Although research has examined stigma among healthcare professionals, few studies have specifically addressed how nurses perceive and contribute to the stigmatization of individuals with mental health conditions. Objective: The aim of this review was to compile and compare the scientific literature addressing nurses’ stigma toward individuals with mental health conditions. Methods: Following the methodological guidelines of the Joanna Briggs Institute and in accordance with the PRISMA 2020 guidelines, an integrative review was conducted of MEDLINE (PubMed), EMBASE, APA PsycInfo (EBSCO), and CINAHL Complete (EBSCO). Database-specific indexing terms were combined with the Boolean operators AND/OR. Studies with quantitative or qualitative methodologies, published in Spanish or English and without restrictions by year of publication, were included. Two independent reviewers selected the studies and performed the critical appraisal. Results: The search retrieved 4256 records, of which 32 articles were finally included. A content analysis of the selected studies was conducted. Most studies used validated questionnaires to assess stigma and its associations with various variables, while only a limited number employed qualitative designs. Across the 32 studies (n = 6283 nurses from 29 countries), stigma was observed across settings but tended to be lower among mental health specialists. Insufficient training and limited contact were consistently associated with higher levels of stigma, whereas specialization and positive contact were linked to lower levels. Associative stigma emerged as a recurrent theme with implications for psychiatric nursing identity. Conclusions: Nurses working in mental health settings generally demonstrate more positive attitudes toward individuals with mental health conditions compared with those in other clinical areas; however, stigma persists across all settings. Associative stigma may be influencing the development and advancement of psychiatric nursing. Specific academic training, capacity building, and specialization in mental health are essential to counteract stigma. Further qualitative research is required to achieve a deeper understanding of this phenomenon.