Implicit and Explicit Stigma of Mental Illness: Links to Clinical Care
Abstract
This study examined implicit and explicit measures of bias toward mental illness among people with different levels of mental health training, and investigated the influence of stigma on clinically-relevant decision-making. Participants (N = 1539) comprised of (1) mental health professionals and clinical graduate students, (2) other health care/social services specialists, (3) undergraduate students, and (4) the general public self-reported their attitudes toward people with mental illness, and completed implicit measures to assess mental illness evaluations that exist outside of awareness or control. In addition, participants predicted patient prognoses and assigned diagnoses after clinical vignettes. Compared with people without mental health training, individuals with mental health training demonstrated more positive implicit and explicit evaluations of people with mental illness. Further, explicit (but not implicit) biases predicted more negative patient prognoses, but implicit (and not explicit) biases predicted over-diagnosis, underscoring the value of using both implicit and explicit measures.
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Peris 2008 found those with mental health training displayed less implicit and explicit prejudices.
“Those with mental health training displayed less implicit and explicit prejudices.”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [42]
Peris 2008 found implicit (and not explicit) biases predicted over-diagnosis.
“Their explicit (but not implicit) biases predicted more negative patient prognoses, but implicit (and not explicit) biases predicted over-diagnosis.”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [42]
Peris 2008 found explicit (but not implicit) biases predicted more negative patient prognoses.
“Their explicit (but not implicit) biases predicted more negative patient prognoses, but implicit (and not explicit) biases predicted over-diagnosis.”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [42]
Peris 2008 found overall, explicit and implicit views were not negative towards individuals with mental illness.
“Overall, explicit and implicit views were not negative towards individuals with mental illness.”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [42]
Four studies included participants who were not trained physicians or nurses and failed to report separate results for these categories of participants.
“Four studies included participants who were not trained physicians or nurses and failed to report separate results for these categories of participants [42, 44, 49, 50].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [42]
Of the seven studies that did not find evidence of bias, one compared the mentally ill with welfare recipients and found a positive correlation between levels of implicit bias and over-diagnosis of the mentally ill patient in the vignette.
“Of the seven studies that did not find evidence of bias, one compared the mentally ill with another potentially unfavourable category, welfare recipients; this study did find a positive correlation between levels of implicit bias and over-diagnosis of the mentally ill patient in the vignette [42].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [42]
Four studies examining the correlation between IAT scores and responses to clinical vignettes found a significant correlation between high levels of pro-white implicit bias and treatment responses that favoured patients specified as white.
“Four studies examining the correlation between IAT scores and responses to clinical vignettes found a significant correlation between high levels of pro-white implicit bias and treatment responses that favoured patients specified as white [42, 45–47].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [42]
Individuals with mental health training demonstrated more positive implicit and explicit evaluations of people with mental illness than those without training.
“individuals with mental health training demonstrated more positive implicit and explicit evaluations of people with mental illness than those without training [42].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [42]
In the same study, graduate students had more positive implicit attitudes towards the mentally ill than mental health professionals.
“Yet in the same study, graduate students had more positive implicit attitudes towards the mentally ill than mental health professionals.”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [42]
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References 46 · Cited by 169
- Authors
- Peris, T. S., Teachman, B. A., & Nosek, B. A.
- Affiliations
- University of California, Los Angeles (US)
- University of Virginia (US)
- Corresponding author
- Peris, Tara S.
- Venue
- Journal of Nervous & Mental Disease
- Published
- 2008-10
- Volume
- 196
- Issue
- 10
- Pages
- 752-760
- ISSN
- 0022-3018 (ISSN-L)
- OpenAlex
- W2082734370
- Cited by
- 169
- References
- 46
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 7 · 2023: 12 · 2022: 8 · 2021: 12 · 2020: 14 · 2019: 20 · 2018: 15 · 2017: 7 · 2016: 14 · 2015: 9 · 2014: 7 · 2013: 7 · 2012: 9
- FWCI
- 7.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (R03 PA03039)
- National Institute of Mental Health (T32 MH073517:01A1, R01MH068447, T32MH073517)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Sociology and Political Science › Social and Intergroup Psychology
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- mental health stigma, implicit bias, explicit bias, mental health training, attitudes toward people with mental illness, clinical decision-making, overdiagnosis, clinical vignettes, mental health professionals
- MeSH terms
- Adult, Attitude of Health Personnel, Mental Disorders, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Prejudice, Stereotyping
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