A cross cultural comparison of general hospital specialists’ attitudes toward management of psychological/psychiatric problems

Abstract

Aim and hypothesis We aim to identify attitudinal differences toward psychiatry among general hospital specialists in relation to practice setting, gender, age, seniority, and specialty. We hypothesise that cultural factors may underlie observed group differences. Background Psychiatric comorbidities are common in physical illness and significantly affect health outcomes. Non-psychiatric specialist attitudes toward consultation-liaison psychiatry (CLP) services in general hospitals are important as they influence referral patterns and thus quality of care. Culture is likely to play a role, but comparisons across culturally diverse practice settings are needed. Methods A cross-sectional study was conducted in New Zealand, China, Sri Lanka, Russia, Israel, Brazil and Netherlands. A target sample size of 100 per country (total 700) was established. Data were collected by anonymous, self-administered questionnaires to senior medical staff of various disciplines working in general hospital settings. The data collection tool was adapted from a previously validated questionnaire, the Doctors’ Attitudes Toward Collaborative Care for Mental Health (DACC-MH) Scale (Thombs BD, et al. Can J Psychiatry 2010; 55:264-267). Results Demographic information • A total of 889 specialists participated from the 7 countries. • Gender distribution – 46% male, 37% female, 7% unknown. • Age distribution – Majority were between 40-49yrs in NZ, Sri Lanka and Brazil; 30-39yrs in Russia and Netherlands; <30yrs in China and 50-59yrs in Israel. • Seniority – Majority had 10+yrs of specialist experience in all the countries except for Sri Lanka, China and Russia. • Significant differences were observed among various subgroups. For example, in the Chinese sample (n=110) female doctors were more likely than males to express concern about emotional care and psychological assessment of patients; surgeons were more likely than others to confine themselves to physical assessment. In Sri Lanka (n=95), more surgeons (90%) than physicians (44%) would seek psychiatric input in managing delirium. Conclusions Results generally indicate positive attitudes toward psychiatry among hospital specialists. However differences were apparent between practice settings and countries, suggesting the importance of cultural influences. Significant subgroup differences are also observed in relation to gender and specialty. These findings lay a foundation for future studies to explore these associations further and thereby help to formulate an agenda to address unmet psychological/psychiatric need in general hospitals.