Social stigma among health-care providers toward patients with schizophrenia and obsessive-compulsive disorders at tertiary hospital in Makkah, Saudi Arabia
Authors: Saad Sami , Bshawri Jolan Ayman , Alsaedi Sara Mohammed , Radi Rahaf Emad , Ghonim Raneem Marwan , Nasraldain Haya Mohammed , Gadeer Abdullah Abdulqadeer 
Published: March 2022

Purpose
Several previous studies showed strong social stigma toward mental illness patients from the health-care providers (HCPs) in Saudi Arabia. This stigma affects the level of care provided by HCPs. Stigma is a major barrier in treating schizophrenia and obsessive-compulsive disorder (OCD) patients. Thus, it is important to clarify the difference regarding the social stigma between both diagnoses. This study aimed to identify and compare the existence of social stigma among HCPs towards schizophrenia patients compared to OCD patients.

Design/methodology/approach
A total of 283 HCPs from King Abdullah Medical City (KAMC), Makkah, Saudi Arabia, were enrolled in this cross-sectional questionnaire-based study between middle and end of January 2021. The scale included a demographic questionnaire plus two vignette cases reflecting OCD and schizophrenia patients’ symptoms without mentioning diagnosis. Each case was followed with 18 questions, which measured some of the thoughts and attitudes of the social stigma of mental illnesses including negative stereotypes, discrimination, social distancing and emotional and cognitive prejudices against mental illness patients. The scale was validated by a pilot study (which included 15 other participants) with acceptable validity and reliability (Cronbach’s alpha: 81.4%).

Findings
Most participants’ responses were “low” in the total score of their stigma score for both diagnosis [OCD (84.1%), mean ± SD (1.15  ±  0.366) and schizophrenia (74.2%), mean ± SD (1.25  ±  0.438)]. However, those who responded “high” in their stigma score regarding the schizophrenia section were higher in their number than those who responded “high” in the OCD section (25.8% vs 15.9%). Most participants had “low” total stigma scores for both diagnoses [OCD (84.1%), mean ± SD (1.15  ±  0.366) and schizophrenia (74.2%), mean ± SD (1.25  ±  0.438)]. However, of those with “high” stigma score responses, more were for the schizophrenia section compared to the OCD section (25.8% vs 15.9%). Being flexible to recruit any of them was more related to promoting them if they deserve promotion. The sample that answered wrong regarding OCD vignette diagnosis and had “high” stigma score was higher (n = 40) than the sample that answered correctly and had “high” stigma score (n = 5). In contrast, the sample that answered wrong regarding the schizophrenia case diagnosis and had “high” stigma score (n = 41) was not significantly different in terms of its number compared to the one that answered correctly and had “high” stigma score (n = 32).

Research limitations/implications
One aspect that reduces the strength of this study is that the target number of the participants could not be reached, meaning a 95% confidence level with a ±5% margin of error could not be reached. Another limitation is the lack of contact between HCPs at the KAMC in Makkah with mental illness patients owing to lack of psychiatric inpatient departments. However, this limitation may be a strength for this study, as we were able to primarily measure medical HCPs rather than psychiatric HCPs. Although the vignette methodology in stigma studies has many benefits, the participants do not respond to real patients, and therefore miss appearance and other nonverbal cues that are typically present in real interactions.

Originality/value
The social stigma level among HCPs against schizophrenia patients is higher than that against OCD patients. The factor of knowing the diagnosis of the case has a positive effect on decreasing stigma toward OCD patients but not toward schizophrenia patients. Educational awareness about stigma against mental illness patients to HCPs, rather than focusing on increasing literature knowledge, may decrease stigma among HCPs.