660994 research-article2016
ISP0010.1177/0020764016660994International Journal of Social PsychiatryDai et al.
E CAMDEN SCHIZOPH
Original Article
Low prevalence of the use of the Chinese term for ‘psychiatry’ in the names of community psychiatry clinics: A nationwide study in Taiwan
International Journal of Social Psychiatry 2016, Vol. 62(7) 601–607 © The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0020764016660994 isp.sagepub.com
Ying-Xiu Dai1, Mu-Hong Chen2 and Tzeng-Ji Chen1,3
Abstract Background: Relabeling has been proposed as a strategy to reduce the stigma associated with mental illnesses. Previous studies have shown that changing the names of psychiatry clinics has led to reduced feelings of being stigmatized among patients. In Taiwan, terms other than ‘psychiatry’ (in Chinese, jīng shén kē) are more commonly used in the names of psychiatry clinics. The term ‘psychosomatic clinics’ is widely used instead. Aims: This study investigated the characteristics of psychiatry clinic names in order to better understand the role of clinic names in primary care settings. Methods: Relevant data were extracted from an open database maintained by the government of Taiwan. These data included the names of community psychiatry clinics and hospital-based psychiatry clinics, population size and the degree of urbanization in the area served by each clinic. Results: At the time of this study, there were 254 community psychiatry clinics and 190 hospital-based psychiatry clinics in Taiwan. Only 18.9% of the community clinic names included the term ‘psychiatry’. Additionally, 14.6% of community clinic names and 28.4% of hospital-based clinic names included the term ‘psychosomatics’. The regions in which clinics without ‘psychiatry’ in their names were located had significantly larger populations and higher levels of urbanization than the regions in which clinics with ‘psychiatry’ in their names were located. Conclusion: A low prevalence of the term ‘psychiatry’ in community psychiatry clinic names was found in Taiwan. The stigma associated with psychiatry and other socio-cultural factors are hypothesized to explain this phenomenon. Keywords Psychiatry, mental health, stigma, clinics, name, Taiwan
Introduction Mental health is an integral part of health and well-being. The World Health Organization (WHO) defines mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to her or his community (WHO, 2014). Mental illnesses contribute a significant portion of the overall disease burden. In 2010, mental and substance use disorders accounted for 183.9 million disability-adjusted life years (DALYs), or 7.4% of all DALYs worldwide. Mental disorders also accounted for 8.6 million lives lost to premature mortality and 175.3 million years lived with disability (YLDs), with mental and substance use disorders being the leading cause of YLDs worldwide. Moreover, the burden of mental and substance use disorders increased by 37.6% between 1990 and 2010 (Baxter et al., 2013). However, there
are still a substantial proportion of people with mental disorders who do not receive any treatment (Kessler et al., 2005; Wang et al., 2007). Several factors have been found to act as barriers to seeking mental healthcare, including a lack of
1Department
of Family Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, R.O.C. 2Department of Psychiatry, Taipei Veterans General Hospital, Taipei City, Taiwan, R.O.C. 3School of Medicine, National Yang-Ming University, Taipei City, Taiwan, R.O.C. Corresponding author: Ying-Xiu Dai, Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei City 11217, Taiwan, R.O.C. Email:
[email protected]
Downloaded from isp.sagepub.com at Taipei Veterans General Hospital on October 25, 2016
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perceived need for treatment (Edlund, Unutzer, & Curran, 2006; Sareen et al., 2007), financial burdens (Mojtabai, 2005; Rowan, McAlpine, & Blewett, 2013) and stigma (Van Voorhees et al., 2006; Wrigley, Jackson, Judd, & Komiti, 2005). In the United States, financial barriers to mental health treatment have grown over the past decade (Mojtabai, 2005). Over the same period, however, public attitudes toward mental health service use have become more favorable (Mojtabai, 2007), including an increase in the proportion of the public that accepts a neurobiological understanding of mental illness. However, this understanding has been found to translate into support for mental health services but not into a reduction in the stigma associated with mental illnesses (Angermeyer, Matschinger, & Schomerus, 2013; Pescosolido et al., 2010). Erving Goffman (1963), a sociologist, defined stigma in terms of undesirable and deeply discrediting attributes that disqualify one from full social acceptance and motivate efforts by the stigmatized individual to hide the mark when possible. Link and Phelan (2001) proposed that stigma exists when elements of labeling, stereotyping, separating, status loss and discrimination co-occur in a power situation that allows these processes to unfold. Stigma and its effects are distinguished into two forms, public stigma and self-stigma. Public stigma is the reaction that the general population has to people with mental illness. Self-stigma is the prejudice which people with mental illnesses turn against themselves (Corrigan & Watson, 2002). Stigma and discrimination may occur at the level of the individual, in interpersonal interactions, in or toward various facilities and in the context of social structures (Stuart, 2008). For example, negative attitudes toward psychiatric facilities have been reported in previous studies (Kotin & Schur, 1969; Lipsitt, 1968). Furthermore, despite all the improvements that have been introduced to psychiatric facilities in recent decades, they are still labeled and stigmatized (Bil, 2016). Many strategies have been developed, however, to reduce stigma and discrimination against people with mental illness (Corrigan & Penn, 1999). Previous studies have shown, for example, that changing the names of psychiatry clinics led to reduced feelings of stigma and negative self-image in patients (Hirosawa, Shimada, Fumimoto, Eto, & Arai, 2002). Many people in Japan have a negative opinion toward the term Seishin-ka, which means ‘department of psychiatry’ in Japanese (Yamazaki, Horikawa, Ogawa, & Nagata, 1989). Relatedly, some psychiatric facilities in Japan avoid using the term Seishin, which means ‘psychiatry’ (Hirosawa, Shimada, & Arai, 2001). This finding suggested that the names of the psychiatric departments in general hospitals are important in terms of their effects on stigma and help-seeking behavior in patients. However, further studies on the role of the term ‘psychiatry’ in primary care settings have been limited. The Chinese term for ‘psychiatry’ is 精神科 (jīng shén kē), which means ‘the specialty of medicine that deals with disorders of the spirit’. According to the Enforcement Rules of the Medical Care Act, only board-certified
specialists are allowed to use the term ‘specialty’ in clinic names. Furthermore, only clinics managed by psychiatrists can use the term ‘psychiatry’ in the clinic’s name. However, terms other than ‘psychiatry’ are commonly used in the names of psychiatry clinics. The term ‘psychosomatic clinics’ is widely used instead. This study is the first to examine the naming patterns psychiatric clinics from a nationwide prospective. In this study, nationwide data on psychiatry clinics in Taiwan were collected and analyzed to examine (1) the pattern of the use of the term ‘psychiatry’ in the names of psychiatry clinics; (2) the associations, if any, between the names of psychiatry clinics, population size and the degree of urbanization in the area served by each clinic; and (3) the common themes for naming psychiatry clinics.
Method Study population The nationwide data were collected from an open database maintained by the government of Taiwan. These data included the names of both community and hospital-based psychiatry clinics, and the variables analyzed included the names of clinics, as well as data on the degree of urbanization and the population of the area served by each clinic. The degree of urbanization was defined using the categorizing methods of Liu et al. (2006), which divide the degree of urbanization into seven types, namely, highly urbanized towns, medium urbanized towns, emerging towns, general towns and cities, aging towns, agricultural towns and remote towns.
Statistical analysis The data were analyzed using the statistical software SPSS version 22.0 (manufactured by IBM). An independent t-test was conducted to analyze the variation in population between two groups (i.e. clinic names including ‘psychiatry’ vs clinic names not including ‘psychiatry’). A chi-square test of independence was performed to assess the relationship between the degree of urbanization and the use of ‘psychiatry’. Considering the small numbers of clinics in aging towns, agricultural towns, remote towns and outlying islands (as shown in Table 1), clinics in those areas were pooled into general towns and cities for further analysis. A p value
