Examining the Role of Perceptions in the Appraisal of Mental Health, Self-Stigma, Resource Availability, and Work Environment Among Healthcare Providers at Different Career Stages in the Emergency Department
Open Access
- Author:
- Harris, Charlotte
- Area of Honors:
- Biobehavioral Health
- Degree:
- Bachelor of Science
- Document Type:
- Thesis
- Thesis Supervisors:
- Thomas J Gould, Thesis Supervisor
Helen Marie Kamens, Thesis Honors Advisor
Joshua Morrison Smyth, Thesis Supervisor - Keywords:
- Mental health
Stigma
Emergency Department
Healthcare Provider
Physician
Mixed-methods
Resource Availability - Abstract:
- Background: Psychological distress among emergency department (ED) providers is a pervasive concern within healthcare, yet very few seek care. This phenomenon is multi-faceted and often attributed to fear, lack of time, inadequate resource availability, and mental health care-seeking stigma. Resource availability, legislation, and recommendations from governing bodies surrounding educational requirements have evolved significantly in recent decades, effectively changing learning environments and customs across providers at different career stages, however, there is still an ongoing need to address concerns. Among a cohort of ED providers at varied career stages, this thesis examined their perceptions of resource availability throughout training, stigma, and the status of mental health in the ED in hopes of understanding how individual experiences shape perceptions. Methods: A two-wave, sequential mixed-methods study was conducted to examine physicians, advanced practice providers (APPs; i.e., nurse practitioners and physician assistants), and resident physicians working in the ED at an academic medical center in the northeastern U.S. The wave 1 survey assessed demographic information in addition to resource availability during training, institutional monitoring, and institutional regulations. Wave 2 qualitative interviews were conducted following the completion of the quantitative survey. Thematic analysis was used to analyze qualitative data. Results: The wave 1 respondent sample included 20 physicians, 10 APPs, and 13 residents (an overall survey response rate of 39% of all ED clinical staff). There were 13 in-training providers, 21 early/mid-career providers, and 9 senior-career providers included in the quantitative sample. From the survey, more than two-thirds of in-training and early/mid-career providers perceived to have access to wellness programming, mental health counselors, crisis resources, and peer support throughout education and training, whereas less than 25% of senior-career providers reported having the same resources. The results from the survey helped in the development of the interview guide and shaped the qualitative assessment. The interview sample included 6 physicians, 8 APPs, and 2 residents (75% of whom had completed the initial survey). 4 participants were designated as in-training, 6 as early/mid-career, and 6 as senior-career. Thematic analysis identified three main themes: (1) perceptions of mental health care and resource accessibility across training, (2) perceived cultural and self-stigma, and (3) a negative ED culture. Conclusion: Findings highlight a significant disconnect in reported resource availability and stigma across stages of professional development. This disconnect may, in part, emphasize the significance of providers' perceptions and clarify how they impact provider mental health and well-being. Future research should examine the evolution of social, occupational, mental, and physiological influences and the impact on provider perceptions, to better understand the mental health crisis in medicine.