The impact of educational interventions on modifying health practitioners' attitudes and practice in treating people with borderline personality disorder: an integrative review

[Development of a self-report questionnaire for the measurement of stigmatizing attitudes of the psychiatric staff towards patients with borderline personality disorder]

OBJECTIVE

The development of a self-report questionnaire for quantitative measurement of stigmatizing attitudes of the psychiatric staff towards patients with borderline personality disorder.

METHOD

Online survey with psychiatrists, psychologists and nursing staff (n=94) in the (semi-)stationary psychiatric sector with translated items of an attitude questionnaire, followed by a principal component analysis and correlations between principal components and social distance.

RESULTS

Analyses revealed a 4-principal component structure (BPD-treatment difficulties, BPD-assessment of suicide risk, BPD-assumption of manipulative tendencies, BPD-negative emotions) with 63,60% explained variance and small to large correlations between principal components and social distance.

CONCLUSION

Results initially indicate possible validity and reliability of the developed questionnaire. Further analyses with larger sample size and confirmatory factor analysis for continued development are advised.

Mental Health Workers' Knowledge and Attitude Towards Borderline Personality Disorder: A Saudi Multicenter Study

Background Borderline personality disorder (BPD) is a mental illness characterized by emotional instability. Its prevalence can be as high as 1.8% among the general population. Poor knowledge and negative perceptions of the disorder by mental health workers (MHWs) can affect patients' care and their help-seeking behavior. This study aims to explore MHW's knowledge and attitudes toward BPD. Method A cross-sectional study was conducted on MHWs across the five regions of Saudi Arabia (SA) using a questionnaire that assessed knowledge, attitude, and training regarding BPD. Results  Data collected from 1028 MHWs showed a good knowledge level. Superior knowledge was observed among females, residents in the central region, physicians, those who received specific BPD training, and MHWs who had more experience and frequent interactions with BPD patients. Participants had moderate to high levels of perceived knowledge and confidence regarding the identification, assessment, and management of BPD patients. Undergraduate training programs were the most reported source of information on the disorder. While 66% of participants admitted that they find dealing with BPD patients more difficult and thought patient management was inadequate, 71% were willing to attend further BPD training. Conclusion MHWs in SA have moderate knowledge of but negative perceptions of BPD; specific training is needed to improve the care provided for BPD patients.

Structural stigma and its impact on healthcare for borderline personality disorder: a scoping review

BACKGROUND

People with Borderline Personality Disorder (BPD) and their carers/families continue to experience structural stigma when accessing health services. Structural stigma involves societal-level conditions, cultural norms, and organizational policies that inhibit the opportunities, resources, and wellbeing of people living with attributes that are the object of stigma. BPD is a serious mental illness characterized by pervasive psychosocial dysfunction including, problems regulating emotions and suicidality. This scoping review aimed to identify, map, and explore the international literature on structural stigma associated with BPD and its impact on healthcare for consumers with BPD, their carers/families, and health practitioners.

METHODS

A comprehensive search of the literature encompassed MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI Evidence-Based databases (from inception to February 28th 2022). The search strategy also included grey literature searches and handsearching the references of included studies. Eligibility criteria included citations relevant to structural stigma associated with BPD and health and crisis care services. Quality appraisal of included citations were completed using the Mixed Methods Appraisal Tool 2018 version (MMAT v.18), the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Research Syntheses Tool, and the AGREE II: advancing guideline development, reporting, and evaluation in health care tool. Thematic Analysis was used to inform data extraction, analysis, interpretation, and synthesis of the data.

RESULTS

A total of 57 citations were included in the review comprising empirical peer-reviewed articles (n = 55), and reports (n = 2). Studies included quantitative, qualitative, mixed methods, and systematic review designs. Review findings identified several extant macro- and micro-level structural mechanisms, challenges, and barriers contributing to BPD-related stigma in health systems. These structural factors have a substantial impact on health service access and care for BPD. Key themes that emerged from the data comprised: structural stigma and the BPD diagnosis and BPD-related stigma surrounding health and crisis care services.

CONCLUSION

Narrative synthesis of the findings provide evidence about the impact of structural stigma on healthcare for BPD. It is anticipated that results of this review will inform future research, policy, and practice to address BPD-related stigma in health systems, as well as approaches for improving the delivery of responsive health services and care for consumers with BPD and their carers/families.

REVIEW REGISTRATION

Open Science Framework ( https://osf.io/bhpg4 ).