How is “stigma” conceived within the biomedical literature on trainee wellness? A directed content analysis

This article was migrated. The article was marked as recommended. Introduction: Institutional discrimination against trainees with suspected mental disorders has rarely been the focus of medical education research. This study explored whether such neglect might be related to the way in which stigma is conceived by academic medical researchers, and was informed by previous scholarship describing the disability models and stigma agendas believed to predominate within the medical field. The aim was to examine whether researchers might be focusing solely on the ways in which stigma prevents trainees from seeking mental health treatment, while neglecting to address mental health discrimination, as predicted by these scholars' descriptions. Methods: The authors searched PubMed and Medline for articles using combined terms wellness or wellbeing; medical student or resident or physician; and stigma and mental, published between September 12, 2011 and September 12, 2016. Directed content analysis of articles with a primary focus on mental health wellness provided counts of the words discrimination and treatment and evaluated authors' recommendations to either reduce discrimination or increase identification and mental health treatment. Results: Of the 25 articles meeting inclusion criteria, 23 used the word treatment (median = 7), while only 7 mentioned discrimination (median = 0). The authors of at least 20 articles recommended identification and treatment, but none provided any recommendations to reduce institutional discrimination. Three surveys also identified concerns about mental health discrimination that were not taken seriously by the authors of these studies. Conclusions: Current trainee wellness research appears to have largely ignored mental health discrimination as a negative influence. Such findings appear consistent with prior descriptions of a medical model of disability/services agenda to reducing stigma that has been criticized by proponents of a social model/rights agenda. Wellness researchers should take steps to reduce mental health discrimination against trainees and consider limitations of current conceptions of stigma within the medical field.