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Resilience and associative stigma among mental health professionals in a tertiary psychiatric hospital: a cross-sectional study in Singapore
  1. Sherilyn Chang,
  2. Louisa Picco,
  3. Edimansyah Abdin,
  4. Qi Yuan,
  5. Siow Ann Chong,
  6. Mythily Subramaniam
  1. Research Division, Institute of Mental Health, Singapore, Singapore
  1. Correspondence to Sherilyn Chang; sherilyn_sh_chang{at}


Objectives The mental health profession exposes healthcare workers to unique stressors such as associative stigma (stigmatisation that is extended from the stigmatised patients to psychiatric professionals and is based on affiliation with an individual with mental illness). Enhancing resilience, or the ability to ‘bounce back’ from adversity, is found to be useful in reducing occupational stress and its negative effects. In view of the high burnout rates reported among mental health professionals, this study aimed to examine resilience in this group of professionals and to explore the association between resilience and associative stigma.

Design Observational study—cross-sectional design.

Setting Tertiary psychiatry hospital in Singapore.

Participants The study was conducted among 470 mental health professionals (doctors, nurses and allied health professionals) working in the hospital.

Measures Resilience was assessed using the Brief Resilience Scale (BRS) and participants completed questionnaires that examined associative stigma. Participants provided their sociodemographic information, length of service, and information on whether they knew of a close friend or family member who had a mental illness.

Results Mean resilience score for the overall sample was 3.59 (SD=0.64). Older age (β=0.012, 95% CI 0.004 to 0.019, p=0.003) and having known a family member or close friend with a mental illness (β=0.155, 95% CI 0.019 to 0.290, p=0.025) predicted higher BRS score. Associative stigma remained significantly associated with resilience score after controlling for sociodemographic factors whereby higher associative stigma predicted lower resilience scores.

Conclusion The present finding suggests that resilience building programmes among mental health workers should target those of the younger age group, and that addressing the issue of associative stigma is essential.

  • resilience
  • associative stigma
  • mental health
  • Brief Resilience Scale

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  • Contributors SC interpreted the findings, wrote the draft manuscript and critically revised the article. LP conceived the study, wrote the protocol and provided inputs for the manuscript. EA performed the statistical analysis and assisted in the interpretation of the findings. QY and SAC critically reviewed the article and provided their inputs. MS reviewed the study protocol and critically reviewed the article. All authors have read and approved the final manuscript.

  • Funding This research is supported by the Singapore Ministry of Health’s National Medical Research Council under the Centre Grant Programme (Grant No: NMRC/CG/004/2013).

  • Competing interests None declared.

  • Patient and public involvement statement There was no patient or public involvement in the study design; however, staff at IMH will be informed of the study findings.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the Domain Specific Review Board of the National Healthcare Group, Singapore (DSRB No: 2016/00043).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are not available for online access, however, readers who wish to gain access to the data can write to the senior author MS at with their requests. Access can be granted subject to the institutional review board (IRB) and the research collaborative agreement guidelines. This is a requirement mandated for this research study by our IRB and funders.

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