Are Clinical Training Models Fueling Mental Health Stigma? New Study Says Yes

A new article published in the International Journal of Social Psychiatry reports that Swedish psychiatrists, psychologists, and social workers differ sharply in how they explain psychological distress. Those differences in attributional style are linked to different levels of stigma toward people experiencing mental health challenges.

The current work, led by Martin Wolgast of Lund University in Sweden, finds that Swedish psychiatrists favor biological attributions of mental health issues, psychologists favor cognitive-behavioral attributions, and social workers are more likely to endorse social-realist attributions. Additionally, the study finds that biological and cognitive-behavioral attributions are associated with more stigmatizing attitudes towards mental health problems, while social-realist attributions are associated with less stigmatizing attitudes.

“The findings demonstrate significant differences in how these professions attribute mental distress and the degree to which these attributions are related to stigmatizing attitudes.,” the authors write. “These insights offer a deeper understanding of how professional roles and training shape clinical perspectives and contribute to the persistence of stigma within mental health systems.”

The goal of the current research was to investigate how mental health professionals attribute psychological problems and distress. Additionally, the authors wanted to explore the links between different attributions and stigmatizing attitudes towards people experiencing mental health problems.

Four types of attributions were explored: biological, cognitive-behavioral, psychodynamic, and social-realist. Biological attributions deal with genetics, brain chemistry, and physical abnormalities in the brain. Cognitive-behavioral attributions focus on faulty thinking and learned maladaptive behaviors. Psychodynamic attributions look towards unconscious internal conflicts. Social-realist attributions include systemic and environmental factors such as social injustice, unemployment, and poverty.

The authors recruited participants for the present study via emails sent to Swedish psychiatrists. To be included in the current work, participants had to work with adults and have a reported profession of psychiatrist, psychologist, or social worker. In total, 715 mental health professionals participated in the study.

Stigmatizing attitudes were measured using a revised version of the Opening Minds Stigma Scale for Health Care Providers. This survey asks participants to rate their level of agreement with statements such as “Despite my professional beliefs, I have negative reactions toward people who have mental illness” and “I would see myself as weak if I had a mental illness and could not fix it myself.”

Attributions on psychological distress and mental health problems were measured using a revised version of the Maudsley Attitude Questionnaire (MAQ-R). This self-report survey asks participants to rate their level of agreement with 16 statements related to attributions of “mental illness,” such as “mental illnesses result from brain dysfunctions” and “mental illness arises as a consequence of social circumstances or conditions.”

Psychiatrists preferred biological attributions, with an average MAQ-R score of 4.00 compared to 3.13 for psychologists and 3.27 for social workers. Psychologists had the highest scores for cognitive-behavioral attributions at 3.35 compared to psychiatrists at 3.07 and social workers at 3.05. Social workers were the most likely to endorse both psychodynamic (2.95) and social-realist (3.49) attributions. While social workers were most likely to endorse psychodynamic and social-realist positions, their responses were not significantly different from those of psychologists in either domain, with psychologists scoring 2.86 for psychodynamic attribution and 3.38 for social-realist. Psychiatrists were less likely to endorse both psychodynamic (2.57) and social-realist (3.13) attributions.

Although the authors report that psychologists favored cognitive-behavioral and psychodynamic attributions, their data show that, among the four attributions measured, psychologists rated psychodynamic lowest. Psychologists were most likely to rate social-realist attributions (3.38) highly, followed closely by cognitive-behavioral (3.35). No explanation is given for this discrepancy between the actual numbers and the way the authors chose to frame their results.

Biological and cognitive-behavioral attributions were both associated with more stigmatizing attitudes. While both associations were weak, the link between biological attributions and stigmatizing attitudes was the strongest. Social-realist attributions were associated with less stigmatizing attitudes, but this association was also relatively weak. Psychodynamic attributions were slightly associated with more stigmatizing attitudes, though the association did not reach statistical significance.

The authors acknowledge several limitations to the current work. The self-report nature of the data could have led participants to underreport stigmatizing attitudes. There may have been issues with the way stigmatizing attitudes were measured. For example, lower levels of compassion could be related to burnout rather than prejudice, and providers’ reluctance to seek mental healthcare may be a result of mistrust in the system or fear of professional consequences rather than their own stigmatizing attitudes towards people experiencing mental health issues.

The study’s design means the authors can only speak to associations, not causes. In other words, this data does not show that biological attributions cause stigmatizing attitudes; it only suggests a connection. The research was conducted entirely with Swedish providers, limiting generalizability to other populations. The population sample was also not random or representative, limiting generalizability within the Swedish context.

Stigma around mental health problems varies by diagnosis and is driven by fear and misunderstanding. As in the current research, past studies have found that biological explanations and attributions of mental “illness” are linked to increased stigma and social rejection. One study also found that essentialist thinking may lead to increased stigmatizing attitudes. Psychosocial explanations and attributions of mental health problems, including sociopolitical turmoil, have been linked to decreased stigma.

Research has found that mental health literacy campaigns do not reduce stigma, and may actually make it worse. One study found that mental health stigma was not linked to behaviors, but to labels given to people by mental health professionals. Research has also found that mental health professionals and service users often disagree on attributions of mental health problems, with service users preferring social explanations.

****

Wolgast, M., Tham, K. F., Straht, M., & Levinsson, H. (2025). Professional perspectives on mental distress: Exploring attributional differences and their association with stigmatizing attitudes among psychiatrists, psychologists, and social workers. International Journal of Social Psychiatry. (Link)