Association of individual and environmental socioeconomic status with mental health-related stigma: Evidence from psychiatric hospital staff in China

Yemin Yuan; Luping Hei; Miaomiao Zhao; Siwei Sun; Beibei Yuan

doi:10.1016/j.schres.2025.07.005

Association of individual and environmental socioeconomic status with mental health-related stigma: Evidence from psychiatric hospital staff in China

Schizophr Res. 2025 Jul 11:283:107-114. doi: 10.1016/j.schres.2025.07.005. Online ahead of print.

Authors

Yemin Yuan¹, Luping Hei¹, Miaomiao Zhao², Siwei Sun³, Beibei Yuan⁴

Affiliations

¹ School of Public Health, Peking University, Beijing 100191, China; China Center for Health Development Studies, Peking University, Beijing 100191, China.
² Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Center for Mental Health Management, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai 200240, China.
³ Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, Peking University, National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing 100191, China. Electronic address: siwei341105@bjmu.edu.cn.
⁴ China Center for Health Development Studies, Peking University, Beijing 100191, China. Electronic address: beibeiyuan@pku.edu.cn.

PMID: 40651292
DOI: 10.1016/j.schres.2025.07.005

Abstract

Background: Mental health-related stigma among healthcare providers impedes quality care and patient outcomes. Socioeconomic status (SES) is a critical factor. Existing studies suggest inconsistent associations between individual SES and stigma across populations, and evidence on how individual SES and environmental SES interact to shape stigma remains limited. This study aimed to (1) describe the mental health-related stigma of psychiatric hospital staff in China; (2) explore the association of individual and environmental SES with stigma; (3) examine the interaction between individual SES and environmental SES.

Methods: The data were obtained from an online survey of stigma and related factors among psychiatric hospital staff in 6 regions of China. In total, 3323 participants were included in the analysis. SES was divided into individual SES (educational attainment and annual income) and structural SES (regional education levels and regional income levels). Multilevel mixed-effects linear regression was used to examine the association and interaction.

Results: We observed that the average score of mental health-related stigma among psychiatric hospital staff in China was 53.3 on a scale of 15-105. In individual SES, a positive association was found between educational attainment and mental health-related stigma (bachelor's degree: adjusted β = 3.252, p < 0.001; master's degree or above: adjusted β = 3.824, p = 0.004). In environmental SES, mental health-related stigma was negatively associated with regional education levels (adjusted β = 3.863, p = 0.012), but positively associated with regional income levels (adjusted β = -3.712, p = 0.018). Regional education levels moderated the positive association between individual SES and mental health-related stigma (adjusted β = -2.226, p = 0.049).

Conclusion: Our findings suggest that psychiatric staff with higher SES may be in greatest need of interventions to reduce mental health-related stigma. Enhancing the contact and interaction between psychiatric staff and the public is also essential to mitigate stigma.

Keywords: Mental health; Multilevel model; Socioeconomic status; Stigma.