Stigma Toward People With Mental Illness Among Romanian Psychiatry Trainees: A Mixed-Methods Study

Background Stigma associated with mental illness is a critical barrier to effective care, and emerging evidence suggests that stigmatizing attitudes exist even among mental health professionals. In Romania, cultural and systemic factors may exacerbate this issue, yet research examining stigma within this group is limited. This mixed-methods study investigated the attitudes and behaviors of Romanian psychiatry trainees toward individuals with mental illness, their knowledge of mental health stigma, and their perspectives on its causes and potential anti-stigma strategies. Methods Qualitative data were collected through individual interviews, and a quantitative assessment was conducted using the Mental Health Provider Stigma Inventory (MHPSI), with 20 participating trainees. Qualitative data were analyzed using thematic analysis, and mean differences were assessed for the total and subscale scores of the MHPSI. Results Quantitative analysis revealed moderate overall levels of stigma, with no significant differences in total or subscale scores across academic years. Statistically significant differences between males and females were observed for the total score (T(17) = 2.19, p = 0.04) and the "coworker influence" subscale (T(18) = 3.13, p = 0.002), with males scoring higher than females. Qualitative findings indicated that manifestations of stigma, such as diagnostic overshadowing and avoidance, were readily recognized among healthcare professionals. However, only a minority of psychiatry trainees acknowledged stigma in their own clinical practice, particularly in the form of judgmental attitudes and a lack of empathy. Key factors contributing to stigma included insufficient stigma education, institutional culture, and burnout. Trainees highlighted the need for targeted interventions to reduce stigma in clinical interactions. Conclusions These findings underscore that both individual and systemic factors contribute to stigma among psychiatry trainees. Addressing this issue requires comprehensive, context-specific anti-stigma interventions integrated into medical curricula and residency programs, with a focus on stigma training and reflective practice.