The relationship between implicit and explicit stigma of mental illness among mental health clinicians: a systematic review and meta-analysis

Background: Mental health clinicians have been found to demonstrate stigma towards people withmental illness through both implicit and explicit methodologies. These are thought to representdistinct yet potentially related dimensions of stigma. However, the association between implicit andexplicit stigma is unclear, limiting our understanding of how these could impact clinical outcomes.Aim: This systematic review and meta-analysis aimed to synthesise research on the relation betweenimplicit and explicit stigma among mental health clinicians and examine its potential moderators.Methods: The protocol was preregistered on PROSPERO (CRD42024614725). A systematic searchwas conducted using PsycINFO, PsycArticles, MEDLINE, EMBASE, ProQuest Central, Web ofScience, CINAHL, and Scopus. A random-effects meta-analysis of r-to-z transformed correlationswas conducted along with tests of heterogeneity, moderators and publication bias. The features ofimplicit and explicit measures, methodological quality and clinical outcomes were also extracted.Results: Ten studies (n = 1,404 clinicians) with 11 independent samples were included. There was astatistically significant, but small, positive pooled correlation between implicit and explicit stigmameasures (r = 0.13; 95% CI: 0.04 to 0.23). Heterogeneity was moderate and largely accounted for bystudies examining substance use disorder, which showed a slightly stronger correlation (r = 0.27)than for other psychiatric disorders (r = 0.08). Publication bias was not detected.Conclusions: Implicit and explicit stigma appear to be weakly related, so could be considered largelydistinct constructs among clinicians. Findings underscore the importance of addressing implicit andexplicit stigma in research and practice, which may inform stigma-reduction efforts.