The Mediating Role of Self-stigma of Seeking Help in the Relationship between Perceived Occupational Prestige and Mental Health: A Cross-Sectional Study on Medical Doctors

Abstract

Based on social identity theory, this study aimed at evaluating the effect of perceived occupational prestige and self-stigma of seeking help on mental health issues (depression, stress, and anxiety) among medical doctors. A self-administered questionnaire survey was conducted on 374 medical doctors working in Vietnam with convenient sampling strategies. The study employed the 22-item version of the Perception of Occupational Status Survey (POSS), the Self-stigma of Seeking Help Scale (SSOSH), and the 21-item version of the Depression-Anxiety-Stress Scale (DASS-21). Results showed that perceived occupational prestige had a negative association with mental health issues among medical doctors. Furthermore, results suggested that the relationship between perceived occupational prestige and mental health was mediated by self-stigma of seeking help. Self-stigma of seeking help increased the risk of mental health issues. However, medical doctors perceived high occupational prestige, which weakened self-stigma of seeking help, and therefore, it indirectly reduces the risk of mental health issues among medical doctors. The results hence provide empirical support for social identity hypothesis. Based on the results, the study also provides some practical suggestions for therapists working with healthcare professionals in intervening mental health issues.

Keywords

self-stigma of seeking help perceived occupational prestige mental health medical doctors

Introduction

Concern for employees’ mental health has been increasing thanks to a growing literature acknowledged its significant impacts on employees and organization as a whole (Cao et al. 2022; Jansson and Gunnarsson 2018). Working at healthcare settings is considered as prestigious but high-risk occupations, because healthcare workers have to cope with various workplace stressors contributive to the risk of mental health problems, such as overload work, lack of autonomy, excessive institutional authority, close supervision, strained associations between them and their colleagues, patients and patients’ relatives (Souza et al. 2018). In addition, healthcare professionals, especially medical doctors, often avoid seeking professional support when they meet mental health risk because of the fear for stigma (Bannatyne et al. 2023). This coping pattern hence increase the risk of mental health illness among them. Research documents that healthcare professionals are facing with various mental health risks such as stress, burnout, or even suicide risk (Harvey et al. 2021; Kirch 2021; Oxtoby 2016). However, research have also identified several factors protective to the mental health of healthcare professionals such as high income, empathy (Huang et al. 2020); or support by colleagues, physical protective measures implemented by the hospital (Osório et al. 2021). Yet, to our knowledge, little is known about the relationship between occupational prestige and mental health of healthcare professionals.

The relationship between occupational prestige and mental health of healthcare professionals is, however, worth considering, as occupational prestige is a powerfully protective factor for mental health (Combs et al. 2023). Since and medical doctors’ occupational prestige is usually high in most of the countries (Bogusz 2018). However, as Bannatyne et al. (2023) also pointed out, self-stigma of seeking help among healthcare professionals is also high, preventing the ontime intervention for their mental health problems. How these two factors—occupational prestige and self-stigma of seeking help—will interact with each other and affect their mental health conditions? Understanding these relationships may provide useful implications for intervention strategies to reduce mental health risks for healthcare professional in general and medical doctors in particular.

In a society where knowledge is considered as a value like Vietnam (Nguyen 2016), occupations which require specialized knowledge and skills as medical doctors are specially respected. In such a context, both medical doctors as well as the public often internalize positive perceptions of this occupation. This internalization may serve as a significant factor to prevent mental health issues among medical doctors, because it reinforces medical doctors’ perception of their identity and worth, and hence positively affects their mental health condition. On the contrary, studies also evidenced that self-stigma of seeking help was a powerful factor negatively affecting individuals’ mental health because it reduced chance of receiving early intervention and proper treatment when needed. Importantly, the negative effect of self-stigma of seeking help was found significant on various populations (Lannin et al. 2016; Reynders et al. 2014) and especially healthcare workers (Mehta and Edwards 2018). In the end, how might perception of occupational prestige and self-stigma of seeking help concurrently affect medical doctors’ mental health?

In this article, we assessed the associations between perceived occupational prestige, self-stigma of seeking help and mental health among medical doctors. We also evaluated the role of self-stigma of seeking help in the relationship between perception of occupational prestige and mental health. Our assumption is based on social identity theory, proposing that internalizing social values on occupation will reduce the risk of mental health issues via an indirect pathway: occupational prestige reduces self-stigma of seeking help which increases the risk of mental health issues.

Social Identity Theory

Social identity theory, first proposed by Tajfel (1978) and then further developed by Tajfel and Turner (1979) is a theoretical framework to explain intergroup behaviors and communications. This theory provides that individuals’ social identity is constructed in a process in which they identify themselves with the social groups to whom they belong (ingroup). While identifying themselves as member of a certain social group, individuals develop a sense of “we”—the individual and the persons in the same group (ingroup), and “they”—the persons who belong to the other groups (outgroups). Groups may be categorized by occupation, education or wealth/income, or family background. When categorizing themselves into a certain group (social identification process), individuals, in order to enhance their self-image, tend to view their group more positively than other groups. This social comparison process does not only affect the way the individuals perceive the relative value of themselves as member of their ingroup, but also affect the way individuals view and interact with members of outgroups (Harwood 2020).

Among medical doctors, the impact of social identity process may, however, be dualistic. On one hand, medical doctors may identify themselves with the positive attributes that societies often assign to their occupation such as “helping,” “proficient,” “professional,” or “reliable.” Therefore, medical doctors may categorize themselves as “we are the ones who provide help” to differentiating themselves from the other groups who are “them—who receive our help.” This conceptualization may increase a resistance to seeking psychological help when these medical doctors have symptoms of mental health issues, because seeking help contradicts with the core attribute which defines their social identity (a helper). On the other hand, positive attributes that societies assign to this occupation group may strengthen their self-esteem. The more medical doctors internalize social positive labels of themselves, the more they perceive self-confidence and self-worth. In its turn, this reinforced self-esteem helps reduce their stigma of seeking help. So, how social identity process may work on medical doctors’ mental health, considering the effects of both perceived occupational prestige and self-stigma of seeking help? This study is to clarify how these three issues—perceived occupational prestige, self-stigma of seeking help and the risk of mental health issues—may co-variate among the specific population as medical doctors.

Occupational Prestige

According to Garbin and Bates (1961), occupational prestige is a social value which is evaluated by societal members. It is manifested in the form of sentiments of admiration or deference which some people have with respect to certain work positions. Regarding criteria to assess occupational prestige, some authors (Garbin and Bates 1961; Osgood and Stagner 1941) suggested a measure based on Occupational Trait Category. The measure covers six criteria including (a) Intrinsic nature of the work (i.e., dealing more with people than with things, honorable and morally good work, Interesting and challenging work, Service to humanity and essential, Work calls for originality and initiative); (b) Intellectual and training requirements (i.e., Education required, Training required, Intelligence required, Scarcity of personal who can do the work); (c) Individual independence in the work situation (Being one’s own boss, Free time on the job); (d) The working conditions (Clean work, Flexible working hours, Safe work); (e) Interpersonal relations (Having an influence over others, Regarded as desirable to associate with, Responsibility to supervise others); and (f) Rewards of the work (Security, Income, Opportunities for advancement). More recently, some authors assessed occupational prestige on five criteria as (a) Level of education, (b) Level of income, (c) Level of responsibility, (d) Level of social standing, and (e) Level of usefulness as a profession (Mandy and Mandy 2009). Also based on these five criteria, Allan Whitfield et al. (1996) supplemented the sixth dimension—“proportion of women in the profession,” concerning gender differences associated with professions and the perceived standing of those professions.

Some studies assessed the effect of occupational prestige on physical health of employees. Research documented that high occupational prestige is associated with a decrease in the risk of cancer, cardiovascular, and respiratory-related mortality (Christ et al. 2012). Employees whose job has high occupational prestige are more physically resilient than those whose jobs’ occupational prestige is low (Sacker et al. 2009). Furthermore, occupational prestige can be an important predictor of morbidity and mortality (Geyer et al. 2006). Besides, low occupational prestige is related to high sickness absence in both male and female employees (Nwaru, Berglund, and Hensing 2021). However, knowledge about the relationship between occupational prestige and mental health remained still limited. Few efforts, such as (Fujishiro, Xu, and Gong 2010), provided evidence that occupational prestige has positive impact on employees’ physical health and reduces employees’ stress at workplace.

Self-stigma of Seeking Help

Stigma is the most cited reason for why people struggling with mental issues do not seek for professional treatment such as psychological counseling (Vogel, Wade, and Hackler 2007). The concept of stigma can be tracked back to the analysis of Goffman (1963) about attributes deeply discredited by the community. Goffman (1963) classified three types of stigmas: tribal stigmas, physical deformities, and blemishes of characters. If tribal stigmas referred to traits of a community stigmatized as blemishes (such as race, nation, and religion), the other two types of stigmas referred to traits of individuals which community perceived as devalued such as physical disability or being too ugly (physical deformities); homosexuality or mental illness (blemishes of characters). When stigma presents, the community is divided into two parts: “we” who are “normal” (who do not bear the stigmatized trait) and the stigmatized persons (who bear the stigmatized trait). “We,” as pointed out by (Goffman 1963:5), exercised a wide range of discrimination against stigmatized persons, including developing theories explaining their inferiority, resorting these stigmatized traits to explain other imperfections of the stigmatized persons. In short, stigmas, according to Goffman’s approach, is a social issue where the community defines some traits as contaminated and hence discriminates persons or groups who bear these traits.

Later, some researchers (Corrigan and Watson 2002; Vogel et al. 2007), following by some others such as referred Goffman’s concept of stigma as public stigmas to differentiate it with “self-stigma.” Corrigan and Watson (2002) further analyze that public stigma is composed of three responses: stereotype, prejudice, and discrimination. These response upon the stigmatized traits together make persons with stigmatized traits feel not only shame but also responsible for the traits they are bearing. Whereas public stigma refers to the public’s response to stigma, self-stigma is the state where individuals internationalize the public’s stereotype, prejudice and discrimination beliefs about the stigmatized trait, and hence reduce their self-esteem for bearing such traits (Corrigan and Watson 2002; Vogel et al. 2007). Self-stigma is different from anticipated stigma although these issues happen concurrently on the persons who bear the stigmatized trait. If self-stigma is the individual’s perception of his/her-self as flawed because of bearing the stigmatized trait, anticipated stigma is the state where the individual expects that his/her community will treat him/her badly because of the stigmatized trait he/she is bearing.

Whereas both self-stigma and anticipated-stigma are individual responses to public stigma, research documented that self-stigma was more powerful than anticipated stigma in preventing persons with mental health issues from seeking help (Schomerus, Matschinger, and Angermeyer 2009). Besides, this study is to investigate how process of social identity construction affect the mental health of medical doctors, we choose to assess self-stigma of seeking help as another explaining factor which may co-variate with perceived of occupational prestige. In this study, self-stigma of seeking help refers to the perception held by the individual that he or she is undesirable or socially unacceptable if they were to seek help (Vogel, Wade, and Haake 2006).

It should be noted that stigma that prevents people with mental health issues from seeking professional help is two-fold, because it combines two stigmas: stigma of mental health issues, and stigma of seeking help. Whereas stigma of mental health issues is among the strongest public stigmas which results in strongest discrimination against people with mental health issues (Johnstone 2001), stigma of seeking help doubles the obstacle for these people for accessing effective treatment in time. Fisher, Nadler, and Whitcher-Alagna (1982) explain that seeking for help threatens the person’s self-esteem because this behavior is often considered as a sign of being weak, inadequate, and inferior, and an acknowledge of failure. Therefore, people avoid seeking help to maintain a positive self-image and protect self-esteem (Miller 1985; Wills and DePaulo 1991). This response may be even greater among healthcare professionals because their occupational identity defines themselves as “helper,” “protector,” and “professional.” The negative labels often assigned to seeking help as “weakness” and “failure” may strongly contradict with their occupational identity and hence increase their self-stigma of seeking help.

Whereas self-stigma of seeking help in general increase mental health issues in various populations as provided above, literature on the relationship between these two issues among healthcare professionals is quite scarce. Whether perceived occupational prestige increases or decreases self-stigma of seeking help among medical doctors remains unknown. In the light of social identity theory and considering the great respect for medical doctors in Vietnamese culture, we propose that perception of occupational prestige reduces the risk of mental health illness among medical doctors. Importantly, perceived occupational prestige helps reduce self-stigma of seeking help which positively predicts mental health issues. Specifically, our study tests four hypotheses as follows:

Hypothesis 1: Perception of occupational prestige reduces the risk of mental health issues among medical doctors.

Hypothesis 2: Self-stigma of seeking help increases mental health issues in medical doctors.

Hypothesis 3: Perception of occupational prestige is related negatively self-stigma of seeking help.

Hypothesis 4: Self-stigma of seeking help mediates the relationship between perception of occupational prestige and mental health issues among medical doctors.

Methodology

Participants and Procedure

This is a cross-sectional study with the convenient sampling strategy. We sent out 500 self-reported questionnaires to medical doctors working at different hospitals in Hanoi, Da Nang, and Ho Chi Minh city, Vietnam. A total of 374 doctors sent back the filled-in questionnaire, making up a response rate of 74.8%.

Among measures applied in this study, the two scales Perception of occupational prestige and Self-stigma of seeking help have not been adapted in Vietnam. To use these scales in Vietnamese, we applied the repeated forward–backward translation procedure as advised by Van de Vijver and Hambleton (1996).

Measurement

Perception of occupational prestige

The 22-item of Perception of Occupational Status Survey—POSS developed by Crawley (2014) was used in this study. Items measure respondents’ perception of their occupation’s prestige (e.g.: People who are employed in this occupation are generally highly respected in society). Psychometric analysis showed that this measure has a single-dimension construct with convergent validity and internal reliability (Crawley 2014). All items of the scale were assessed on a 6-point Likert scale, scoring from 1—strongly disagree to 6—strongly agree. Negative items were coded in the reverse direction. The higher the score is on a range from 22 to 132, the higher occupational prestige the respondent perceived. Confirmatory factor analysis (CFA) demonstrated that all 22 items demonstrated significant loadings onto a single factor “Perception of occupational prestige”—which fitted the data reasonably well: χ² = 614.053, df = 140, p = 0.000, Comparative Fit Index (CFI) = 0.941; Tucker–Lewis Index (TLI) = 0.902; root mean square error of approximation (RMSEA) = 0.054 (90% confidence interval [CI] = 0.050–0.058). In this study, Cronbach alpha value of this measure is 0.82.

Self-stigma of seeking help was measured using the Self-stigma of seeking help scale—SSOSH (Vogel et al. 2006). This is a 10-item scale, each item was assessed on 4-point Likert-type scale ranging from 1—strongly disagree to 4—strongly agree. The scale measures respondent’ attitude toward seeking psychological intervention (e.g., Seeking psychological help would make me feel less intelligent). Negative items were reversely coded. Higher score indicated a greater level of self-stigma of seeking psychological help. Results from CFA suggested one factor model with 10 items which fitted the data reasonably well: χ² = 90.250, df = 25, p = 0.000, CFI = 0.978, TLI = 0.961, RMSEA = 0.047 [95% CI: 0.037–0.058]. This scale has a Cronbach’s α at 0.72 in this sample.

Mental health was measured using the 21-item version of the Depression-Anxiety-Stress Scale (DASS-21) which screens symptoms of depression, anxiety, and stress (Lovibond and Lovibond 1995). This measure is comprised of three subscales, each has seven items. Items were scored on a 4-point Likert-type scale ranging from 0—did not apply to me at all to 3—applied to me very much, or most of the time. Each subscale score ranged from 0 to 21. We resort to DASS-21 because it has been adapted on various Vietnamese populations including medical doctors (e.g., Thu Pham et al. 2023; Tran et al. 2019) and accepted three-dimension structure including (1) Depression (e.g., I found it difficult to work up the initiative to do things), (2) Anxiety (e.g, I was aware of dryness of my mouth), and (3) Stress (e.g., I tended to over-react to situations). The Cronbach’s alpha coefficients were 0.89, 0.84, 0.86, and 0.91 for Depression, Anxiety, Stress, and the overall scale, respectively.

Data Analysis

We first analyzed descriptive statistics (mean value, standard deviation), then using Pearson’s correlation coefficients to analyze the correlations among perception of occupational prestige, self-stigma of seeking help, and mental health. The associations between all independent and dependent variables were examined by a linear regression. The mediating analyses were performed with structural equation modeling (SEM), using AMOS version 23.0. The model fit was evaluated by several fit indices: CFI, TLI, RMSEA with 90% CIs, and the Standardized Root Mean Square Residual (SRMR). Hu and Bentler (1999) recommended researchers to adopt cutoff values close to .95 for the TLI and the CFI, cutoff values close to .06 for the RMSEA, and cutoff values close to .08 for the SRMR. We also report χ² but do not focus on the significance of the ratio of the chi-square and its related degree of freedom (χ²/df), because χ² is almost significant, suggesting poor model fit when the sample size is large (Jöreskog 1993). All statistical analyses were performed using IBM SPSS version 23.0 (SPSS Inc., Chicago, IL, USA) and Analysis of Moment Structures (AMOS) version 22.0 (IBM, New York, NY, USA). Statistical significance was set at p < 0.05.

Ethical Considerations

The study protocol was reviewed and approved by the Institutional Review Board, Vietnam National University, Hanoi School of Medicine and Pharmacy (approval no. 06/2020/CN-HDDD).

All doctors participated in this study on a volunteer basis and their participation is kept anonymous. All participants fully understood the research and signed an informed consent form before joining this study and were ensured that they could leave the study any time they wanted without any harm.

Results

Sample Characteristics

As presented in Table 1, the study sample includes both male doctors (60.2% of the total sample size) and female doctors (39.8%). Sample’s age ranges from 24 to 70, with a mean of 33.18 (SD = 9.17). Around 72.6% of the survey participants aged from 25 to 35. About marital status, 52.7% of participants are married and 46% are single. Half of the participant (50%) hold a master degree, whereas 35.3% hold Bachelor Degree and the remaining 14.7% hold PhD. Around 62% of participants currently work at public hospital with financial autonomy (62%), 27.3% at public hospital without financial autonomy, and 10.7% at private hospital.

Table 1.

Sample Characteristics (N = 374).

		N	%
Sex	Male	225	60.2
Sex	Female	149	39.8
Age	≤35	270	72.6
	36–50	75	20.2
	≥51	29	7.6
Marital status	Single	172	46.0
	Married	197	52.7
	Divorced	05	1.3
Education level	Bachelor	132	35.3
	Master	187	50.0
	PhD	55	14.7
Type of hospital	Private hospital	40	10.7
	Public hospital without financial autonomy	102	27.3
	Public hospital with financial autonomy	232	62.0

Correlation Analysis

Table 2 shows the mean scores and correlations between all variables. The results demonstrate that perception of occupational prestige had a negative correlation with both of self-stigma of seeking help and mental health’s variables. While self-stigma of seeking help had a positive correlation with all of dimension’s mental health.

Table 2.

Descriptive Data and Correlation between Variables (N = 374).

	Range	Mean (SD)	(1)	(2)	(3)	(4)
1.Perception of occupational prestige	57–123	94.32 (12.03)	—	—	—	—
2.Self-stigma of seeking help	14–37	26.44 (4.93)	−0.21***	—	—	—
3.Depression	0–36	5.60 (7.88)	−0.25***	0.26***	—	—
4.Anxiety	0–36	5.22 (7.13)	−0.25***	0.23***	0.84***	—
5.Stress	0–42	8.99 (8.54)	−0.20***	0.16**	0.86***	0.79***

p < .01. ***p < .001.

Table 3 presents the results of regression analysis. Gender is not related to any mental health issue, whereas work position is only related to anxiety. Result show that medical doctors undertaking positions in management system have more risk of anxiety than those who did only professional jobs (β = −0.09). Our data document that perception of occupational prestige was negatively related to depression (β = −0.20), anxiety (β = −0.21), and stress (β = −0.17) while self-stigma of seeking help was related to all of these three mental health’s dimensions (with β value was 0.22, 0.19, and 0.13 respectively). Concretely, 10.2% of the variance of Depression was explained by Perception of occupational prestige and Self-stigma of seeking help. The prevalence was 9.5% and 5.4% for Anxiety and Stress, respectively. Besides, results also demonstrate that Perception of occupational prestige can explain 4.5% of the variance of Self-stigma of seeking help in negative direction (β = −0.21, p < 0.001). These results support Hypothesis 1 (perception of occupational prestige reduce the risk of mental health issue), Hypothesis 2 (self-stigma of seeking help increase the risk of mental health issue), and Hypothesis 3 (perception of occupational prestige decreases self-stigma of seeking help).

Table 3.

Linear Regression Results (N = 374).

Independent variables	Depression		Anxiety		Stress
Independent variables	Beta	t	Beta	t	Beta	t
Constant	—	2.16*	—	2.61**	—	3.13
Gender	−0.02	−0.49, ns	−0.06	−1.19, ns	−0.04	−0.68, ns
Work position	−0.09	−1.87, ns	−0.11	−2.22*	−0.09	−1.73, ns
Perception of occupational prestige	−0.20	4.04***	−0.21	−4.15***	−0.17	−3.27**
Self-stigma of seeking help	0.22	4.33***	0.19	3.68***	0.13	2.49*
R² (%)	11.6		11.2		5.90

Note. ns = nonsignificant.

p < .05. **p < .01. ***p < .001.

Mediation Analysis

Figure 1 illustrates the correlations and relevant estimates, using a structural equation model to analyze the relationship between all variables. We added the socio-demographic variables as covariates (male—female, employee—employer), the results show that the direction of the associations among the core variable in the SEM remained unchanged, and the changes in the corresponding coefficients are insignificant. Therefore, the socio-demographic variables were not confounding factors. All indices meet the reference value, indicating that this model fits data well, χ² = 42.46, df = 18, p = 0.008, TLI = 0.95, CFI = 0.94, RMSEA = 0.06 (90% CI: 0.03–0.12), and SRMR = 0.02.

Figure 1.

Mediation analyses of self-stigma of seeking help in the relationship between perception of occupational prestige and mental health.

Bias-corrected bootstrap with 2000 replications using maximum likelihood estimation is used for each path. The estimates for direct, indirect, and total effects with bias-corrected 95% CI are shown in Table 4. The total effect results indicate that: Perception of occupational prestige is significantly negatively correlated with Depression (β = −0.25, 95% CI [−0.33, −0.17]), Anxiety (β = −0.25, 95% CI [–0.32, –0.18]), Stress (β = −0.22, 95% CI [−0.31, −0.13]), and Self-stigma of seeking help (β = −0.21, 95% CI [−0.28, −0.11]). Furthermore, results also show that Self-stigma of seeking help is positively correlated with Depression (β = 0.22, 95% CI [0.14, 0.28]), Anxiety (β = 0.19, 95% CI [0.12, 0.25]), and Stress (β = 0.15, 95% CI [0.07, 0.26]).

Table 4.

Path Coefficients between Structural Variables and Significance Test of Mediating Way.

Model pathways	Estimated	95% CI
Total effects
Perception of occupational prestige → Depression	−0.25	(−0.33) to (−0.17)
Perception of occupational prestige → Anxiety	−0.25	(−0.32) to (−0.18)
Perception of occupational prestige → Stress	−0.22	(−0.31) to (−0.13)
Perception of occupational prestige → Self-stigma of seeking help	−0.21	(−0.28) to (−0.11)
Self-stigma of seeking help → Depression	0.22	(0.14) to (0.28)
Self-stigma of seeking help → Anxiety	0.19	(0.12) to (0.25)
Self-stigma of seeking help → Stress	0.15	(0.07) to (0.26)
Direct effects
Perception of occupational prestige → Depression	−0.20	(−0.29) to (−0.12)
Perception of occupational prestige → Anxiety	−0.21	(−0.29) to (−0.14)
Perception of occupational prestige → Stress	−0.19	(−0.29) to (−0.10)
Perception of occupational prestige → Self-stigma of seeking help	−0.21	(−0.28) to (−0.11)
Self-stigma of seeking help → Depression	0.22	(0.14) to (0.28)
Self-stigma of seeking help → Anxiety	0.19	(0.12) to (0.25)
Self-stigma of seeking help → Stress	0.15	(0.07) to (0.26)
Indirect effects through self-stigma of seeking help
Perception of occupational prestige → Depression	−0.05	(−0.07) to (−0.03)
Perception of occupational prestige → Anxiety	−0.04	(−0.06) to (−0.02)
Perception of occupational prestige → Stress	−0.03	(−0.06) to (−0.02)

Finally, results indicate that Perception of occupational prestige has a significantly indirect effect on Depression (β = −0.05, 95% CI [−0.07, −0.03]), Anxiety (β = −0.04, 95% CI [−0.06, −0.02]), and Stress (β = −0.03, 95% CI [−0.06, −0.02]) through Self-stigma of seeking help, which indicates a mediating role of self-stigma of seeking help on the association between perception of occupational prestige and mental health. These results support the Hypothesis 4 (Self-stigma of seeking help can mediate the relationship between perception of occupational prestige and mental health issues among medical doctors).

Discussion

This article is to examine the associations between perception of occupational prestige, self-stigma of seeking help and mental health status on medical doctors. Some important findings were found. First, medical doctors’ perception of occupational prestige has a negative association with their mental health status. This finding suggests that perception of occupational prestige may be a protective factor for healthcare professionals against popular mental health issues as depression, anxiety, and stress. This finding is in the same line with previous studies, holding that occupational prestige has positive impact on employees’ health. Yet previous studies mainly support the association between occupational prestige and employees’ physical health, this study found significant relationship between occupational prestige and mental health. It is worth to note that previous research has rarely investigated the association between occupational prestige and mental health of employees, their findings however suggest some indirect associations. It was evidenced that high occupational prestige increased employees’ self-esteem (Faunce 1989) and boosted their satisfaction in work (Judge and Bono 2001). High self-esteem and work satisfactions were found positively related to both physical and mental health of employees (Faragher, Cass, and Cooper 2005). This study’s findings further show that internalizing positive values on healthcare profession helps increase medical doctors’ self-esteem. High occupational prestige assigned to healthcare professions integrate into their perception of their own identity and self-worth. In addition, working at high social positions creates more positive social interactions than working at lower social positions (Matthews et al. 2000), which also reduces the risk of mental health issues. Therefore, our study supports the idea that high occupational prestige is a protective factor to employees’ mental health.

Besides, our research showed that perception of occupational prestige was negatively associated with self-stigma of seeking help. Medical doctors who internalize higher occupational prestige have lower level of self-stigma of seeking help. As suggested by social identity theory, medical doctors, as other occupation groups, tend to identify themselves with the values and labels that society assigns to their occupation, making these attributes become their own (i.e., these occupational attributes represent their personal attribute). Since the values and label attached to medical doctor are positive, particularly in Vietnam, the occupational prestige helps heighten medical doctors’ self-esteem. This process is also strengthened thanks to the social rewards and privileges that they receive when playing their professional roles. Previous studies also confirmed that high occupational prestige increased employees’ self-esteem (Duemmler and Caprani 2017). Although our study did not evaluate medical doctors’ self-esteem, its findings suggest that heightened self-esteem helps lower down self-stigma of seeking help, as similarly found in previous study studies (Maharjan and Panthee 2019).

While perception of occupation prestige is found negatively associated with self-stigma of seeking help, our study documents that self-stigma of seeking help is positively related to mental health issues. This finding is in the same line with previous studies. Self-stigma of seeking help increases the risk of mental health issues because the self-stigmatized persons, in order to protect their self-esteem, avoid seeking help when they feel symptoms of mental health issues (Alluhaibi and Awadalla 2022; Vogel et al. 2006). This process is particularly popular among healthcare professionals who often experience self-stigma of seeking help, and hence they hesitate in seeking professional help and treatment for themselves when facing mental health issues (Endriulaitienė et al. 2019).

Finally, this study suggests that self-stigma of seeking help probably mediate the relationship between healthcare professional’s perception of their occupational prestige and their mental health. Although perception of occupational prestige is found negatively associated with mental health issues, this relation is indirect. In other words, how healthcare professionals are highly proud of their job does not reduce the risk of having mental health issues. However, perception of occupational prestige lowers stigma of seeking help (path a), and in its turn, stigma of seeking helps lowers the risk of having mental health issues (path b). Because research on the relationship between perception of occupational prestige and self-stigma of seeking help is quite scarce, we are unable to find empirical findings about this relationship to compare with ours. Yet this relationship is theoretically understandable. Occupation is often considered as a master status in modern societies because most of working-aged persons spends most of their time for work. Therefore, occupational identity is commonly conceptualized as the principal component of individuals’ overall sense of identity, determining not only their occupation choice and attainment but also their self-assessment (Skorikov and Vondracek 2011). Accordingly, the higher a person perceives his/her occupation’s prestige, the more his/her self-esteem might be strengthened. And, in its turn, strengthened self-esteem help prevents self-stigma which is conceptualized as “the reduction of an individual’s self-esteem or self-worth caused by the individual self-labeling herself or himself as someone who is socially unacceptable” (Vogel et al. 2006:325).

These findings hence also provide some suggestions for practical intervention with mental health issues on this specific population. To prevent mental health issues which are increasingly challenging for healthcare professionals, it is important to intervene their self-stigma of seeking help. Strengthening healthcare professionals’ perception of their occupation’s prestige can help decreases their self-stigma of seeking help, and hence reduce the risk of having mental health issues as stress, depression and anxiety. The mechanism underlying this intervention is that the boosted occupational self-esteem can effectively remove barrier against seeking help for mental health issues and hence reduce the risk of suffer from mental health disorder. According to Corey, Corey, and Callanan (2011), cultural values of persons and communities can interfere with psychological intervention process. Therefore, psychologists need to understand clients’ viewpoint and tailor their intervention in accordance to clients’ culture. In the same line with Corey et al. (2011), the results of this study also underscore the importance of multicultural competence of psychologists.

Conclusion

In conclusion, our study showed that internalizing high occupational prestige can reduce self-stigma of seeking help and hence reduce the risk of mental health issues. Even on medical doctors whose occupational identity may increase self-stigma of seeking help, increasing their perception of social values assigned to their occupations may help reduce self-stigma of seeking help. This finding suggests hospital quality managers, occupation counselor/psychologists that investing in propaganda strategies to promote occupational prestige may help prevent mental health issues for healthcare professionals.

Limitation of the Study

This study assessed the mediating role of self-stigma of seeking help in the relationship between occupational prestige and mental health issues, which implied a causal relationship. However, cross-sectional study is not appropriate research design to evaluate a causal inference like mediation effect. In this study, to supplement the inappropriate research design our study was based on both thorough theoretical considerations and evidence from previous studies to qualify the finding on mediation effect. It needs longitudinal study in the future to confirm this mediating role of self-stigma of seeking help. Besides, this conceptual framework is tested only on Vietnamese population. More tests in different populations needs to be conducted to examine how valid this conceptual framework is in explaining mental health risks among medical doctors. In addition, self-report design of the questionnaire survey may limit the reveal of the underlying impact of multicultural factors on seeking help behaviors.

Recommendations for Future Research

Since there remains a large gap in the literature on self-stigma and seeking help among medical doctors in general and especially medical doctors in Vietnam, and this study contains certain limitations in examining these issues, we highly recommend that more research on self-stigma of seeking help, in both qualitative and quantitative approach, should be conducted on different populations. Future research should explore further how socio-cultural factors affect seeking help behaviors of individuals when they have mental health issues. Case study or experimental study should be used to demonstrate psychological mechanism boost or restrict medical doctors to seek help when they experience mental health issues as depression, anxiety, or stress.

Footnotes

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work is funded by Vietnam National Foundation for Science and Technology Development (NAFOSTED) under grant number 501.02-2020.01

Ethical Approval

The study protocol was reviewed and approved by the Institutional Review Board, Vietnam National University, Hanoi School of Medicine and Pharmacy (approval no. 06/2020/CN-HDDD).

ORCID iD

Bui Thi Hong Thai

Author Biographies

Bui Thi Hong Thai, associate professor, Dr. Phil., is a Psychology lecturer and researcher. She is also working as an independent counseling psychologist. Both of her research interests and counseling service focus on adults’ mental health, especially in organization counseling.

Nguyen Thi Nhu Trang is an associate professor of Social Work, working at the Faculty of Sociology, VNU University of Social Sciences and Humanities, since 2002. Her research interests include work/study engagement and motivation, delinquency and mental health.

References

Allan Whitfield

T. W.

Allison

Laing

Turner

P. A.

1996. “Perceptions of the Physiotherapy Profession: A Comparative Study.” Physiotherapy Theory and Practice 12:39–48.

Alluhaibi

B. A.

Awadalla

A. W.

2022. “Attitudes and Stigma toward Seeking Psychological Help among Saudi Adults.” BMC Psychology 10:216.

Bannatyne

A. J.

Jones

Craig

B. M.

Jones

Forrest

2023. “A Systematic Review of Mental Health Interventions to Reduce Self-stigma in Medical Students and Doctors.” Frontiers in Medicine 10:1–10.

Bogusz

2018. “Prestige of the Medical Profession. Is There a Connection between Feminization and Decreased Prestige?” Polish Journal of Public Health 128:85–88.

Cao

Zhang

Huang

2022. “The Influence of Mental Health on Job Satisfaction: Mediating Effect of Psychological Capital and Social Capital.” Frontiers in Public Health 10:797274.

Christ

S. L.

Fleming

L. E.

Lee

D. J.

Muntaner

Muennig

P. A.

Caban-Martinez

A. J.

2012. “The Effects of a Psychosocial Dimension of Socioeconomic Position on Survival: Occupational Prestige and Mortality among US Working Adults.” Sociology of Health & Illness 34:1103–17.

Combs

Freeland

R. E.

Alfaro Hudak

K. M

Mumford

E. A.

2023. “The Effect of Occupational Status on Health: Putting the Social in Socioeconomic Status.” Heliyon 9:e21766.

Corey

M. S.

Callanan

2011. Issues and Ethics in the Helping Professions. Belmont, CA: Cengage Learning.

Corrigan

P. W.

Watson

A. C.

2002. “Understanding the Impact of Stigma on People with Mental Illness.” World Psychiatry 1:16–20.

10.

Crawley

2014. “Gender and Perceptions of Occupational Prestige: Changes Over 20 Years.” SAGE Open 4:2158244013518923.

11.

Duemmler

Caprani

2017. “Identity Strategies in Light of a Low-prestige Occupation: The Case of Retail Apprentices.” Journal of Education and Work 30:339–52.

12.

Endriulaitienė

Žardeckaitė-Matulaitienė

Pranckevičienė

Markšaitytė

Tillman

D. R.

Hof

D. D.

2019. “Self-stigma of Seeking Help and Job Burnout in Mental Health Care Providers: The Comparative Study of Lithuanian and the USA Samples.” Journal of Workplace Behavioral Health 34:129–48.

13.

Faragher

E. B.

Cass

Cooper

C. L.

2005. “The Relationship between Job Satisfaction and Health: A Meta-analysis.” Occupational and Environmental Medicine 62:105–12.

14.

Faunce

W. A.

1989. “Occupational Status-assignment Systems: The Effect of Status on Self Esteem.” American Journal of Sociology 95:378–400.

15.

Fisher

Nadler

Whitcher-Alagna

1982. “Recipient Reactions to Aid.” Psychological Bulletin 91:27–54.

16.

Fujishiro

Gong

2010. “What Does ‘Occupation’ Represent as an Indicator of Socioeconomic Status? Exploring Occupational Prestige and Health.” Social Science & Medicine 71:2100–107.

17.

Garbin

A. P.

Bates

F. L.

1961. “Occupational Prestige: An Empirical Study of Its Correlates.” Social Forces 40:131–36.

18.

Geyer

Hemström

Peter

Vågerö

2006. “Education, Income, and Occupational Class Cannot Be Used Interchangeably in Social Epidemiology. Empirical Evidence against a Common Practice.” Journal of Epidemiology and Community Health 60:804–10.

19.

Goffman

1963. Stigma. Notes on the Management of Spoiled Identity. London, England: Penguin Books.

20.

Harvey

S. B.

Epstein

R. M.

Glozier

Petrie

Strudwick

Gayed

Dean

Henderson

2021. “Mental Illness and Suicide among Physicians.” The Lancet 398:920–30.

21.

Harwood

2020. “Social Identity Theory.” Pp. 1–7 in The International Encyclopedia of Media Psychology, edited by van den Bulck Wiley

22.

L. T.

Bentler

P. M.

1999. “Cutoff Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria Versus New Alternatives.” Structural Equation Modeling: A Multidisciplinary Journal 6:1–55.

23.

Huang

Caspari

J. H.

Sun

Thai

Chen

F. Z.

Zhao

X. D.

2020. “Risk and Protective Factors for Burnout among Physicians from Standardized Residency Training Programs in Shanghai: A Cross-sectional Study.” BMC Health Services Research 20:965.

24.

Jansson

Gunnarsson

A. B.

2018. “Employers’ Views of the Impact of Mental Health Problems on the Ability to Work.” Work 59:585–98.

25.

Johnstone

M. J.

2001. “Stigma, Social Justice and the Rights of the Mentally Ill: Challenging the Status Quo.” Australian and New Zealand Journal of Mental Health Nursing 10:200–209.

26.

Jöreskog

K. G.

1993. Testing Structural Equation Models.” Pp. 294–316 in Testing Structural Equation Models, edited by Bollen

K. A.

Long

J. S.

Thousand Oaks, CA: Sage.

27.

Judge

Bono

2001. “Relationship of Core Self-evaluations Traits—Self-esteem, Generalized Self-efficacy, Locus of Control, and Emotional Stability—With Job Satisfaction and Job Performance: A Meta-analysis.” The Journal of Applied Psychology 86:80–92.

28.

Kirch

D. G.

2021. “Physician Mental Health: My Personal Journey and Professional Plea.” Academic Medicine 96:618–20.

29.

Lannin

D. G.

Vogel

D. L.

Brenner

R. E.

Abraham

W. T.

Heath

P. J.

2016. “Does Self-stigma Reduce the Probability of Seeking Mental Health Information?” Journal of Counseling Psychology 63:351–58.

30.

Lovibond

S. H.

Lovibond

P. F.

1995. Manual for the Depression Anxiety & Stress Scales. Sydney, New South Wales, Australia: Psychology Foundation.

31.

Maharjan

Panthee

2019. “Prevalence of Self-stigma and Its Association with Self-esteem among Psychiatric Patients in a Nepalese Teaching Hospital: A Cross-sectional Study.” BMC Psychiatry 19:347.

32.

Mandy

2009. “Occupational Prestige: Perceptions of First-year Podiatry, Physiotherapy and Occupational Therapy Students.” Podiatry Now 12:18.

33.

Matthews

K. A.

Räikkönen

Everson

S. A.

Flory

J. D.

Marco

C. A.

Owens

J. F.

Lloyd

C. E.

2000. “Do the Daily Experiences of Healthy Men and Women Vary According to Occupational Prestige and Work Strain?” Psychosomatic Medicine 62:346–53.

34.

Mehta

Edwards

2018. “Suffering in Silence: Mental Health Stigma and Physicians’ Licensing Fears.” American Journal of Psychiatry Residents’ Journal 13:2–4.

35.

Miller

W. R.

1985. “Motivation for Treatment: A Review with Special Emphasis on Alcoholism.” Psychological Bulletin 98:84–107.

36.

Nguyen

T. N. Q.

2016. “The Vietnamese Values System: A Blend of Oriental, Western and Socialist Values.” International Education Studies 9:32–40.

37.

Nwaru

C. A.

Berglund

Hensing

2021. “Occupational Prestige and Sickness Absence Inequality in Employed Women and Men in Sweden: A Registry-based Study.” BMJ Open 11:e050191.

38.

Osgood

C. E.

Stagner

1941. “Analysis of a Prestige Frame of Reference by a Gradient Technique.” Journal of Applied Psychology 25:275–90.

39.

Osório

F. L.

Silveira

I. L. M.

Pereira-Lima

Crippa

J. A. S.

Hallak

J. E. C.

Zuardi

A. W.

Loureiro

S. R.

2021. “Risk and Protective Factors for the Mental Health of Brazilian Healthcare Workers in the Frontline of COVID-19 Pandemic.” Frontiers in Psychiatry 12:662742.

40.

Oxtoby

2016. “Doctors’ Own Mental Health Issues.” British Medical Journal 352:i1238.

41.

Reynders

Kerkhof

A. J.

Molenberghs

Van Audenhove

2014. “Attitudes and Stigma in Relation to Help-seeking Intentions for Psychological Problems in Low and High Suicide Rate Regions.” Social Psychiatry and Psychiatric Epidemiology 49:231–39.

42.

Sacker

Head

Gimeno

Bartley

2009. “Social Inequality in Physical and Mental Health Comorbidity Dynamics.” Psychosomatic Medicine 71:763–70.

43.

Schomerus

Matschinger

Angermeyer

M. C.

2009. “The Stigma of Psychiatric Treatment and Help-seeking Intentions for Depression.” European Archives of Psychiatry and Clinical Neuroscience 259:298–306.

44.

Skorikov

V. B.

Vondracek

F. W.

2011. “Occupational Identity.” Pp. 693–714 in Handbook of Identity Theory and Research, edited by Schwartz

S. J.

Luyckx

Vignoles

V. L.

New York: Springer.

45.

Souza

R. C.

Silva

S. M.

Sousa Costa

M. L. A

. 2018. “Occupational Stress in Hospital Settings: Review of Coping Strategies of Nursing Professionals.” Revista Brasileira de Medicina do Trabalho 16:493–502.

46.

Tajfel

1978. Differentiation between Social Groups: Studies in the social psychology of intergroup relations. London, England: Academic Press.

47.

Tajfel

Turner

1979. “An Integrative Theory of Intergroup Conflict.” Pp. 33–47 in The Social Psychology of Intergroup Relations, edited by Williams

J. A.

Worchel

Belmont. CA: Wadsworth.

48.

Thu Pham

Viet Cao

Bich Le

Nguyen

N. T.-T.

Thi Ngoc Vuong N

Vu Dieu Pham

Thu Hoang

Thi Hanh Pham

Ngoc Nguyen

Thi Thu Bui

Van Tran

Thuy Vu

Thi Le

2023. “Depression, Anxiety and Stress among Healthcare Workers in the Context of the COVID-19 Pandemic: A Cross-sectional Study in a Tertiary Hospital in Northern Vietnam.” Frontiers in Public Health 11:1231326.

49.

Tran

T. T. T.

Nguyen

N. B.

Luong

M. A.

Bui

T. H. A.

Phan

T. D.

Tran

V. O.

Ngo

T. H.

Minas

Nguyen

T. Q.

2019. “Stress, Anxiety and Depression in Clinical Nurses in Vietnam: A Cross-sectional Survey and Cluster Analysis.” International Journal of Mental Health Systems 13:3.

50.

Van de Vijver

Hambleton

1996. “Translating Tests: Some Practical Guidelines.” European Psychologist 1:89–99.

51.

Vogel

D. L.

Wade

N. G.

Haake

2006. “Measuring the Self Stigma Associated with Seeking Psychological Help.” Journal of Counseling Psychology 53:325–37.

52.

Vogel

D. L.

Wade

N. G.

Hackler

A. H.

2007. “Perceived Public Stigma and the Willingness to Seek Counseling: The Mediating Roles of Self-stigma and Attitudes toward Counseling.” Journal of Counseling Psychology 54:40–50.

53.

Wills

T. A.

DePaulo

B. M.

1991. “Interpersonal Analysis of the Help-seeking Process.” Pp. 350–75 in Handbook of Social and Clinical Psychology: The Health Perspective, edited by Snyder

C. R.

Forsyth

New York: Pergamon Press.