AIMS: To measure the stigma of healthcare providers toward people suffering from mental illness, the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a commonly applied instrument. However, this scale has not been thoroughly validated in many European countries, its psychometric properties are still unknown and data on practicing psychiatrists is lacking. Therefore, this multicenter study aimed to assess the psychometric characteristics of the 15-item OMS-HC in trainees and specialists in adult and child psychiatry in 32 countries across Europe. MATERIALS AND METHODS: The OMS-HC was conducted as an anonymous online survey and sent via Email to European adult and child psychiatrists. Parallel analysis was used to estimate the number of OMS-HC dimensions. Separate for each country, the bifactor ESEM, a bifactor exploratory structural equation modeling approach, was applied to investigate the factor structure of the scale. Cross-cultural validation was done based on multigroup confirmatory factor analyses and reliability measures. RESULTS: A total of 4,245 practitioners were included, 2,826 (67%) female, 1,389 (33%) male. The majority (66%) of participants were specialists, with 78% working in adult psychiatry. When country data were analyzed separately, the bifactor model (higher-order factor solution with a general factor and three specific factors) showed the best model fit (for the total sample χ2/df = 9.760, RMSEA = 0.045 (0.042-0.049), CFI = 0.981; TLI = 0.960, WRMR = 1.200). The average proportion of variance explained by the general factor was high (ECV = 0.682). This suggests that the aspects of 'attitude,' 'disclosure and help-seeking,' and 'social distance' could be treated as a single dimension of stigma. Among the specific factors, the 'disclosure and help-seeking' factor explained a considerable unique proportion of variance in the observed scores. CONCLUSION: This international study has led to cross-cultural analysis of the OMS-HC on a large sample of practicing psychiatrists. The bifactor structure displayed the best overall model fit in each country. Rather than using the subscales, we recommend the total score to quantify the overall stigmatizing attitudes. Further studies are required to strengthen our findings in countries where the proposed model was found to be weak.

Acute Detoxification Ward State Psychiatric Hospital for Treatment of Drug Addiction and Alcoholism Sofia Bulgaria

Acute Psychiatric Department 1 Psychiatric Hospital Michalovce Michalovce Slovakia

Admission Ward State Psychiatric Hospital Gintermuiza Jelgava Latvia

Centre for Clinical Psychiatry University Psychiatric Clinic Ljubljana Ljubljana Slovenia

Centro de Investigacion Biomedica en Red de Salud Mental Instituto de Salud Carlos 3 Barcelona Spain

Child and Adolescent Psychiatry Sultanbeyli State Hospital Istanbul Türkiye

Child Psychiatry Unit University Children's Hospital University Medical Centre Ljubljana Ljubljana Slovenia

Coimbra Institute for Biomedical Imaging and Translational Research Coimbra Portugal

Department for Child Psychiatry Clinical Centre of Montenegro Institute for Children's Diseases Podgorica Montenegro

Department of Child and Adolescent Psychiatry Capital Region of Denmark Copenhagen Denmark

Department of Child and Adolescent Psychiatry EPSM du Finistère Sud Quimper France

Department of Clinical Psychology Ukrainian Catholic University Lviv Ukraine

Department of General Adult Psychiatry South Meath Mental Health Service Meath Ireland

Department of Medical and Surgical Sciences University Magna Græcia of Catanzaro Catanzaro Italy

Department of Mental Health Heim Pál National Pediatric Institute Budapest Hungary

Department of Neuroscience University Hospital Center Mother Theresa Tirana Albania

Department of Personality and Health Psychology Károli Gáspár University of the Reformed Church Budapest Hungary

Department of Psychiatry Aladar Petz County Teaching Hospital Győr Hungary

Department of Psychiatry and Psychological Medicine Division of Child and Adolescent Psychiatry and Psychotherapy University Hospital Centre Zagreb Zagreb Croatia

Department of Psychiatry and Psychotherapy Semmelweis University Budapest Hungary

Department of Psychiatry Erasmus University Medical Center Rotterdam Netherlands

Department of Psychiatry United City Hospital N15 Baku Azerbaijan

Department of Psychiatry University of Ioannina Ioannina Greece

Department of Psychiatry Vrije Universiteit Brussel Brussels Belgium

Department of Psychology Illinois Institute of Technology Chicago IL United States

Department of Urgent and Post Urgent Psychiatry CHU Montpellier Montpellier France

Division of Medical Psychology 3rd Faculty of Medicine Charles University Prague Czechia

Division of Medical Psychology Psychosomatics and Psychotherapy Medical University of Graz Graz Austria

FIDMAG Germanes Hospitalàries Research Foundation Barcelona Spain

Freelancer Larnaca Cyprus

Hospital Benito Menni Complex Assistencial Salut Mental Sant Boi de Llobregat Spain

Inpatient Psychiatric Department 2 Psychiatric Clinic of Minsk City Minsk Belarus

Institute of Behavioural Sciences Semmelweis University Budapest Hungary

Institute of Functional Genomics University of Montpellier CNRS INSERM Montpellier France

Institute of Mental Health Belgrade Serbia

Institute of Psychological Medicine Faculty of Medicine University of Coimbra Coimbra Portugal

Klinikum rechts der Isar der Technischen Universität München Klinik und Poliklinik für Psychiatrie und Psychotherapie Technische Universität München Munich Germany

Mental Health Services Mount Carmel Hospital Attard Malta

Pennine Care NHS Foundation Trust Oldham United Kingdom

Psychiatric Clinic Faculty of Medicine Institute of Clinical Medicine Vilnius University Vilnius Lithuania

Psychiatric Hospital Littenheid Sirnach Switzerland

Psychiatry Department Centro Hospitalar e Universitário de Coimbra Coimbra Portugal

The Serbsky State Scientific Center for Social and Forensic Psychiatry Moscow Russia

University of Tartu Tartu Estonia

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Attitudes of psychiatrists towards people with mental illness: a cross-sectional, multicentre study of stigma in 32 European countries