Influence of a 3-week psychiatric training programme on attitudes toward mental illness in medical students

Physicians' and medical students' beliefs and attitudes toward psychotic disorders: A systematic review

OBJECTIVE

The aim of this study was to analyze physicians' and medical students' (MS) beliefs and attitudes toward people with psychotic disorders.

METHODS

This systematic review follows the PRISMA guidelines. It was conducted on 5 databases (Pubmed, PsycINFO, Pascal & Francis, Scopus and EMBASE) with a keyword string combining words for physicians' and students' professional status, attitudes toward people, and psychotic disorders. No limitations on publication dates were imposed.

RESULTS

This review includes 39 articles, among which quantitative studies are in the majority, and general practioners are mainly represented. Schizophrenia is the main condition used to illustrate psychotic disorders and measure stigmatizing attitudes. Physicians' and MS' beliefs toward people with psychotic disorders are mainly represented by dangerousness and unpredictability. They can be reinforced with socio-demographic criteria (age and female gender) or physicians' beliefs about the disease's etiology. The desire for social distance is higher toward patients with schizophrenia compared to other psychiatric disorders, and medical care could be impacted with a tendency to refer them at psychiatric specific care or to anticipate their difficulties and to modify their treatment plan. Stigma scores remain globally high during medical training. Even if specific anti-stigma trainings have a positive impact on beliefs and attitudes, these effects do not last in time.

CONCLUSION

This review highlights the importance to explore physicians' and medical students' representations about patient with psychosis to understand better their difficulties in the management of these patients.

Does the clerkship/internship in psychiatry affect medical students' level of knowledge about schizophrenia, attitudes, and beliefs toward schizophrenia and other mental disorders?

Undergraduate medical students' attitudes and beliefs toward mental illnesses are a crucial phenomenon as these students will be care providers of the future. The current study aimed to analyze whether the psychiatry clerkship/internship affects these students' level of knowledge about schizophrenia as well as their attitudes and beliefs toward schizophrenia and other mental illnesses. A total of 158 medical students, 92 in their fifth year and 66 in their sixth year, were included in the study. The participants completed the Knowledge About Schizophrenia Questionnaire (KASQ), Beliefs toward Mental Illness Scale (BMI), and Attitudes toward People with Mental Disorders Scale (APMDS) before and after the psychiatry clerkship/internship. The KASQ and APMDS total scores were significantly higher whereas BMI and BMI-Dangerousness subscale scores were significantly lower after the clerkship/internship in psychiatry. Postclerkship/internship KASQ total scores were negatively correlated with BMI total scores and BMI-Dangerousness subscale scores. Additionally, BMI total scores and APMDS total scores were also negatively correlated. Although the change in KASQ scores was significantly associated with the decrease in BMI total scores after the clerkship/internship, it was not associated with the increase in APMDS total score in the hierarchical multiple linear regression analysis. In conclusion, the present study revealed that knowledge about schizophrenia and attitudes and beliefs toward mental illnesses improved significantly after the clerkship/internship in psychiatry. While improvement in medical students' knowledge about schizophrenia and mental illnesses is a predictor of the decrease in negative beliefs about mental illnesses, a similar relationship was not found regarding attitudes. This study not only provides information about the relationship between knowledge about schizophrenia and attitudes and beliefs about mental illness but also highlights the need to consider the multifactorial nature of attitudes when developing intervention programs for medical students.

Public stigma of obsessive compulsive disorder and schizophrenic disorder: Is there really any difference?

A substantial delay for help-seeking is a serious problem for people with obsessive-compulsive disorder (OCD), a heterogeneous and debilitating mental health condition. Stigma is a major barrier to treatment seeking and further cause social and occupational impairment. Lack of comprehensive research led us to examine the public's stigmatizing attitudes towards checking, contamination, sexuality, aggression, and religion-related OCD symptoms, compared to schizophrenia. After reading one of six random case vignettes, 621 adults completed social distance scale. Analysis of Covariance or ANCOVA indicated that social distance towards violence and sexuality-related OCD symptoms and schizophrenia did not differ; but social distance for those was higher than religion, contamination, and checking subtypes. Although the contamination vignette did not differ from religion and checking vignettes, the theme of religion had a higher social distance than checking symptoms. Consequently, the current findings imply that there is a difference in public stigma among various symptoms of OCD and symptoms related to sexuality and violence, as well as schizophrenia, are associated with more social rejection. Thus, the general public needs access to educational methods of intervention and contact to eliminate stigma and improve the quality of life for people with mental health disorders.

Medical students' attitudes to mental illnesses and to psychiatry before and after the psychiatric clerkship: Training in a specialty and a general hospital

Medical students' attitudes to mental illnesses and psychiatry may be reshaped during the psychiatric training, with important implications in their future practice of the profession. Therefore, the present study set out to explore the impact of the psychiatric clerkship in students' attitudes, while taking into consideration the site of their practical training. To this end, a total of 678 final-year medical students were recruited. Students completed a self-reported questionnaire entailing the Attitudes to Psychiatry scale, the Attitudes to Mental Illness scale and the Greek Social Distance scale before and after their placement. Findings indicate that the psychiatric clerkship had a positive effect in reducing stigma towards both psychiatry and mental illnesses, with the effect being more pronounced in the general hospital with respect to the former, while in the specialty hospital was more marked regarding the latter. A further exploration of the determinants of change revealed that the improvement discerned in the general hospital was only among those without professional experience of mental illnesses. Therefore, the psychiatric clerkship may exert a substantial influence on shaping favourable attitudes towards mental illnesses and psychiatry; however, other elements should also be taken into consideration, if the clerkship is to tackle stigma in healthcare.

The differential effects of a focus on symptoms versus recovery in reducing stigma of schizophrenia

PURPOSE

We extend investigations of the impact of the content of video contact with an individual with schizophrenia on stigma reduction. We examine whether differential impacts persist over a 2-week period and the extent to which they are mediated by perceived similarity and feelings of empathy and/or sympathy.

METHOD

We used a randomized control trial wherein participants were exposed to a video in which an individual described his recovery from schizophrenia, or the same person described acute symptoms of schizophrenia, or a no-video control condition. Outcomes included impressions of and preferred social distance to the person in the video and people in general with schizophrenia and well as perceptions of similarity and feelings of sympathy and empathy. We also measured an overt behaviour, seating distance, at 2-week follow-up.

RESULTS

The recovery-focused material was generally more effective in improving impressions and reducing preferred level of social distance. Although the symptom-focused video resulted in great sympathy for the person, this did not translate into positive impressions or reduced social distance. Mediational analyses yielded findings consistent with the benefits of the recovery video being mediated by increased perceptions of similarity and lower feelings of sympathy. Exposure to the recovery-focused video resulted in less anxiety in anticipation of meeting the person in the video relative to the control condition.

CONCLUSIONS

Video contact emphasizing potential for recovery from schizophrenia was more effective in reducing stigmatizing responses than contact highlighting acute symptoms. Increased sympathy does not necessarily translate into reductions in stigma.

The Effect of Clinical Exposure to Patients on Medical Students' Attitude Towards Mental Illness

BACKGROUND

Stigma of mental disorders causes a reduction in seeking help from the health care professionals and is evident across the world.

OBJECTIVES

The current study aimed to compare medical students' attitude towards mental illness after two different psychiatry clerkships in terms of the level of clinical exposure to patients with mental illness.

PATIENTS AND METHODS

Through a quasi-experimental study, all of the 4^th-year medical students were invited to enroll this study conducted in Tehran University of Medical Sciences (TUMS). They were non-randomly assigned into two different psychiatry clerkships from January 2009 to January 2010. One group was enrolled in the traditional lecture-based course (low-exposure) while the second group participated in a novel method with increased hours of patient exposure (high-exposure). Attitude towards mental illness (AMI) was measured by a 22-item questionnaire before and after the clerkship and data were compared between the two groups in terms of changing attitude towards mental illness in five different categories.

RESULTS

A total of 211 participants were enrolled in the study (115 female) of which 115 students (54.5%) were in low-exposure group and 96 students (45.5%) in the high-exposure group. Generally, AMI scores did not differ between the two groups and did not show any significant changes before and after the psychiatry clerkship. The only exceptions to this were AMI4 category (the concept of etiology of the mental illness), which significantly improved after the clerkship in the low-exposure (P = 0.011) and the high-exposure groups (P = 0.024), respectively.

CONCLUSIONS

Exposure of medical students to patients with mental illness did not improve attitude towards mental illness and psychiatric conditions.

Stigmatising attitudes of undergraduates towards their peers with depression: a cross-sectional study in Sri Lanka

BACKGROUND

There is limited research examining mental health-related stigma of undergraduates in non-western developing countries. This study examined stigma of undergraduates in Sri Lanka towards another depressed undergraduate.

METHODS

A hypothetical vignette of an undergraduate suffering from depression was presented. A total of 4650 undergraduates responded to scales assessing their personal stigma towards and desire for social distance from this individual. Exploratory structural equation modelling (ESEM) was performed to determine the dimensionality and loading pattern of the items on these two stigma scales. Multiple linear regressions were used to explore correlates of the identified dimensions of stigma.

RESULTS

Previous findings that the Social Distance Scale forms a single dimension and that the Personal Stigma Scale consists of two dimensions were supported. However, the measurement structure of the dimensions of stigma on the latter scales, labelled 'Weak-not-Sick' and 'Dangerous-Undesirable' , differed from previous work. A high level of stigma in relation to the 'Weak-not-Sick' Scale was observed. However, some correlates associated with lower levels of stigma on this scale, such as being in the Medical Faculty, were associated with higher levels of stigma on the 'Dangerous-Undesirable' and 'Social Distance' scales. In contrast, labelling the problem as a mental health-related problem, with absence of specific psychiatric terminology, was associated with lower levels of stigma on these latter two scales. Exposure to a mental health problem in family or friends or from personal experience was also associated with lower stigma on the Social Distance Scale. However, the effect sizes of these relationships were small.

CONCLUSIONS

The findings highlight differences in the measurement structure and score distribution of the 'Weak-not-Sick' and 'Dangerous-Undesirable' scales when used in different cultural and demographic contexts. The dimensionality of stigma relevant to these scales must always be established prior to their use in different contexts. Furthermore, campaigns targeted at improving knowledge about depression as a real illness and as a psychiatric condition need to ensure that such attempts are not associated with increases in other aspects of stigma.

An assessment of attitudes towards people with mental illness among medical students and physicians in Ibadan, Nigeria

OBJECTIVE

The authors surveyed attitudes towards mental illness among Nigerian medical personnel at three different levels of training and experience: medical students who had not completed their psychiatry rotation, medical students who had competed their psychiatry rotation, and graduate physicians.

METHODS

Six questions addressed beliefs about the effectiveness of treatments for four specific mental illnesses (schizophrenia, bipolar disorder, depression, and anxiety) and two medical illnesses (diabetes and hypertension) among the three groups. A self-report questionnaire including 56 dichotomous items was used to compare beliefs about and attitudes towards people with mental illness. Factor analysis was used to identify key attitudes and analysis of covariance (ANCOVA) was used to compare the groups adjusting for age and personal experience with people with mental illness.

RESULTS

There were no significant trends in attitudes towards the effectiveness of medication. Exploratory factor analysis of the beliefs and attitudes items identified four factors: (1) comfort socializing with people with mental, illness; (2) non-superstitious beliefs about the causes of mental illness; (3) neighborly feelings towards people with mental illness; and (4) belief that stress and abuse are part of the etiology of mental illness. ANCOVA comparing attitudes among the three groups showed that on three (1, 2, and 4) of the four factors medical students who had completed a rotation in psychiatry had significantly higher scores than the medical students who had not completed a rotation in psychiatry. Graduate physicians showed a similar pattern scoring higher than the medical students who had not completed a rotation in psychiatry in two factors (1 and 4) but showed no differences from students who had completed their psychiatry rotation.

CONCLUSION

While beliefs about medication effectiveness do not differ between medical trainees and graduate professionals, stigmatizing attitudes towards people with mental illness seem to be most strongly affected by clinical training. Psychiatric education and especially clinical experience result in more progressive attitudes towards people with mental illness.

"Social dangerousness and incurability in schizophrenia": results of an educational intervention for medical and psychology students

This study explored the influence of an educational intervention addressing common prejudices and scientific evidence about schizophrenia on medical and psychology students' views of this disorder. The intervention--consisting in two three-hour lessons with an interval of a week between--was run at first for medical students and then for psychology students. Participants' views of schizophrenia were assessed at baseline vs. at post intervention by matched questionnaires. At medical school, participation was voluntary and also included a six-month online re-assessment, while at psychology school, participation was mandatory. A total of 211 students attended the educational initiative. At post intervention assessment, students more frequently mentioned psychosocial causes of schizophrenia, and more firmly believed that recovery in schizophrenia is possible and that persons with this disorder are not unpredictable and dangerous vs. their baseline assessment. The online six-month assessment confirmed favourable changes in medical students' views found at post intervention. These results confirm that an educational intervention including personal experiences and scientific evidence can be successful in reducing students' prejudices toward persons with schizophrenia.

Attitudes toward mental illness and changes associated with a brief educational intervention for medical and nursing students in Nigeria

OBJECTIVE

This study assessed beliefs about mental disorders and changes in those beliefs following an educational intervention for a convenience sample of Nigerian medical and nursing students.

METHODS

A 43-item questionnaire was used to assess perceptions regarding mental disorders and attitudes toward people with mental illness before and after a 4-day educational intervention.

RESULTS

Factor analysis identified four domains: (1) socializing with people with mental illness, (2) belief in witchcraft or curses as causes of mental illness, (3) favorable attitudes toward normalization of the lives of people with mental illness, and (4) biopsychosocial approaches to mental illness. The greatest changes were in attitudes favoring normalization of the lives of people with mental illness (p = 0.0002), socializing with the mentally ill (p = 0.01), and biopsychosocial perspectives on mental illness (p = 0.01).

CONCLUSION

Brief educational interventions may alter some stigmatizing negative attitudes toward mental illness in healthcare trainees in low- and middle-income countries.

Impact of the psychiatry clerkship on medical student attitudes towards psychiatry and to psychiatry as a career

OBJECTIVE

The psychiatry clerkship forms part of the core curriculum of medical schools worldwide and provides psychiatric educators with an ideal opportunity to positively influence students. The aim of this paper is to systematically review literature on the impact of the psychiatry clerkship to determine the effect on attitudes towards psychiatry and to psychiatry as a career.

METHOD

A systematic review was undertaken. The following key search words were used to search a number of electronic databases: medical student/s, attitude/s, psychiatry and clerkship. Studies published in the English language from 1990 to the present were included. Studies were included if they were based on a pre-/post-design, i.e. the same students must have participated in the study both before and after the clerkship.

RESULTS

Twenty-six studies from 19 countries were identified for the review. Sixteen studies reported an overall improvement in attitudes towards psychiatry post-clerkship, and ten found no change in attitudes. In terms of career choice, nine studies reported an increase in the number of students interested in psychiatry as a career post-clerkship, nine found no impact on career choice and, in eight studies, it was not assessed. A number of positive and negative factors regarding the clerkship were identified.

CONCLUSION

Overall, the psychiatry clerkship has a positive impact on students' attitudes towards psychiatry, but does not improve interest in psychiatry as a career option. For those students particularly interested in psychiatry, the challenge is to maintain their enthusiasm post-clerkship. Charismatic teachers, mentorship and stigma reduction may be effective strategies. Future research needs to more clearly identify specific components of the clerkship that are viewed favorably by students.

Mental health consumers and caregivers as instructors for health professional students: a qualitative study

PURPOSE

The purpose of this study was to explore the self-reported effect of consumer and caregiver-led education for pharmacy students and to explore the goals, challenges and benefits of mental health consumer educators providing education to health professional students.

METHODS

Five focus groups (mean duration 46 min, SD 22 min) were held with 23 participants (11 undergraduate pharmacy students, 12 mental health consumer educators) using semi-structured interview guides. The focus groups were digitally audio-recorded, transcribed verbatim and thematically content analyzed using a constant comparison approach.

RESULTS

Three major themes emerged from the data; raising awareness about mental health, impact on professional practice and impact on mental health consumers. The students reported decreased stigma, improved attitudes toward mental illness and behavior changes in their professional practice. The primary reason for becoming an educator was to raise awareness and reduce mental health stigma. However, educators also benefited personally through empowerment, improved confidence and social skills.

CONCLUSION

Providing students the opportunity to have contact with consumers with a mental illness in a safe, educational setting led to decreases in stigma, the fostering of empathy and self-reported behavior changes in practice. Sharing personal stories about mental illness is a powerful tool to decrease mental health stigma and may be an important aspect of a person's recovery from mental illness. Contact with mental health consumers in an educational setting is recommended, particularly for future health care professionals. Appropriate training and support of consumers is crucial to ensure the experience is positive for all involved.

Stigma toward schizophrenia among parents of junior and senior high school students in Japan

Background

Stigma toward schizophrenia is a substantial barrier to accessing care and adhering to treatment. Provisions to combat stigma are important, but in Japan and other developed countries there are few such provisions in place that target parents of adolescents. The attitudes of parents are important to address as first schizophrenic episodes typically occur in adolescence. In overall efforts to develop an education program and provisions against stigma, here we examined the relationship between stigma toward schizophrenia and demographic characteristics of parents of junior and senior high school students in Japan. The specific hypothesis tested was that contact and communication with a person with schizophrenia would be important to reducing stigma. A questionnaire inquiring about respondent characteristics and which included a survey on stigma toward schizophrenia was completed by 2690 parents.

Results

The demographic characteristics significantly associated with the Devaluation- Discrimination Measure were family income, occupation, presence of a neighbor with schizophrenia, and participation in welfare activities for people with mental illness (p < 0.05). The mean ± SD score was 32.74 ± 5.66 out of a maximum of 48 points on the Link Devaluation-Discrimination Measure.

Conclusions

Stigma toward schizophrenia among parents of junior and senior high school students was in fact significantly stronger among members of the general public who had had contact with individuals with schizophrenia. In addition, stigma was associated with family income.

Reducing stigma and discrimination: Candidate interventions

This paper proposes that stigma in relation to people with mental illness can be understood as a combination of problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). From a literature review, a series of candidate interventions are identified which may be effective in reducing stigmatisation and discrimination at the following levels: individuals with mental illness and their family members; the workplace; and local, national and international. The strongest evidence for effective interventions at present is for (i) direct social contact with people with mental illness at the individual level, and (ii) social marketing at the population level.

Does stigma concerning mental disorders differ through medical education? A survey among medical students in Istanbul

BACKGROUND

Stigma and discrimination toward mentally disabled persons might exist within the medical environment and may form a barrier for patients to receive appropriate care. The aim of this study is to determine the attitudes of medical students toward mentally disabled people and to understand the impact of schooling on attitude difference by evaluating second and sixth year medical students.

METHOD

The study was carried out among 452 students from the all the three public medical schools located in Istanbul, Turkey. Attitudes were assessed through a Likert scale by presenting vignettes for depression and schizophrenia.

RESULTS

In both men and women, the scores of last year students for depression and schizophrenia scales were better compared with those of the second graders, and the differences were statistically significant (p<0.05). However, the proportion of students who did not perceive schizophrenia as "temporary" and "curable" and the perceived likelihood of dangerousness for schizophrenia were higher among the last year students compared with the second graders.

CONCLUSION

As a result of this study, it was determined that last year students had improved attitudes toward the mentally ill; however, they still had striking stigmatizing opinions and judgments. The improvement in the attitude score between the second and the sixth graders is considered a result of the students' contact and interaction with persons having mental disorders throughout their medical education. The challenge is to maintain a social environment that aims to reduce the distance between the patient and the medical staff through introducing a holistic approach in medical schools.