Attitudes of hospital staff toward mentally ill patients in a teaching hospital, Turkey

[Stigmatisation of patients with mental disorders by medical interns specialising in general practice: A national survey]

OBJECTIVES

The objective was to assess the level of stigmatisation of psychiatric patients by medical interns specialising in general practice (GP), and to assess the influencing factors of stigmatisation.

METHODS

A national survey was carried out among interns in general practice (GP) contacted through their local associations from December 10, 2019 to March 9, 2020. An online questionnaire was diffused. The validated French version of the Mental Illness Clinicians' Attitudes (MICA) was used to measure stigmatising attitudes towards psychiatry and persons with psychiatric disorder by the interns. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness with scores ranging from 16 to 96 (the most stigmatizing). Several covariates were collected: socio-demographics, personal experiences with mental health, and mental health trainings during medical studies. All questionnaires were strictly anonymized. Comparative analyses of the MICA score by group were performed using Student's tests.

RESULTS

A total of 389 interns responded. The majority of respondents were female (n=277; 71%) and the mean age was 27years [standard deviation (SD)±2.39]. The mean MICA rate was 40.64 (SD±8.09) for a neutral score of 56, reflecting low overall stigmatizing attitudes. MICA scores were significantly lower among female interns (40.11 vs. 41.95; P=0.042), those who had benefited from personal psychological or psychiatric support (38.70 vs. 41.61; P=0.001), and those who had completed a psychiatric externship (39.47 vs. 42.16; P=0.001).

CONCLUSIONS

GP interns had an attitude that is generally not very stigmatizing even if its improvement should still be sought. This is particularly verified among those who have completed a psychiatric internship during their externship. This suggested association should be supported by other studies. The stakes are high for the future management of patients since stigmatisation by a physician is strongly implied in the worse healthcare management of patients with psychiatric disorders, leading them to a shorter lifespan.

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.

The effect of mental health training on the knowledge of common mental disorders among medical officers in primary health centres in rural Karnataka

Background

Deficits in knowledge regarding identification and treatment of common mental disorders (CMD) and stigmatizing attitudes towards CMDs exist among primary care physicians in India.

Objectives

We aimed to assess the gain in knowledge of CMDs among primary health centre (PHC) doctors, after they underwent training in the identification and treatment of CMDs, and to assess the relationship between the gain in knowledge and demographic variables. We also assessed attitudes towards depression among PHC doctors who underwent training.

Methods

We assessed knowledge of CMDs among 38 PHC doctors before and after training using a multiple-choice questionnaire (MCQ). The training session included didactic teaching and case-based discussions.

Results

The post-test mean score was significantly higher compared to the pre-test mean score (P < 0.0001), indicative of a significant mean gain in knowledge of CMDs among PHC doctors following training. Significant improvements were noted on the questions assessing identification of CMDs, knowledge of depressive symptoms and identification of panic attacks, post-training (all P < 0.05). Participants with lower pre-test scores had greater improvements in knowledge post-training. Around half of the PHC doctors endorsed negative attitudes towards depression.

Conclusions

We demonstrated the efficacy of a training programme for PHC doctors in improving their knowledge of CMDs. Stigmatizing attitudes towards depression were present among around half the PHC doctors even after the training. This has implications for the strategy of integrating mental healthcare into primary care, with the overall goal of reducing the treatment gap for CMDs.

What Do Nursing Students Tell Us About Their Communication With People With Mental Illness? A Qualitative Study

BACKGROUND

Communication with individuals with mental disorder (IMDs) may often be a nonlinear, complex, and variable situation. In general, the first contact of nurses with IMDs occurs during training rotations at a psychiatric clinic. Psychiatric nursing students' initial communication experiences with IMDs may be critical to their thinking of psychiatric nursing as a career.

AIM

To determine the communication experiences of psychiatric nursing students with IMDs.

METHOD

A qualitative interview study was conducted with psychiatric nursing students studying at a nursing faculty in the east of Turkey in 2019 who completed the clinical practice. Semistructured interviews were conducted by an independent researcher. The data were analyzed using content analysis with an inductive approach.

RESULTS

In this study, maximum effort was made for data saturation criteria, and data saturation was achieved with 26 students. As a result of the data analysis, four main themes and 11 categories were developed. The main themes were as follows: (1) restrictions caused by psychological barriers, (2) restrictions caused by thinking and perceptions, (3) restrictions caused by personal and behavioral barriers, and (4) effective communication and therapeutic environment.

CONCLUSIONS

In this study, although it is seen that nursing students encounter many communication barriers with IMDs, it is an important development that they implement approaches to provide effective therapeutic communication. The results show the importance of effective nurse-patient communication skills as the first step in improving the clinical practice of nurses in psychiatry clinics.

Nurses' and Mental Health Technicians' Attitudes and Social Acceptance of People with Mental Illness

Over 43 million Americans are diagnosed with a mental illness. Various factors, including health professionals' attitudes, prevent patients from seeking care. Previous evidence fails to identify nursing staff attitudes toward patients with mental illness. This cross-sectional study investigated attitudes toward mental illness of 146 registered nurses and mental health technicians in a psychiatric hospital. The study was guided by the Modified Labeling Theory. Respondents expressed stereotyping beliefs that people with mental illness would be devaluated and discriminated, and endorsed stigmatizing attitudes expressing stronger desire for social distance from a person with schizophrenia than depression or diabetes. Implications for future research, nursing education and practice are discussed.

Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial

This study evaluated the impact of didactic videos and service user testimonial videos on mental illness stigma among medical students. Two randomized controlled trials were conducted in Nepal. Study 1 examined stigma reduction for depression. Study 2 examined depression and psychosis. Participants were Nepali medical students (Study 1: n = 94, Study 2: n = 213) randomized to three conditions: a didactic video based on the mental health Gap Action Programme (mhGAP), a service user video about living with mental illness, or a control condition with no videos. In Study 1, videos only addressed depression. In Study 2, videos addressed depression and psychosis. In Study 1, both didactic and service user videos reduced stigma compared to the control. In Study 2 (depression and psychosis), there were no differences among the three arms. When comparing Study 1 and 2, there was greater stigma reduction in the service user video arm with only depression versus service user videos describing depression and psychosis. In summary, didactic and service user videos were associated with decreased stigma when content addressed only depression. However, no stigma reduction was seen when including depression and psychosis. This calls for considering different strategies to address stigma based on types of mental illnesses. ClinicalTrials.gov identifier: NCT03231761.

Health workers' attitude towards children and adolescents with mental illness in a teaching hospital in north-central Nigeria

Objective: Public stigma against mental illness is well studied. However, there is a dearth of research into health workers' attitude towards children and adolescents with mental illness, especially in low- and middle income countries such Nigeria. Methods: A cross-sectional study was conducted among 395 health workers in a Teaching Hospital in North-Central Nigeria. Participants were selected by random sampling from clinical and non-clinical departments. Participants completed questionnaires to assess stigma, knowledge, personal contact, previous training, and exposure to religious teaching on child and adolescent mental illness (CAMI). Results: The response rate was 90%. Many health workers (42%) indicated that affected children should not play with other children, 38% would feel ashamed if a child in their family had mental illness, 42% would be concerned if their child sat with an affected child, and 27% would be afraid to speak to a child or adolescent with mental illness. Independent predictors of negative attitudes were: poor knowledge, exposure to religious teaching that affected children are possessed or dangerous, and being from a non-medical professional group. Conclusion: CAMI is stigmatised by health workers in this specialist Hospital in Nigeria. Urgent intervention is required to avoid adverse impact on affected children.

Nonpsychiatric Healthcare Professionals' Attitudes Toward Patients with Mental Illnesses in Makkah City, Saudi Arabia: A Cross-Sectional Study

PURPOSE

Most patients exhibiting psychiatric manifestations often remain undetected, misdiagnosed, and inappropriately managed. This cross-sectional study aims to ascertain the level of knowledge of mental illnesses among nonpsychiatric healthcare workers and their attitudes toward patients with mental illness in Makkah, Saudi Arabia.

PATIENTS AND METHODS

A cross-sectional study was conducted in four public hospitals in Makkah from November 2017 to February 2018. A total of 407 participants were involved. A self-reported structured questionnaire was used, and data were collected electronically.

RESULTS

Of 407 respondents, 183 (45%) were females and 244 (55%) were males. The majority of respondents were physicians with medical specialties 116 (28.5%), followed by physicians with surgical specialties 99 (24.3%). More than half 229 (56.3%) of the respondents had work experience of >10 years. Although 128 (31.4%) of the participants lacked adequate knowledge of mental illnesses, only 104 (25.6%) had relevant knowledge.154 (37.8%) respondents displayed favorable (good) attitude, whereas 82 (44.7%) displayed an unfavorable (poor) attitude toward mentally ill patients.

CONCLUSION

The study revealed that nearly one-fourth of the participants appear to have adequate knowledge of mental disorders. However, 44.7% have an unfavorable attitude toward patients with mental illnesses. Hence, respondent professionals markedly correlated with both knowledge and attitude toward patients with mental illnesses, and the positive attitude strongly correlated with having adequate knowledge.

Public attitudes towards depression and schizophrenia in an urban Turkish sample

Stigma towards mental illness influences help-seeking behavior and prevents individuals with a mental illness from seeking the appropriate treatment for their condition. In Turkey, a shift from inpatient psychiatric mental health care towards a community-based, low-threshold system highlights the importance of understanding public attitudes towards the mentally ill. This study aims to underpin developments in mental health care through culturally sensitive research. Public stigma towards schizophrenia and depression is examined for the first time simultaneously in a community sample. Unlabeled case vignettes of either schizophrenia or depression as well as an assessment of mental illness attribution and the desire for social distance (SDS) were presented to an urban Turkish sample (N = 295). Analysis of variance revealed that attribution to mental illness determines significant levels of stigma for schizophrenia, however not for depression. Furthermore, desire for social distance (SDS) was significantly higher for the schizophrenia condition compared to depression. Depression and schizophrenia evoke different reactions within the Turkish population, specifically the attribution to mental illness increases stigma. This finding is discussed in light of the contact hypothesis, and furthermore contextualized within literature on familiarity with depression symptoms on the one hand, and perceived dangerousness and symptom severity of schizophrenia on the other hand. Implementation of timely and culturally sensitive adapted interventions within the ongoing reform of the Turkish mental health care system is recommended.

General Medical Clinicians' Attitudes Toward People with Serious Mental Illness: A Scoping Review

Individuals with serious mental illness (SMI) experience significant premature mortality due to somatic conditions but often receive sub-optimal somatic care, but little research has been done to understand how general medical clinicians' attitudes may affect care provision or health outcomes. This review describes general medical clinicians' attitudes toward people with SMI, compares these attitudes to attitudes among mental health clinicians or toward individuals without SMI, and examines the relationship between attitudes and clinical decision making. Seventeen studies were reviewed. General medical clinicians reported negative attitudes toward individuals with SMI. These attitudes were generally more negative than attitudes among mental health clinicians and were consistently more negative when compared to attitudes toward individuals without SMI. Four studies suggest that these negative attitudes have an adverse effect on clinician decision making.

Exploring the relationships among personality traits, burnout dimensions and stigma in a sample of mental health professionals

A sample of mental health professionals (n = 215) from six Community Mental Health Services was examined using a short version of the Attribution Questionnaire-27, the Maslach Burnout Inventory and the Ten Items Personality Inventory to detect possible associations among stigma, burnout dimensions and personality traits. The role of demographic and professional variables was also explored. Perception of workplace safety resulted to significantly affect attitudes toward patients. The concern about being assaulted and a low level of Personal Accomplishment were both related to avoidant attitudes, while the presence of procedures for managing the violent patient was associated with a higher level of Personal Accomplishment. Conversely, Emotional Stability and Openness to new experiences were inversely correlated with burnout dimensions and avoidant attitudes, respectively. Overall, our study supports the view of a significant association among some dimensions of stigma, burnout and personality factors. In particular, avoidant attitudes toward patients may be influenced by Personal Accomplishment and Openness to new experiences.

Knowledge and Attitudes Towards Clinical Depression among Community Medical Providers in Gujarat, India

There is limited data on how community medical providers in India attempt to diagnose and treat depression, as well as on their general knowledge of and attitudes toward depression. A cross-sectional survey was conducted assessing knowledge and views of clinical depression with 80 non-psychiatric physicians and physician trainees recruited from community clinics and hospitals in Gujarat, India. Interviews were also held with 29 of the physicians to assess what they do in their own practices in regards to detection of and treatment of clinical depression. Although subjects showed a generally good basic understanding of the definition of clinical depression and its treatment, their responses reflected the presence of some negative and/or stigmatized attitudes toward clinical depression. Our findings raise the question of possible stigma among physicians themselves and underscore the importance of combatting physicians' stigma against and increasing awareness of how to detect and treat clinical depression.

The first clinical practice experiences of psychiatric nursing students: A phenomenological study

OBJECTIVE

The purpose of this study was to evaluate student nurses clinical experiences during their first clinical contacts with psychiatric patients by using a qualitative phenomenological approach.

DESIGN

A phenomenological approach was used. Face-to-face interviews were conducted to collect data focusing on the reality of student nurses' experience.

SETTINGS

This study was conducted at a university in the capital city of Turkey.

PARTICIPANTS

The participants were undergraduate nursing students. A purposive sampling of 15 students who had completed their first psychiatric clinical practicum was used in this study.

METHODS

The data were collected by using unstructured interviews. The data were analysed by using Colaizzi's seven-step phenomenological method.

RESULTS

Four themes were identified: theoretical information insufficient to break the stigma; breaking down the mental illness stigma; communication: the medication of mental illness; and personal development.

CONCLUSION

At the end of clinical practice, stigma towards mental illness was reduced with empathy through the development of therapeutic relationships. The students stated that communication had a very important place in the treatment of mental illnesses and that psychiatric clinical practice helped them develop interpersonal relations. The results of this study can provide guidance for educators on the planning and development of clinical education.

Atitudes dos trabalhadores de saúde mental em relação aos pacientes psiquiátricos em uma cidade do interior do Estado do Rio de Janeiro

Resumo Introdução Existem poucos estudos acerca da avaliação das atitudes dos trabalhadores em saúde mental em relação aos indivíduos com transtornos mentais no Brasil, principalmente em cidades de médio e pequeno porte. Portanto, foi conduzido um estudo seccional para avaliar as atitudes dos profissionais de saúde mental que trabalham em uma pequena cidade do interior do Estado do Rio de Janeiro. Método Foram avaliados 155 trabalhadores em saúde mental do município de Carmo, em novembro de 2015, utilizando a escala Community Attitudes Toward Mentally Ill (CAMI-BR). A CAMI tem quatro subescalas: Autoritarismo, Benevolência, Restrição Social e Ideologia de Saúde Mental Comunitária. Resultados Os trabalhadores, na sua maioria, apresentaram atitudes positivas para com os pacientes psiquiátricos. A subescala que teve pontuação mais alta foi Benevolência, seguida por Ideologia Comunitária, enquanto Restrição Social e Autoritarismo obtiveram as pontuações mais baixas. As variáveis que tiveram associação significativa com as atitudes positivas foram: faixa etária, categoria profissional e nível educacional. As pessoas mais jovens e com mais anos de estudo foram as que mostraram atitudes mais positivas. Os Cuidadores apresentaram atitudes mais negativas quando comparados às outras categorias. Conclusão Embora ainda persistam algumas atitudes autoritárias no cuidado dos pacientes psiquiátricos, os trabalhadores de Carmo têm atitudes positivas relacionadas às pessoas com transtorno mental e sua inclusão na comunidade, o que fortalece a implementação das reformas da assistência psiquiátrica no município.

Stigma toward psychosis and its formulation process: prejudice and discrimination against early stages of schizophrenia

BACKGROUND

Stigma toward psychosis can prevent social attendance and help-seeking behavior. Early detection and intervention has been shown to improve patient outcome in schizophrenia. The aim of this study was to reveal the characteristics and formulation process of stigma toward each clinical stage of schizophrenia, taking people's backgrounds into consideration.

METHODS

The participants consisted of three groups: general public, patients with mental illness, and psychiatric professionals. We performed a survey examining stigmas toward people with psychotic-like-experiences (PLE), at-risk mental state for psychosis (ARMS), schizophrenia, or depression. Prejudice was measured using a 21-item questionnaire, and discrimination was measured using the Social Distance Scale.

RESULTS

The participants consisted of 149 people from the general public, 97 patients, and 119 psychiatric professionals. Generally, a similar pattern was observed among the groups in which prejudice and discrimination against PLE was mildest, followed by that against ARMS and depression, and finally schizophrenia. When the stigma of the general public was compared with that of psychiatric professionals, the prejudice and discrimination against PLE of the general public were both lower than those of the psychiatric professionals. However, the prejudice of the general public was stronger than that of the professionals for ARMS. Furthermore, the discrimination of the general public was stronger than that of the professionals for schizophrenia.

CONCLUSIONS

The stigmas of mental illness differed according to the clinical stage, although the pattern of severity was similar among the three groups. A formulation process is suggested in which stigma toward schizophrenia develops from an attitudinal property (prejudice) against ARMS and a behavioral property (discrimination) against schizophrenia.

The Variability of Nursing Attitudes Toward Mental Illness: An Integrative Review

Mental illnesses are common worldwide, and nurses' attitudes toward mental illness have an impact on the care they deliver. This integrative literature review focused on nurses' attitudes toward mental illness. Four databases were searched between January 1, 1995 to October 31, 2015 selecting studies, which met the following inclusion criteria: 1) English language; and 2) Research in which the measured outcome was nurses' attitudes toward mental illness. Fourteen studies conducted across 20 countries that 4282 participants met the inclusion criteria. No study was conducted in the United States (U.S.). Studies reported that nurses had mixed attitudes toward mental illness, which were comparable to those of the general public. More negative attitudes were directed toward persons with schizophrenia. Results indicate the need for further research to determine whether attitudes among nurses in the U.S. differ from those reported from other countries and to examine potential gaps in nursing curriculum regarding mental illness.

Personnel attitudes toward people with mental illness at a psychiatric hospital in Taiwan

BACKGROUND

The attitudes of psychiatric hospital personnel are critically related to the quality of mental health care, but few studies have investigated this issue.

AIMS

This study is aimed at an exploration of the attitudes of psychiatric hospital personnel toward people with mental illness and at an examination of the associated factors.

METHOD

A self-report questionnaire, the Mental Illness Attitude Scale (MIAS), was used to collect data from psychiatric hospital personnel in Taiwan (n = 290). The MIAS included 46 items and 4 dimensions: acceptance, rehabilitation and prognosis, social distance and recommendations for interventions.

RESULTS

Rehabilitation and prognosis had the highest item average scores (4.03) and social distance had the lowest item average scores (3.22). Stigmatization and the number of different types of contacted clients were two significantly associated attitude factors.

CONCLUSION

Psychiatric hospital personnel in Taiwan tend to have positive attitudes toward people with mental illness in general situations but hold less positive attitudes in terms of community integration-related issues and intimate relationships. More evidence-based community services should be conducted to decrease personnel concerns about the successful community integration of those who are mentally ill. Future studies can investigate the concept and impact of stigmatization more deeply.

Cross-National Analysis of Beliefs and Attitude Toward Mental Illness Among Medical Professionals From Five Countries

This quantitative study sought to compare beliefs about the manifestation, causes and treatment of mental illness and attitudes toward people with mental illness among health professionals from five countries: the United States, Brazil, Ghana, Nigeria, and China. A total of 902 health professionals from the five countries were surveyed using a questionnaire addressing attitudes towards people with mental illness and beliefs about the causes of mental illness. Chi-square and analysis of covariance (ANCOVA) were used to compare age and gender of the samples. Confirmatory factor analysis was employed to confirm the structure and fit of the hypothesized model based on data from a previous study that identified four factors: socializing with people with mental illness (socializing), belief that people with mental illness should have normal roles in society (normalizing), non-belief in supernatural causes (witchcraft or curses), and belief in bio-psycho-social causes of mental illness (bio-psycho-social). Analysis of Covariance was used to compare four factor scores across countries adjusting for differences in age and gender. Scores on all four factors were highest among U.S. professionals. The Chinese sample showed lowest score on socializing and normalizing while the Nigerian and Ghanaian samples were lowest on non-belief in supernatural causes of mental illness. Responses from Brazil fell between those of the U.S. and the other countries. Although based on convenience samples of health professional robust differences in attitudes among health professionals between these five countries appear to reflect underlying socio-cultural differences affecting attitudes of professionals with the greater evidence of stigmatized attitudes in developing countries.

Mental health professionals' attitudes toward patients with PTSD and depression

BACKGROUND

To date, mental health professionals' attitudes toward posttraumatic stress disorder (PTSD), compared to other psychiatric disorders such as schizophrenia or depression, have rarely been studied.

OBJECTIVE

We assessed mental health professionals' attitudes toward patients with PTSD compared to patients suffering from depression.

METHOD

Case vignettes of a patient with either PTSD or depression were presented to two samples of mental health professionals: attendees of a conference on posttraumatic stress (N=226) or of a lecture for psychiatry residents (N=112). Participants subsequently completed a questionnaire that assessed their attitude reactions to the presented case.

RESULTS

Participants showed similarly positive attitudes toward depression and PTSD. PTSD elicited a more favorable attitude with regard to prosocial reactions, estimated dependency, attributed responsibility, and interest in the case, particularly in mental health professionals specializing in psychotraumatology. Across diagnoses, higher age and longer professional experience were associated with more positive attitudes toward patients.

CONCLUSIONS

Mental health professionals' positive attitudes toward patients with depression and PTSD correlate with their specific knowledge about the disorder, their level of professional training, and their years of professional experience.

LIMITATIONS

The instruments used, although based on established theoretical concepts in attitude research, were not validated in their present versions.

The phenomenon of co-morbid physical and mental illness in acute medical care: the lived experience of Australian health professionals

Background

An estimated 30–50% of patients admitted to acute medical care settings experience co-morbid physical and mental illness. Research suggests that health professionals in these settings find managing this patient group challenging. A number of studies have investigated health professional’s attitudes and perceptions however there is limited research that investigates the lived experience in a current Australian healthcare context. The aim of this study was to explicate an in-depth description of the health professional’s experience when caring for patients experiencing co-morbid physical and mental illness in Australian acute medical care settings.

Methods

A phenomenological design was undertaken with six participants representing nursing and medical disciplines. In 2013–2014 one-on-one semi-structured interviews were used and the data collected underwent thematic analysis using an extended version of Colaizzi’s phenomenological inquiry.

Results

Six themes emerged including—challenging behaviours, environmental and organisational factors, lack of skills, knowledge and experience, hyper-vigilance and anxiety, duty of care and negative attitudes with an overarching theme of fear of the unknown.

Conclusions

Staff in acute medical care settings were unsure of patients with mental illness and described them as unpredictable, identifying that they lacked requisite mental health literacy. Regular training is advocated.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-015-1264-z) contains supplementary material, which is available to authorized users.

Evaluating Explicit and Implicit Stigma of Mental Illness in Mental Health Professionals and Medical Students

The study investigated explicit and implicit attitudes towards people with mental illness among medical students (non-professionals) with no previous contact with mentally ill patients and psychiatrists and psychotherapists (professionals) who had at least 2 years of professional contact with mentally ill patients. Explicit attitudes where assessed by self-report. Implicit attitudes were measured with the Go/No-Go Association Task, a variant of the Implicit Association Test that does not require the use of a comparison category. Compared to non-professionals, mental health professionals reported significantly higher approach emotions than non-professionals towards people with mental illness, showed a lesser tendency to discriminate against them, and held less restrictive attitudes. Both groups reported negative implicit attitudes towards mentally ill. Results suggest that both non-professionals and professionals display ambivalent attitudes towards people with mental illness and that professional, long-term contact with people with mental illness does not necessarily modify negative implicit attitudes.

Psychometric evaluation of the Korean version of the Attitudes Toward Acute Mental Health Scale

The purpose of this study was to adapt the Attitudes Toward Acute Mental Health Scale (ATAMHS) into the Korean language and culture and then to determine the reliability and validity of it by administering it to a sample of Korean nursing students and nurses. We conducted a psychometric evaluation that included a two-step item analysis (analysis and reanalysis), exploratory factor analysis and concurrent validity. The ATAMHS was translated into Korean by bilingual nurses. Then, 429 participants (224 undergraduate nursing students and 205 nurses, all with psychiatric experience) completed the translated version of the ATAMHS. The item analysis revealed that nine items correlated poorly with the rest; thus, they were deleted from the scale. The final Korean version of the scale, which we refer to as the Korean version of the ATAMHS (ATAMHS-K), contains 24 items. The ATAMHS-K showed good internal consistency. Exploratory factor analysis revealed three factors (professional perspective, semantic differentials and positive attitudes) that explained 39.5% of the variance. The ATAMHS-K had strong correlations with the Korean version of the Community Attitudes towards the Mentally Ill Scale, thus confirming the concurrent validity. Therefore, the ATAMHS-K demonstrated acceptable psychometric properties as a measure of attitudes toward acute mental health in Korean nursing students and nurses.

Effects of a Crisis Intervention Team (CIT) training program upon police officers before and after Crisis Intervention Team training

In communities across the United States and internationally, police officers frequently come into contact with individuals experiencing mental health crisis despite not having the skills to safely intervene. This often results in officers resorting to excessive or even deadly force. The Crisis Intervention Team (CIT) is heralded as a revolutionary and transformative intervention to correct this gap in practice. Several previous interdisciplinary national and international studies, including criminology and sociology, have examined these concepts using quantitative and qualitative methodological designs, however, no prior nursing studies have been done on this topic. The purpose of this study was to determine the effect of CIT training on police officers' knowledge, perception, and attitude toward persons with mental illness. Twenty five police officers participated. An explorative, quasi experimental, descriptive design was used to collect the data on the three major concepts. Results on knowledge about mental illness improved at p<.0125 (p<.05 after Bonferroni correction). Perception scores improved at p<.0125 (p<.05 after Bonferroni correction), and attitudes were more favorable at p<.0125 (p<.05 after Bonferroni correction). The results of this study validated the CIT program as an innovative community health program that benefits law enforcement, consumers, mental health professionals, and stakeholders.

Investigation on the influence of a didactic course in psychiatry on attitudes of mental illness in Chinese college students

INTRODUCTION

With the modernization of Chinese society and increased general levels of education, the stigmatization of mental illness may have declined, especially among advanced students. However, misunderstandings about mental illness may remain and adversely affect service delivery to this population. Educational initiatives in psychiatry may support a more accepting and scientific understanding of these illnesses among college students.

METHOD

Attitudes towards mental illness were compared between 161 medical students who received a basic 48-hour introductory course in psychiatry and 170 college students who had not received such a course using a 43-item questionnaire. Previous factor analysis had shown this questionnaire to address four factors: 1. Personal willingness to socialize with people with mental illness; 2. Support for normalizing relationships and activities of people with mental illness; 3. Rejecting supernatural explanations of mental illness; and 4. Agreeing with a biopsychosocial view of the etiology of mental illness. Analysis of Co-Variance was used to compare the groups on these factors with adjustment for significant differences in age and years of education.

RESULT

The two groups of students scored similarly on the socializing factor (P = 0.252), the rejection of supernatural causes factor (P = 0.248) and the normalizing factor (P = 0.362), but students who had the didactic psychiatry course scored more positively on the biopsychosocial factor (percent difference = 15.06%, P = 0.001).

DISCUSSION

A single formal psychiatry course may improve understanding of the biopsychosocial causes of mental illness but did not affect other attitudinal domains among Chinese college students.

A service user-initiated project investigating the attitudes of mental health staff towards clients and services in an acute mental health unit

Mental Health Service Users (MHSU) are becoming increasingly recognized as very valuable contributors to the research process. The current study originated from the idea of a group of MHSU within a service user and carer research group. They wanted to investigate the attitudes of mental health staff towards clients in an acute mental health setting, as well as their attitudes towards certain aspects of service. An amended version of the 'Attitudes Towards Acute Mental Health Scale' was sent to nursing and allied staff at an acute psychiatric unit within the Gloucestershire 2gether NHS Foundation Trust. Fifty-seven of the 200 anonymous questionnaires were returned. Generally positive opinions of MHSU were obtained, but there were divided opinions on questions regarding the aetiology of mental health problems (e.g. social vs. genetic determinants). Opinions on aspects of the admissions process, therapeutic aspects of care, the use of medication and the use of control and restraint techniques were also obtained. Demographic variables of staff age, status and years of experience in mental health were found to be associated with attitudes and opinions. This MHSU-initiated study has extended the literature on mental health staff attitudes towards clients and services in an acute mental health setting. This study is split into two parts, Part A is focused on the process of involving MHSU in this project, Part B is concerned with the empirical investigation.

Nurses' attitudes towards breastfeeding among women with schizophrenia in southern Israel

Breastfeeding is the best source of nutrition for infants. Approximately half of women with schizophrenia become mothers, yet the issue of breastfeeding is often overlooked by the health professional community. The aim of this study was to survey attitudes among registered nurses regarding breastfeeding by schizophrenic women. Cross-sectional descriptive design was used involving a sample of nurses (40 midwives, 37 psychiatric and 33 postpartum) in two medical centres in southern Israel. The validated semistructured questionnaire included sociodemographic and professional questions, personal and professional breastfeeding experience, attitudes and knowledge concerning schizophrenia and attitudes towards breastfeeding by schizophrenic women. The study results indicate that 70% of the respondents held positive attitudes towards breastfeeding in women with schizophrenia, although no significant differences were found between the different types of nurses. Multivariate analysis reveals that academic education was the only variable associated with positive attitudes, while negative feelings towards women with schizophrenia, and extensive knowledge regarding schizophrenia were negatively associated. This study can serve as a foundation for future research to further examine nurses' role in providing postpartum education and care for women with schizophrenia.

Intention to work with individuals with dual diagnosis: testing the theory of planned behavior among students from various professions

Providing holistic care to individuals with the dual diagnosis (DD) of intellectual disability and mental illness is a challenging task that requires the work of various health care specialists. The aim of the current study was to examine the intentions of students from various fields to work with individuals with DD. A questionnaire was completed by 512 social work, occupational therapy, speech and language therapy, special education, and nursing students in Israel to measure students' attitudes toward working with individuals with DD, as well as their perceptions of subjective norms, controllability, and self-efficacy. Structural equation modeling showed that the students' intentions to work with individuals with DD were predicted by their attitudes and perceptions of subjective norms. Controllability was found to negatively affect their behavioral intentions. Furthermore, social work and nursing students were found to have the lowest behavioral intentions. Given the lack of education in the field of DD and the prevailing stigmatic attitudes toward this population, university programs should focus on increasing knowledge, promoting positive contact, and reducing the fear attached to working with people with DD.

Fighting stigma of mental illness in midsize European countries

PURPOSE

Stigma is the most powerful obstacle to the development of mental health care. Numerous activities aiming to reduce the stigma of mental illness and the consequent negative discrimination of the mentally ill and their families have been conducted in Europe. Descriptions of many of these activities are not easily available, either because there are no publications that describe them, or because descriptions exist only in local languages. This supplement aims to help in overcoming this imbalance by providing a description of anti-stigma activities in 14 countries in Europe regardless of the language in which they were published and regardless whether they were previously published.

METHODS

The review was undertaken by experts who were invited to describe anti-stigma activities in the countries in which they reside. It was suggested that they use all the available evidence and that they consult others in their country to obtain a description of anti-stigma activities that is as complete as possible.

RESULTS

The anti-stigma activities undertaken in the countries involved are presented in a tabular form. The texts contributed by the authors focus on their perception of the stigma of mental illness and of activities undertaken to combat it in their country.

CONCLUSIONS

Although much has been done against the stigmatization and discrimination of the mentally ill, fighting stigma remains an essential task for mental health programs and for society. The descriptions summarized in this volume might serve as an inspiration for anti-stigma work and as an indication of potential collaborators in anti-stigma programs.

Effects of psychiatric training on nursing students' attitudes towards people with mental illness in Japan

BACKGROUND

Nursing students' attitudes towards people with mental illness can be influenced by training experience.

AIM

To examine the relationship between the attitudes of nursing students towards people with mental illness and the psychiatric training imparted to the students by using textual data and conducting frequency analysis.

METHODS

We identified the words/phrases which were considered to represent the attitudes towards people with mental illness at pre-training (T1) and post-training (T2) stages from reports written by 76 Japanese nursing students, and examined the differences in the frequencies of the words/phrases used at T1 and T2.

RESULTS

With regard to the students' attitudes towards people with mental illness, generally, the frequencies of words/phrases that had somewhat negative to strongly negative nuances were high at T1, whereas those of the words/phrases that had somewhat positive or neutral nuances were high at T2. Also, analysis showed that words/phrases such as 'scary' were used more frequently at T1, whereas words/phrases such as 'not scary' were used more often at T2.

CONCLUSION

The students' attitudes may change favourably owing to, at least in part, psychiatric training.

The influence of causal explanations and diagnostic labeling on medical students' views of schizophrenia

PURPOSE

Negative attitudes toward mental illness among medical professionals can influence the quality of medical care they provide. The authors examined the impact of causal explanations and diagnostic labeling on medical students' views of schizophrenia.

METHOD

Medical students in their fifth and sixth years at the Second University of Naples (Italy) who attended lectures from April through June 2010 completed a self-report questionnaire regarding their beliefs about the mental disorder described (but not named) in a case vignette depicting a person who meets the International Classification of Diseases-10 criteria for schizophrenia.

RESULTS

Of the 232 students invited, 194 (84%) completed the questionnaire. Students most frequently cited heredity as the cause (81%), followed by stress (69%), psychological traumas (45%), and misuse of street drugs (44%). Most students (82%) labeled the case "schizophrenia"; a minority (24%) believed that persons with the case vignette disorder could be well again. Both labeling the case as "schizophrenia" and naming heredity as the cause were independently associated with pessimism about the possibility of recovery and with the perception that "others" keep their distance from persons with this diagnosis. Heredity was more frequently cited by respondents who labeled the case schizophrenia and was significantly associated with students' perception that people with this diagnosis are unpredictable.

CONCLUSIONS

These findings confirm that, in a sample of medical students, biogenetic causal explanations and diagnostic labeling have negative effects on beliefs about schizophrenia. They highlight the need to educate medical students about recovery from and stigma related to schizophrenia.

Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

Background

The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes.

Methods

General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants.

Results

Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356) gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298).

Conclusions

Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented through survey method is required to support these conclusions.

Attitudes toward schizophrenia in the general population, psychiatric staff, physicians, and psychiatrists: a web-based survey in Japan

Little is known about possible differences in the attitudes toward schizophrenia between the general public and various healthcare professionals. After screening for the study enrollment, 197 subjects in the general population, 100 psychiatric staff (other than psychiatrists), 112 physicians (other than psychiatrists) and 36 psychiatrists were enrolled in a web-based survey using an Internet-based questionnaire format. To assess subjects' attitudes toward schizophrenia, we used a 13-item questionnaire created by Uçok et al. (2006), to which five items were added. These 18 items were subjected to exploratory factor analysis, which yielded three factors classified as "stigma," "underestimation of patients' abilities," and "skepticism regarding treatment." These factors were compared between the four groups using analysis of covariance (ANCOVA), controlling for potential confounders. The ANCOVA for the "stigma" factor showed that psychiatrists scored significantly lower than the other three groups. The ANCOVA for the "underestimation of patients' abilities" factor revealed that psychiatric staff scored significantly lower than the general population. The present results indicated that attitudes toward schizophrenia consist of at least three separable factors. Psychiatrists had the least negative attitudes toward schizophrenia, which was followed by the psychiatric staff, and attitudes of the general population and of physicians were equally stigmatizing.

Stigma in child and adolescent mental health services research: understanding professional and institutional stigmatization of youth with mental health problems and their families

To understand the low utilization rates of child and adolescent mental health services, it is necessary to recognize the kinds of professional and institutional stigma that may produce barriers to care. We address the large literature on the stigmatization of mental illness, linkages between such literature and children's mental health services use, and the kinds of professional and institutional attitudes and practices that communicate shame and low expectations to youth and their families. It will take recognition of such stigmatizing practices-including overcoming resistance to the messages presented herein-to make real progress in the effort to increase utilization of evidence-based practices. Multi-faceted, multi-level, and multi-disciplinary approaches to both research and intervention are recommended.

Attitudes of ward attendants towards mental illness: comparisons and predictors

BACKGROUND

In India few studies exist that explore attitudes of mental health professionals, especially psychiatric ward attendants, towards psychiatric illnesses. This study aimed to explore attitudes of psychiatric ward attendants since they work closely with psychiatric patients in the hospital ward, and which may differ given their cultural and social background.

METHODS

Five hundred psychiatric ward attendants were targeted and a 100 sample size chosen based on systematic random sampling. A control group from guardians attending the outpatient department of Central Institute of Psychiatry was selected using the same methods. Attitudes of both groups were assessed using Community Attitudes towards Mental Illness (CAMI) after written informed consent.

RESULTS

There were no significant differences noted in Authoritarianism and Benevolence domains of CAMI. However, there were significant differences in the domains of Social Restrictiveness and Community Mental Health Ideology with psychiatric ward attendants scoring higher than the general attendants. Among the socio-demographic variables, there was significant correlation between age, duration of contact and educational background and various domains of CAMI.

CONCLUSIONS

Psychiatric ward attendants had more positive attitudes than general attendants towards psychiatric illnesses. Socio-demographic variables like older age, higher education and longer duration of contact with the psychiatrically ill predicted more favourable attitudes.

Discriminatory behavior of family physicians toward a person with Alzheimer's disease

BACKGROUND

It has been anecdotally suggested that health care professionals have stigmatic beliefs about persons with Alzheimer's disease (AD). However, the nature and prevalence of those beliefs have yet to be elucidated. The aim of the present study is to examine stigma towards a person with AD among primary care physicians.

METHODS

A nationally representative sample of 501 family physicians (54.1% female, mean age = 49, mean years in the profession = 21) were interviewed using a computer-assisted telephone interview and a structured questionnaire based on an expanded version of attribution theory.

RESULTS

The findings showed that physicians' discriminatory behavior was especially high in the dimension of avoidance and coercion, but low in the dimension of segregation. Two central emotions (anger-fear and pity) were found to affect participants' tendency to discriminate, as were attributions of dangerousness.

CONCLUSIONS

Addressing these factors may require targeted education of health professionals as well as the enforcement of anti-discrimination policies.

The impact of stigma on somatic treatment and care for people with comorbid mental and somatic disorders

PURPOSE OF REVIEW

The problems associated with high rates of medical comorbidities among people with mental disorders have multidimensional consequences, including the challenge of their management. The stigma on the treatment of these complex situations is the focus of this review. The time span and context of the review are set to cover the period from 2006 to the present; the review includes related themes of stigma.

RECENT FINDINGS

The stigma attached to the management of somatic illnesses of patients with mental disorders is considered as a more recent issue of concern. Few relevant studies could be found. Medical comorbidities among people with mental disorders along with the treatment gap constitute a public-health problem.

SUMMARY

The stigma attached to mental disorders in general forms the basis of the stigma towards the physical health problems of these patient groups. The impact of stigma on somatic treatment and care for people with comorbid mental and somatic disorders is discussed in its context as a public-health problem. Integrative services, and optimism and hope in health professionals are essential factors in reducing such stigma, and hence in enhancing better healthcare.

Doctors' attitude towards people with mental illness in Western Nigeria

INTRODUCTION

It had been suggested that those more knowledgeable about mental illness are less likely to endorse negative or stigmatizing attitudes. This study aimed to evaluate the attitude of doctors in Nigeria towards the mentally ill.

METHODS

Medical doctors (n = 312) from eight selected health institutions in Nigeria completed various questionnaires on knowledge and attitude towards people with mental illness.

RESULTS

Beliefs in supernatural causes were prevalent. The mentally ill were perceived as dangerous and their prognosis perceived as poor. High social distance was found amongst 64.1% and the associated factors include not having a family member/friend with mental illness (OR 7.12, 95% CI 3.71-13.65), age less than 45 years (OR 2.33, 95% CI 1.23-4.40), less than 10 years of clinical experience (OR 6.75, 95% CI 3.86-11.82) and female sex (OR 4.98, 95% CI 2.70-9.18).

CONCLUSION

Culturally enshrined beliefs about mental illness were prevalent among Nigerian doctors. A review of medical curriculum is needed and the present anti-stigma campaigns should start from the doctors.

Surveying the attitudes of acute mental health nurses

Recent UK policy and guidance indicates the importance of positive attitudes towards mental health service users. This is especially true in acute inpatient care, where service users are often at their most vulnerable and have higher levels of contact with mental health staff. The following paper details secondary analysis of data collected for the validation of an attitude measurement scale with a sample of 140 nursing staff in acute settings. The results demonstrate that a wide range of attitudes are held by mental health nurses towards acute mental health care. Overall, the results indicate generally positive attitudes. Significant differences were found between qualified and unqualified staff, and males and females for some questions. Recommendations are made for future attitudinal research of mental health staff.

Stigma towards people with mental illness in developing countries in Asia

BACKGROUND

There is a wide range of literature on stigmatization and discrimination of people with mental illness. Most studies, however, derive from Western countries. This review aims at summarizing results from developing countries in Asia published between 1996-2006.

METHOD

Medline search focusing on English-speaking literature.

RESULTS

Comparable to Western countries, there is a widespread tendency to stigmatize and discriminate people with mental illness in Asia. People with mental illness are considered as dangerous and aggressive which in turn increases the social distance. The role of supernatural, religious and magical approaches to mental illness is prevailing. The pathway to care is often shaped by scepticism towards mental health services and the treatments offered. Stigma experienced from family members is pervasive. Moreover, social disapproval and devaluation of families with mentally ill individuals are an important concern. This holds true particularly with regards to marriage, marital separation and divorce. Psychic symptoms, unlike somatic symptoms, are construed as socially disadvantageous. Thus, somatisation of psychiatric disorders is widespread in Asia. The most urgent problem of mental health care in Asia is the lack of personal and financial resources. Thus, mental health professionals are mostly located in urban areas. This increases the barriers to seek help and contributes to the stigmatization of the mentally ill. The attitude of mental health professionals towards people with mental illness is often stigmatizing.

CONCLUSION

This review revealed that the stigmatization of people with mental illness is widespread in Asia. The features of stigmatization-beliefs about causes of and attitudes towards mental illness, consequences for help-seeking-have more commonalities than differences to Western countries.

Attitudes of nursing staff towards co-workers returning from psychiatric and physical illnesses

BACKGROUND

Co-worker support, or lack of it, plays an important role in the contribution of workplace pressure to psychiatric illness and rehabilitation after sickness.

AIMS

To develop and validate a measure to compare attitudes towards co-workers with different illnesses to identify specific aspects of colleagues' attitudes which may hinder the reintegration in the workplace after sickness absence of individuals with common psychiatric conditions.

METHOD

A measure of co-worker behavioural concern was developed and validated using focus groups and a pilot study to determine questionnaire items. This was followed by a cross-sectional survey of 532 nursing staff within a UK hospital assessing attitudes to vignettes of a co-worker with different embedded diagnoses.

RESULTS

A measure of attitudes to co-workers was developed and validated. In the survey of nurses this revealed that attitudes were significantly more negative towards co-workers returning after psychiatric illnesses than to those with diabetes. Those with alcohol problems were held in particularly low esteem.

CONCLUSIONS

Psychiatric illnesses are stigmatised compared with physical illnesses, with the degree of behavioural blame evidently important. Co-worker reliability, predictability and coping were more important issues than particular work-related skills and could be incorporated into return-to-work plans.

The impact of antistigma education on the attitudes of general practitioners regarding schizophrenia

The aim of this study was to examine the views and attitudes of general practitioners (GP) with respect to schizophrenia, and the changes in their attitudes after antistigma education. A total of 106 GPs working in 71 health institutions were included in the study. A questionnaire of 16 items, focussing on doctors' views and attitudes towards schizophrenia, was applied. Questions were about the views and attitudes of doctors towards general myths related to schizophrenia. Doctors were asked to select one of two responses: 'I agree' or 'I disagree', for statements such as 'schizophrenic patients cannot work' and 'schizophrenic patients are aggressive and dangerous'. After completing the questionnaire, all the GPs were given a single session of antistigma education. The questionnaire was repeated 3 months after training meetings in a subsample of 54 GPs which represented the whole sample in terms of gender, age, and years in medical practice. The authors found statistically significant, positive changes on five items out of the 16 items in the post-test survey when compared to attitudes before training, including items about the treatability of schizophrenia, harmfulness and untrustworthiness of schizophrenic patients. The authors' findings suggest that one antistigma education session, supported by the distribution of related documents, can improve GPs attitudes towards schizophrenia.

Effects of an antistigma program on medical students' attitudes towards people with schizophrenia

People with schizophrenia are amongst the most stigmatized of those with mental illnesses. The purpose of this study was to examine whether an antistigma program which consists of education, contact, and viewing a film that depicts an individual with schizophrenia, can change attitudes towards people with schizophrenia. The antistigma program was carried out with first-year medical students (n=25). Students' attitudes towards people with schizophrenia were assessed before and after the program. In parallel, a control group of first-year medical students were questioned (n=35). Assessment was repeated after 1 month. Favorable attitudinal changes were observed in terms of 'belief about the etiology of schizophrenia', 'social distance to people with schizophrenia', and 'care and management of people with schizophrenia'. In contrast, no significant change was observed in the control group. Attitude changes tended to decrease at the 1-month follow up. These results suggest that attitudes towards schizophrenia could be changed favorably with this program. To sustain changed attitudes towards people with schizophrenia, antistigma programs should be offered on a regular basis.

Community psychiatry: results of a public opinion survey

BACKGROUND

Mental health authorities must know the public's attitude to community psychiatry when planning community mental health services. However, previous studies have only investigated the impact of demographic variables on the attitude to community psychiatry.

AIM

To assess the influence of psychological and sociological parameters on the public opinion of community psychiatry in Switzerland.

METHOD

Linear regression analyses of the results of a public opinion survey on a representative population sample in Switzerland (n = 1737).

RESULTS

Most respondents have positive attitudes to community psychiatry. In the regression analysis (R2 adjusted = 21.2%), negative emotions towards mentally ill people as depicted in the vignette, great social distance, a positive attitude to restrictions, negative stereotypes, high rigidity and no participation in community activities significantly influenced negative attitudes to community psychiatry. Additionally, other parameters, e.g. contact with mentally ill people and the nationality of the interviewee, have a significant influence.

CONCLUSIONS

In planning psychiatric community services, general individual traits and emotive issues should be considered because they influence the response towards community psychiatry facilities in the host community.

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.

Social distance towards people with mental illness amongst Nigerian university students

BACKGROUND

It had been claimed that stigma and social distance are less severe in African countries, although not enough research had been done to confirm this. Most of the studies had focussed on the general community, and specific population groups had been neglected.

AIMS

The aims of this study are to examine the level of social distance of students in a Nigerian university towards people with mental illness and to assess the possible socio-demographic variables involved. This is to enable the development of appropriate mental health educational and stigma-reducing programmes.

METHODS

A modified version of Bogardus Social Distance Scale was used to assess the desire for social distance towards people with mental illness amongst 1,668 students of a Nigerian federal university. Socio-demographic details were also obtained.

RESULTS

The social distances increased with the level of intimacy required in the relationship and were higher than those from the western culture, with 65.1% of the respondents categorised as having high social distance towards the mentally ill people. The predictors of high social distance towards the mentally ill include female gender [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.69-2.60], studying a non-medical course (OR 4.65, 95% CI 3.01-7.19) and not having a family member with mental illness (OR 6.73, 95% CI 4.34-10.44).

CONCLUSION

Social distance towards the mentally ill is higher amongst Nigerian university students than expected. This challenges the notion that stigma and negative attitude towards the mentally ill are less severe in Africa than in western cultures. There are needs for intensive public awareness, effective stigma-reducing educational programmes and more research in this area.