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

Persian translation and validation of community attitudes toward the mentally ill scale: a tool for assessing social stigma about mental illness

No study, best of our knowledge, has been conducted on assessing the validity and reliability of community attitudes toward the mentally ill (CAMI) inventory in Iran. The questionnaire was translated into Persian and then returned to English. Content validity ratio (CVR), content validity index (CVI), impact score (IS) to assess content validity, Cronbach's alpha, and test-retest reliability was used to prove the internal and external reliabilities, respectively. The questionnaires were distributed to 130 people from different levels of society. Some were in contact with at least one patient with mental illness and some others had no connection. After 2 weeks, the questionnaires were resent to 50 participants to evaluate the reliability using the test-retest method. All questions had CVI (>0.79) and CVR (>0.49) except for three questions (Q 10, 24, and 30), which were excluded from the questionnaire. The questions were relevant, clear, simple, and valid. The IS was more than 1.5. The Cronbach's alpha values of four subscales including authoritarianism, benevolence, social restrictiveness, and community mental health ideology were recorded as 0.61, 0.49, 0.64, and 0.76, respectively. The CAMI scale is a valid and sustainable tool over time to assess the negative attitude toward mental illness.

Social distance and stigma towards persons with serious mental illness among medical students in five European Central Asia countries

The study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in the Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students' responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of enhanced range of integrated training opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them.

Developing an Educational Package to Improve Attitude of Medical Students Toward People With Mental Illness: A Delphi Expert Panel, Based on a Scoping Review

INTRODUCTION

The importance of stigma toward patients with mental illness in medical students as future physicians cannot be overemphasized. There is currently no formal training to reduce stigma toward mental illness in medical students in their educational curriculums in Iran like most other low and middle income countries. Therefore, aiming to provide a practical and effective training package focused on reducing stigma toward patients with mental illness in medical students, the current study conducted, as an expert panel with Delphi method, based on a scoping review, to develop an education package to improve attitude of medical students toward patients with mental illness.

MATERIALS AND METHODS

We surveyed the available international databases including PubMed, Google Scholar, Scopus, PsycINFO, Tripdatabase, Web of Science, Cochrane Database of Systematic Reviews as well as Persian databases including Iranmedex, SID, Irandoc and Magiran in February and March 2020. After an extensive review of related resources, 13 articles met our inclusion criteria. Then, we extracted the related data including type and duration of the interventions, sample size, mean and standard deviation of stigma scores before and after interventions. To develop the package among the included interventions, we asked 16 experts in psychology, psychiatry, and social medicine to rate the interventions based on a number of variables such as effectiveness, feasibility and applicability in a Delphi process.

RESULTS

The selected intervention in Delphi method with consensus of experts included a set of four sequential interactive interventions: showing a movie and discussing it, psychiatric training including contact with people who affected psychiatric disorders, social communication with people who affected psychiatric disorders, and group discussion on defining stigma and personal experiences.

CONCLUSION

In the present study, we recommend a set of interventions to reduce stigma toward patients with mental illness among medical students in the form of a package of combined, interactive and sequential interventions that have been previously been shown to be effective in reducing stigma related to mental illness. We expect that implementation of these interventions would reduce mental illness stigma in medical students; which needs further verification.

Medical Students' Knowledge and Attitudes Regarding Justice-Involved Health

Despite the demonstrated need for sustainable and effective carceral health care, justice-involved medical education curricula are limited, and it's unclear if informal clinical education is sufficient. Investigators aimed to quantify medical student involvement with carceral populations and explore how students' knowledge of and attitudes towards justice-involved patients changed over the course of their training. A survey was designed by the investigators and sent to all current medical students at a single United States medical school. Stata 14.0 was used to compare results between the years of medical school. Differences between groups were tested using linear regression. Most 4th year students reported working in a carceral health setting. An increase in overall knowledge of justice-involved patients was observed as carceral medicine education (p_trend = 0.02), hours worked in a jail (p_trend < 0.01), and substance abuse training (p_trend < 0.01) increased. Overall attitude score increased with the students' reported number of hours working in a jail (p_trend < 0.01) and the amount of substance abuse training (p_trend < 0.01). Finally, we found a trend of increasing knowledge and attitude scores as the year of standing increased (p_trend < 0.01). Our data suggest that most USC medical students work in a carceral setting during medical school. Didactic and experiential learning opportunities correlated with improved knowledge of and attitude toward justice-involved patients, with increases in both metrics increasing as the year in medical school increased. However, senior medical students still scored poorly. These findings underscore the need for a formal curriculum to train our healthcare workforce in health equity for carceral populations.

Evaluation of mental health stigma on medical education: an observational study with Portuguese medical students

Background

The Portuguese mental health care plan emphasizes that health care professionals can be a source of stigma against people with mental illness enhancing self-stigma and leading to a decrease in the search for help and adherence to treatment.

Methods

In this exploratory study, we surveyed 111 first and last year students from the Faculty of Medicine of the University of Porto, Portugal, using the Portuguese version of the Attribution Questionnaire AQ-27 to assess the attitudes toward mental illness.

Results

The students showed a significant difference in the segregation dimension, and in some items related with pity and coercion in the end of the course. These results express a positive will to integrate people with mental illness in community, a decrease of pity and a valorization of the pharmacological treatment in this kind of disease. The previous personal experience of psychiatric problems decreases the level of segregation and psychological problems increase the motivation to help.

Conclusion

Final-year students express more positive and less discriminatory attitudes toward people with severe mental illness than first-year students. This is likely due to education and contact opportunities promoted throughout the medical school, as well as due to the experience of having gone to a psychology or psychiatric consultation. Knowledge of stigma levels of future medical doctors is therefore crucial for the prevention of attitudes that could condition the provision of medical care.

Effects of contact-based, short-term anti-stigma training for medical students : Results from a randomized controlled trial

BACKGROUND

Mental health stigma (MHS) places a burden on those affected that far exceeds psychosocial harms. Contact-based anti-stigma work has been found effective for several target groups. For medical students however, its efficacy remains unclear.

AIM

The purpose of this study was to examine the efficacy of contact-based, trialogic anti-stigma training for medical students.

METHODS

A randomized controlled trial (RCT) was conducted, controlling for standard clinical placement in psychiatry. External validity was maximized by including all students (n = 204) who started their 6‑week obligatory psychiatry course during the study period between March and July 2018. Assessments were conducted at the beginning of each of the two covered terms and immediately postintervention.

RESULTS

Students who received the anti-stigma training displayed significantly less stigmatizing attitudes after the intervention, measured using the MICA (Mental Illness-Clinicians' Attitudes) scale as primary outcome. Analogous findings were noted for social distance and stereotypes, whereas these could not be observed for emotional reactions. All significant changes were independent of gender and age.

CONCLUSION

The positive results underpin the research in this field and point towards the inclusion of comparable interventions in regular student curricula. Given the limitation of a missing late follow-up, however, further research regarding the persistence of stigma reduction is needed.

Assessing the attitudes of medical students towards psychiatry: A new paradigm

BACKGROUND

Gauging the probability that medical students will select psychiatry as a career is a challenge, especially in Saudi Arabia, where the profession of psychiatry has still to gain ground. Thus, the aim of the current study was to investigate the attitudes of Saudi medical students towards psychiatry.

METHOD

A total of 317 medical students were recruited in a cross-sectional study. An ATP-30 questionnaire was used. In addition to the suggested cut-off point of 90 in previous studies, the data were also categorized using the visual binning procedure. To enhance the number of significant predictors and obtain more realistic results, an Ordinal Logistic Regression model was applied.

RESULT

The attitudes of medical students towards the three outcomes (dependent) variables; "Overall attitudes towards psychiatry, I want to be a psychiatrist, and Attitudes towards psychiatric treatment" varied across the five explanatory (predictor) variables, when assessed using Ordinal Logistic Regression. Age and gender proved significant with the three outcome variables, whereas Exposure to Psychiatric Clerkship identified "Overall attitudes towards psychiatry" and "Attitudes towards psychiatric treatment". Significant effects from a "Psychiatrist Relative" was found in "Overall attitudes towards psychiatry"and "I want to be a psychiatrist". The predictor variable; "Having a relative who is a psychiatric patient" was found to be significant only with, "I want to be a psychiatrist".

CONCLUSION

The attitudes of medical students towards psychiatry can be predicted in the presence of specific factors. This is discussed in more detail in the relevant part of the study.