Mental illness attitudes in medical education: Assessing the stigma in medical students

Ernesto Márquez-Cervantes, Daniela Haydé Romero-Guerra, Antonio Costilla-Esquivel

DOI: https://doi.org/10.17711/SM.0185-3325.2023.014

Abstract


Introduction. Factors affecting the quality of physician care include a shortage of trained staff, stigma, and discrimination.

Objective. The objective was to compare the intensity of stigmatization before and after a Psychiatry course, as measured by the scale of clinicians’ attitudes towards mental illness, a version for medical students (MICA-2) designed to identify stigmatic attitudes towards mental disorders.

Method. The fifth-year Medicine students enrolled in the Psychiatry course answered anonymously using the MICA-2 test at the start and the end of their course. Additionally, we asked the students to answer a question about their interest in learning more about mental illness.

Results. Three hundred and thirty students were invited; 300 agreed to participate in the first application of the scales, and 291 in the follow-up. The average age was 22 ± 2 years, with a range of 20-30 years, and there was a similar gender distribution in both applications. In the initial application, the average score of the MICA-2 was 41.34 (SD = 7.86, 95% CI = [40.43, 42.25]). The follow-up application’s mean was 37.10 (SD = 8.15, 95% CI = [36.30, 38.15]). Also, there was a decrease in interest in learning more about mental illness.

Discussion and conclusion. A reduction in the average scores of the MICA-2 was observed after a Psychiatry course, suggesting that attitudes toward mental disorders improved. A Psychiatry clerkship with close supervision modified the attitudes of medical students toward mental disorders. However, it did not increase their interest in learning more about mental illness.

Keywords


Stigma; mental illness; medical students; Psychiatry

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References


Adams, E., Lee, A., Pritchard, C., & White, R. (2010). What Stops Us from Healing the Healers: A Survey of Help-Seeking Behaviour, Stigmatisation and Depression within the Medical Profession. International Journal of Social Psychiatry, 56(4), 359-370. doi: 10.1177/0020764008099123

Babicki, M., Małecka, M., Kowalski, K., Bogudzińska, B., & Piotrowski, P. (2021). Stigma Levels Toward Psychiatric Patients Among Medical Students—A Worldwide Online Survey Across 65 Countries. Frontiers in Psychiatry, 12, 798909. doi: 10.3389/fpsyt.2021.798909

Balon, R., Morreale, M. K., Guerrero, A., Beresin, E. V., Brenner, A., Coverdale, J. H., … Roberts, L. W. (2017). Impact of Educational Experience on Attitudes Toward Mental Illness and Career Choice. Academic Psychiatry, 41(3), 309-311. doi: 10.1007/S40596-017-0686-4

Borg, N., Testa, L., Sammut, F., & Cassar, D. (2020). Attitudes of Medical Students in Malta Toward Psychiatry and Mental Illness. Academic Psychiatry, 44(6), 709-713. doi: 10.1007/s40596-020-01304-y

Corrigan, P., Rüsch, N., & Scior, K. (2018) Adapting Disclosure Programs to Reduce the Stigma of Mental Illness. Psychiatric Services, 69(7), 826-828. doi: 10.1176/appi.ps.201700478

Desai, R., Panchal, B., Vala, A., Ratnani, I. J., Vadher, S., & Khania, P. (2019). Impact of Clinical Posting in Psychiatry on the Attitudes towards Psychiatry and Mental Illness in Undergraduate Medical Students. General Psychiatry, 32(3), e100072. doi: 10.1136/gpsych-2019-100072

Eksteen, H. C., Becker, P. J., & Lippi, G. (2017). Stigmatization towards the Mentally Ill: Perceptions of Psychiatrists, Pre-Clinical and Post-Clinical Rotation Medical Students. International Journal of Social Psychiatry, 63(8), 782-791. doi: 10.1177/0020764017735865

Gervás, R., García-Ullán, L., Amor, V., Bullon, A., Vicente, P., & Roncero, C. (2022). Effectiveness and Types of Interventions to Reduce Mental Illness-Related Stigma among Medical university students: A literature review (1997-2020). Actas Españolas de Psiquiatría, 50(2), 106-113.

Hankir, A., Fletcher-Rogers, J., Ogunmuyiwa, J., Carrick, F. R., & Zaman, R. (2020). Reducing mental health stigma in medical students and doctors towards their peers with mental health difficulties: a protocol. Psychiatria Danubina, 32(Suppl 1), 130-134.

Heim, E., Henderson, C., Kohrt, B. A., Koschorke, M., Milenova, M., & Thornicroft, G. (2019). Reducing Mental Health-Related Stigma among Medical and Nursing Students in Low- and Middle-Income Countries: ASystematic Review. Epidemiology and Psychiatric Sciences. 29, e28. doi: 10.1017/S2045796019000167

IESM-OMS. (2011). Informe Sobre el Sistema de Salud Mental en México. Organización Mundial de la Salud.

Janoušková, M., Formánek, T., Bražinová, A., Mílek, P., Alexová, A., Winkler, P., & Bankovská L. (2021). Attitudes towards People with Mental Illness and Low Interest in Psychiatry among Medical Students in Central and Eastern Europe. Psychiatric Quarterly, 92(1), 407-418. doi: 10.1007/s11126-020-09817-3

Kassam, A., Papish, A., Modgill, G., & Patten, S. (2012). The Development and Psychometric Properties of a New Scale to Measure Mental Illness Related Stigma by Health Care Providers: The Opening Minds Scale for Health Care Providers (OMS-HC). BMC Psychiatry, 12(1), 62. doi: 10.1186/1471-244X-12-62

Kerebih, H., Salelew, E., & Hailesilassie, H. (2019). Factors Associated with Medical Students’ Choice of Psychiatry as Future Specialty: A Cross-Sectional Study. Advances in Medical Education and Practice, 10, 751-758. doi: 10.2147/AMEP.S210286

Korszun, A., Dinos, S., Ahmed, K., & Bhui, K. (2012). Medical Student Attitudes About Mental Illness: Does Medical-School Education Reduce Stigma?. Academic Psychiatry, 36(3), 197-204. doi: 10.1176/appi.ap.10110159

Lasalvia, A., Bonetto, Ch., Miglietta, E., Giacco, D., Nicaise, P., Lorant, V., … Priebe, S. (2021). Comparing Discrimination among People with Schizophrenia, Affective and Anxiety Disorders. A Multilevel Study in Five European Countries. Journal of Affective Disorders, 279, 191-202. doi: 10.1016/J.JAD.2020.10.002

Leung, K., Awani, T., Chima, C., & Udo, I. (2015). What Can Qualitative Studies Reveal About Recruitment into Psychiatry?. Academic Psychiatry, 39(3), 286-292. doi: 10.1007/s40596-015-0290-4

Lien, Y.-Y., Lin, H.-S., Lien, Y.-J., Tsai, C.-H., Wu, T.-T., Li, H., & Tu, Y.-K. (2021). Challenging Mental Illness Stigma in Healthcare Professionals and Students: A Systematic Review and Network Meta-Analysis. Psychology & Health, 36(6), 669-684. doi: 10.1080/08870446.2020.1828413

Lyons, Z., & Janca, A. (2015). Impact of a Psychiatry Clerkship on Stigma, Attitudes towards Psychiatry, and Psychiatry as a Career Choice. BMC Medical Education, 15, 34. doi: 10.1186/s12909-015-0307-4

Masedo, A, Grandón, P., Saldivia, S., Vielma-Aguilera, A., Castro-Alzate, E. S., Bustos, C., … Moreno-Küstner, B. (2021). A multicentric study on stigma towards people with mental illness in health sciences students. BMC Medical Education, 21(1), 324. doi: 10.1186/s12909-021-02695-8

Meng, N., Huang, X., Wang, J., Wang, M., & Wang, Y. (2022). The Factors and Outcomes of Stigma toward Mental Disorders among Medical and Nursing Students: A Cross-Sectional Study. BMC Psychiatry, 22(1), 357. doi: 10.1186/s12888-022-03996-y

Oliveira, A. M., Machado, D., Fonseca, J. B., Palha, F., Moreira, P. S., Sousa, N., … Morgado, P. (2020). Stigmatizing Attitudes Toward Patients with Psychiatric Disorders Among Medical Students and Professionals. Frontiers in Psychiatry, 11, 326. doi: 10.3389/fpsyt.2020.00326

Pandian, H., Mohamedali, Z., Chapman, G. E., Vinchenzo, P., Ahmed, S., Mulliez, Z., … Tracy, D. K. (2020). Psych Socs: Student-Led Psychiatry Societies, an Untapped Resource for Recruitment and Reducing Stigma. BJPsych Bulletin, 44(3), 91-95. doi: 10.1192/bjb.2019.88

Petkari, E., Masedo Gutiérrez, A. I., Xavier, M., & Moreno Küstner, B. (2018). The Influence of Clerkship on Students’ Stigma towards Mental Illness: A Meta-Analysis. Medical Education, 52(7), 694-704. doi: 10.1111/medu.13548

Potts, L. C., Bakolis, I., Deb, T., Lempp, H., Vince, T., Benbow, Y., … The Indigo Read Study Group. (2022). Anti-Stigma Training and Positive Changes in Mental Illness Stigma Outcomes in Medical Students in Ten Countries: A Mediation Analysis on Pathways via Empathy Development and Anxiety Reduction. Social Psychiatry and Psychiatric Epidemiology, 57(9), 1861-1873. doi: 10.1007/s00127-022-02284-0

Rezvanifar, F., Shariat, S. V., Shalbafan, M., Salehian, R., & Rasoulian, M. (2022). Developing an Educational Package to Improve Attitude of Medical Students Toward People With Mental Illness: A Delphi Expert Panel, Based on a Scoping Review. Frontiers in Psychiatry, 13, 860117. doi: 10.3389/fpsyt.2022.860117

Roberts, L. W., & Bandstra, B. S. (2012). Addressing Stigma to Strengthen Psychiatric Education. Academic Psychiatry, 36(5), 347-350. doi: 10.1176/appi.ap.12060118

Rüsch, N., & Kösters, M. (2021). Honest, Open, Proud to Support Disclosure Decisions and to Decrease Stigma’s Impact among People with Mental Illness: Conceptual Review and Meta-Analysis of Program Efficacy. Social Psychiatry and Psychiatric Epidemiology, 56, 1513-1526. doi: 10.1007/s00127-021-02076-y

Sandhu, H. S., Arora, A., Brasch, J., & Streiner, D. L. (2019). Mental Health Stigma: Explicit and Implicit Attitudes of Canadian Undergraduate Students, Medical School Students, and Psychiatrists. Canadian Journal of Psychiatry, 64(3), 209-217. doi: 10.1177/0706743718792193

Sartorius, N., Gaebel, W., Cleveland, H. R., Stuart, H., Akiyama, T., Arboleda-Flórez, J., … Tasman, A. (2010). WPA Guidance on How to Combat Stigmatization of Psychiatry and Psychiatrists. World Psychiatry. World Psychiatric, 9(3), 131-144. doi: 10.1002/j.2051-5545.2010.tb00296.x

Seeman, N., Tang, S., Brown, A. D., & Ing., A. (2016). World Survey of Mental Illness Stigma. Journal of Affective Disorders, 190, 115-121. doi: 10.1016/j.jad.2015.10.011

Simon, N., & Verdoux, H. (2018). Impact of Education Program and Clinical Posting in Psychiatry on Medical Students’ Stigmatizing Attitudes towards Psychiatry and Psychiatric Disorders. Encephale, 44(4), 329-336. doi: 10.1016/j.encep.2017.05.003

Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., ... Henderson C. (2016). Evidence for Effective Interventions to Reduce Mental-Health-Related Stigma and Discrimination. The Lancet, 387(10023), 1123-1132. doi: 10.1016/S0140-6736(15)00298-6

Wang, K., Link, B. G., Corrigan, P. W., Davidson, L., & Flanagan, E. (2018). Perceived Provider Stigma as a Predictor of Mental Health Service Users’ Internalized Stigma and Disempowerment. Psychiatry Research, 259, 526-531. doi: 10.1016/j.psychres.2017.11.036

Waqas, A., Malik, S., Fida, A., Abbas, N., Mian, N., Miryala, S., … Naveed, S. (2020). Interventions to Reduce Stigma Related to Mental Illnesses in Educational Institutes: A Systematic Review. Psychiatric Quarterly, 91(3), 887-903. doi: 10.1007/s11126-020-09751-4

World Health Organization [WHO]. (2018). Mental Health Atlas 2017. WHO: Geneva. Retrieved from https://apps.who.int/iris/handle/10665/272735


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