Mental illness attitudes in medical education: Assessing the stigma in medical students
##plugins.themes.bootstrap3.article.main##
Abstract
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.
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
