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

Homayoun Amini, Saeed Shoar, Maryam Tabatabaee, Somaye Arabzadeh, Homayoun Amini, Saeed Shoar, Maryam Tabatabaee, Somaye Arabzadeh

Abstract

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

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

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

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

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

Keywords: Attitude; Exposure to Patients with Mental Illness; Health Personnel; Medical Students: Mental Disorders.

References

    1. Thornicroft G. Stigma and discrimination limit access to mental health care. Epidemiol Psichiatr Soc. 2008;17(1):14–9.
    1. Angermeyer MC, Dietrich S. Public beliefs about and attitudes towards people with mental illness: a review of population studies. Acta Psychiatr Scand. 2006;113(3):163–79. doi: 10.1111/j.1600-0447.2005.00699.x.
    1. Sartorius N. Iatrogenic stigma of mental illness. BMJ. 2002;324(7352):1470–1.
    1. Sartorius N. Lessons from a 10-year global programme against stigma and discrimination because of an illness. Psychol Health Med. 2006;11(3):383–8. doi: 10.1080/13548500600595418.
    1. Chambers M, Guise V, Valimaki M, Botelho MA, Scott A, Staniuliene V, et al. Nurses' attitudes to mental illness: a comparison of a sample of nurses from five European countries. Int J Nurs Stud. 2010;47(3):350–62. doi: 10.1016/j.ijnurstu.2009.08.008.
    1. Hugo M. Mental health professionals' attitudes towards people who have experienced a mental health disorder. J Psychiatr Ment Health Nurs. 2001;8(5):419–25.
    1. Nordt C, Rossler W, Lauber C. Attitudes of mental health professionals toward people with schizophrenia and major depression. Schizophr Bull. 2006;32(4):709–14. doi: 10.1093/schbul/sbj065.
    1. Ogunsemi OO, Odusan O, Olatawura MO. Stigmatising attitude of medical students towards a psychiatry label. Ann Gen Psychiatry. 2008;7:15. doi: 10.1186/1744-859X-7-15.
    1. Jugal K, Mukherjee R, Parashar M, Jiloha RC, Ingle GK. Beliefs and attitudes towards mental health among medical professionals in Delhi. Indian J Community Med. 2007;32:198–200. doi: 10.4103/0970-0218.36827.
    1. Kleinman A, Cohen A. Psychiatry's global challenge. Sci Am. 1997;276(3):86–9.
    1. Mino Y, Yasuda N, Tsuda T, Shimodera S. Effects of a one-hour educational program on medical students' attitudes to mental illness. Psychiatry Clin Neurosci. 2001;55(5):501–7. doi: 10.1046/j.1440-1819.2001.00896.x.
    1. Welch LC, Litman HJ, Borba CP, Vincenzi B, Henderson DC. Does a physician's attitude toward a patient with mental illness affect clinical management of diabetes? Results from a mixed-method study. Health Serv Res. 2014;50(4) doi: 10.1111/1475-6773.12267.
    1. Buchanan A, Bhugra D. Attitude of the medical profession to psychiatry. Acta Psychiatr Scand. 1992;85(1):1–5.
    1. Kerby J, Calton T, Dimambro B, Flood C, Glazebrook C. Anti-stigma films and medical students attitudes towards mental illness and psychiatry: randomised controlled trial. Psychiatr Bull. 2008;32(9):345–9. doi: 10.1192/pb.bp.107.017152.
    1. Lawrie SM, Martin K, McNeill G, Drife J, Chrystie P, Reid A, et al. General practitioners' attitudes to psychiatric and medical illness. Psychol Med. 1998;28(6):1463–7.
    1. Mino Y, Kodera R, Bebbington P. A comparative study of psychiatric services in Japan and England. Br J Psychiatry. 1990;157:416–20.
    1. Salokangas RK, Der G, Wing JK. Community psychiatric services in England and Finland. Soc Psychiatry. 1985;20(1):23–9.
    1. Covarrubias I, Han M. Mental health stigma about serious mental illness among MSW students: social contact and attitude. Soc Work. 2011;56(4):317–25.
    1. Papish A, Kassam A, Modgill G, Vaz G, Zanussi L, Patten S. Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial. BMC Med Educ. 2013;13:141. doi: 10.1186/1472-6920-13-141.
    1. Ando S, Yamaguchi S, Aoki Y, Thornicroft G. Review of mental-health-related stigma in Japan. Psychiatry Clin Neurosci. 2013;67(7):471–82. doi: 10.1111/pcn.12086.
    1. Cohen J, Struening EL. Opinions about mental illness in the personnel of two large mental hospitals. J Abnorm Soc Psychol. 1962;64:349–60.
    1. Crocetti G, Spiro HR, Siassi I. Are the ranks closed? Attitudinal social distance and mental illness. Am J Psychiatry. 1971;127(9):1121–7. doi: 10.1176/ajp.127.9.1121.
    1. Ghasemi A, Fatemi MM. The effect of an educational film on the attitudes of mentally ill patients' families toward mental illness [in Persian]. Tehran: Tehran University of Medical Sciences; 1999.
    1. Amini H, Majdzadeh R, Eftekhar-Ardebili H, Shabani A, Davari-Ashtiani R. How Mental Illness is Perceived by Iranian Medical Students: A Preliminary Study. Clin Pract Epidemiol Ment Health. 2013;9:62–8. doi: 10.2174/1745017901309010062.
    1. Yamaguchi S, Wu SI, Biswas M, Yate M, Aoki Y, Barley EA, et al. Effects of short-term interventions to reduce mental health-related stigma in university or college students: a systematic review. J Nerv Ment Dis. 2013;201(6):490–503. doi: 10.1097/NMD.0b013e31829480df.
    1. Arkar H, Eker D. Influence of a 3-week psychiatric training programme on attitudes toward mental illness in medical students. Soc Psychiatry Psychiatr Epidemiol. 1997;32(3):171–6.
    1. Desforges DM, Lord CG, Ramsey SL, Mason JA, Van Leeuwen MD, West SC, et al. Effects of structured cooperative contact on changing negative attitudes toward stigmatized social groups. J Pers Soc Psychol. 1991;60(4):531–44.
    1. Peterson CL. Changing community attitudes toward the chronic mentally ill through a psychosocial program. Hosp Community Psychiatry. 1986;37(2):180–2.
    1. Trute B, Tefft B, Segall A. Social rejection of the mentally ill: a replication study of public attitude. Soc Psychiatry Psychiatr Epidemiol. 1989;24(2):69–76.
    1. Rabkin JG. Opinions about mental illness: a review of the literature. Psychol Bull. 1972;77(3):153–71.
    1. Kelly B, Raphael B, Byrne G. The evaluation of teaching in undergraduate psychiatric education: students' attitudes to psychiatry and the evaluation of clinical competency. Med Teach. 1991;13(1):77–87.
    1. Kopera M, Suszek H, Bonar E, Myszka M, Gmaj B, Ilgen M, et al. Evaluating explicit and implicit stigma of mental illness in mental health professionals and medical students. Community Ment Health J. 2014;51(5):628–34. doi: 10.1007/s10597-014-9796-6.
    1. Eker D. Attitudes of Turkish and American clinicians and Turkish psychology students toward mental patients. Int J Soc Psychiatry. 1985;31(3):223–9.
    1. Arkar H, Eker D. Influence of having a hospitalized mentally ill member in the family on attitudes toward mental patients in Turkey. Soc Psychiatry Psychiatr Epidemiol. 1992;27(3):151–5.
    1. Furnham A, Bower P. A comparison of academic and lay theories of schizophrenia. Br J Psychiatry. 1992;161:201–10.
    1. Malla A, Shaw T. Attitudes towards mental illness: the influence of education and experience. Int J Soc Psychiatry. 1987;33(1):33–41.
    1. Rabkin JG. Who is called mentally ill: public and professional views. J Community Psychol. 1979;7(3):253–8.
    1. Sellick K, Goodear J. Community attitudes toward mental illness: the influence of contact and demographic variables. Aust N Z J Psychiatry. 1985;19(3):293–8.
    1. Galletly CA, Schrader GD, Chesterman HM, Tsourtos G. Medical student attitudes to psychiatry: lack of effect of psychiatric hospital experience. Med Educ. 1995;29(6):449–51.
    1. Pessar LF, Pristach CA, Leonard KE. What troubles clerks in psychiatry? A strategy to explore the question. Acad Psychiatry. 2008;32(3):194–8. doi: 10.1176/appi.ap.32.3.194.
    1. Corrigan PW, Fong MW. Competing perspectives on erasing the stigma of illness: what says the dodo bird? Soc Sci Med. 2014;103:110–7. doi: 10.1016/j.socscimed.2013.05.027.
    1. Adewuya AO, Oguntade AA. Doctors' attitude towards people with mental illness in Western Nigeria. Soc Psychiatry Psychiatr Epidemiol. 2007;42(11):931–6. doi: 10.1007/s00127-007-0246-4.
    1. Ay P, Save D, Fidanoglu O. Does stigma concerning mental disorders differ through medical education? A survey among medical students in Istanbul. Soc Psychiatry Psychiatr Epidemiol. 2006;41(1):63–7. doi: 10.1007/s00127-005-0994-y.
    1. Baxter H, Singh SP, Standen P, Duggan C. The attitudes of 'tomorrow's doctors' towards mental illness and psychiatry: changes during the final undergraduate year. Med Educ. 2001;35(4):381–3.
    1. Mino Y, Yasuda N, Kanazawa S, Inoue S. Effects of medical education on attitudes towards mental illness among medical students: a five-year follow-up study. Acta Med Okayama. 2000;54(3):127–32.
    1. Chung KF, Chen EY, Liu CS. University students' attitudes towards mental patients and psychiatric treatment. Int J Soc Psychiatry. 2001;47(2):63–72.
    1. Dalky HF. Mental illness stigma reduction interventions: review of intervention trials. West J Nurs Res. 2012;34(4):520–47. doi: 10.1177/0193945911400638.
    1. Evans-Lacko S, London J, Japhet S, Rusch N, Flach C, Corker E, et al. Mass social contact interventions and their effect on mental health related stigma and intended discrimination. BMC Public Health. 2012;12:489. doi: 10.1186/1471-2458-12-489.
    1. Al-Adawi S, Dorvlo AS, Al-Ismaily SS, Al-Ghafry DA, Al-Noobi BZ, Al-Salmi A, et al. Perception of and attitude towards mental illness in Oman. Int J Soc Psychiatry. 2002;48(4):305–17.
    1. Schomerus G, Schwahn C, Holzinger A, Corrigan PW, Grabe HJ, Carta MG, et al. Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatr Scand. 2012;125(6):440–52. doi: 10.1111/j.1600-0447.2012.01826.x.
    1. Weissman SH, Haynes RA, Killian CD, Robinowitz C. A model to determine the influence of medical school on students' career choices: psychiatry, a case study. Acad Med. 1994;69(1):58–9.
    1. Tesser A. The importance of heritability in psychological research: the case of attitudes. Psychol Rev. 1993;100(1):129–42.

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