Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial

Andriyka Papish, Aliya Kassam, Geeta Modgill, Gina Vaz, Lauren Zanussi, Scott Patten, Andriyka Papish, Aliya Kassam, Geeta Modgill, Gina Vaz, Lauren Zanussi, Scott Patten

Abstract

Background: The stigma of mental illness among medical students is a prevalent concern that has far reaching negative consequences. Attempts to combat this stigma through educational initiatives have had mixed results. This study examined the impact of a one-time contact-based educational intervention on the stigma of mental illness among medical students and compared this with a multimodal undergraduate psychiatry course at the University of Calgary, Canada that integrates contact-based educational strategies. Attitudes towards mental illness were compared with those towards type 2 diabetes mellitus (T2DM).

Method: A cluster-randomized trial design was used to evaluate the impact of contact-based educational interventions delivered at two points in time. The impact was assessed by collecting data at 4 time points using the Opening Minds Scale for Health Care Providers (OMS-HC) to assess changes in stigma.

Results: Baseline surveys were completed by 62% (n=111) of students before the start of the course and post-intervention ratings were available from 90 of these. Stigma scores for both groups were significantly reduced upon course completion (p < 0.0001), but were not significantly changed following the one-time contact based educational intervention in the primary analysis. Student confidence in working with people with a mental illness and interest in a psychiatric career was increased at the end of the course. Stigma towards mental illness remained greater than for T2DM at all time points.

Conclusions: Psychiatric education can decrease the stigma of mental illness and increase student confidence. However, one-time, contact-based educational interventions require further evaluation in this context. The key components are postulated to be contact, knowledge and attention to process, where attending to the student's internal experience of working with people with mental illness is an integral factor in modulating perceptions of mental illness and a psychiatric career.

Figures

Figure 1
Figure 1
Mean Likert scores for medical student responses to four questions about attitudes towards mental illness and type 2 diabetes mellitus (T2DM), asked at three different time points. A larger value corresponds with more stigmatizing attitudes. Error bars indicate standard error. T1 = baseline; T2 = following the intervention; T3 = following the course.
Figure 2
Figure 2
Model for decreasing stigma and improving medical student attitudes towards mental illness. The authors propose that changing medical student attitudes towards mental illness requires a combination of accurate knowledge, contact-based educational methods and attention to process factors. In this model, attending to the student’s internal experience of working with people with mental illness is particularly important as it provides an opportunity to correct misconceptions that have occurred as a result of student’s knowledge and contact-based educational experiences, and can help increase student confidence in working with people with mental illness.

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