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Gupta S, Kumar A, Kathiresan P, Pakhre A, Pal A, Singh V. Mental health stigma and its relationship with mental health professionals - A narrative review and practice implications. Indian J Psychiatry 2024; 66:336-346. [PMID: 38778855 PMCID: PMC11107930 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_412_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 05/25/2024] Open
Abstract
The extent and magnitude of the mental health stigma are enormous, with substantial clinical and social implications. There is a complex relationship between mental health stigma and mental health professionals (MHPs); MHPs can be anti-stigma crusaders, victims of stigma, and even a source of stigma. Unfortunately, literature is scarce talking about the relationship between stigma and MHPs. Hence, the current review aims to bridge the existing gap in the literature on various aspects of stigma and the role of MHPs. For the current review, we ran a search in PubMed and Google Scholar databases; we restricted our study to records focusing on the interplay of mental health stigma and the MHPs, published during 2012-2022, in English, and having a full text available. We found that MHPs (psychiatrists, psychologists, and psychiatric nurses) can also be the recipients of the stigma. The stigma faced by the MHPs is determined by the negative stereotypes set by the media, or medical students, or other health professionals; the marginal position of psychiatry in the health system; difficult-to-treat mental disorders; MHPs' own experience of stigma; and the attitude or beliefs of various caders of the MHPs, their professional experience, and expertise in managing various mental health conditions. Notably, MHPs can also be a source of stigma (stigmatizers). MHPs need to be sensitized concerning this, and the anti-stigma interventions must incorporate this aspect of stigma. Novel interventions, such as digital-based programs, should be used instead of traditional anti-stigma programs in order to decrease stigma around mental health issues and make anti-stigma initiatives more appealing and scalable. To address the issues of stigma, there has to be more communication between MHPs, other health professionals, service users, and policymakers.
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Affiliation(s)
- Snehil Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Akash Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Preethy Kathiresan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Pakhre
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Arghya Pal
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Vijender Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Chen YH, Hsiao CY, Chien HW. Attitudes Toward People With Schizophrenia Among Undergraduate Nursing Students. J Am Psychiatr Nurses Assoc 2024; 30:313-321. [PMID: 35620801 DOI: 10.1177/10783903221096360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Negative attitudes toward mental disorders are not only an interpersonal issue but also a concern of mental health care. Given that nursing students are future health care providers, it is pivotal to improve their attitudes toward individuals with mental disorders prior to their transition into clinical practice. However, research on nursing students' attitudes in relation to schizophrenia in Taiwan remains unexplored. AIM The aim of this article is to examine the correlates of attitudes toward individuals with schizophrenia among Taiwanese undergraduate nursing students. METHOD A descriptive, correlational, and cross-sectional study was adopted. Self-reported questionnaires were conducted with a convenience sample of 306 Taiwanese undergraduate nursing students. Descriptive statistics, independent t tests, one-way analysis of variance, Pearson's correlations, and a stepwise regression analysis were performed. RESULTS Nursing students expressed negative attitudes toward individuals with schizophrenia. Nursing students, who were female, had contact with individuals with mental disorders, and expressed greater empathy and personality traits held more favorable attitudes toward individuals with schizophrenia. The study found that empathy, personality traits, and academic year were the most crucial attributes contributing to attitudes of nursing students toward individuals with schizophrenia. CONCLUSION Findings suggest that nursing education programs with empathy- and personality-tailored modules in mental health are pivotal to provide humanistic approaches with supportive attitudes regarding schizophrenia.
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Affiliation(s)
- Yi-Han Chen
- Yi-Han Chen, BSN, RN, China Medical University Hospital, Taichung City, Taiwan, Republic of China
| | - Chiu-Yueh Hsiao
- Chiu-Yueh Hsiao, PhD, RN, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Hui-Wen Chien
- Hui-Wen Chien, PhD, RN, Asia University, Taichung City, Taiwan, Republic of China
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Vargas SM, Rivas WA, Ryder A, Lara Muñoz MDCE, López SR. Cultural pathways to psychosis care: Patient and caregiver narratives from Puebla, Mexico. Transcult Psychiatry 2024:13634615241233683. [PMID: 38470500 DOI: 10.1177/13634615241233683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
The current study used the McGill Illness Narrative Interview (MINI) to explore patients' (n = 6) and caregivers' (n = 3) narratives about how they identified and sought care for psychosis. Participants were recruited from an outpatient clinic at the Hospital Psiquiátrico Dr. Rafael Serrano, a public psychiatric hospital in Puebla, Mexico. All participants consented to complete semi-structured interviews in Spanish. Thematic analyses were used to inductively identify common themes in participants' narratives. The results indicated that during the initial symptom onset, most participants noticed the presence of hallucinations but did not seek help for this hallmark symptom. Participants described seeking care only when they or their ill relative exhibited escalating aggressive behaviors or physical symptoms that were interpreted as common medical problems. As participants became connected to specialty mental health services, they began to develop a conceptualization of psychosis as a disorder of aggression. For some participants, this conceptualization of psychosis as an illness of aggression contributed to their ambivalence about the diagnosis. These results can be understood using a cultural scripts framework, which suggests that cultural norms are influenced by collective understandings of normalcy and valorization of behaviors. Implications for community campaigns are discussed.
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Affiliation(s)
- Sylvanna M Vargas
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
- Departments of Psychology and Psychiatry, University of California, Los Angeles, CA, USA
| | - Wilmer A Rivas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- San Diego VA Healthcare System, San Diego, CA, USA
| | - Andrew Ryder
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | | | - Steven R López
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
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Gearing RE, Brewer KB, Washburn M, Yu M, de la Cruz PI, Garcia Andres A, Torres LR. Mental health help-seeking in Mexico. Glob Health Promot 2024; 31:55-64. [PMID: 37888755 DOI: 10.1177/17579759231204357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Most people in need of mental health services in Mexico do not seek formal support or professional services to address their mental health needs. Understanding help-seeking behaviors is crucial to addressing underutilized mental health services and to leverage health promotion efforts. Data were collected as part of a larger research project on stigma and help-seeking for mental-health-related concerns in Mexico. A convenience sample of 469 adults residing in Mexico City participated in the study using an experimental vignette methodology assessing stigma toward individuals with mental health conditions, along with characteristics and demographic correlates of help-seeking. All survey measures were administered in Spanish. A structural regression was conducted for the outcome 'openness to professional help seeking for mental health problems' as a latent variable. Compared with males, females were more open to professional help seeking (b = 0.09, p = 0.038), as were people who endorsed higher spirituality (b = 0.01, p = 0.006); while people who experienced self-stigma were less open to professional help-seeking for mental health concerns (b = -0.15, p = 0.005). Self-stigma was a major driver of low service utilization. Contrary to previous studies, spirituality was a significant positive predictor of professional help-seeking. A more nuanced understanding of mental health help-seeking in Mexico can be useful for outreach efforts to increase service utilization both in Mexico and among Latinos in the United States (US). Given historical, geographic, and cultural ties with the US, it is important to understand mental health help-seeking in Mexico, which may relate directly to help-seeking behaviors in many US Latinos who have immigrated to the US. Directions for future research and practice implications are discussed, including a roadmap for health promotion activities.
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Affiliation(s)
- Robin E Gearing
- University of Houston Graduate College of Social Work, Houston, TX, USA
| | - Kathryne B Brewer
- University of New Hampshire Department of Social Work, Durham, NH, USA
| | - Micki Washburn
- University of Texas at Arlington School of Social Work, Arlington, TX, USA
| | - Miao Yu
- University of Texas at Arlington School of Social Work, Arlington, TX, USA
| | - Pedro Isnardo de la Cruz
- Universidad Nacional Autonoma de Mexico Escuela, Nacional de Trabajo Social, Ciudad de Mexico, Mexico
| | | | - Luis R Torres
- University of Texas Rio Grande Valley School of Social Work, Edinburg, TX, USA
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Washburn M, Gearing RE, Yu M, Brewer KB, Cruz PDL, Torres LR. Predictors of Stigma toward Alcohol Misuse in Mexico. Subst Use Misuse 2023; 58:1805-1812. [PMID: 37644694 DOI: 10.1080/10826084.2023.2247067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Objective: This study explored factors associated with public stigma toward individuals misusing alcohol in Mexico. Methods: A randomized experimental vignette methodology was used to assess multiple domains of substance use-related stigma and their relationship to the gender of the vignette subject and the sociodemographic characteristics of respondents. Results: Although levels of stigma toward women who were misusing alcohol did not differ significantly from stigma toward men misusing alcohol, stigma levels and type of stigma reported varied with the sociodemographic characteristics of respondents. Education level, gender, self-stigma and openness to seeking mental health services were differentially associated with the three stigma domains. Conclusions: Accordingly, targeted community based stigma reduction efforts are needed to decrease stigma toward those misusing alcohol, and to support treatment initiation, ongoing treatment engagement and long term recovery efforts. Suggestions for future research on the relationship between substance use and stigma are offered.
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Affiliation(s)
- Micki Washburn
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Robin E Gearing
- University of Houston Graduate College of Social Work, Houston, Texas, USA
| | - Miao Yu
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Kathryne B Brewer
- Department of Social Work, University of New Hampshire, Durham, New Hampshire, USA
| | - Pedro de la Cruz
- Universidad Nacional Autonoma de Mexico Escuela Nacional de Trabajo Social, Avenida Universidad 3000, Mexico City, Mexico
| | - Luis R Torres
- School of Social Work, University of Texas Rio Grande Valley, Edinburg, Edinburg, Texas, USA
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Favre S, Aubry JM, Richard-Lepouriel H. Perceived public stigma and perceived public exposure by persons living with bipolar disorder: A qualitative study. Int J Soc Psychiatry 2023; 69:378-387. [PMID: 35506642 PMCID: PMC9983048 DOI: 10.1177/00207640221093495] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stigma impact the lives of persons living with bipolar disorder. AIM The aim of this study was to explore how perceived public stigma is described by people living with bipolar disorder and examine the links between perceived public stigma and perceived public exposure. METHOD Face-to-face in-depth interviews were conducted in a purposive sample of euthymic people living with bipolar disorder recruited in a mood disorder ambulatory unit. RESULTS Thematic analysis of the transcript yielded five independent themes that were related to perceived public stigma. Perceived public stigma of bipolar disorder was modeled as comprising the three elements of public stigmas (stereotype, prejudice, and discrimination), with the addition of public exposure as a core component. CONCLUSION The representation of bipolar disorder in society via newspapers, films/TV series, conferences, and celebrity self-disclosures is considered to have multiple impacts. People living with bipolar disorder have also reported a perceived public stigma of bipolar disorder that has both specific features and characteristics of general mental illness.
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Affiliation(s)
- Sophie Favre
- Mood Disorder Unit, Psychiatric Specialties Service, Geneva University Hospital, Switzerland
| | | | - Hélène Richard-Lepouriel
- Mood Disorder Unit, Psychiatric Specialties Service, Geneva University Hospital, Switzerland.,Department of Psychiatry, University of Geneva, Switzerland
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Henderson C, Ouali U, Bakolis I, Berbeche N, Bhattarai K, Brohan E, Cherian A, Girma E, Gronholm PC, Gurung D, Hanlon C, Kallakuri S, Kaur A, Ketema B, Lempp H, Li J, Loganathan S, Maulik PK, Mendon G, Mulatu T, Ma N, Romeo R, Venkatesh RK, Zgueb Y, Zhang W, Thornicroft G. Training for mental health professionals in responding to experienced and anticipated mental health-related discrimination (READ-MH): protocol for an international multisite feasibility study. Pilot Feasibility Stud 2022; 8:257. [PMID: 36514144 PMCID: PMC9745687 DOI: 10.1186/s40814-022-01208-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mental health and other health professionals working in mental health care may contribute to the experiences of stigma and discrimination among mental health service users but can also help reduce the impact of stigma on service users. However, few studies of interventions to equip such professionals to be anti-stigma agents took place in high-income countries. This study assesses the feasibility, potential effectiveness and costs of Responding to Experienced and Anticipated Discrimination training for health professionals working in mental health care (READ-MH) across low- and middle-income countries (LMICs). METHODS This is an uncontrolled pre-post mixed methods feasibility study of READ-MH training at seven sites across five LMICs (China, Ethiopia, India, Nepal and Tunisia). OUTCOME MEASURES knowledge based on course content, attitudes to working to address the impact of stigma on service users and skills in responding constructively to service users' reports of discrimination. The training draws upon the evidence bases for stigma reduction, health advocacy and medical education and is tailored to sites through situational analyses. Its content, delivery methods and intensity were agreed upon through a consensus exercise with site research teams. READ-MH will be delivered to health professionals working in mental health care immediately after baseline data collection; outcome measures will be collected post-training and 3 months post-baseline, followed by qualitative data collection analysed using a combined deductive and inductive approach. Fidelity will be rated during the delivery of READ-MH, and data on training costs will be collected. Quantitative data will be assessed using generalised linear mixed models. Qualitative data will be evaluated by thematic analysis to identify feedback about the training methods and content, including the implementability of the knowledge and skills learned. Pooled and site-specific training costs per trainee and per session will be reported. CONCLUSIONS The training development used a participatory and contextualised approach. Evaluation design strengths include the diversity of settings, the use of mixed methods, the use of a skills-based measure and the knowledge and attitude measures aligned to the target population and training. Limitations are the uncertain generalisability of skills performance to routine care and the impact of COVID-19 restrictions at several sites limiting qualitative data collection for situational analyses.
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Affiliation(s)
- Claire Henderson
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park Box, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
| | - Uta Ouali
- Department Psychiatry A, Razi University Hospital, Cité des Orangers, 2010, La Manouba, Tunisia
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nada Berbeche
- Department of Psychology, Laboratory of Clinical Psychology: Intersubjectivity and Culture, University of Tunis, Tunis, Tunisia
| | | | - Elaine Brohan
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Anish Cherian
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Petra C Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park Box, London, SE5 8AF, UK
| | - Dristy Gurung
- Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sudha Kallakuri
- George Institute for Global Health, 308 Elegance Tower, New Delhi, 110025, India
| | - Amanpreet Kaur
- George Institute for Global Health, 308 Elegance Tower, New Delhi, 110025, India
| | - Bezawit Ketema
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, Weston Education Centre, 10, Cutcombe Rd, London, SE5 9RJ, UK
| | - Jie Li
- The Affiliated Brain Hospital of Guangzhou Medical University, No. 36 Mingxin Road, Liwan District, Guangzhou, 510370, China
| | - Santosh Loganathan
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Pallab K Maulik
- George Institute for Global Health, 308 Elegance Tower, New Delhi, 110025, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Gurucharan Mendon
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Tesfahun Mulatu
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ning Ma
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University, No 51, Huayuanbei Road, Haidian District, Beijing, 100191, China
| | - Renee Romeo
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park Box, London, SE5 8AF, UK
| | | | - Yosra Zgueb
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Wufang Zhang
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University, No 51, Huayuanbei Road, Haidian District, Beijing, 100191, China
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park Box, London, SE5 8AF, UK
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Lagunes-Cordoba E, Lagunes-Cordoba R, Fresan-Orellana A, Gonzalez-Olvera J, Jarrett M, Thornicroft G, Henderson C. Mexican Psychiatric Trainees' Attitudes Towards People with Mental Illness: A Qualitative Study. Community Ment Health J 2022; 58:982-991. [PMID: 34716830 PMCID: PMC9187538 DOI: 10.1007/s10597-021-00907-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
Despite their training, psychiatrists have been found to have negative attitudes towards people with mental illness, including the patients they treat. Similarly, studies focused on service users have identified psychiatrists as a source of stigma. Even though negative attitudes in psychiatrists have been identified in different countries and settings, in Mexico the attitudes of these professionals have never been assessed. Because of this, we invited psychiatric trainees from a hospital in Mexico to participate in individual interviews to describe their opinions regarding mental health-related stigma, to evaluate their attitudes towards people with mental illness and to identify factors that could be influencing their attitudes. Interviews were audio recorded, transcribed and analysed using thematic analysis. A total of 29 trainees participated in the study. The results suggested that trainees recognised psychiatrists can have negative attitudes towards people with mental illness, such as poor empathy, judgement and labelling, and mainly towards patients considered difficult and with borderline personality disorder. Participants recognised these attitudes can influence their relationship with patients, and considered it is necessary to develop interventions to improve their own attitudes and reduce mental health stigma. From this study we concluded Mexican psychiatrists are not free from stigma towards people with mental illness. However, Mexican psychiatric trainees are interested in improving their attitudes and reactions towards their patients.
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Affiliation(s)
- Emmeline Lagunes-Cordoba
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Roberto Lagunes-Cordoba
- Instituto de Investigaciones Psicológicas, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Ana Fresan-Orellana
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Jorge Gonzalez-Olvera
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Mexico City, Mexico.,Comisión Nacional Para la Prevención de Adicciones, Mexico City, Mexico
| | - Manuela Jarrett
- School of Health Sciences, City, University of London, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Claire Henderson
- Centre for Global Mental Health and Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Wainipitapong S, Chiddaycha M. Assessment of dropout rates in the preclinical years and contributing factors: a study on one Thai medical school. BMC MEDICAL EDUCATION 2022; 22:461. [PMID: 35710367 PMCID: PMC9202226 DOI: 10.1186/s12909-022-03527-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The highest dropout rate for medical students is during the preclinical years of education. Several studies have reported possible contributing factors, however, studies regarding the dropout rate from medical education among Thai medical students and its associated factors are still lacking. This study aimed to identify the prevalence of dropout from medical education within the preclinical period and its associated factors among Thai medical students. METHODS We collected data from preclinical medical students who entered one medical school in Bangkok, Thailand, between 2017-2019. Demographic data, admission program, pre-admission mental health status assessed by the Thai Mental Health Indicator 66, mental health records from the faculty-based counseling services, and academic achievement were extracted. Data were reported in a descriptive fashion. We analyzed the association between dropout and these factors by robust Poisson regression. RESULTS In total, 914 students were recruited. Dropout was only 1.5%, which was lower than the previous studies. Regression analysis showed a significant association between dropout and mental health problems [Prevalence ratio (PR) 58.20, 95%CI 13.72- 246.95] but not admission program [PR 0.32, 95%CI 0.09 - 1.16] or failing examinations [PR 0.59, 95%CI 0.18 - 1.90]. However, other contributing factors such as financial status, family problems, medical illness, and students' motivation, were not evaluated in this study. CONCLUSIONS Mental health problems during medical education were associated with dropout after adjusting for other confounding variables. Further longitudinal studies are needed to identify the impacts of academic failure on dropout in higher clinical years.
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Affiliation(s)
- Sorawit Wainipitapong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
- Center of Excellence in Transgender Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Mayteewat Chiddaycha
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
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Henderson C, Ouali U, Bakolis I, Berbeche N, Bhattarai K, Brohan E, Cherian A, Girma E, Gronholm PC, Gurung D, Hanlon C, Kallakuri S, Kaur A, Ketema B, Lempp H, Li J, Loganathan S, Maulik PK, Mendon G, Mulatu T, Ma N, Romeo R, Venkatesh RK, Zgueb Y, Zhang W, Thornicroft G. Training for mental health professionals in responding to experienced and anticipated mental health related discrimination (READ-MH): protocol for an international multisite feasibility study. RESEARCH SQUARE 2022:rs.3.rs-1466318. [PMID: 35378758 PMCID: PMC8978942 DOI: 10.21203/rs.3.rs-1466318/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Mental health and other health professionals working in mental health care may contribute to the experiences of stigma and discrimination among mental health service users, but can also help reduce the impact of stigma on service users. However the few studies of interventions to equip such professionals to be anti-stigma agents those took place in High-Income Countries. This study assesses the feasibility, potential effectiveness and costs of Responding to Experienced and Anticipated Discrimination training for health professionals working in mental health care (READ-MH) across Low- and Middle-Income Countries (LMICs). Methods: This is an uncontrolled pre-post mixed methods feasibility study of READ-MH training at seven sites across five LMICs (China, Ethiopia, India, Nepal, and Tunisia). Outcome measures: knowledge based on course content; attitudes to working to address the impact of stigma on service users; and skills in responding constructively to service users' reports of discrimination. The training draws upon the evidence bases for stigma reduction, health advocacy and medical education and is tailored to sites through situational analyses. Its content, delivery methods and intensity were agreed through a consensus exercise with site research teams. READ-MH will be delivered to health professionals working in mental health care immediately after baseline data collection; outcome measures will be collected post-training and three months post-baseline, followed by qualitative data collection. Fidelity will be rated during delivery of READ-MH, and data on training costs will be collected. Quantitative data will be assessed using generalised linear mixed models. Qualitative data will be evaluated by thematic analysis to identify feedback about the training methods and content, including the implementability of the knowledge and skills learned. Pooled and site-specific training costs per trainee and per session will be reported. Conclusions: The training development used a participatory and contextualized approach. Evaluation design strengths include the diversity of settings; the use of mixed methods; the use of a skills-based measure; and knowledge and attitude measures aligned to the target population and training. Limitations are the uncertain generalisability of skills performance to routine care, and the impact of COVID-19 restrictions at several sites limiting qualitative data collection for situational analyses.
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Affiliation(s)
- Claire Henderson
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | | | - Ioannis Bakolis
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | | | | | - Elaine Brohan
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | - Anish Cherian
- NIMHANS: National Institute of Mental Health and Neuro Sciences
| | | | - Petra C Gronholm
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | - Dristy Gurung
- TPO Nepal: Transcultural Psychosocial Organization Nepal
| | - Charlotte Hanlon
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | | | | | | | | | - Jie Li
- Affiliated Brain Hospital of Guangzhou Medical University: Guangzhou Huiai Hospital
| | | | | | | | - Tesfahun Mulatu
- Addis Ababa University Department of Community Health: Addis Ababa University School of Public Health
| | - Ning Ma
- Peking University Institute of Mental Health: Peking University Sixth Hospital
| | - Renee Romeo
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | | | | | - Wufang Zhang
- Peking University Institute of Mental Health: Peking University Sixth Hospital
| | - Graham Thornicroft
- King’s College London Institute of Psychiatry Psychology and Neuroscience
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Domínguez-González AD, Guzmán-Valdivia G, Ángeles-Téllez FS, Manjarrez-Ángeles MA, Secín-Diep R. Depression and suicidal ideation in Mexican medical students during COVID-19 outbreak. A longitudinal study. Heliyon 2022; 8:e08851. [PMID: 35128117 PMCID: PMC8806407 DOI: 10.1016/j.heliyon.2022.e08851] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/16/2021] [Accepted: 01/14/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction The COVID-19 pandemic has been particularly difficult for populations at risk for mental health problems, such as healthcare professionals and medical students. In the present study, we evaluated the effect of the pandemic on mental health in a sample of Mexican medical students with and without a mental health diagnosis. Method Longitudinal and descriptive study based on scales of suicidal ideation, depressive symptoms and risk of alcohol consumption, conducted in April and December 2020. Results Sample includes 247 medical students, 64.4% are women. Prevalence of depression increased between April and December from 19.84% to 40.08%. In the case of women from 23.67% to 42.60% (χ2 = 0.000) and in men from 11.54% to 34.62% (χ2 = 0.001). In April 16.92% of healthy students presented some sign of depression and in December the percentage increased to 40.80% (χ2 = 0.000). Regarding medicated students, the prevalence in April was 32.61% and in December it was 36.96% (χ2 = 0.662). In April, the medicated students with risk of suicidal ideation were 17 out of 46 (36.96%), compared to the students without a diagnosis of psychiatric illness were 29 out of 201 (13.43%) (χ2 = 0.000). For December, the non-medicated students at risk of suicidal ideation were 34 out of 201 (16.91%), and the medicated students were 12 out of 46 (26.09%) (χ2 = 0.149). Conclusions The pandemic has increase the rate of depression in medical students, being more severe in women. Students under psychiatric treatment showed a higher prevalence of depression; however, the fact of being under treatment resulted in a protective factor for the increase in the prevalence of depression. It is important to deepen the understanding of the causes of depression and to disseminate among the university community the benefits of early detection and treatment of people with socio-emotional disorders.
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Affiliation(s)
- A D Domínguez-González
- Universidad La Salle-México, BenjamÃ-n Franklin 45, Mexico City 06140, Mexico.,Facultad Mexicana de Medicina, Las Fuentes 17, Mexico City 14000, Mexico
| | - G Guzmán-Valdivia
- Universidad La Salle-México, BenjamÃ-n Franklin 45, Mexico City 06140, Mexico.,Facultad Mexicana de Medicina, Las Fuentes 17, Mexico City 14000, Mexico
| | - F S Ángeles-Téllez
- Facultad Mexicana de Medicina, Las Fuentes 17, Mexico City 14000, Mexico
| | | | - R Secín-Diep
- Facultad Mexicana de Medicina, Las Fuentes 17, Mexico City 14000, Mexico.,Hospital Ãngeles Pedregal, Camino Santa Teresa 1055, Mexico City 10700, Mexico
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Lagunes-Cordoba E, Alcala-Lozano R, Lagunes-Cordoba R, Fresan-Orellana A, Jarrett M, Gonzalez-Olvera J, Thornicroft G, Henderson C. Evaluation of an anti-stigma intervention for Mexican psychiatric trainees. Pilot Feasibility Stud 2022; 8:5. [PMID: 35031066 PMCID: PMC8759153 DOI: 10.1186/s40814-021-00958-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/03/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND There is research evidence regarding the presence of stigmatising attitudes in psychiatrists towards people with mental illness, but a lack of studies and interventions focused on this issue in low and middle-income countries. AIMS To assess the feasibility of implementing an anti-stigma intervention for Mexican psychiatric trainees, and its potential effects. METHODS This study comprised a pre-post design with outcome measures compared between baseline and 3-month follow-up. Quantitative outcome measures were used to evaluate the potential effects of the intervention, whilst the process evaluation required the collection and analysis of both quantitative and qualitative data. RESULTS Twenty-nine trainees (25% of those invited) participated in the intervention, of whom 18 also participated in the follow-up assessment. Outcome measures showed the intervention had moderately large effects on reducing stereotypes and the influence of other co-workers on trainees' own attitudes. The main mechanisms of impact identified were recognition of negative attitudes in oneself and colleagues, self-reflection about the impact of stigma, one's own negative attitudes and recognition of one's ability to make change. Participants accepted and were satisfied with the intervention, which many considered should be part of their routine training. However, trainees' work overload and lack of support from the host organisation were identified as barriers to implement the intervention. CONCLUSIONS A brief anti-stigma intervention for Mexican psychiatric trainees is feasible, potentially effective, well accepted and was considered necessary by participants. This study also suggests mechanisms of impact and mediators should be considered for developing further interventions, contributing to reducing the damaging effects that mental health-related stigma has on people's lives.
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Affiliation(s)
- Emmeline Lagunes-Cordoba
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Ruth Alcala-Lozano
- Laboratorio de Neuromodulación, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Roberto Lagunes-Cordoba
- Instituto de Investigaciones Psicológicas, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Ana Fresan-Orellana
- Laboratorio de Neuromodulación, Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Manuela Jarrett
- School of Health Science at City, University of London, London, UK
| | | | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Claire Henderson
- Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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