Help-seeking behaviors for mental health problems in medical students: Studies in Thailand and India

Mental Illnesses and Stigma among Medical Undergraduates in India

The current Medical Education system of India, with its enormous workload and academic demands tend to cause the medical students stress. There is evidence showing medical students at a higher risk of depression, anxiety and burnout compared to other Indian students. Despite, the huge reported numbers, the proportion of students and doctors who seek help for their problems is alarmingly low. One of the reasons provided for the same is stigma towards mental health and an apprehension regarding labels and treatment history on the careers of the students. Increased awareness and with a National Health Programme catered towards mental health, there has been a boost in the utilization and provision of mental health services but it rarely translates into better mental health facilities for the healthcare providers. The special set of challenges faced by a medical students are gradually being recognized and efforts are being made to address them. Curriculum guidelines, teaching methods, student welfare centres and helplines have been the areas of intervention. There should also be changes in approaches towards the students who face problems and providing a safe environment for them to discuss their problems, including encouraging peer support. Thus, a fine balance needs to be present between ensuring the protection of the mental health of a medical student and ensuring a quality medical education for them. Further exploration to address stigma and building empathy among the students and evaluation of the intervention methods devised to address the same becomes very necessary to ensure fruitful interventions. It is the need of the hour to help Indian Medical students overcome their struggles with mental health.

Prevalence of Depression and Generalized Anxiety Among LGBTQ+ Medical Students in Thailand

This study evaluated the prevalence and associated factors of depression and generalized anxiety among LGBTQ+ in five medical schools in Thailand. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess major depressive disorder (MDD) and generalized anxiety disorder (GAD), respectively, and multivariable logistic regression was employed to identify associated factors. Of 1,322 students, 412 (31.16%) identified as LGBTQ+. The prevalence for MDD and GAD among LGBTQ+ students were 32.77% and 17.23%, respectively. Significant associated factors for both MDD and GAD were a history of psychiatric illness (AOR for MDD = 2.32, p = .020; AOR for GAD = 3.67, p < .001), educational problems (AOR for MDD = 6.62, p < .001; AOR for GAD = 5.12, p < .001), and dissatisfaction with gender identity or sexual orientation (AOR for MDD = 1.92, p = .019; AOR for GAD = 2.47, p = .005). Additional factors associated with MDD were preclinical years (AOR = 2.30, p = .023), financial struggles (AOR = 2.05, p = .021), and inadequate peer support (AOR = 2.57, p = .044). In conclusion, nearly one-third and one-fifth of Thai LGBTQ+ medical students suffer from MDD and GAD, respectively. Our findings suggest that Thai medical schools should promote LGBTQ+ inclusivity to enhance students' identity satisfaction. Peer support groups should be encouraged, especially for preclinical LGBTQ+ students who face educational and financial challenges.

Detection and disclosure of workplace mental health challenges: an exploratory study from India

Workplace mental health challenges have emerged as a significant concern post-pandemic. Despite this, the pervasive stigma surrounding mental illness leads to the concealment of symptoms and reluctance to seek professional help among employees. This study aims to explore the perception of different stakeholders towards the 'Detection and disclosure' of workplace mental health challenges in the Indian context. Fifteen semi-structured interviews were conducted with human resource professionals, counselors, and employees who had previously experienced mental health challenge(s). Thematic analysis was done to identify recurring themes and sub-themes. Three critical pathways were identified: minimizing the inhibitory factors, including lack of awareness, denial, low self-efficacy, stigma, and underestimating organizational capability; maximizing the encouraging factors, including psychological safety, perceived social support, and communicating success stories; and implementing supportive organizational practices, including generating awareness and literacy, build the organizational capability, strengthen the role of managers, leadership advocacy, policies, and processes. By fostering a culture of support and prioritizing employee well-being, organizations in India can create healthier and more resilient work environments, benefiting both individuals and the larger society.

Needs Expressed in Peer-to-Peer Web-Based Interactions Among People With Depression and Anxiety Disorders Hospitalized in a Mental Health Facility: Mixed Methods Study

BACKGROUND

Hospitalization in psychiatric wards is a necessary step for many individuals experiencing severe mental health issues. However, being hospitalized can also be a stressful and unsettling experience. It is crucial to understand and address the various needs of hospitalized individuals with psychiatric disorders to promote their overall well-being and support their recovery.

OBJECTIVE

Our objectives were to identify and describe individual needs related to mental hospitals through peer-to-peer interactions on Polish web-based forums among individuals with depression and anxiety disorders and to assess whether these needs were addressed by peers.

METHODS

We conducted a search of web-based forums focused on depression and anxiety and selected samples of 160 and 176 posts, respectively, until we reached saturation. A mixed methods analysis that included an in-depth content analysis, the Pearson χ2 test, and φ coefficient was used to evaluate the posts.

RESULTS

The most frequently identified needs were the same for depression and anxiety forums and involved informational (105/160, 65.6% and 169/393, 43%, respectively), social life (17/160, 10.6% and 90/393, 22.9%, respectively), and emotional (9/160, 5.6% and 66/393, 16.8%, respectively) needs. The results show that there is no difference in the expression of needs between the analyzed forums. The needs were directly (42/47, 89% vs 98/110, 89.1% of times for depression and anxiety, respectively) and not fully (27/47, 57% vs 86/110, 78.2% of times for depression and anxiety, respectively) addressed by forum users. In quantitative analysis, we found that depression-related forums had more posts about the need for informational support and rectification, the expression of anger, and seeking professional support. By contrast, anxiety-related forums had more posts about the need for emotional support; social life; and information concerning medications, hope, and motivation. The most common co-occurrence of expressed needs was between sharing own experience and the need for professional support, with a strong positive association. The qualitative analysis showed that users join web-based communities to discuss their fears and questions about psychiatric hospitals. The posts revealed 4 mental and emotional representations of psychiatric hospitals: the hospital as an unknown place, the ambivalence of presumptions and needs, the negative representation of psychiatric hospitals, and the people associated with psychiatric hospitals. The tone of the posts was mostly negative, with discussions revolving around negative stereotypes; traumatic experiences; and beliefs that increased anxiety, shock, and fright and deterred users from hospitalization.

CONCLUSIONS

Our study demonstrates that web-based forums can provide a platform for individuals with depression and anxiety disorders to express a wide range of needs. Most needs were addressed by peers but not sufficiently. Mental health professionals can benefit from these findings by gaining insights into the unique needs and concerns of their patients, thus allowing for more effective treatment and support.

Social Support Mediates the Relationship Between Coping Styles and the Mental Health of Medical Students

Purpose

This study aimed to explore the impact that coping styles and social support have on the mental health of medical students by constructing a corresponding structural situation model that reveals the complex relationship between these three factors. In doing so, it seeks to help medication students better manage mental health problems.

Patients and Methods

The online study was conducted between March 6, 2021 and May 6, 2021. A total of 318 participants from multiple medical schools were involved. The general information questionnaire, simple coping style questionnaire (SCSQ), perceived social support scale (PSSS) and symptom checklist 90 (SCL-90) were used to collect relevant information from the subjects by snowball sampling. An independent t-test, ANOVA, Pearson correlation coefficient analysis, and intermediary effect analysis were all used to analyze the relevant data and construct the structural equation model.

Results

There was a significant difference in SCL-90 between medical students and national college students (1.78±0.70, P < 0.001), and the positive rate of mental health status was as high as 40.3%. Sleep quality, regular diet, and positive coping style were positively correlated with mental health (P < 0.01), while negative coping styles and total scores of coping style as well as family, friends, and other sources of social support and total scores of social support were negatively correlated with mental health problems (P < 0.01). Positive and negative coping styles have an impact on mental health through the mediating effect of between social support and coping styles, as well as in the direct pathway.

Conclusion

The mental health status of medical students was significantly poor. Medical schools should thus pay close attention to the mental health status of students and encourage them to develop healthy living habits, optimize coping styles, and establish stable sources of social support to improve their psychological wellbeing.

Stigma towards mental illness and help-seeking behaviors among adult and child psychiatrists in Hungary: A cross-sectional study

Objective

Stigma towards people with mental health problems is a growing issue across the world, to which healthcare providers might contribute. The aim of the present study was to explore psychiatrists’ attitudes towards their patients and link them to psychosocial and professional factors.

Methods

An online questionnaire was used to approach the in- and outpatient psychiatric services across Hungary. A total of 211 trainees and specialists in adult and child psychiatry participated in our study. Their overall stigmatizing attitudes were measured, with focus on attitude, disclosure and help-seeking, and social distance dimensions by using the self-report Opening Minds Stigma Scale for Health Care Providers (OMS-HC). Multiple linear regression analyses were performed to elucidate the dimensions of stigma and its association with sociodemographic, professional and personal traits.

Results

Stigmatizing attitudes of close colleagues towards patients were statistically significant predictors of higher scores on the attitude [B = 0.235 (0.168–0.858), p = 0.004], the disclosure and help-seeking subscales [B = 0.169 (0.038–0.908), p = 0.033], and the total score of the OMS-HC [B = 0.191 (0.188–1.843), p = 0.016]. Psychiatrists who had already sought help for their own problems had lower scores on the disclosure and help-seeking subscale [B = 0.202 (0.248–1.925), p = 0.011]. The overall stigmatizing attitude was predicted by the openness to participate in case discussion, supervision or Balint groups [B = 0.166 (0.178–5.886), p = 0.037] besides the more favorable attitudes of their psychiatrist colleagues [B = 0.191 (0.188–1.843), p = 0.016].

Conclusions

The favorable attitudes of psychiatrists are associated with their own experiences with any kind of psychiatric condition, previous help-seeking behavior and the opportunity to work together with fellow psychiatrists, whose attitudes are less stigmatizing. The perception of fellow colleagues’ attitudes towards patients and the openness to case discussion, supervision and Balint groups were the main two factors that affected the overall attitudes towards patients; therefore, these should be considered when tailoring anti-stigma interventions for psychiatrists.

A systematic review and meta-analysis of substance use among medical students in India

BACKGROUND AND AIMS

Substance use among medical students may have consequences like poor academic performance and impaired patient care. There is a growing literature on substance use among medical students in India. This systematic review and meta-analysis were done to synthesize the literature on substance use among medical students in India.

METHODS

Medline and Google Scholar were used as search engines to ascertain the literature that reported substance use among Indian medical students from January 2000 to January 2022. The pooled prevalence of tobacco, alcohol, other substance, and overall substance use was computed.

RESULTS

A total of 65 studies were included. The pooled prevalence of tobacco use was 21.9% (95% confidence intervals [CI] 18.5% to 25.3%, n = 20,165, k = 51), while the pooled prevalence of alcohol use was 27.1% (95% CI of 23.0% to 31.1%, n = 11,823, k = 31). The overall pooled prevalence of substance use was 40.3% (95% CI of 25.5% to 55.2%, n = 4960, k = 10), while pooled prevalence of cannabis was 8.2% (95% CI of 4.9% to 11.5%, n = 2418, k = 7). The use of tobacco was about 10 times higher in males than females, while the odds of alcohol use were about five times higher in males.

CONCLUSION

Substance use is common among medical students, with rates of substance use being generally higher in males as compared to females. Targeted interventions may help to reduce substance use and prevent the development of substance use disorders in this population.

The Assessment of Attitudes of Students at Medical Schools towards Psychiatry and Psychiatric Patients-A Cross-Sectional Online Survey

The aim of the study was the assessment of the level of stigmatisation of psychiatric patients and psychiatry as a field of study by students at medical schools in Poland and the comparison of students’ attitudes over the years. The study was conducted based on a proprietary questionnaire assessing the stage of tertiary education, sociodemographic status, and MICA-2 psychometric tool that is used for assessing both the attitudes of students at medical schools towards psychiatry as a field of study and patients with mental health disorders. According to the MICA score, those who have higher scores have more negative attitudes towards psychiatry. The survey consisted of two rounds at an interval of 3 years. Results. The first-round survey, conducted in 2017, involved 480 students. The second-round survey, conducted in 2020, involved 573 students. In both cases, women constituted the vast majority of respondents. Women, as well as medical major students, achieved significantly lower scores than men p < 0.001. The said relationship was also observed for individual experience with mental illness. There was no correlation between the MICA-2 total score and the psychiatry course completion—p = 0.105. However, the levels of stigmatisation are still high. The implementation of educational methods to improve the perception of psychiatric patients by students at medical schools should be taken into consideration. An increase in direct student–patient contact, for example, by means of intensive elective classes, could be beneficial.

Stigma Levels Toward Psychiatric Patients Among Medical Students-A Worldwide Online Survey Across 65 Countries

Background: According to epidemiological data, over 450 million people worldwide suffer from mental disorders, presenting one of the major challenges of modern medicine. In their everyday lives, patients, in addition to fighting the disease itself, often struggle with stigmatization. This phenomenon negatively affects both the diagnostic and therapeutic processes, as well as the patients' everyday functioning. This study aimed to assess stigma attitudes toward psychiatry and psychiatric patients among undergraduate medical students. Methods: This study used a Computer-Assisted Web Interview (CAWI), which included the standardized items from the Mental Illness: Clinicians' Attitudes (MICA-2) scale to evaluate stigma. The study was disseminated via the internet to students from medical universities from 65 countries worldwide. Participation was voluntary and anonymous. The study involved 1,216 students from these 65 countries. Most of the sample were women, and most were medical faculty students and students living in cities with more than 500,000 residents. Taking into consideration Gross Domestic Product (GDP) per capita and Human Development Index (HDI) variables, it can be seen that there was a prevalence of medical students from highly developed countries. Results: For the whole sample, the mean MICA-2 score was 40.5 points. Women and medical and nursing students showed more positive attitudes toward psychiatric patients. Students from countries with the highest economic development levels also achieved statistically lower MICA-2 scores. Lower score means a more positive attitude. Conclusion: Stigma toward both psychiatry and psychiatric patients is common among undergraduate medical students. Female students and respondents with a history of mental disorders in countries with high HDI and GDP per capita indices show more favorable attitudes than other medical students. There is a need to further our understanding of the problem of stigmatization, both among the general population and among medical personnel, and to implement and maintain appropriate measures to reduce stigma toward psychiatry.