Evaluation of mental health stigma on medical education: an observational study with Portuguese medical students

Simulation with a standardised patient to reduce stigma towards people with schizophrenia spectrum disorder among nursing students: A quasi-experimental study

OBJECTIVES

This study examined the effectiveness of simulation with a standardised patient on the perception of stigma associated with schizophrenia among undergraduate nursing students. It also assessed the reliability of the AQ-27 questionnaire in this context.

METHOD

A quasi-experimental study without a control group was conducted on a non-probabilistic sample. The simulation programme used a standardised patient portrayed by a nurse with mental health experience.

RESULTS

After simulation, statistically significant stigma improvements were found in six out of nine dimensions; anger and help obtained larger effect sizes (r = 0.392 and 0,307, respectively). Regarding gender, the intragroup analysis revealed that simulation improved stigma among women in six dimensions and among men in four dimensions, with anger and fear showing the highest effect size (r = 0.414 and 0.446, respectively). Regarding previous contact with mental illness among the study participants, the intergroup analysis did not show differences. In the intragroup analysis, simulation improved fear only in the contact group (p = 0,040, r = 0.353). In contrast, simulation changed the response in six dimensions in the no-contact group, similar to the entire group.

CONCLUSION

Simulation with a standardised patient is an effective teaching tool for reducing the stigmatisation of people with schizophrenia, thus reducing people's perception of internal causal attribution. It allows for experiencing situations that may be anticipated in clinical practice and reflectively addressing emerging aspects during simulation.

Physicians' and medical students' beliefs and attitudes toward psychotic disorders: A systematic review

OBJECTIVE

The aim of this study was to analyze physicians' and medical students' (MS) beliefs and attitudes toward people with psychotic disorders.

METHODS

This systematic review follows the PRISMA guidelines. It was conducted on 5 databases (Pubmed, PsycINFO, Pascal & Francis, Scopus and EMBASE) with a keyword string combining words for physicians' and students' professional status, attitudes toward people, and psychotic disorders. No limitations on publication dates were imposed.

RESULTS

This review includes 39 articles, among which quantitative studies are in the majority, and general practioners are mainly represented. Schizophrenia is the main condition used to illustrate psychotic disorders and measure stigmatizing attitudes. Physicians' and MS' beliefs toward people with psychotic disorders are mainly represented by dangerousness and unpredictability. They can be reinforced with socio-demographic criteria (age and female gender) or physicians' beliefs about the disease's etiology. The desire for social distance is higher toward patients with schizophrenia compared to other psychiatric disorders, and medical care could be impacted with a tendency to refer them at psychiatric specific care or to anticipate their difficulties and to modify their treatment plan. Stigma scores remain globally high during medical training. Even if specific anti-stigma trainings have a positive impact on beliefs and attitudes, these effects do not last in time.

CONCLUSION

This review highlights the importance to explore physicians' and medical students' representations about patient with psychosis to understand better their difficulties in the management of these patients.

Perspectives on mental health services for medical students at a Ugandan medical school

BACKGROUND

University-based mental health services for medical students remain a challenge, particularly in low-income countries, due to poor service availability. Prior studies have explored the availability of mental health services in high-income countries but little is known about mental health services in countries in sub-Saharan Africa, such as Uganda. Medical students are at a higher risk of developing mental health challenges during their course of study as compared with other students. Thus, there is a need for well-structured mental health services for this group of students. The aim of this study was to explore perspectives on mental health services for medical students at a public University in Uganda.

METHODS

This was a qualitative study where key informant interviews were conducted among purposively selected university administrators (n = 4), student leaders (n = 4), and mental health employees of the university (n = 3), three groups responsible for the mental well-being of medical students at a public university in Uganda. Interviews were audio-recorded, transcribed, and thematically analyzed to identify relevant themes.

RESULTS

The working experience of university administrators and mental health providers was between eight months to 20 years, while student leaders had studied at the university for over four years. We identified five broad themes: (1) Burden of medical school: A curriculum of trauma, (2) Negative coping mechanisms and the problem of blame, (3) The promise of services: Mixed Messages, (4) A broken mental health system for students, and (5) Barriers to mental health services.

CONCLUSION

Distinguishing between psychological distress that is anticipated because of the subject matter in learning medicine and identifying those students that are suffering from untreated psychiatric disorders is an important conceptual task for universities. This can be done through offering education about mental health and well-being for administrators, giving arm's length support for students, and a proactive, not reactive, approach to mental health. There is also a need to redesign the medical curriculum to change the medical education culture through pedagogical considerations of how trauma informs the learning and the mental health of students.

Knowledge, attitude and perceptions of medical students towards mental health in a university in Uganda

BACKGROUND

The prevalence of mental illness among medical students is high. A gap remains on what knowledge should be given to improve the attitudes and perceptions towards mental health. Despite the vast body of literature globally, no study has been conducted in Uganda to assess the levels of knowledge, attitude, and perception among medical students in Uganda.

OBJECTIVE

To determine the level of knowledge, attitude, and perception and their associated factors among medical students in Uganda.

METHODS

A cross-sectional study was done among 259 undergraduate medical students in a public university capturing information on knowledge, attitude, and perception towards mental health. Linear regression analysis was used to determine the factors associated with knowledge, attitude, and perception.

RESULTS

About 77.72% had high knowledge, 49.29% had positive attitudes, and 46.92% had good perceptions of mental health. There was a significant positive relationship between attitude and perceptions towards mental illness. At multilevel analysis, being in year 4 increased the level of knowledge (β = 1.50 [95% confidence interval (CI) = 0.46-2.54], p = 0.005) while a positive history of mental illness worsened perceptions towards mental illness (β = -4.23 [95% CI = -7.44-1.03], p = 0.010).

CONCLUSION

Medical students have a high level of knowledge about mental illness but the majority had poor attitudes and perceptions of mental illness. Exposure to psychiatry knowledge about mental illness in year four increased students' knowledge while prior experience with mental illness conditions was associated with poorer perceptions. The information present in this study can be used by policymakers and future researchers to design future studies and interventions to improve knowledge, perceptions, and attitudes especially among students who have a history of mental illness. Improvements in knowledge, attitude, and perception may improve the mental health services for the future patients of these medical students.

Social distance and stigma towards persons with serious mental illness among medical students in five European Central Asia countries

The study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in the Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students' responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of enhanced range of integrated training opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them.