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Harhaji S, Tomori S, Nakov V, Chihai J, Radić I, Mana T, Stoychev K, Esanu A, Pirlog MC. Stigmatising Attitudes Towards Mental Health Conditions Among Medical Students In Five South-Eastern European Countries. Zdr Varst 2024; 63:188-197. [PMID: 39319025 PMCID: PMC11417508 DOI: 10.2478/sjph-2024-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 08/02/2024] [Indexed: 09/26/2024] Open
Abstract
Introduction Stigmatising attitudes towards mentally ill people are present among healthcare professionals. The aim of the study was to evaluate medical students' attitudes in five medical schools from Albania, Bulgaria, Moldova, Romania and Serbia and to determine if psychiatry clerkship improves these attitudes. Methods In the first stage, the study included students from the first and final years of medical school; in the second stage, only final-year students were included; The Mental Illness Clinicians' Attitude Scale (MICA-2) and the Attribution Questionnaire (AQ-9) were used in this study. The total sample comprised 1,526 medical students in the first stage and 614 in the second stage. Results The analysis of the average AQ-9 and MICA-2 scores between countries revealed significant differences (p<0.05). Multivariable analysis showed that female students were 30% more likely to have elevated AQ-9 scores than male students (p=0.029). Final-year students had a significantly lower chance of having a higher MICA-2 score compared to first-year students (OR=0.7; p<0.05). Conclusions Psychiatry clerkship contributes to a decrease in the level of stigmatising attitudes among medical students. Further research is required to assess the curricula to achieve better results in reducing stigma among future doctors.
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Affiliation(s)
- Sanja Harhaji
- Institute of Public Health of Vojvodina, Futoška 121, 21000, Novi Sad, Serbia
| | - Sonila Tomori
- Tirana Medical University, Rruga e Dibrës 371, AL1005, Tirana, Albania
| | - Vladimir Nakov
- National Centre of Public Health and Analyses, Akad. Iv. E. Geshov Blvd 15, Sofia, Bulgaria
| | - Jana Chihai
- Nicolae Testemitanu State University of Medicine and Pharmacy, Ştefan cel Mare şi Sfant Blvd 165Chisinau, Moldova
| | - Ivana Radić
- Institute of Public Health of Vojvodina, Futoška 121, 21000, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000, Novi Sad, Serbia
| | - Tedi Mana
- Tirana Medical University, Rruga e Dibrës 371, AL1005, Tirana, Albania
| | - Kaloyan Stoychev
- Faculty of Medicine, Medical University Pleven, Sv. Kliment Ohridski 1, 5800, Pleven, Bulgaria
| | - Andrei Esanu
- Nicolae Testemitanu State University of Medicine and Pharmacy, Ştefan cel Mare şi Sfant Blvd 165Chisinau, Moldova
| | - Mihail Cristian Pirlog
- Medical Sociology Department, University of Medicine and Pharmacy of Craiova, Petru Rares 2, 200349, Craiova, Romania
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Kassam A, Antepim B, Sukhera J. A Mixed Methods Study of Perceptions of Mental Illness and Self-Disclosure of Mental Illness Among Medical Learners. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:336-348. [PMID: 38855532 PMCID: PMC11160393 DOI: 10.5334/pme.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/27/2024] [Indexed: 06/11/2024]
Abstract
Introduction Mental illness stigma remains rooted within medical education and healthcare. We sought to measure perceptions toward mental illness and explore perceptions of self-disclosure of mental illness in medical learners. Method In a mixed-methods, sequential design, authors recruited medical learners from across Canada. Quantitative data included the Opening Minds Scale for Healthcare providers (OMS-HC), the Self Stigma of Mental Illness Scale (SSMIS), and a wellbeing measure. Qualitative data included semi-structured interviews, which were collected and analyzed using a phenomenological approach. Results N = 125 medical learners (n = 67 medical students, n = 58 resident physicians) responded to our survey, and N = 13 participants who identified as having a mental illness participated in interviews (n = 10 medical students, n = 3 resident physicians). OMS-HC scores showed resident physicians had more negative attitudes towards mental illness and disclosure (47.7 vs. 44.3, P = 0.02). Self-disclosure was modulated by the degree of intersectional vulnerability of the learner's identity. When looking at self-disclosure, people who identified as men had more negative attitudes than people who identified as women (17.8 vs 16.1, P = 0.01) on the OMS-HC. Racially minoritized learners scored higher on self-stigma on the SSMIS (Geometric mean: 11.0 vs 8.8, P = 0.03). Interview data suggested that disclosure was fraught with tensions but perceived as having a positive outcome. Discussion Mental illness stigma and the individual process of disclosure are complex issues in medical education. Disclosure appeared to become more challenging over time due to the internalization of negative attitudes about mental illness.
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Affiliation(s)
- Aliya Kassam
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada
| | - Benedicta Antepim
- Department of Community Health Sciences and research associate in the Office of Postgraduate Medical Education in the Office of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Canada
| | - Javeed Sukhera
- Hartford Hospital and the Institute of Living and an Associate Clinical Professor of Psychiatry at Yale School of Medicine, Connecticut, USA
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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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Shi J, Chen Y, Jiang Y, Li Y, Wang W, Zhao H, Guo L, Liao Y, Zhang H, Gao C, McIntyre RS, Zhang WH, Han X, Lu C. Stigma and its associations with medication adherence in major depressive disorder. Psychiatry Res 2024; 331:115664. [PMID: 38070363 DOI: 10.1016/j.psychres.2023.115664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/02/2024]
Abstract
This study sought to evaluate internalized stigma (IS) and perceived stigma (PS), in persons (n = 522) living with major depressive disorder (MDD), with a view to analyzing the association of IS and PS with medication adherence in a cohort of participants with MDD in China. Perceived stigma is the awareness of societal negative views and attitudes towards depression, and IS is applying others' attitudes to oneself, both measured by the Depression Stigma Scale (DSS). Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). We observed that 76.0 % of participants reported IS and 84.5 % reported PS. Factors associated with increased IS included older age, marital status, disease history, and a higher baseline Patient Health Questionnaire-9 (PHQ-9). Higher education level, family income, and scores on the Connor-Davidson Resilience Scale (CD-RISC) were associated with lower levels of IS. Higher education levels, Childhood Trauma Questionnaire (CTQ) scores, and living with others were also associated with higher PS, while engagement in exercise and higher number of prior episodes were associated with lower PS. IS had a negative association with medication adherence, whereas PS did not significantly associate with adherence. In conclusion, a testable hypothesis is derived from our data that strategies targeting IS amongst persons with MDD may improve overall rates of adherence to antidepressant treatment, a necessary prelude to improving recovery.
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Affiliation(s)
- Jingman Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Yan Chen
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Yingchen Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Hao Zhao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Yuhua Liao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Huimin Zhang
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Caihong Gao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; School of Public Health, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China.
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Valdivia Ramos HN, Mora-Rios J, Natera G, Mondragón L. Psychometric properties of the Mexican version of the opening minds stigma scale for health care providers (OMS-HC). PeerJ 2023; 11:e16375. [PMID: 38025693 PMCID: PMC10655721 DOI: 10.7717/peerj.16375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Healthcare providers are one of the main groups that contribute to the stigmatization of people with mental disorders. Apathy, accusation, fatalism, and morbid curiosity are the most common forms of stigmatization encountered, and these are associated with inadequate treatment, reduced treatment adherence, decreased help-seeking behavior, an increased risk of relapse, and complications with other medical conditions. The aim of this study was to examine the psychometric properties of an adapted Spanish version of the Opening Minds Stigma Scale (OMS-HC) for healthcare providers in Mexico and identify certain stigmatizing attitudes within this group. Methods An ex-post facto cross-sectional observational study was conducted with 556 healthcare providers in Mexico, with an average age of 29.7 years, who were mostly women (80.4%). Validity was examined through confirmatory factor analysis. Differences according to gender, discipline, occupation, and educational level were analyzed using multivariate methods. Results The factor structure of the OMS-HC, consisting of three subscales identified by the original authors of the instrument (attitudes of healthcare providers towards people with mental illness, secrecy/help-seeking, and social distance), was confirmed. The model demonstrated good fit (x2/df = 2.36, RMSEA = 0.050, CFI = 0.970, TLI = 0.962, SRMR = 0.054, NFI = 0.950, PNFI = 0.742). Internal consistency was found to be adequate (α = 0.73, ω = 0.76) for the scale itself and slightly lower than acceptable for the subscales. Significant differences were found by discipline, educational level, and, for student providers, by academic semester. Higher scores were observed on the OMS-HC scale among nursing and medical professionals, undergraduate students, and those in early semesters. Conclusions The Spanish version of the OMS-HC has demonstrated adequate psychometric properties and could be a useful tool to facilitate research on this topic in Mexico, and to carry out comparative studies with healthcare personnel in other Spanish-speaking countries.
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Affiliation(s)
- Hugo Noel Valdivia Ramos
- Programa de Maestría y Doctorado de Ciencias Médicas, Ontológicas y de la Salud, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Jazmín Mora-Rios
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Guillermina Natera
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Liliana Mondragón
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
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Vaishnav M, Javed A, Gupta S, Kumar V, Vaishnav P, Kumar A, Salih H, levounis P, NG B, Alkhoori S, Luguercho C, Soghoyan A, Moore E, Lakra V, Aigner M, Wancata J, Ismayilova J, Islam MA, Da Silva AG, Chaimowitz G, Xiaoping W, Okasha T, Meyer-Lindenberg A, Schulze T, NG R, Chiu SN, (Sherry) CKW, Tanra AJ, Park YC, Panteleeva L, Taveras M, Mazaliauskiene R, Sulaiman AHB, Sanchez T, Sedain CP, Sheikh TL, Lien L, Rasool G, Buenaventura R, Gambheera HC, Ranasinghe K, Sartorius N, Charnsil C, Larnaout A, Nakku J, Ashurov Z. Stigma towards mental illness in Asian nations and low-and-middle-income countries, and comparison with high-income countries: A literature review and practice implications. Indian J Psychiatry 2023; 65:995-1011. [PMID: 38108051 PMCID: PMC10725213 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_667_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/23/2023] [Accepted: 09/23/2023] [Indexed: 12/19/2023] Open
Abstract
Background Stigma related to mental illness (and its treatment) is prevalent worldwide. This stigma could be at the structural or organizational level, societal level (interpersonal stigma), and the individual level (internalized stigma). Vulnerable populations, for example, gender minorities, children, adolescents, and geriatric populations, are more prone to stigma. The magnitude of stigma and its negative influence is determined by socio-cultural factors and macro (mental health policies, programs) or micro-level factors (societal views, health sectors, or individuals' attitudes towards mentally ill persons). Mental health stigma is associated with more serious psychological problems among the victims, reduced access to mental health care, poor adherence to treatment, and unfavorable outcomes. Although various nationwide and well-established anti-stigma interventions/campaigns exist in high-income countries (HICs) with favorable outcomes, a comprehensive synthesis of literature from the Low- and Middle-Income Countries (LMICs), more so from the Asian continent is lacking. The lack of such literature impedes growth in stigma-related research, including developing anti-stigma interventions. Aim To synthesize the available mental health stigma literature from Asia and LMICs and compare them on the mental health stigma, anti-stigma interventions, and the effectiveness of such interventions from HICs. Materials and Methods PubMed and Google Scholar databases were screened using the following search terms: stigma, prejudice, discrimination, stereotype, perceived stigma, associate stigma (for Stigma), mental health, mental illness, mental disorder psychiatric* (for mental health), and low-and-middle-income countries, LMICs, High-income countries, and Asia, South Asian Association for Regional Cooperation/SAARC (for countries of interest). Bibliographic and grey literature were also performed to obtain the relevant records. Results The anti-stigma interventions in Asia nations and LMICs are generalized (vs. disorder specific), population-based (vs. specific groups, such as patients, caregivers, and health professionals), mostly educative (vs. contact-based or attitude and behavioral-based programs), and lacking in long-term effectiveness data. Government, international/national bodies, professional organizations, and mental health professionals can play a crucial in addressing mental health stigma. Conclusion There is a need for a multi-modal intervention and multi-sectoral coordination to mitigate the mental health stigma. Greater research (nationwide surveys, cultural determinants of stigma, culture-specific anti-stigma interventions) in this area is required.
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Affiliation(s)
- Mrugesh Vaishnav
- Samvedana Group of Hospital and Research Centre, Institute of Psychological and Sexual Research-Samvedana Foundation, Ahmedabad, Gujarat, India
| | - Afzal Javed
- World Psychiatric Association (WPA), Geneva, Switzerland
| | - Snehil Gupta
- Associate Professor, Dept. of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Vinay Kumar
- President, Indian Psychiatric Society, Ahmedabad, Gujarat, India
| | | | - Akash Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Hakimullah Salih
- President, Afghanistan National Psychiatrists Association, San Diego, USA
| | | | - Bernardo NG
- Clinical Assistant Professor, Department of Psychiatry, University of California, San Diego, USA
| | - Samia Alkhoori
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Cora Luguercho
- President, Association of Argentine Psychiatrists (APSA), Australia
| | | | - Elizabeth Moore
- President of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), Australia
| | - Vinay Lakra
- Divisional Director, Mental Health, Northern Health, Australia
| | - Martin Aigner
- President, Austrian Society for Psychiatry, Psychotherapy and Psychosomatics
| | - Johannes Wancata
- Professor and Chair for Social Psychiatry, Medical University of Vienna, University Campus
| | - Jamila Ismayilova
- The National Mental Health Center of the Ministry of Health of Azerbaijan
| | - Md. Azizul Islam
- President, Bangladesh Association of Psychiatrist, Principal, US-Bangla Medical College
| | | | - Gary Chaimowitz
- Head of Service, Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton
| | | | - Tarek Okasha
- Professor of Psychiatry, Okasha Institute of Psychiatry, Faculty of Medicine Ain Shams University in Cairo, Egypt
| | | | - Thomas Schulze
- Director of the Institute of Psychiatric Phenomics and Genomics (www.ippg.eu) at the University Hospital of LMU, Munich, Germany
| | | | - SN Chiu
- President, Hong Kong College of Psychiatrists
| | - Chan Kit Wa (Sherry)
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | | | - Yong Chon Park
- Emeritus Professor, Department of Psychiatry, Han Yang University, Seoul, Korea
| | | | - Marisol Taveras
- Department of Mental Health, Dr. Ney Arias Lora Traumatology Hospital, Santo Domingo Norte
| | - Ramune Mazaliauskiene
- Lithuanian Health Sciences University; Lithuanian Health Sciences University Kaunas Hospital
| | | | | | | | | | - Lars Lien
- Department of Health and Social Science, Innlandet University of Applied Science, Elverum, Norway
| | | | - Robert Buenaventura
- Associate Professor II, La Consolacion University Philippines College of Medicine
| | | | | | - Norman Sartorius
- President, Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - Chawanun Charnsil
- Professor of Psychiatry: Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Amine Larnaout
- Razi Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Juliet Nakku
- Butabika Hospital and Makerere University, Kampala, Uganda
| | - Zarif Ashurov
- Head of the Psychiatry and Narcology, Department of the Tashkent Medical Academy
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McAllister A, Dickson K, Rangi M, Griffiths L, Dimov S, Reavley N, Knaak S. Embedding interpersonal stigma resistance into the medical curriculum: a focus group study of medical students. BMC MEDICAL EDUCATION 2023; 23:686. [PMID: 37735393 PMCID: PMC10515016 DOI: 10.1186/s12909-023-04512-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 07/14/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Mental-health-related stigma among physicians towards people with mental illnesses remains a barrier to quality care, yet few curricula provide training with a proactive focus to reduce the potential negative impacts of stigma. The aim of our study was to explore medical students' perspectives on what areas of learning should be targeted (where stigma presents) and how they could be supported to prevent the formation of negative attitudes. METHODS Six focus group discussions were conducted with second, third, and fourth-year postgraduate medical students (n = 34) enrolled at The University of Melbourne Medical School in September - October 2021. Transcripts were analysed using inductive thematic analysis. RESULTS In terms of where stigma presents, three main themes emerged - (1) through unpreparedness in dealing with patients with mental health conditions, (2) noticing mentors expressing stigma and (3) through the culture of medicine. The primary theme related to 'how best to support students to prevent negative attitudes from forming' was building stigma resistance to reduce the likelihood of perpetuating stigma towards patients with mental health conditions and therefore enhance patient care. The participants suggest six primary techniques to build stigma resistance, including (1) reflection, (2) skills building, (3) patient experiences, (4) examples and exemplars, (5) clinical application and (6) transforming structural barriers. We suggest these techniques combine to form the ReSPECT model for stigma resistance in the curriculum. CONCLUSIONS The ReSPECT model derived from our research could provide a blueprint for medical educators to integrate stigma resistance throughout the curriculum from year one to better equip medical students with the potential to reduce interpersonal stigma and perhaps self-stigma. Ultimately, building stigma resistance could enhance care towards patients with mental health conditions and hopefully improve patient outcomes.
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Affiliation(s)
- Ashley McAllister
- School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Kara Dickson
- School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Mediya Rangi
- School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Leonie Griffiths
- Melbourne Medical School, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Stefanie Dimov
- School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Nicola Reavley
- School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Stephanie Knaak
- Faculty of Nursing and Department of Psychiatry, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
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Sevak RJ, Chandler C, Lui MC, Kaye AM, Halliwell RF, Rogan EL. Impact of a Neuropsychiatric Therapeutics Course and a Case-Based Course on Pharmacy Students' Mental Health Stigma. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100125. [PMID: 37714654 DOI: 10.1016/j.ajpe.2023.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Mental health education can reduce the stigma held by medical and nursing students; however, findings in this regard are limited in pharmacy academia. This study investigated the impact of a neuropsychiatric therapeutics course followed by a case-based course on the mental health stigma held by pharmacy students. METHODS A survey was conducted of second-year pharmacy students (n = 202) on the first and last day of a neuropsychiatric therapeutics course and 4 months later, at the end of a case-based course. The questionnaires included the Opening Minds Stigma Scale for HealthCare Providers (OMS-HC) scale, Recovery scale, Empowerment scale, and Attribution Questionnaire (AQ-9). Omnibus Friedman tests evaluated the main effect of time, followed by Wilcoxon signed-rank post hoc tests to compare baseline and postcourse scores. RESULTS Friedman test outcomes showed significant main effects of Time for OMS-HC, Recovery, Empowerment, and AQ-9 scales. Post hoc analysis indicated that compared to the baseline scores, the scores on Recovery and Empowerment scales significantly increased, OMS-HC scores decreased, but AQ-9 scores did not change after the therapeutics course. Compared to the baseline, OMS-HC and AQ-9 scores decreased, Recovery scale score increased, but the Empowerment scale score did not change after the case-based course. The scores did not decrease further after the case-based course compared to those after the therapeutics course. CONCLUSION The decreases in OMS-HC and AQ-9 scores and increases in Recovery and Empowerment scores indicate reductions in mental health stigma. Stigma among students was overall reduced after the therapeutics course and this reduction was maintained after the case-based course.
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Affiliation(s)
- Rajkumar J Sevak
- Department of Pharmacy Practice, University of the Pacific School of Pharmacy, Stockton, CA, USA.
| | - Celine Chandler
- Department of Pharmacy Practice, University of the Pacific School of Pharmacy, Stockton, CA, USA
| | - May C Lui
- Department of Pharmacy Practice, University of the Pacific School of Pharmacy, Stockton, CA, USA
| | - Adam M Kaye
- Department of Pharmacy Practice, University of the Pacific School of Pharmacy, Stockton, CA, USA
| | - Robert F Halliwell
- Department of Physiology and Pharmacology, University of the Pacific School of Pharmacy, Stockton, CA, USA
| | - Edward L Rogan
- Department of Pharmacy Practice, University of the Pacific School of Pharmacy, Stockton, CA, USA
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Makhado TG, Lebese RT, Maputle MS. Development and Validation of Epilepsy Life Skills Guidelines for Primary School Learners and Teachers in Limpopo and Mpumalanga Provinces. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1194. [PMID: 37508691 PMCID: PMC10377971 DOI: 10.3390/children10071194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
Epilepsy is a disorder that disturbs nerve cell activity in the brain, resulting in seizures. It was noted that it occurs mostly in children, especially at the primary school level, and could result from a genetic condition. The aim of this study was to develop and validate life skills education guidelines for primary school learners of Limpopo and Mpumalanga provinces in South Africa to educate them about epilepsy with the aim of reducing stigma and discrimination towards people with epilepsy. The guidelines were developed by adapting the World Health Organization (WHO) guideline development guide, which included the formulation of PICOS (population, intervention, comparison, outcome, study design) questions, conducting a systematic review of the literature, and using GRADE (grading of recommendations assessment, development, and evaluation) to develop evidence-based recommendations. The recommendations that informed the guideline development were that epilepsy education should be included in the primary school life skills curriculum to improve learners' understanding, attitudes, and skills related to epilepsy. This epilepsy education should be tailored to the needs of primary school learners and cover topics such as seizure recognition, management, medication, and coping strategies. Collaboration between healthcare providers, educators, and policymakers is crucial to developing culturally appropriate and evidence-based epilepsy education guidelines. Teachers and healthcare providers should also receive training on how to support learners living with epilepsy. The resulting guidelines provide clear and concise guidance on epilepsy education in life skills for primary school learners, caregivers, and teachers. The guidelines are expected to improve the quality of epilepsy life skills education and contribute to the overall well-being and inclusion of learners with epilepsy in Mpumalanga and Limpopo provinces, South Africa.
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Affiliation(s)
- Thendo Gertie Makhado
- Department of Advanced Nursing Sciences, Faculty of Health Sciences, University of Venda, P. Bag X5050, Thohoyandou 0950, South Africa
| | - Rachel Tsakani Lebese
- The Research Office, Faculty of Health Sciences, University of Venda, P. Bag X5050, Thohoyandou 0950, South Africa
| | - Maria Sonto Maputle
- Department of Advanced Nursing Sciences, Faculty of Health Sciences, University of Venda, P. Bag X5050, Thohoyandou 0950, South Africa
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Shi XL, Li LY, Fan ZG. Psychiatrists’ occupational stigma conceptualization, measurement, and intervention: A literature review. World J Psychiatry 2023; 13:298-318. [PMID: 37383285 PMCID: PMC10294130 DOI: 10.5498/wjp.v13.i6.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 06/19/2023] Open
Abstract
Psychiatrists require frequent contact with and treatment of patients with mental illnesses. Due to the influence of associative stigma, psychiatrists may also be targets of stigma. Occupational stigma warrants special consideration because it significantly affects psychiatrists' career advancement, well-being, and their patients’ health. Given that there is no complete summary of this issue, this study reviewed the existing literature on psychiatrists' occupational stigma to clearly synthesize its concepts, measurement tools, and intervention strategies. Herein, we emphasize that psychiatrists’ occupational stigma is a multifaceted concept that simultaneously encompasses physically, socially, and morally tainted aspects. Currently, standardized methods to specifically measure psychiatrists’ occupational stigma are lacking. Interventions for psychiatrists’ occupational stigma may consider the use of protest, contact, education, comprehensive and systematic methods, as well as the use of psychotherapeutic approaches. This review provides a theoretical basis for the development of relevant measurement tools and intervention practices. Overall, this review seeks to raise public awareness of psychiatrists' occupational stigma, thereby promoting psychiatric professionalism and reducing its stigma.
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Affiliation(s)
- Xiao-Li Shi
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| | - Lu-Yao Li
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
| | - Zhi-Guang Fan
- School of Education, Jilin International Studies University, Changchun 130000, Jilin Province, China
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11
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Kanyadan P, Ganti L, Mangal R, Stead T, Hahn L, Sosa M. Understanding factors that influence whether a woman will seek care for reproductive health: A national survey. Health Psychol Res 2023; 11:67959. [PMID: 36777811 PMCID: PMC9907319 DOI: 10.52965/001c.67959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A number of studies have characterized the importance of regular OB/GYN visits for women who are above the age of 18. As more emphasis is placed on reproductive healthcare, there has been an overall decrease in the rates of adverse sexual and reproductive health outcomes. In this study, a population of 200 women were surveyed to find factors that influence whether they had sought care from an OB/GYN in the past year. These results can be further extrapolated to whether women will seek OB/GYN healthcare in the future. A survey research platform was used to collect demographic data in addition to the survey responses. Thirteen survey questions were designed, some of which were adapted from the NIH Healthcare Access and Utilization Survey. This study found that women of minority races (African American and Hispanic) were more likely to report that they didn't feel like they were asked for their opinions about their healthcare. Additionally, women who were younger, who didn't feel like they were asked for their opinions, and who were of minority races were more likely to have not seen an OB/GYN in the past year. These findings can be used to focus on fixing the factors that deter women from seeking regular OB/GYN care. Efforts must be made to ensure that patients feel supported and understood, for this is the only way that we can make progress towards a healthier society.
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Affiliation(s)
| | | | | | - Thor Stead
- Warren Alpert Medical School of Brown University
| | - Lindsey Hahn
- Obstetrics and GynecologyLakeland Regional Medical Center
| | - Marcos Sosa
- Obstetrics and GynecologyLakeland Regional Medical Center
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12
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Bouyssi A, Prebois S, Rougé-Bugat ME, Dupouy J, Driot D. [Stigmatisation of patients with mental disorders by medical interns specialising in general practice: A national survey]. L'ENCEPHALE 2023; 49:65-71. [PMID: 36253178 DOI: 10.1016/j.encep.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The objective was to assess the level of stigmatisation of psychiatric patients by medical interns specialising in general practice (GP), and to assess the influencing factors of stigmatisation. METHODS A national survey was carried out among interns in general practice (GP) contacted through their local associations from December 10, 2019 to March 9, 2020. An online questionnaire was diffused. The validated French version of the Mental Illness Clinicians' Attitudes (MICA) was used to measure stigmatising attitudes towards psychiatry and persons with psychiatric disorder by the interns. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness with scores ranging from 16 to 96 (the most stigmatizing). Several covariates were collected: socio-demographics, personal experiences with mental health, and mental health trainings during medical studies. All questionnaires were strictly anonymized. Comparative analyses of the MICA score by group were performed using Student's tests. RESULTS A total of 389 interns responded. The majority of respondents were female (n=277; 71%) and the mean age was 27years [standard deviation (SD)±2.39]. The mean MICA rate was 40.64 (SD±8.09) for a neutral score of 56, reflecting low overall stigmatizing attitudes. MICA scores were significantly lower among female interns (40.11 vs. 41.95; P=0.042), those who had benefited from personal psychological or psychiatric support (38.70 vs. 41.61; P=0.001), and those who had completed a psychiatric externship (39.47 vs. 42.16; P=0.001). CONCLUSIONS GP interns had an attitude that is generally not very stigmatizing even if its improvement should still be sought. This is particularly verified among those who have completed a psychiatric internship during their externship. This suggested association should be supported by other studies. The stakes are high for the future management of patients since stigmatisation by a physician is strongly implied in the worse healthcare management of patients with psychiatric disorders, leading them to a shorter lifespan.
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Affiliation(s)
- A Bouyssi
- Département universitaire de médecine générale, université Paul-Sabatier Toulouse III, 133, route de Narbonne, 31062 Toulouse, France
| | - S Prebois
- Centre hospitalier universitaire Toulouse Purpan, service de psychiatrie, place du Dr-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - M-E Rougé-Bugat
- Département universitaire de médecine générale, université Paul-Sabatier Toulouse III, 133, route de Narbonne, 31062 Toulouse, France; UMR 1295 CERPOP Inserm, université Paul-Sabatier, 37, allées Jules-Guesde, 31000 Toulouse, France
| | - J Dupouy
- Département universitaire de médecine générale, université Paul-Sabatier Toulouse III, 133, route de Narbonne, 31062 Toulouse, France; UMR 1295 CERPOP Inserm, université Paul-Sabatier, 37, allées Jules-Guesde, 31000 Toulouse, France
| | - D Driot
- Département universitaire de médecine générale, université Paul-Sabatier Toulouse III, 133, route de Narbonne, 31062 Toulouse, France; UMR 1295 CERPOP Inserm, université Paul-Sabatier, 37, allées Jules-Guesde, 31000 Toulouse, France.
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Movahedi S, Shariat SV, Shalbafan M. Attitude of Iranian medical specialty trainees toward providing health care services to patients with mental disorders. Front Psychiatry 2022; 13:961538. [PMID: 35966498 PMCID: PMC9366058 DOI: 10.3389/fpsyt.2022.961538] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/01/2022] [Indexed: 02/03/2023] Open
Abstract
Introduction The stigma of mental illness has a negative impact on the diagnosis and treatment of these disorders. Considering the high prevalence of mental illness, the attitude of medical specialists toward mental disorders, who are front liners in diagnosing and treating these patients, is critical. Therefore, we examined the attitude of Iranian medical specialty trainees toward providing health care services for patients with mental illness. Methods We included 143 residents in the fields that have the most interactions with patients with mental disorders, including internal medicine, surgery, neurology, cardiovascular diseases, and psychiatry. A demographic checklist, as well as the opening minds scale for health care providers stigma assessment questionnaire, was provided, which measures five dimensions of improvement, social responsibility, social distance, exposure, and other (such as risk) in health care providers toward delivering the healthcare services to patients with mental disorders. Results The mean score of stigma for mental illness in medical specialty trainees was 61.36 ± 4.83 out of 100. Psychiatric residents have the least stigmatizing attitude (58.38 ± 3.54), and internal medicine and cardiology residents have the highest score, respectively, (62.96 ± 6.05, 62.45 ± 3.80). As for comparing subscales between specialties, only the social responsibility subscale showed a significant difference, with psychiatry having less stigma toward social responsibility (12.93 ± 2.01) than cardiology (15.09 ± 1.50) trainees. Conclusion The attitude of medical specialty trainees toward providing health care services for patients with mental illness is not uniform; internal medicine and cardiology residents have more stigmatizing attitude, while psychiatric residents have less stigmatizing attitude. It seems that not every contact could be useful in making a better attitude toward mental illness, but it needs preconditions, like a structured contact that leads to positive outcomes. Anti-stigma interventions are needed to improve the attitude of medical specialty trainees toward providing health care services to patients with mental illness.
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Affiliation(s)
| | | | - Mohammadreza Shalbafan
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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14
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Demonstration of Caring and Motivational Interviewing in Online Simulation: A Cross-Sectional Observational Study. Nurse Educ Pract 2022; 63:103370. [DOI: 10.1016/j.nepr.2022.103370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/15/2022]
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Lai HJ, Lien YJ, Chen KR, Lin YK. The Effectiveness of Mental Health Literacy Curriculum among Undergraduate Public Health Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095269. [PMID: 35564671 PMCID: PMC9104026 DOI: 10.3390/ijerph19095269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022]
Abstract
Mental health literacy (MHL) plays an important role in public health. Improving MHL can promote mental health at the individual and public levels. To date, no published studies have assessed the effectiveness of MHL curriculum interventions among undergraduate public health students. The participants in this study were undergraduate public health students (n = 48) who were enrolled in an 18-week MHL curriculum for 100 min per week. MHL was assessed using the Mental Health Literacy Scale for Healthcare Students. A paired sample t-test was performed to examine the immediate and delayed effects of the MHL curriculum. The total MHL score significantly improved, and a moderate effect size was found directly after the intervention and six weeks later. There were significant differences in the recognition of mental illness (p < 0.01), help-seeking efficacy (p < 0.05), and help-seeking attitude (p < 0.05) in the five components of MHL between pre- and post-test. Furthermore, significant improvements were obtained for the maintenance of positive mental health (p < 0.05) and reduction of mental illness stigma (p < 0.001) between the pre-test and follow-up. Our findings provide evidence for the development and implementation of an MHL curriculum for public health education.
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Affiliation(s)
- Hsuan-Jung Lai
- Department of Health Promotion and Health Education, National Taiwan Normal University, 162, Heping East Road Section 1, Taipei 106, Taiwan;
| | - Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, 162, Heping East Road Section 1, Taipei 106, Taiwan;
- Correspondence: ; Tel.: +886-2-7749-1736; Fax: +886-2-2363-0326
| | - Kai-Ren Chen
- Department of Public Health, Fu Jen Catholic University, 510, Zhongzheng Road, New Taipei 242, Taiwan;
| | - Yu-Kai Lin
- Department of Health and Welfare, University of Taipei, 101, Zhongcheng Road Section 2, Taipei 111, Taiwan;
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Kunkle L, Butterfield A, Lovato L, Sakai J. Addressing Mental Health Stigma in Medical Student Education. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:278-279. [PMID: 34449053 DOI: 10.1007/s40596-021-01519-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | | | | | - Joseph Sakai
- University of Colorado School of Medicine, Denver, CO, USA
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17
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Neikrug AB, Stehli A, Xiong GL, Suo S, Le-Bucklin KV, Cant W, McCarron RM. Train New Trainers Primary Care Psychiatry Fellowship-Optimizing Delivery of Behavioral Health Care Through Training for Primary Care Providers. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:105-114. [PMID: 35439771 DOI: 10.1097/ceh.0000000000000432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To expand and optimize the behavioral health workforce, it is necessary to improve primary care providers' (PCPs) overall knowledge and clinical skills in primary care-based psychiatry. Studies on the effects of postgraduate psychiatric education programs for PCPs on psychiatric knowledge are limited. METHODS A total of 251 PCPs completed a 1-year fellowship. Data from program development and evaluation were analyzed for 4 fellowship years (2016-2019). Fellows were surveyed at baseline, midpoint, and postfellowship about mental health stigma, perceived competency, attitudes about psychiatry, satisfaction with current psychiatric knowledge, confidence and comfort to treat psychiatric illnesses, and program satisfaction. Psychiatric knowledge was evaluated at baseline, midpoint, and postfellowship. RESULTS Large effects were noted on perceived competency/self-efficacy and confidence in the treatment of common psychiatric disorders encountered in primary care settings. Positive effects were observed on attitudes of mental health stigma, and even more robust effects were found with improvement in psychiatry clinical knowledge. Knowledge improved by 12% at postfellowship (P < .0001). Correlations of the degree of change in attitude with improved psychiatric literacy demonstrated significant relationships with reduction of stigma total score (r = -0.2133, P = .0043), increased willingness (r = 0.1941, P = .0096), and increased positive attitudes (r = 0.1894, P = .0111). CONCLUSION Innovative initiatives to improve and expand psychiatric knowledge and clinical skills among those who provide the most behavioral health care (PCPs) can have marked impacts on attitudes toward mental health care delivery, stigma, and competency/self-efficacy. Future studies are necessary to consider the impact of this program on clinical practice pattern outcomes on a larger scale.
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Affiliation(s)
- Ariel B Neikrug
- Neikrug: Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA. Stehli: Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA. Xiong: Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA. Suo: Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA. Le-Bucklin: Susan and Henry Samueli College of Health Sciences, University of California Irvine, Irvine, CA. Cant: Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA. McCarron: Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA
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Munir K, Oner O, Kerala C, Rustamov I, Boztas H, Juszkiewicz K, Wloszczak-Szubzda A, Kalmatayeva Z, Iskandarova A, Zeynalli S, Cibrev D, Kosherbayeva L, Miriyeva N, Jarosz MJ, Kurakbayev K, Soroka E, Mancevska S, Novruzova N, Emin M, Olajossy M, Bajraktarov S, Raleva M, Roy A, Waqar Azeem M, Bertelli M, Salvador-Carulla L, Javed A. Social distance and stigma towards persons with serious mental illness among medical students in five European Central Asia countries. Psychiatry Res 2022; 309:114409. [PMID: 35121341 DOI: 10.1016/j.psychres.2022.114409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Kerim Munir
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA; World Psychiatric Association, Geneva, Switzerland.
| | - Ozgur Oner
- World Psychiatric Association, Geneva, Switzerland; Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Coskun Kerala
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | | | | | - Konrad Juszkiewicz
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan; Al-Farabi Kazakh National Medical University, Almaty, Kazakhstan
| | | | | | | | | | - Dragan Cibrev
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Lyazzat Kosherbayeva
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan; Al-Farabi Kazakh National Medical University, Almaty, Kazakhstan
| | | | | | | | | | - Sanja Mancevska
- Faculty of Human Sciences, University of Economics and Innovation, Lublin, Poland
| | | | - Melda Emin
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | | | - Stojan Bajraktarov
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Marija Raleva
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Ashok Roy
- World Psychiatric Association, Geneva, Switzerland; Coventry and Warwickshire Partnership NHS Trust, Birmingham, UK
| | - Muhammad Waqar Azeem
- World Psychiatric Association, Geneva, Switzerland; Department of Psychiatry, Sidra Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Marco Bertelli
- World Psychiatric Association, Geneva, Switzerland; CREA (Centro Ricerca E Ambulatori), Fondazione San Sebastiano, Florence, Italy
| | - Luis Salvador-Carulla
- World Psychiatric Association, Geneva, Switzerland; Health Research Institute, Faculty of Health, University of Canberra, Australia
| | - Afzal Javed
- World Psychiatric Association, Geneva, Switzerland; Warwick Medical School, University of Warwick, UK
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Gervás R, García-Ullán L, Amor V, Bullón A, Galindo PV, Roncero C. Effectiveness and types of interventions to reduce mental illness-related stigma among Medical university students: A literature review (1997-2020). ACTAS ESPANOLAS DE PSIQUIATRIA 2022; 50:106-113. [PMID: 35312996 PMCID: PMC10803865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
There is a high prevalence of stigma among medical students towards mental illness, which can have far reaching negative consequences. It is essential to intervene and modify their preconceptions in order to fight against stigma.
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Affiliation(s)
- Ruth Gervás
- PhDc, Pys, MSc, Department of Medicine. Psychiatry Area (University of Salamanca) Salamanca, Spain; Associate Investigator, IBSAL (Institute of Biomedicine of Salamanca) University Hospital of Salamanca; Salamanca, Spain
| | - Llanyra García-Ullán
- Professor, MD, PhD, Department of Medicine. Psychiatry Area (University of Salamanca), Salamanca, Spain. Psychiatrist of Psychiatry Service (Health Care Complex of Salamanca) Salamanca, Spain. Associate Investigator, IBSAL (Institute of Biomedicine of Salamanca), University Hospital of Salamanca; Salamanca, Spain
| | - Víctor Amor
- Professor, PhD, Department of Medicine. Statistics Area (University of Salamanca), Salamanca, Spain
| | - Alberto Bullón
- Psychiatrist, MD, Psychiatry Service (Health Care Complex of Salamanca)Salamanca, Spain
| | | | - Carlos Roncero
- Professor, MD, PhD, Department of Medicine. Psychiatry Area (University of Salamanca), Salamanca, Spain. Head of Psychiatry Service (University of Salamanca Health Care Complex)Salamanca, Spain. Principal Investigator, IBSAL (Institute of Biomedicine of Salamanca) University Hospital of Salamanca; Salamanca, Spain
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20
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Stigmatizing attitudes and social perception towards mental illness among Moroccan medical students. Encephale 2022; 49:275-283. [DOI: 10.1016/j.encep.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 11/20/2022]
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Conceição V, Rothes I, Gusmão R. The effects of a video-based randomized controlled trial intervention on depression stigma and help-seeking attitudes in university students. Psychiatry Res 2022; 308:114356. [PMID: 34972028 DOI: 10.1016/j.psychres.2021.114356] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/10/2021] [Accepted: 12/19/2021] [Indexed: 12/20/2022]
Abstract
University students are a risk group for developing mental illness, but they do not receive the care they need because of hampered help-seeking induced by stigma. This study evaluates the effects of a video-based stigma reduction intervention and help-seeking attitudes promotion in university students. We randomly distributed a sample of university students among one control group (CG, n = 188) and two intervention groups (IG-1, n = 222 and IG-2, n = 216): IG-1 watched a contact-based video and IG-2 the same video plus a psychoeducational video. The study followed an experimental single-blind randomized control trial design with a pre-test before the intervention (M0), a post-test, and a follow-up test. We evaluated participants using a sociodemographic questionnaire, the Attitudes Toward Seeking Professional Psychological Help Questionnaire, the Depression Stigma Scale, the 9-item Patient Health Questionnaire, and the 7-item Generalized Anxiety Disorder. A total of 626 participants with a mean age of 19.85 (SD=1.48) responded to all evaluation moments. At M0, there were no differences between groups on stigma or help-seeking attitudes. Immediately after the intervention, stigma levels significantly decreased, and help-seeking attitudes significantly improved. These effects persisted for the next five months. Video-based depression stigma reduction intervention can be an essential tool to reduce depression stigma and improve help-seeking attitudes.
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Affiliation(s)
- Virgínia Conceição
- EPIUnit - Institute of Public Health, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
| | - Inês Rothes
- Faculty of Psychology and Education Science, University of Porto, Portugal; Centre for Psychology, University of Porto, Portugal
| | - Ricardo Gusmão
- EPIUnit - Institute of Public Health, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Portugal
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Vela MB, Erondu AI, Smith NA, Peek ME, Woodruff JN, Chin MH. Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs. Annu Rev Public Health 2022; 43:477-501. [PMID: 35020445 PMCID: PMC9172268 DOI: 10.1146/annurev-publhealth-052620-103528] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers’ work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities.
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Affiliation(s)
- Monica B Vela
- Department of Medicine, Section of Academic Internal Medicine, University of Illinois College of Medicine in Chicago, Chicago, Illinois, USA;
| | - Amarachi I Erondu
- Department of Internal Medicine and Pediatrics, University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Nichole A Smith
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica E Peek
- Department of Medicine, Section of General Internal Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, Illinois, USA
| | - James N Woodruff
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Marshall H Chin
- Department of Medicine and Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, Illinois, USA
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Doan K, Shabo L, Crouse EL. The impact of pharmacy candidates' understanding of psychiatry on personal mental health concerns and patient treatment. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:56-61. [PMID: 35125196 DOI: 10.1016/j.cptl.2021.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/31/2021] [Accepted: 11/28/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Psychiatry modules in pharmacy education have the potential to address mental health stigma and may help future pharmacists discuss mental health concerns by altering willingness to engage persons with mental illness to better help this patient population. This research aimed to compare the effectiveness of a psychiatry module on pharmacy candidates' own utilization of mental health resources for themselves, as patients, and the ability to address mental illness during patient interactions. METHODS Forty-six participants completed a 22-item, anonymous questionnaire. Pre- and posttest data were collected to assess perceived impact on patient treatment and self-reflection from their own mental health and treatment. The survey also assessed doctor of pharmacy candidates' changes in comfort level of treating patients with mental illness, referring family or friends for mental health counseling, and personal willingness to obtain counseling with regards to mental health. RESULTS There were significant differences in pre- and posttest mean scores in participants' comfort level counseling patients with mental illness, comfort level in discussing mental health concerns with patients, and personal willingness to speak with a provider regarding personal mental health. A significant reduction was seen in candidates who personally sought counseling. There was no significant difference in inquiring about personal assistance with mental health concerns or involvement in extracurricular activities within pharmacy school. CONCLUSIONS A psychiatry module in pharmacy education may positively impact mental health stigma and the ability of pharmacy candidates to openly discuss mental illness as well as improve medication counseling skills for patients needing psychotropic medications.
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Affiliation(s)
- Kevin Doan
- Virginia Commonwealth University School of Pharmacy, 410 N. 12(th) St, Richmond, VA 23298, United States.
| | - Leah Shabo
- Doctor of Medicine Candidate Class of 2022, University of Virginia School of Medicine, 1240 Lee Street, Charlottesville, VA 22903, United States.
| | - Ericka L Crouse
- VCU School of Pharmacy, 410 N. 12(th) St, Richmond, VA 23298, United States.
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Rezvanifar F, Shariat SV, Shalbafan M, Salehian R, Rasoulian M. Developing an Educational Package to Improve Attitude of Medical Students Toward People With Mental Illness: A Delphi Expert Panel, Based on a Scoping Review. Front Psychiatry 2022; 13:860117. [PMID: 35360140 PMCID: PMC8964120 DOI: 10.3389/fpsyt.2022.860117] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/16/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The importance of stigma toward patients with mental illness in medical students as future physicians cannot be overemphasized. There is currently no formal training to reduce stigma toward mental illness in medical students in their educational curriculums in Iran like most other low and middle income countries. Therefore, aiming to provide a practical and effective training package focused on reducing stigma toward patients with mental illness in medical students, the current study conducted, as an expert panel with Delphi method, based on a scoping review, to develop an education package to improve attitude of medical students toward patients with mental illness. MATERIALS AND METHODS We surveyed the available international databases including PubMed, Google Scholar, Scopus, PsycINFO, Tripdatabase, Web of Science, Cochrane Database of Systematic Reviews as well as Persian databases including Iranmedex, SID, Irandoc and Magiran in February and March 2020. After an extensive review of related resources, 13 articles met our inclusion criteria. Then, we extracted the related data including type and duration of the interventions, sample size, mean and standard deviation of stigma scores before and after interventions. To develop the package among the included interventions, we asked 16 experts in psychology, psychiatry, and social medicine to rate the interventions based on a number of variables such as effectiveness, feasibility and applicability in a Delphi process. RESULTS The selected intervention in Delphi method with consensus of experts included a set of four sequential interactive interventions: showing a movie and discussing it, psychiatric training including contact with people who affected psychiatric disorders, social communication with people who affected psychiatric disorders, and group discussion on defining stigma and personal experiences. CONCLUSION In the present study, we recommend a set of interventions to reduce stigma toward patients with mental illness among medical students in the form of a package of combined, interactive and sequential interventions that have been previously been shown to be effective in reducing stigma related to mental illness. We expect that implementation of these interventions would reduce mental illness stigma in medical students; which needs further verification.
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Affiliation(s)
- Farahnaz Rezvanifar
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Vahid Shariat
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shalbafan
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Razieh Salehian
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Rasoulian
- Mental Health Research Center, Psychosocial Health Research Institute, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Morris SG, Greenstone H, Chute R. Keeping it human: Pandemic era psychiatry teaching. CLINICAL TEACHER 2021; 18:641-649. [PMID: 34590420 PMCID: PMC8662026 DOI: 10.1111/tct.13415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 08/05/2021] [Accepted: 08/24/2021] [Indexed: 02/02/2023]
Abstract
Background Mental health is an important global issue, and doctors in training need a grounding in the principles of psychiatry. Undergraduate clinical placements in psychiatry can develop core knowledge and skills as well as challenging stigma towards mental illness. The onset of the coronavirus pandemic saw disruption to undergraduate clinical placements. In a U.K. medical school, th e authors were tasked with transforming a 6‐week clinical placement in psychiatry into a primarily online course. Approach A 4‐week online course was developed in preparation for a condensed clinical placement. A range of resources were drawn upon to address key learning objectives and to engage students in broader thinking about mental health. These included videos and blogs describing personal experiences of mental illness, as well as interviews with prominent psychiatrists. Peer‐ and tutor‐led sessions complemented these self‐directed elements and reduced social isolation. Evaluation Sixty‐seven students undertook the course, supported by eight consultant tutors. The content and structure of the course were highly rated; however, students indicated that peer group activities could benefit from further development. Students felt prepared for clinical placements and performed equally well in summative written examinations. Feedback indicated the development of positive attitudes towards mental health and illness. Implications This course demonstrates how, even when clinical contact is challenged, a strong focus can be maintained on social elements of learning and patients' experiences of mental illness. This approach provides opportunities to develop essential knowledge and skills alongside broader attitudinal learning that may have a de‐stigmatising effect.
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Affiliation(s)
- Simon George Morris
- Medical Education, Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Harriet Greenstone
- Medical Education, Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Rachel Chute
- Medical Education, Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
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Fekih-Romdhane F, Chebbi O, Sassi H, Cheour M. Knowledge, attitude and behaviours toward mental illness and help-seeking in a large nonclinical Tunisian student sample. Early Interv Psychiatry 2021; 15:1292-1305. [PMID: 33300260 DOI: 10.1111/eip.13080] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 10/12/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mental disorders are widespread among students. However, mental health help-seeking remains low. Several reviews and meta-analyses have shown that the main barrier to seeking help from mental health professionals is stigma. This paper aimed to assess stigma in a sample of students, and its association with help-seeking intentions and comfort with disclosing a mental illness. METHOD The 'Community Attitudes toward the Mentally Ill', the 'Mental Health Knowledge Schedule', and the 'Reported and Intended Behaviour Scale' were administered to a total of 714 college students (62.2% female; mean age = 20.9). RESULTS We found that 43.8% of students agreed that one of the main causes of mental illness is a lack of self-discipline and willpower, 21.9% did not consider depression as a mental illness, and 39.6% felt that they would be 'unlikely' or 'very unlikely' to seek the help of a health professional for mental health problems. Females had higher scores in help-seeking intentions (p < .001) and knowledge of mental illness (p = .019). Students' age negatively correlated with knowledge (p < .001, r = -.147). Pearson correlations indicated that help-seeking intentions positively correlated with more favourable future intentions of being in contact with a person with a mental illness (p < .001, r = .103) and greater mental health knowledge (p < .001, r = .163); and that comfort with disclosing significantly and negatively correlated with attitudes (p < .001, r = -.125). CONCLUSION To date, few young people see mental health professionals as a preferred source of support, and action is needed to change this perception or reform mental health services to make them more attractive to this age group.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,The Tunisian Center of Early Intervention In Psychiatry, Department of Psychiatry "Ibn Omrane", Razi Hospital, Tunisia
| | - Ons Chebbi
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,The Tunisian Center of Early Intervention In Psychiatry, Department of Psychiatry "Ibn Omrane", Razi Hospital, Tunisia
| | - Hadhami Sassi
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,The Tunisian Center of Early Intervention In Psychiatry, Department of Psychiatry "Ibn Omrane", Razi Hospital, Tunisia
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,The Tunisian Center of Early Intervention In Psychiatry, Department of Psychiatry "Ibn Omrane", Razi Hospital, Tunisia
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Memory for syntactic differences in mental illness descriptions. Mem Cognit 2021; 50:407-424. [PMID: 34494182 DOI: 10.3758/s13421-021-01208-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/08/2022]
Abstract
The American Psychiatric Association recommends that practitioners discuss mental illnesses using person-first, or comparatively state-based language, rather than trait-based language. The aim of this initiative is to both avoid treating the symptoms of an illness as a defining characteristic of the people who experience these symptoms and to reduce the stigmatization of mental illness. However, some of the implications of these initiatives have not been tested. Here, we investigate one of these implications-people's memory for changes in syntactic constructions in descriptions of mental illness. In three experiments, we observed that people form similar representations of state- and trait-based passages as reflected by their performance in two recognition tasks and a free-recall task. However, a fourth experiment suggested that participants' memories of the exact syntax they read are not so degraded that they are unable to recover what they read when explicitly prompted. Altogether, these results suggest that some aspects of the person-first language initiative are likely to be transient.
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Sølvhøj IN, Kusier AO, Pedersen PV, Nielsen MBD. Somatic health care professionals' stigmatization of patients with mental disorder: a scoping review. BMC Psychiatry 2021; 21:443. [PMID: 34493245 PMCID: PMC8424966 DOI: 10.1186/s12888-021-03415-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/06/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals' stigmatization toward patients with mental disorders. METHODS We conducted a scoping review using Arksey and O'Malley's framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May-June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008-2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo. RESULTS A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions. CONCLUSIONS The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.
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Affiliation(s)
- Ida Nielsen Sølvhøj
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Denmark.
| | - Amalie Oxholm Kusier
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Pia Vivian Pedersen
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
| | - Maj Britt Dahl Nielsen
- grid.10825.3e0000 0001 0728 0170National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark
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Gu L, Xu D, Yu M. Mediating effects of stigma on the relationship between contact and willingness to care for people with mental illness among nursing students. NURSE EDUCATION TODAY 2021; 103:104973. [PMID: 34049122 DOI: 10.1016/j.nedt.2021.104973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/06/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Previous studies have demonstrated that contact positively impacts nursing students' willingness to care for people with mental illness. However, studies that have explored the mechanism of such a relationship between contact and willingness remain few. OBJECTIVES To examine the direct relationship between contact and nursing students' willingness to care for people with mental illness and to explore the potential mediating roles of stigma. DESIGN This was a cross-sectional study design. SETTINGS The study was conducted in a nursing school in Nanjing city, China. PARTICIPANTS A total of 839 nursing students were recruited in the study through convenience sampling. METHODS Nursing students' stigma, contact, and willingness to care for people with mental illness were measured online through the Stigma toward People with Mental Illness Scale (SPMI), the Level of Contact Report, and one item of "which degree indicates your willingness to provide care for people with mental illness," respectively. The structural equation model was applied to explore the potential mediating roles of stigma. RESULTS Contact with people suffering from mental illness directly affected nursing students' willingness to care for them (β = 0.076, p < 0.05). Meanwhile, stigma partly mediated the effect of students' contact on willingness to care for people with mental illness (β = 0.048, p < 0.05). CONCLUSIONS High level of contact can improve nursing students' willingness to care and the relationship is partly mediated by stigma. Measures to improve the level of contact and reduce stigmatizing attitudes of nursing students are accordingly essential in influencing them to have more willingness to care for people with mental illness.
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Affiliation(s)
- Libin Gu
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing 210023, China.
| | - Deguo Xu
- School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing 210023, China.
| | - Mingming Yu
- School of Nursing, Peking University, Beijing, China.
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Gordon SE, Kininmonth LA, Newton-Howes G, Purdie GL, Gardiner T. A comparative analysis of two alternative programmes to counter stigma and discrimination associated with mental illness delivered to medical students. Australas Psychiatry 2021; 29:357-360. [PMID: 33231093 DOI: 10.1177/1039856220971935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess and compare attitudes of medical students in response to two service-user-led anti-stigma and discrimination education programmes. METHOD Two programmes, consistent with the key elements of effective contact-based anti-stigma and discrimination education programmes for healthcare providers, were delivered to medical students in their penultimate and final year: a more intensive version of the programme in 2015/2016 and a briefer programme in 2016/2017. Attitudes were assessed using the Recovery Attitudes Questionnaire (RAQ) and the Opening Minds Stigma Scale for Health Care Providers (OMS-HC-20) at the beginning and end of their final year. RESULTS There were no significant differences between the years in initial scores on either scale. Both cohorts showed statistically significant reductions in scores on both scales after completion of the programme, indicating overall improvements in students' attitudes with reductions in stigma, and more positive attitudes towards recovery of those in mental distress. The more intensive programme led to significantly greater improvement in reductions in stigma than the less intensive programme. CONCLUSION Findings support the need for contact-based anti-stigma and discrimination education programmes for medical students that are both intensive and repeated over time.
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Affiliation(s)
- Sarah E Gordon
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Leah A Kininmonth
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Giles Newton-Howes
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Gordon L Purdie
- Dean's Department, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Tracey Gardiner
- Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
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Weber LC, Ortega JC, Bastea S, Robitz RA, Mumma BE. Women Leading Healthy Change: A Reciprocal Learning Experience for Women in the Sex Trade and Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11154. [PMID: 34041359 PMCID: PMC8113279 DOI: 10.15766/mep_2374-8265.11154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Service learning can teach medical students about the social determinants of health and prepare them to better serve marginalized populations, while people in the sex trade can serve as effective educators for their peers and health professions trainees. However, service-learning projects involving medical students and people in the sex trade are currently rare. METHODS We modified a curriculum from an author's prior institution to provide a unique service-learning experience for medical students and peer health education for women in the sex trade in a new city and new context. Medical students partnered with a local community organization to implement a 10-week course on physical and mental health for women in the sex trade. Coled by a medical student and a woman who had utilized the community partner's services, the course's instructional methods included in-class demonstrations, group discussion, games, and worksheets. RESULTS Ten women participated in the course, and six medical students facilitated its implementation. The participants demonstrated increased knowledge in physical and mental health topics and reported being more comfortable speaking with health care providers. The coleaders developed skills and confidence to pursue additional leadership opportunities. The medical student coleader gained a better understanding of addiction and was more prepared to work with patients with substance use disorders. DISCUSSION This mutual learning experience was a valuable health education opportunity for a local underserved community and helped medical students understand the barriers women in the sex trade face when seeking health care and how physicians can better meet their needs.
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Affiliation(s)
| | | | - Silvia Bastea
- Third-Year Medical Student, University of California, Davis, School of Medicine
| | - Rachel A. Robitz
- Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, University of California, Davis, School of Medicine
| | - Bryn Elissa Mumma
- Associate Professor, Department of Emergency Medicine, University of California, Davis, School of Medicine
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Moreira AR, Oura MJ, Santos P. Stigma about mental disease in Portuguese medical students: a cross-sectional study. BMC MEDICAL EDUCATION 2021; 21:265. [PMID: 33971862 PMCID: PMC8108321 DOI: 10.1186/s12909-021-02714-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/22/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND The stigma about mental diseases is common in the population and also in medical students, where it may condition their future practice and the way they deal with these patients. AIM To evaluate and characterize the stigma on mental diseases in Portuguese sixth-year medical students, based on a clinical scenario of a classmate suffering from a mental disorder. METHODS Observational cross-sectional study, involving sixth-year students of all Portuguese medical schools. We applied an online self-response questionnaire, using the Portuguese version of the Attribution Questionnaire AQ-9, and a vignette of a classmate colleague, presenting mental illness symptoms. Stigma scores were calculated. We used logistic regression to estimate the effect of social determinants on stigma pattern, and we analysed the correlation between 9 variables evaluated by the AQ-9 and total stigma. RESULTS A total of 501 participants were included for analysis (69.5% females, median age of 24 years old). Medical students were available to help in the proposed clinical scenario (6.93/9.00; 95%CI:6.77-7.10), if necessary using coercion for treatment (3.85; 95%CI:3.63-4.07), because they felt pity (6.86; 95%CI:6.67-7.06) and they perceived some kind of dangerousness (4.06; 95%CI:3.84-4.28). Stigma was lower in students having a personal history of mental illness (OR:0.498; 95%CI:0.324-0.767; p = 0.002) and in those with positive familial history (OR: 0.691; 95%CI:0.485-0.986; p = 0.041). CONCLUSION Our results show the importance of implementing anti-stigma education, to improve medical students' attitudes towards peers living with mental diseases.
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Affiliation(s)
- Ana-Raquel Moreira
- Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria-Joao Oura
- Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Santos
- Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Alameda Hernani Monteiro, 4200-319, Porto, Portugal.
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Scale development and an educational program to reduce the stigma of schizophrenia among community pharmacists: a randomized controlled trial. BMC Psychiatry 2021; 21:211. [PMID: 33902519 PMCID: PMC8077925 DOI: 10.1186/s12888-021-03208-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/11/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Stigma associated with mental disorders is rooted among many pharmacists, and represents a major barrier to patient support in community-based psychiatry. We developed an assessment scale that is specifically designed to assess the level of stigma that pharmacists may have toward schizophrenia, and then examined the effects of reducing stigma with an educational program that focuses on communication with patients diagnosed with schizophrenia (PDS) using the newly developed Stigma Scale towards Schizophrenia for Community Pharmacists (SSCP). METHODS SSCP was developed by exploratory factor analysis with promax rotation based on responses from 822 randomly selected community pharmacists. Furthermore, a randomized controlled trial was conducted for 115 community pharmacists to clarify the effects of reducing the stigma of schizophrenia using an educational program for them with a focus on communication with PDS. Participants were individually allocated to two groups: educational lecture group (56; only attending a lecture on schizophrenia) or contact-based intervention group (59; communicating with PDS and attending the lecture). The stigma assessment using SSCP was conducted immediately before and after the educational intervention. RESULTS A total of 4 factors and 27 items were extracted from the exploratory factor analysis to comprise the SSCP. Cronbach's α of SSCP, social distance at professional pharmacy service (factor I), attitudes towards PDS (factor II), self-disclosure (factor III), and social distance in personal (factor IV) were 0.89, 0.88, 0.76, 0.62, and 0.62, respectively. Educational program-related changes of the median (interquartile range) total SSCP score from baseline were - 9.0 (- 16.0 - - 5.0) in the contact-based intervention group and - 3.0 (- 7.0-1.0) in the educational lecture group, reflecting a significant reduction of stigma levels in the contact-based intervention group. On examining the SSCP subscales, scores for factor I and factor II significantly improved. The educational program was more effective for pharmacists aged 20-39 years or with negligible experience of communicating with PDS at work and/or in private life. CONCLUSIONS SSCP and the educational program for community pharmacists that focuses on communication with PDS were useful for assessing and reducing, respectively, the stigma attached by these pharmacists to schizophrenia. TRIAL REGISTRATION UMIN Clinical Trials Registry ( UMIN000043189 , registered on January 30, 2021), Retrospectively registered.
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Javed A, Lee C, Zakaria H, Buenaventura RD, Cetkovich-Bakmas M, Duailibi K, Ng B, Ramy H, Saha G, Arifeen S, Elorza PM, Ratnasingham P, Azeem MW. Reducing the stigma of mental health disorders with a focus on low- and middle-income countries. Asian J Psychiatr 2021; 58:102601. [PMID: 33611083 DOI: 10.1016/j.ajp.2021.102601] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/07/2021] [Indexed: 01/12/2023]
Abstract
Mental health disorders are a burgeoning global public health challenge, and disproportionately affect the poor. Low- and middle-income countries (LMICs) bear 80 % of the mental health disease burden. Stigma associated with mental health results in delayed help seeking, reduced access to health services, suboptimal treatment, poor outcomes and an increased risk of individuals' human rights violations. Moreover, widespread co-occurrence of physical comorbidities such as noncommunicable diseases with mental health disorders makes the treatment of both conditions challenging and worsens prognosis. This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals (mental health professionals, non-psychiatric specialists and general practitioners) imparting mental health care. Cultural, socio-economic and religious factors determine various aspects of mental health in LMICs, ranging from perceptions of health and illness, health seeking behavior, attitudes of the individuals and health practitioners and mental health systems. Addressing stigma requires comprehensive and inclusive mental health policies and legislations; sustainable and culturally-adapted awareness programs; capacity building of mental health workforce through task-shifting and interprofessional approaches; and improved access to mental health services by integration with primary healthcare and utilizing existing pathways of care. Future strategies targeting stigma reduction must consider the enormous physical comorbidity burden associated with mental health, prioritize workplace interventions and importantly, address the deterioration of population mental health from the COVID-19 pandemic.
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Affiliation(s)
- Afzal Javed
- Pakistan Psychiatric Research Centre, Lahore, Pakistan; World Psychiatric Association (WPA), UK.
| | - Cheng Lee
- Institute of Mental Health, Singapore
| | - Hazli Zakaria
- Malaysian Psychiatric Association (MPA), Kuala Lumpur, Malaysia
| | - Robert D Buenaventura
- Department of Neurosciences, Manila Theological College - College of Medicine, Manila, Philippines
| | - Marcelo Cetkovich-Bakmas
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Kalil Duailibi
- Department of Psychiatry, Santo Amaro University, São Paulo, Brazil
| | - Bernardo Ng
- Asociación Psiquiátrica Mexicana, Mexico; University of California, San Diego, CA, USA
| | - Hisham Ramy
- NeuroPsychiatry Department, Ain Shams University, Cairo, Egypt; Egyptian Psychiatric Association (EPA), Cairo, Egypt; Egyptian Association of Cognitive Behavioral Therapy (EACBT), Cairo, Egypt
| | - Gautam Saha
- Clinic Brain Neuropsychiatric Institute and Research Center, Kolkata, India; Indian Psychiatric Society, Kolkata, India
| | | | - Paola M Elorza
- Research, Development & Medical, Upjohn - A Pfizer Division, Buenos Aires, Argentina
| | | | - Muhammad Waqar Azeem
- Department of Psychiatry, Sidra Medicine, Weill Cornell Medical College, Doha, Qatar
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Mort SC, Díaz SR, Beverly EA. Using contact-based education to destigmatize opioid use disorder among medical students. TEACHING AND LEARNING IN MEDICINE 2021; 33:196-209. [PMID: 33196302 DOI: 10.1080/10401334.2020.1820869] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
All first- and second-year (i.e., pre-clinical) medical students at a large, Midwestern medical school with three campuses were invited to participate in a two-arm, parallel educational study comparing the efficacy of two types of curricular interventions. Students at the main campus attended the modified contact-based education panel or the didactic lecture in person, while students at the two distance campuses attended the modified contact-based education or lecture remotely using the University's videoconferencing system. Impact: A total of 109 students participated in the study (average age 24.2 years (SD = 2.6), 64.2% female, 79.8% white, 56.0% second-year students, 67.9% attended on main campus, lecture = 52 participants, modified contact-based = 57 participants). Baseline responses were similar across groups. Following the session, participants in both interventions rated drug abuse (percent increase = 21.2%, p < .001) and prescription drug diversion (percent increase = 7.6%, p = .004) as more serious problems. Participants from both interventions expressed increased confidence in caring for patients with OUD (percent increase = 45.5%, p < .001) and increased interest in pursuing MAT training (percent increase = 21.5%, p = .04). Both curricular interventions were equally effective at reducing OUD stigma with a significant 8.2% decrease in total stigma scores and a large effect size (p < .001, ηp2 = .34). Lastly, participants with lower post-assessment OUD stigma scores were more likely to indicate that they would pursue additional training to provide MAT (p = .02). Lessons learned: Exposure to opioid-specific education with a focus on MAT and recovery, regardless of education type, positively affected opioid-related postgraduate intentions and reduced OUD stigma. Notably, these findings suggest that there are multiple efficacious techniques to reduce OUD stigma during preclinical training.
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Affiliation(s)
- Sophia C Mort
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
- The Graduate College, Translational Biomedical Sciences Program, Ohio University, Athens, Ohio, USA
| | - Sebastián R Díaz
- Dean's Office of Medical Education, Northeast Ohio Medical University College of Medicine, Rootstown, Ohio, USA
| | - Elizabeth A Beverly
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
- The Diabetes Institute, Ohio University, Athens, Ohio, USA
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36
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Gu L, Jiao W, Xia H, Yu M. Psychiatric-mental health education with integrated role-play and real-world contact can reduce the stigma of nursing students towards people with mental illness. Nurse Educ Pract 2021; 52:103009. [PMID: 33735744 DOI: 10.1016/j.nepr.2021.103009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
Stigma and negative attitudes towards people with mental illness are frequently found among nursing students. Interventions targeting mental illness stigma are the critical elements in altering the status. The aim of the present study was to examine the effects of the psychiatric-mental health education with role-play and real-world contact on stigma of nursing students towards people with mental illness in China. A single group pretest and posttest study design was adopted and total 373 students were recruited whilst 343 completed the course. We integrated the role-play and contact with patients in the routine psychiatric-mental health education. After the education was completed, the students' stigma towards people with mental illness were positively changed (pretest mean score of stigma: 53.77, posttest mean score of stigma: 49.01, 95% CI: 2.63-6.87) and their willingness to care for the people with mental illness was also significantly increased (pretest mean score of willingness: 5.45, posttest mean score of willingness: 7.38, 95% CI: -2.22--1.65). The psychiatric-mental health education especially with integrated role-play and real-world contact is an effective way to reduce nursing students' stigma and negative attitudes towards people with mental illness and increases their willingness to care for people with mental illness.
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Affiliation(s)
- Libin Gu
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, 210023, China.
| | - Wenjuan Jiao
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, 210023, China.
| | - Haozhi Xia
- School of Nursing, Nanjing University of Chinese Medicine, 138 Xianlin Avenue, Qixia District, Nanjing, 210023, China.
| | - Mingming Yu
- School of Nursing, Peking University, Beijing, China.
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Tergesen CL, Gurung D, Dhungana S, Risal A, Basel P, Tamrakar D, Amatya A, Park LP, Kohrt BA. Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042143. [PMID: 33671743 PMCID: PMC7926497 DOI: 10.3390/ijerph18042143] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 12/12/2022]
Abstract
This study evaluated the impact of didactic videos and service user testimonial videos on mental illness stigma among medical students. Two randomized controlled trials were conducted in Nepal. Study 1 examined stigma reduction for depression. Study 2 examined depression and psychosis. Participants were Nepali medical students (Study 1: n = 94, Study 2: n = 213) randomized to three conditions: a didactic video based on the mental health Gap Action Programme (mhGAP), a service user video about living with mental illness, or a control condition with no videos. In Study 1, videos only addressed depression. In Study 2, videos addressed depression and psychosis. In Study 1, both didactic and service user videos reduced stigma compared to the control. In Study 2 (depression and psychosis), there were no differences among the three arms. When comparing Study 1 and 2, there was greater stigma reduction in the service user video arm with only depression versus service user videos describing depression and psychosis. In summary, didactic and service user videos were associated with decreased stigma when content addressed only depression. However, no stigma reduction was seen when including depression and psychosis. This calls for considering different strategies to address stigma based on types of mental illnesses. ClinicalTrials.gov identifier: NCT03231761.
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Affiliation(s)
- Cori L. Tergesen
- Department of Psychology, DePaul University, Chicago, IL 60604, USA;
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA;
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal;
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Saraswati Dhungana
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; (S.D.); (P.B.)
| | - Ajay Risal
- Department of Psychiatry, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; (A.R.); (D.T.)
| | - Prem Basel
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; (S.D.); (P.B.)
| | - Dipesh Tamrakar
- Department of Psychiatry, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; (A.R.); (D.T.)
| | | | - Lawrence P. Park
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA;
- Infectious Disease Division, Department of Medicine, Duke University Medical Center, Durham, NC 27708, USA
| | - Brandon A. Kohrt
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA;
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal;
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC 20037, USA
- Correspondence: ; Tel.: +1-202-741-2896
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38
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van 't Hof M, van Nieuwenhuyzen ADY, van Berckelaer-Onnes I, Deen M, Hoek HW, Ester WA. Autism Spectrum Disorder Alertness in Dutch Youth and Family Center Physicians: Effects of a Live Online Educational Program. J Autism Dev Disord 2021; 51:3401-3411. [PMID: 33420937 DOI: 10.1007/s10803-020-04842-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/24/2022]
Abstract
We investigated the effect of a live online educational program in 93 Dutch Youth and Family Center (YFC) physicians who were screening for Autism Spectrum Disorder (ASD) in the general child population. The educational program raised the physicians' level of specific ASD knowledge and it remained higher at six months follow-up (p < .01). Their self-confidence in detecting ASD was also higher and maintained at follow-up (p < .01). The educational program had no effect on the physicians' stigmatizing attitudes toward mental illness nor on the number of potential ASD referrals in children of 4-6 years of age. In conclusion, the online educational program on early detection of ASD has a six month long effect on YFC physicians' level of ASD knowledge and self-confidence.
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Affiliation(s)
- Maarten van 't Hof
- Sarr Expert Centre for Autism, Lucertis Child and Adolescence Psychiatry, Dynamostraat 18, 3083 AK, Rotterdam, The Netherlands.,Parnassia Psychiatric Institute, Kiwistraat 30, 2552 DH, The Hague, The Netherlands
| | - Annemyn D Y van Nieuwenhuyzen
- Sarr Expert Centre for Autism, Lucertis Child and Adolescence Psychiatry, Dynamostraat 18, 3083 AK, Rotterdam, The Netherlands
| | - Ina van Berckelaer-Onnes
- Sarr Expert Centre for Autism, Lucertis Child and Adolescence Psychiatry, Dynamostraat 18, 3083 AK, Rotterdam, The Netherlands.,Faculty of Social and Behavioural Sciences, Clinical Child and Adolescent Studies, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Mathijs Deen
- Parnassia Psychiatric Institute, Kiwistraat 30, 2552 DH, The Hague, The Netherlands.,Faculty of Social and Behavioural Sciences, Institute of Psychology, Methodology and Statistics Unit, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Hans W Hoek
- Parnassia Psychiatric Institute, Kiwistraat 30, 2552 DH, The Hague, The Netherlands.,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St, New York, NY, 10032, USA
| | - Wietske A Ester
- Sarr Expert Centre for Autism, Lucertis Child and Adolescence Psychiatry, Dynamostraat 18, 3083 AK, Rotterdam, The Netherlands. .,Parnassia Psychiatric Institute, Kiwistraat 30, 2552 DH, The Hague, The Netherlands. .,Department of Child and Adolescent Psychiatry, Curium-LUMC, Leiden University Medical Center, Endegeesterstraatweg 27, 2342 AK, Oegstgeest, The Netherlands.
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39
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Wilson N, Langan-Martin J. Burnout and attitudes toward deliberate self harm amongst UK junior doctors. PSYCHOL HEALTH MED 2020; 26:162-176. [PMID: 33125265 DOI: 10.1080/13548506.2020.1840599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Deliberate self-harm (DSH) is a major global health problem and a significant risk factor for death by suicide. Despite this, those who suffer are often confronted with negative attitudes from healthcare professionals whilst seeking help, with detrimental consequences for treatment outcomes. While several factors may affect attitudes to DSH amongst healthcare professionals, there is now growing evidence to suggest an association with burnout. As current levels of burnout amongst junior doctors are estimated to be high, understanding the nature of this association is crucial. The over-arching aim of this project is therefore to explore junior doctors' attitudes toward DSH in comparison with other presenting conditions and to explore any possible relationship these may have with features of burnout. We conducted an online cross-sectional survey of junior doctors working within NHS Greater Glasgow and Clyde. After collecting sociodemographic information, participants were presented with both the abbreviated Maslach Burnout Inventory and the Medical Condition Regard Scale for patients presenting with; Chronic Obstructive Pulmonary Disease (COPD), Type I Diabetes Mellitus (T1DM), Schizophrenia and DSH. Significant differences in attitudes according to presenting complaints/conditions were identified. Participants reported the highest regard for TIDM and lowest regard for DSH, varying as a function of speciality and years of NHS service. 21% of participants were experiencing 'burnout' to a high degree, and scores also varied as a function of speciality and years of NHS service. No association between burnout and attitudes were observed for any of the investigated diagnoses. Our findings highlight the desperate need for evidence-based interventions to address burnout and negative attitudes toward DSH amongst junior doctors. Moreover, they may suggest that these attitudes worsen through the course of junior doctor training. We would therefore advocate for further research to assess the efficacy of interventions designed to address this.
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Affiliation(s)
- N Wilson
- Department of Health and Well-being, University of Glasgow , Glasgow, Scotland
| | - J Langan-Martin
- Department of Health and Well-being, University of Glasgow , Glasgow, Scotland
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40
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Lien YY, Lin HS, Lien YJ, Tsai CH, Wu TT, Li H, Tu YK. Challenging mental illness stigma in healthcare professionals and students: a systematic review and network meta-analysis. Psychol Health 2020; 36:669-684. [PMID: 33017193 DOI: 10.1080/08870446.2020.1828413] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Stigma among healthcare professionals may lead to poor quality of healthcare services for patients with mental illness. This study conducts a network meta-analysis to estimate the relative efficacy between different types of anti-stigma interventions for healthcare professionals. DESIGN Network meta-analysis. MAIN OUTCOME MEASURES The attitudes and behavior intension of healthcare professionals toward mental illness. RESULTS A total of 18 studies (22 trials) from 9 countries are included in the analysis. In the network meta-analysis, rank probabilities show interventions with indirect contact plus lecture (SUCRA = 81.5%), direct contact plus problem-based learning workshop (SUCRA = 77.4%), and indirect contact (SUCRA = 72.2%) having the highest probability of being ranked first, second, and third, respectively. CONCLUSION Our findings suggest that education combining social contact is the most effective anti-stigma intervention, which can be implemented in clinical practices to help reduce this stigma and improve healthcare services for patients with mental illness.
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Affiliation(s)
- Yin-Yi Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hui-Shin Lin
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Chi-Hsuan Tsai
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Ting-Ting Wu
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hua Li
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
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41
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van 't Hof M, van Berckelaer-Onnes I, Deen M, Neukerk MC, Bannink R, Daniels AM, Hoek HW, Ester WA. Novel Insights into Autism Knowledge and Stigmatizing Attitudes Toward Mental Illness in Dutch Youth and Family Center Physicians. Community Ment Health J 2020; 56:1318-1330. [PMID: 32048132 PMCID: PMC7434787 DOI: 10.1007/s10597-020-00568-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 01/30/2020] [Indexed: 12/13/2022]
Abstract
Professionals' limited knowledge on mental health and their stigmatizing attitudes toward mental illness can delay the diagnosis of autism. We evaluated the knowledge on Autism Spectrum Disorder (ASD) and stigmatizing attitudes in 93 physicians at Dutch Youth and Family Centers (YFC). These physicians screen for psychiatric symptoms in children. We show that their general ASD knowledge scored 7.1 (SD 1.2), but their specific ASD knowledge was only 5.7 (SD 1.7) (weighted means on 1-10 scale, 1 = least knowledge, 10 = most knowledge). Our physicians had positive attitudes toward mental illness (CAMI scores 2.18 (SD 0.33) to 2.22 (SD 0.40) on a 5-point Likert scale) but they had higher levels of stigmatizing attitudes than other Western healthcare professionals. Their levels were considerably lower than in non-Western professionals. We found no relations between ASD knowledge, stigmatizing attitudes and demographic variables. In conclusion, ASD knowledge and stigmatizing attitudes toward mental illness in Dutch YFC physicians require attention.
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Affiliation(s)
- Maarten van 't Hof
- Sarr Expert Centre for Autism, Lucertis Child and Adolescent Psychiatry, Carnissesingel 51, 3083 JA, Rotterdam, The Netherlands.,Parnassia Psychiatric Institute, Kiwistraat 30, 2552 DH, The Hague, The Netherlands
| | - Ina van Berckelaer-Onnes
- Sarr Expert Centre for Autism, Lucertis Child and Adolescent Psychiatry, Carnissesingel 51, 3083 JA, Rotterdam, The Netherlands.,Faculty of Social and Behavioural Sciences, Clinical Child and Adolescent Studies, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Mathijs Deen
- Parnassia Psychiatric Institute, Kiwistraat 30, 2552 DH, The Hague, The Netherlands.,Faculty of Social and Behavioural Sciences, Institute of Psychology, Methodology and Statistics Unit, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Monique C Neukerk
- Sarr Expert Centre for Autism, Lucertis Child and Adolescent Psychiatry, Carnissesingel 51, 3083 JA, Rotterdam, The Netherlands
| | - Rienke Bannink
- Department of Youth Health Care, Regional Public Health Service Rijnmond, 3003 AB, Rotterdam, The Netherlands
| | - Amy M Daniels
- Simons Foundation, 160 Fifth Avenue, New York, NY, 10010, USA
| | - Hans W Hoek
- Parnassia Psychiatric Institute, Kiwistraat 30, 2552 DH, The Hague, The Netherlands.,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St., New York, NY, 10032, USA
| | - Wietske A Ester
- Sarr Expert Centre for Autism, Lucertis Child and Adolescent Psychiatry, Carnissesingel 51, 3083 JA, Rotterdam, The Netherlands. .,Parnassia Psychiatric Institute, Kiwistraat 30, 2552 DH, The Hague, The Netherlands. .,Department of Child and Adolescent Psychiatry, Curium-LUMC, Leiden University, Endegeesterstraatweg 27, 2342 AK, Oegstgeest, The Netherlands.
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42
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Waqas A, Malik S, Fida A, Abbas N, Mian N, Miryala S, Amray AN, Shah Z, Naveed S. Interventions to Reduce Stigma Related to Mental Illnesses in Educational Institutes: a Systematic Review. Psychiatr Q 2020; 91:887-903. [PMID: 32372401 PMCID: PMC7395002 DOI: 10.1007/s11126-020-09751-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This investigation reviews the effectiveness of anti-stigma interventions employed at educational institutes; to improve knowledge, attitude and beliefs regarding mental health disorders among students. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist guidelines were followed and protocol was registered in PROSPERO (CRD42018114535). Forty four randomized controlled trials were considered eligible after screening of 104 full-text articles against inclusion and exclusion criteria.Several interventions have been employed to tackle stigma toward psychiatric illnesses, including education through lectures and case scenarios, contact-based interventions, and role-plays as strategies to address stigma towards mental illnesses. A high proportion of trials noted that there was a significant improvement for stigma (19/25, 76%), attitude (8/11, 72%), helping-seeking (8/11, 72%), knowledge of mental health including recognition of depression (11/14, 78%), and social distance (4/7, 57%). These interventions also helped in reducing both public and self-stigma. Majority of the studies showed that the anti-stigma interventions were successful in improving mental health literacy, attitude and beliefs towards mental health illnesses.
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Affiliation(s)
- Ahmed Waqas
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Salma Malik
- Program Director: Child and Adolescent Psychiatry Fellowship, Institute of Living/Hartford Healthcare, Hartford, CT USA
| | - Ania Fida
- King Edward Medical University, Lahore, Pakistan
| | - Noureen Abbas
- FMH College of Medicine & Dentistry, Lahore, Pakistan
| | - Nadeem Mian
- Mental Health Counselor, PICACS, Washington, USA
| | | | | | | | - Sadiq Naveed
- Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas, USA
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43
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Luigi M, Rapisarda F, Corbière M, De Benedictis L, Bouchard AM, Felx A, Miglioretti M, Abdel-Baki A, Lesage A. Determinants of mental health professionals' attitudes towards recovery: A review. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e62-e73. [PMID: 33062092 PMCID: PMC7522886 DOI: 10.36834/cmej.61273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The attitudes of mental health professionals towards consumers' recovery are far more pessimistic than what is needed for the recovery-orientation to truly permeate systems of care. It has become pressing to depict determinants for these attitudes and how they evolve during professionalization. This, in the hopes to adjust not only medical education, but also ongoing training of professionals. METHODS A systematic search of PubMed and PsycINFO databases was conducted, yielding a net 15 303 records. Twenty-two publications from specific educational journals and reference lists were added. Finally, thirty-four full texts were read, from which twenty-two articles were included. RESULTS From the reviewed studies emerged five main determinants: profession, education, age, clinical experience, and nature of the contact with consumers. Traditional clinical placements during residency, negative experiences with acute patients, younger age and the professional attitudes of psychiatrists seem to all be determining factors for professionals' pessimistic attitudes towards recovery. CONCLUSIONS This review found specific determinants for attitudes in recovery and four out of five can be acted upon. For a recovery-orientation to be implemented across our mental health system, we formulate recommendations within the Canadian context for revision of curriculum, recovery-specific training, and operationalisation through state/provincial technical assistance centers.
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Affiliation(s)
- Mimosa Luigi
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
| | - Filippo Rapisarda
- Department of Psychology, Università degli Studi di Milano-Bicocca, Italy
| | - Marc Corbière
- Department of Education and Pedagogy – Faculty of the Sciences of Education, University of Quebec, Quebec, Canada
| | - Luigi De Benedictis
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
- Program for psychotic disorders, Institut Universitaire en Santé Mentale de Montréal, CIUSSS East-of-Montreal, Quebec, Canada
| | - Anne-Marie Bouchard
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
| | - Amélie Felx
- Mental health and substance abuse program, Institut Universitaire en Santé Mentale Douglas, CIUSSS West-of-Montreal, Quebec, Canada
| | | | - Amal Abdel-Baki
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
| | - Alain Lesage
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
- Research Centre, Institut Universitaire en Santé Mentale de Montréal, CIUSSS East-of-Montreal, Quebec, Canada
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44
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Ma HI, Hsieh CE. An Anti-Stigma Course for Occupational Therapy Students in Taiwan: Development and Pilot Testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155599. [PMID: 32756448 PMCID: PMC7432861 DOI: 10.3390/ijerph17155599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 01/05/2023]
Abstract
Attitudes of healthcare professionals towards people with disorders/disabilities are important for the development of therapeutic relationships, as well as to the evaluation and intervention processes. Therefore, it is critical to be aware and reduce stigmatizing attitudes in future healthcare professionals. An 18-week anti-stigma course was developed for occupational therapy students based on literature review and focus group interview. The course consisted of three components, including social contact, roleplaying, and critical reflection strategies. A quasi-experimental design was implemented to evaluate participants at three time points (i.e., pre-test, post-test, and one year after completion) using the Social Distance Scale and several questionnaires (i.e., stigmatising attitudes towards mental illness, physical disabilities, and children with emotional behavioural disorders). A total of 16 students completed the course and had significantly decreased social distance and stigmatising attitudes towards mental illness and emotional behavioural disorders in the post-test. These decreases remained one year later. The results support the provision of an anti-stigma course for occupational therapy students to reduce stigmatising attitudes. Future research should extend the anti-stigma course to occupational therapy students at other universities to increase both the sample size and overall generalisability.
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Affiliation(s)
- Hui-Ing Ma
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan 700, Taiwan;
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 700, Taiwan
- Correspondence: ; Tel.: +86-6235-3535
| | - Chu-En Hsieh
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan 700, Taiwan;
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O'Ferrall-González C, Almenara-Barrios J, García-Carretero MÁ, Salazar-Couso A, Almenara-Abellán JL, Lagares-Franco C. Factors associated with the evolution of attitudes towards mental illness in a cohort of nursing students. J Psychiatr Ment Health Nurs 2020; 27:237-245. [PMID: 31663221 DOI: 10.1111/jpm.12572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/28/2019] [Accepted: 10/28/2019] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: People with mental health difficulties have poorer physical health than the general population. The stigmatizing attitude of health professionals impacts the quality of care for these people. There is a broad background on the effectiveness of activities based on theoretical training, clinical practices or social contact to improve nursing students' attitudes towards people with mental health difficulties. There is an important need to assess whether the benefits identified in the short term are maintained in the longer term. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The positive evolution of attitudes towards mental illness does not last over time. Some students' attitude towards people with a mental health difficulty worsened in the final stage of their training after completing clinical practices. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is necessary for tutors incorporate an understanding of stigma throughout the degree training and to discuss with the students the emotional aspects experienced during the performance of clinical practices. The design of any anti-stigma intervention must include the factor of "time". ABSTRACT: Introduction The stigma of health professionals is a contributing factor to morbi-mortality among people with mental health difficulties. There is a lack of research on long-term outcomes in nursing students. Objective To identify factors associated with the evolution of stigmatizing attitudes towards mental illness in a cohort of students trained in mental health. Method A prospective observational study of the impact of training in mental health care. Age, gender, stigma, level of previous familiarity with mental illness, self-education by Internet, academic performance and the place where practicums are conducted were evaluated on three occasions over 15 months. Results Academic performance, online consultation and the size or origin of the theoretical group were indicators of better attitudes. The positive evolution of attitudes does not last over time. Discussion Instability over time could be explained by students' experience in the practicum, although the time itself has been identified as a determining factor. Practical implications Further studies should be promoted in academia to assess the content of mental health training and its influence on the evolution of the stigmatizing attitude. It is also necessary to address stigma in small groups, where students with better academic results lead anti-stigma activities.
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Affiliation(s)
- Cristina O'Ferrall-González
- Department of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain.,Research Group PAIDI CTS-391, University of Cádiz, Cádiz, Spain
| | - José Almenara-Barrios
- Department of Biomedicine, Biotecnology and Public Health, University of Cádiz, Cádiz, Spain
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Wechsler D, Schomerus G, Mahlke C, Bock T. Effects of contact-based, short-term anti-stigma training for medical students : Results from a randomized controlled trial. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2020; 34:66-73. [PMID: 32112263 DOI: 10.1007/s40211-020-00337-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/08/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mental health stigma (MHS) places a burden on those affected that far exceeds psychosocial harms. Contact-based anti-stigma work has been found effective for several target groups. For medical students however, its efficacy remains unclear. AIM The purpose of this study was to examine the efficacy of contact-based, trialogic anti-stigma training for medical students. METHODS A randomized controlled trial (RCT) was conducted, controlling for standard clinical placement in psychiatry. External validity was maximized by including all students (n = 204) who started their 6‑week obligatory psychiatry course during the study period between March and July 2018. Assessments were conducted at the beginning of each of the two covered terms and immediately postintervention. RESULTS Students who received the anti-stigma training displayed significantly less stigmatizing attitudes after the intervention, measured using the MICA (Mental Illness-Clinicians' Attitudes) scale as primary outcome. Analogous findings were noted for social distance and stereotypes, whereas these could not be observed for emotional reactions. All significant changes were independent of gender and age. CONCLUSION The positive results underpin the research in this field and point towards the inclusion of comparable interventions in regular student curricula. Given the limitation of a missing late follow-up, however, further research regarding the persistence of stigma reduction is needed.
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Affiliation(s)
- Dominik Wechsler
- Centre for Psychosocial Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany.
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Candelaria Mahlke
- Centre for Psychosocial Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Thomas Bock
- Centre for Psychosocial Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
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Ma HI, Hsieh CE. Questionnaires on stigmatizing attitudes among healthcare students in Taiwan: development and validation. BMC MEDICAL EDUCATION 2020; 20:59. [PMID: 32106850 PMCID: PMC7045580 DOI: 10.1186/s12909-020-1976-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/20/2020] [Indexed: 06/09/2023]
Abstract
BACKGROUND People may be stigmatized if they have mental illness, emotional and behavioral disorders (EBD), or physical or intellectual disabilities. Being stigmatized adversely affects one's psychological well-being and quality of life. While occupational therapists frequently work with people with EBD and disabilities, all healthcare practitioners may encounter these populations, and stigmatizing attitudes of healthcare professionals towards such clients can negatively affect the therapeutic relationship, evaluation, and treatment. Therefore, understanding attitudes of healthcare students-as future practitioners in all fields of healthcare-towards people in this regard is fundamental to the future implementation of anti-stigma programs. We aimed to develop and test questionnaires for examining stigmatizing attitudes of healthcare students towards people with mental illness or disabilities and children with EBD. METHODS A literature review was conducted to identify surveys related to attitudes towards people with mental illness, EBD, and disabilities. Items that were pertinent to the concept of stigma were selected and modified to fit into the Taiwanese context. A total of 336 students from departments of occupational therapy, physical therapy, nursing, and medicine in 7 universities across Taiwan completed the questionnaires. Item analysis and factor analysis were used to examine the reliability and validity of the questionnaires. Gender differences were also considered. RESULTS Factor analyses of the three questionnaires yielded factor structures that explained 61.34 to 67.15% of the variance, with Cronbach's α values ranging from 0.71 to 0.89. The Questionnaire on Stigmatizing Attitudes Towards Mental Illness consisted of 16 items with 4 subscales: deviant behavior, social isolation, negative stereotype, and self-stigma. The Questionnaire on Stigmatizing Attitudes Towards Children with EBD consisted of 14 items with 3 subscales: rejective attitude, negative stereotype, and deviant behavior. The Questionnaire on Stigmatizing Attitudes Towards Disabilities consisted of 10 items with 3 subscales: positive stereotype, negative stereotype, and pessimistic expectation. In addition, men had slightly higher stigmatizing attitudes than women. CONCLUSIONS The results showed satisfactory factor structures and internal consistency, and thus support the use of these questionnaires to understand attitudes of healthcare students towards these populations. In addition, particular attention should be paid to gender differences in stigmatizing attitudes of healthcare students.
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Affiliation(s)
- Hui-Ing Ma
- Department of Occupational Therapy, National Cheng Kung University, 1 University Road, Tainan, 701 Taiwan
- National Cheng Kung University, Institute of Allied Health Sciences, 1 University Road, Tainan, 701 Taiwan
| | - Chu-En Hsieh
- Department of Occupational Therapy, National Cheng Kung University, 1 University Road, Tainan, 701 Taiwan
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Kong L, Fan W, Xu N, Meng X, Qu H, Yu G. Stigma Among Chinese Medical Students Toward Individuals With Mental Illness. J Psychosoc Nurs Ment Health Serv 2020; 58:27-31. [PMID: 31710369 DOI: 10.3928/02793695-20191022-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 08/23/2019] [Indexed: 12/27/2022]
Abstract
The current study aimed to examine medical students' attitudes toward individuals with mental illness. Stratified cluster sampling was used to survey 735 Chinese medical students from three medical universities in Shandong, China. Participants completed the Perceived Devaluation and Discrimination Scale (PDD). Scores on the devaluation subscale items (mean = 2.80, SD = 0.59) were lower than the midpoint score (i.e., 3) (p < 0.001), and scores on the discrimination subscale items (mean = 3.20, SD = 0.52) were higher than the midpoint score (p < 0.001). Higher scores indicated more negative attitudes toward individuals with mental illness. Significant gender differences were found in the discrimination subscale scores and total PDD scores, with lower scores in men compared with women. Compared with medical students in other years, students in their senior year of medical school had the lowest scores on the discrimination subscale. Students may benefit from increased education regarding psychology and psychiatry and by having more contact with individuals with mental illness. [Journal of Psychosocial Nursing and Mental Health Services, 58(2), 27-31.].
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Al Saif F, Al Shakhoori H, Nooh S, Jahrami H. Association between attitudes of stigma toward mental illness and attitudes toward adoption of evidence-based practice within health care providers in Bahrain. PLoS One 2019; 14:e0225738. [PMID: 31790468 PMCID: PMC6886841 DOI: 10.1371/journal.pone.0225738] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/11/2019] [Indexed: 12/24/2022] Open
Abstract
The health care system is one of the key areas where people with mental illnesses could experience stigma. Clinicians can hold stigma attitudes during their interactions with patients with mental illness. To improve the quality of mental health services and primary care, evidence-based practices should be disseminated and implemented. In this study, we evaluated the attitudes of health care providers in Bahrain toward people with mental illness and adoption of evidence-based practice using the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) and Evidence-Based Practice Attitude Scale (EBPAS). We conducted a cross-sectional study across 12 primary health care centers and a psychiatric hospital (the country's main mental health care facility). A self-report questionnaire was distributed among all health care providers. A total of 547 health care providers participated, with 274 from mental health services and 273 from primary care services. Results of the OMS-HC indicated differences between both main groups and subgroups. Regression model analysis reported significant outcomes. There was no statistical difference found between both groups in EBPAS scores. A weak but statistically significant negative association was reported between both scales. Participants showed varying stigma attitudes across different working environments, with less stigma shown in mental health services than in primary care services. Providers who were more open to adopting evidence-based practices showed less stigma toward people with mental illness. Comparing our findings with previous research showed that health care providers in Bahrain hold more stigma attitudes than other groups studied. We hope that this study serves as an initial step toward future campaigns against the stigma of mental illness in Bahrain and across the region.
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Affiliation(s)
- Feras Al Saif
- Psychiatric Hospital, Ministry of Health, Manama, Kingdom of Bahrain
| | | | - Suad Nooh
- Psychiatric Hospital, Ministry of Health, Manama, Kingdom of Bahrain
| | - Haitham Jahrami
- Psychiatric Hospital, Ministry of Health, Manama, Kingdom of Bahrain
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
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Dingle AD, Torres-Reveron A, Gil M, Fernandez F, Escobedo IM, Terry V, Maestre GE, de Erausquin GA. Mind, Brain, and Behavior: an Integrative Approach to Teaching Neuroscience to Medical Students. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:639-643. [PMID: 31222575 PMCID: PMC8722773 DOI: 10.1007/s40596-019-01079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/27/2019] [Accepted: 06/03/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Arden D Dingle
- University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA.
| | | | - Mario Gil
- University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | - Francisco Fernandez
- University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | | | - Valerie Terry
- University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
| | - Gladys E Maestre
- University of Texas Rio Grande Valley School of Medicine, Harlingen, TX, USA
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