A Mixed Methods Study of Perceptions of Mental Illness and Self-Disclosure of Mental Illness Among Medical Learners

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.