Exclusion sociale et suivi psychologique: un cas clinique

Abstract

Explorer chez des étudiants en médecine l’impact de l’enseignement théorique et d’un stage clinique en psychiatrie sur les attitudes stigmatisantes envers la psychiatrie et les pathologies psychiatriques.Les attitudes stigmatisantes ont été évaluées au moyen de la version française de la Mental Illness : Clinicians’ Attitudes (MICA) chez des étudiants en quatrième année de médecine avant et après les cours théoriques de psychiatrie. Deux groupes d’étudiants ont été recrutés selon le lieu de stage hospitalier concomitant à l’enseignement, psychiatrie (n = 72) ou neurologie (n = 102). Des analyses multivariées ont été utilisées afin d’identifier les variables indépendamment associées au score total à l’échelle MICA.Les scores MICA étaient significativement plus bas en fin de stage quel que soit le lieu (b = − 2,8 ; p = 0,001), chez les femmes (b = − 1,8 ; p = 0,03) et en cas de pathologie psychiatrique parmi les proches (b = − 1,92 ; p = 0,02). Les analyses stratifiées, conduites après la mise en évidence d’une interaction significative entre « lieu de stage » et « période d’évaluation », montraient que les attitudes stigmatisantes ne s’améliorent significativement que chez les externes en psychiatrie (b = − 4,66 ; p = 0,001) et pas chez les externes en neurologie (b = − 1,45 ; p = 0,16).Les étudiants en médecine, en tant que futurs médecins, constituent une cible prioritaire pour les actions de déstigmatisation de la pathologie psychiatrique. Leur formation initiale devrait intégrer des stages en psychiatrie et des interventions visant à réduire la stigmatisation tout au long du cursus.The aim of the study was to explore whether a medical student education program and clinical posting in psychiatry had an impact on medical students’ stigmatizing attitudes towards psychiatry and psychiatric disorders.Medical students from the University of Bordeaux were recruited during their 4-year course at the beginning of the academic education program in psychiatry. Medical students who were concomitantly in a clinical posting in wards of psychiatry or neurology were invited to participate in the study. The medical student version of the scale Mental Illness: Clinicians’ Attitudes (MICA) was used to measure their attitudes towards psychiatry and persons with psychiatric disorder. This 16-item scale is designed to measure attitudes of health care professionals towards people with mental illness, a higher score indicating more stigmatizing attitudes. Items exploring history of psychiatric disorders in close persons were added at the end of the MICA scale. The questionnaire was completed twice by each student, at the beginning and the end of the 11-week clinical posting. All questionnaires were strictly anonymized. Multivariate linear regression analyses were used to identify the variables independently associated with MICA total score.At the beginning of the education program and clinical posting, 174 students completed the MICA scale: the mean MICA total score was equal to 46.4 (SD 6.9) in students in clinical posting in psychiatry (n = 72) and 45.1 (SD 7.01) in those in neurology (n = 102). At the end of the academic and clinical training, 138 students again completed the questionnaire, with mean MICA total scores equal to 41.4 (SD 8.1) in students in clinical posting in psychiatry (n = 51) and 43.5 (SD 7.3) in those in neurology (n = 87). Multivariate analyses showed that lower total MICA scores were independently associated with the time of assessment (lower scores at the end of education program and clinical posting) (b = − 2.8; P = 0.001), female gender (b = − 1.8; P = 0.03) and history of a psychiatric disorder in a close person (b = − 1.92; P = 0.02). Type of clinical posting (psychiatry vs. neurology) was not independently associated with MICA total scores (b = − 0.02; P = 0.98). A significant interaction was found between the variables “time of assessment” and “type of clinical posting” (P = 0.05): stratified analyses showed that MICA total scores decreased significantly only when the clinical posting was in psychiatry (b = − 4.66; P = 0.001), with no significant change in medical students in neurology wards (b = − 1.45; P = 0.16).Stigmatizing attitudes of medical students towards psychiatry and psychiatric disorders are reduced by an education program in psychiatry, with a positive impact more marked when the education program is concomitant to a clinical posting in psychiatry. As future health professionals in charge of persons with psychiatric disorders, medical students are key targets of actions aimed at reducing stigma towards mental health disorders. It is hence of great importance to promote clinical training in psychiatric wards during medical studies for all future practitioners, irrespective of their future specialty.