Reducing Stigma Towards Psychiatry Among Medical Students: A Multicenter Controlled Trial

Abstract

Objective: Stigma towards people with mental illness and psychiatry is prevalent among healthcare providers, including medical students, and might adversely affect medical care. This study examined the effect of including a novel Anti-stigma Intervention Curriculum (ASIC) during rotation in psychiatry. It addressed medical students' stigmatic views towards psychiatric patients and psychiatric treatments, and the knowledge base of clinical practice in psychiatry.   Methods: Medical students from eight hospitals were divided into intervention (one hospital, n=57) and control (seven hospitals, n=163) arms at the beginning of a 6-week psychiatry rotation throughout one academic year (2017/18). The students completed the Attitudes to Psychiatry scale (ATP-30) and the Attitudes toward Mental Illness scale (AMI) at rotation onset and conclusion. The ASIC was designed to target prejudices and stigma by direct informal encounters with people with severe mental illness during periods of remission and recovery, and under the supervision of the group's tutors. Small group discussions were held following those encounters to facilitate processing of the thoughts and emotions that emerged during the encounters, and to discuss salient topics, such as psychiatric care, evidence-based medicine in psychiatry, and the neuroscientific underpinnings of clinical psychiatry. Results: ATP-30 scores in the intervention group increased from 108.51±13.02 to 115.27±14.09 (t=2.65, df=111, p<0.01), and the AMI scores from 73.51±7.40 to 76.93±5.95 (t=2.71, df=111, p<0.01). ATP-30 scores in the control group also increased significantly (from 107.99 ±13.45 to 111.28±14.87; t=2.07, df=315, p=0.04), but there was no significant increase in their AMI scores. There was a significant reduction in the proportion of students endorsing stigmatic statements on core issues: specifically, views about people with mental illness, psychiatric treatments, the knowledge base of clinical practice in psychiatry, and psychiatry as a possible career choice only in the intervention group.   Conclusion: Our findings indicate that implementing an ASIC that includes live social contact and small group discussions during psychiatry rotation seem to be effective in reducing medical students' stigmatic positions towards people with mental illness, psychiatric treatments, the knowledge base of clinical practice in psychiatry, and psychiatry as a profession. The long-term destigmatizing effects of an ASIC and its applicability in academic settings, warrant further evaluation.   Funding: Our research was not funded. All the physicians who participated in the study volunteered to reduce stigma among medical students and did not receive any payment. Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article. Ethical Approval: The study was conducted after receiving Helsinki ethics committee approval for a multicenter study. Because the ethics committee approval was on the condition that individual data will be de-identified, we used aggregated pre- and post-rotation data for each item of the Attitudes to Psychiatry (ATP-30)22 and the Attitudes to Mental Illness (AMI).