Next Article in Journal
Health Sciences Students’ Perceptions of the Role of the Supervisor in Clinical Placements
Previous Article in Journal
Gait Speed as a Predictor for Diabetes Incidence in People with or at Risk of Knee Osteoarthritis: A Longitudinal Analysis from the Osteoarthritis Initiative
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
IJERPH
Volume 18
Issue 9
10.3390/ijerph18094425
ijerph-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

The Assessment of Attitudes of Students at Medical Schools towards Psychiatry and Psychiatric Patients—A Cross-Sectional Online Survey

by
Mateusz Babicki
1,*,
Krzysztof Kowalski
2,
Bogna Bogudzińska
2 and
Patryk Piotrowski
3
1
Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
2
Students’ Scientific Group at the Faculty of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland
3
Section of Epidemiology and Social Psychiatry, Department and Clinic of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2021, 18(9), 4425; https://doi.org/10.3390/ijerph18094425
Submission received: 24 March 2021 / Revised: 19 April 2021 / Accepted: 19 April 2021 / Published: 21 April 2021
Versions Notes

Abstract

:
The aim of the study was the assessment of the level of stigmatisation of psychiatric patients and psychiatry as a field of study by students at medical schools in Poland and the comparison of students’ attitudes over the years. The study was conducted based on a proprietary questionnaire assessing the stage of tertiary education, sociodemographic status, and MICA-2 psychometric tool that is used for assessing both the attitudes of students at medical schools towards psychiatry as a field of study and patients with mental health disorders. According to the MICA score, those who have higher scores have more negative attitudes towards psychiatry. The survey consisted of two rounds at an interval of 3 years. Results. The first-round survey, conducted in 2017, involved 480 students. The second-round survey, conducted in 2020, involved 573 students. In both cases, women constituted the vast majority of respondents. Women, as well as medical major students, achieved significantly lower scores than men p < 0.001. The said relationship was also observed for individual experience with mental illness. There was no correlation between the MICA-2 total score and the psychiatry course completion—p = 0.105. However, the levels of stigmatisation are still high. The implementation of educational methods to improve the perception of psychiatric patients by students at medical schools should be taken into consideration. An increase in direct student–patient contact, for example, by means of intensive elective classes, could be beneficial.

1. Introduction

According to the report published in 2011 by the European College of Neuropsychopharmacology and the European Brain Council, which is a result of a three-year study, 38.2% of EU citizens per year suffered from a mental health disorder. This result makes mental health disorders one of the greatest challenges of modern medicine [1]. The patients with mental disorders have to face not only their health problem but also their perception by society [2]. Stigmatisation is a process of stigma creation and leads to the ostracism of individuals from various parts of social life [3]. This may be due to citizens’ lack of knowledge, prejudice, and discriminatory behaviour [4]. The stigmatisation process can be a real obstacle to patient treatment [5].
The stigma attached to mental disorders causes psychiatry to be perceived as less attractive, which is related to a decline in interest in psychiatry as a career path chosen by medical major students. A similar phenomenon is observed not only in Poland but also worldwide [6,7]. According to studies involving students of medicine, they consider patients with mental disorders to be unpredictable and dangerous. Moreover, 4–21% of students at medical schools consider schizophrenia to be an incurable disease [8]. In a survey conducted in 20 countries, only 4.5% of respondents chose psychiatry as their potential career path [9].
According to studies, the ratio of the number of psychiatrists in Poland is 9.02 per 100,000 citizens. Poland ranks penultimately in the European Union. In the best functioning health care systems in Europe, i.e., Germany, Greece, France and the Netherlands, this ratio ranges between 22.89and 27.33 [1].
Due to a significant shortage in psychiatrists, the authors of scientific reports suggest that appropriate strategies should be implemented to increase the attractiveness of psychiatry and thus the interest in psychiatry as a field of study. This would enable meeting the needs of the health care system in the future [10], in particular, that the problem of stigma is common among medical students. Although they have advanced medical knowledge, the research suggested that they keep a great distance from patients with mental disorders. The above-described relationship was confirmed by a study evaluating the views of medical students on the aetiology of diagnosis and prognosis in schizophrenia, conducted in a group of 381 people. Observations on another 419 students confirmed that they have difficulties in direct contact with patients; they focus mainly on pharmacotherapy, avoiding psychological aspects. The psychiatric curricula for medical students should include the greater integration of psychological and pharmacological aspects. [8]
Tackling stigmatising attitudes among students of medicine is important for effective medical interventions in the future [11]. There are several tools that assess the level of stigmatisation. The MICA Scale is the most reliable and universal tool [12]. This is a short, fully autonomous questionnaire used for assessing health care professionals’ attitudes towards psychiatric patients and psychiatry as a field of study. MICA-2 is a version designed for students at medical schools.
This study aims to assess the level of stigmatisation of psychiatric patients and psychiatry as a field of study by students at medical schools in Poland and the comparison of students’ attitudes over the years. As part of the study, the following hypotheses were proposed: (1) Students after completing the course in psychiatry show a lower level of stigmatisation. (2) Women show more favourable attitudes towards psychiatric diseases than men. (3) Medical students show a lower level of stigma than paramedical students. (4) Own experiences with mental disorders affect the level of stigmatisation.

2. Materials and Methods

2.1. Methods

The survey was conducted using a proprietary questionnaire distributed online through a social network. The survey was fully anonymous and voluntary. Participants were informed about the objectives, duration, and methodology of the survey before they were allowed to take part in the survey. After the respondents were familiarised with the information, they gave their informed consent to be surveyed. The respondents were given the opportunity to opt out at any stage of the survey without giving any reason. Finally, the respondents were given contact details of the authors of the survey.
The survey consisted of two rounds. The first-round survey concerned the stigmatisation process of students at medical schools in Poland in 2017. The survey was repeated in 2020.
The presented study was approved by the Bioethics Committee of the Wroclaw Medical University, and it was conducted in accordance with the Declaration of Helsinki.
The questionnaire consisted of two parts. The first part addressed questions assessing sociodemographic status, i.e., age, sex, and place of residence, as well as questions concerning the stage of tertiary education, including the year of study, taking psychiatry classes, and having personal experience with mental illness. The second part of the questionnaire was a standardised psychometric tool, MICA-2. The Mental Illness Clinicians’ Attitude Scale (MICA-2) is a 16-item psychometric tool designed to assess the attitudes of students at medical schools towards both psychiatry as a field of study and patients with mental health disorders. The questionnaire is based on a 6-point Likert scale [13]. Questions 3, 9, 10, 11, 12, and 16 are scored as follows: I strongly agree = 1 point; I agree = 2 points; I rather agree = 3 points; I rather disagree = 4 points; I disagree = 5 points; I strongly disagree = 6 points. Other questions are scored inversely [14].
The analysis of the tool is based on the overall assessment of the number of points scored by the participants. The score range is between 16 and 96 points. High scores indicate stigmatising attitudes towards both psychiatry as a field of study and psychiatric patients [13]. The Mica-2 scale shows high internal consistency and reliability [12]. However, the questionnaire has not been yet validated in Polish conditions.
The tool can also be interpreted at the level of individual questions. It should also be noted that the individual questions were divided into five thematic groups, as proposed by Gabbidon et al. [13]:
(a)
Views concerning mental illness and mental health care (questions 3, 10, 12, 16);
(b)
Knowledge of mental illness (questions 1, 2, 5, 6);
(c)
Willingness to disclose one’s own mental illness (questions 4, 7);
(d)
Distinction between physical and mental health (questions 8, 13, 14, 15);
(e)
Medical care for patients with mental illness (questions 9, 11).

2.2. Statistical Analysis

The statistical analysis was performed using the Statistica 13 software, (Cracow, Poland, StatSoft.) The variables were qualitative (and dichotomous), interval, as well as ordinal.
A chi-squared test was used for determining the relationships between the compared ordinal variables. Depending on the strength in two-way tables, the Yates’s chi-squared test and a detailed F-test were also used. For variables based on interval scales, basic descriptive statistics were determined. The normality of distributions of those variables was assessed using three different statistical tests: the Kolmogorov–Smirnov test, Lilliefors test, and Shapiro–Wilk test at the significance level of p = 0.05. The homogeneity of variance was assessed using the Levene’s test and Brown–Forsy the test at the assumed significance level of p = 0.05. The statistical significance of differences between mean values was assessed using the nonparametric Mann–Whitney U test or the Kruskal–Wallis test. An analysis of covariance (ANCOVA) was then performed to assess the differences between two rounds of research while taking into account the potential confounding factors (sex, major, year of study, psychiatry classes undertaken, and mental health problems)
A confidence level of α = 0.05 was assumed in all tests assessing the statistical significance of differences between means.

3. Results

3.1. Participants

A detailed profile of the study group is shown in Table 1.
A total of 1053 respondents (representing students at medical schools and universities from all over Poland) were surveyed. Among them, 645 (61%) were students of medicine, while 408 (39%) were students of other majors at medical schools (i.e., dentistry, nursing, obstetrics, and medical rescue). The mean age of the respondents was 22.91 years (min. 18, max. 48; SD 3.13). The first 2017 round survey involved 480 participants, while the second 2020 round survey involved 573 participants. The mean age was 23.40 (±2.5) and 22.51 (±3.51), respectively.

3.2. The Analysis of the MICA-2 Questionnaire

In the survey, the mean MICA-2 score among the respondents was 41.05 (min. 20, max. 80; SD 8.09) points. Women obtained significantly lower values than men (40.39 ± 7.59 vs. 43.94 ± 9.44)—p < 0.001. There were no statistically significant differences between the year of studies and the mean MICA-2 score (p = 0.071).
Individual experience with one’s own mental illness (40.48 ± 7.37) and that in immediate family members and friends (40.03 ± 8.34) was related to significantly lower MICA-2 scale scores compared to the lack of such experience (44.10 ± 7.65; p < 0.001). Completion of a course in psychiatry did not have any statistically significant effect on the overall score of the survey (41.35 ± 8.28 vs. 40.76 ± 7.90 (p = 0.105).
Students of medicine achieved a lower mean score on the MICA-2 scale compared to students studying other majors at medical schools (40.09 ± 8.38 vs. 42.56 ± 7.36; p < 0.001).
Table 2 shows a detailed comparison of responses to each question.
As regards future physicians, both women (p < 0.001) and men (p = 0.002) achieved significantly lower scores than their co-workers studying other majors at medical schools. In both cases, one’s own experience with mental illness affects the perception of psychiatric patients in a significant way (p < 0.001). A detailed comparison is shown in Table 3.
According to the analysis of individual questions addressed in MICA-2, as many as one out of three surveyed students admit that they studied psychiatry only because they had an exam, and they show little interest in psychiatry as a field of study. At the same time, 97% of the respondents consider psychiatry to be an equal field of study as other branches of medicine. The survey shows that 3% of future medical workers believe that a psychiatrist is not a “real doctor.” However, as many as 71% of the respondents believe that psychiatrists know more about their patients’ lives than their family members. More than half of the respondents believe that psychiatric patients often pose a threat to other people, and 59% of students disagree that society should not be protected from seriously mentally ill patients. There is a noticeably high fear of disclosing one’s own mental illness, and nearly 31% of the respondents claim that if they suffered from mental illness, they would never tell any of their friends about it. A total of 33% of the surveyed students were reluctant to continue professional cooperation with a person suffering from a mental health disorder. The exact distribution of responses addressed in MICA-2 is shown in Table 4.
As regards most aspects addressed in the MICA-2 questionnaire, women were significantly more likely to express a positive judgment than men—p < 0.05. A similar relationship was observed when assessing the likelihood of using the word “nut” and “madman” towards a mentally ill person, where 93% of female medical workers and 82% of male medical workers would not express such an opinion—p < 0.001. A total of 97% of female respondents and 92% of male respondents would not want to stop working with a co-worker, despite receiving the information regarding their mental illness—p < 0.001. Almost one-third (33%) of non-physician medical students believe that psychiatric patients will never fully recover, compared to 18% of future physicians (p < 0.01). A detailed comparison of MICA-2 responses in relation to sex, a completed psychiatry course, experience with mental illness, and a major is shown in Table 5.
The analysis of potential confounding factors is shown in Table 6.

4. Discussion

The presented study concerned the assessment of the stigmatisation of psychiatry and its patients by students at Polish medical schools. A particular emphasis was put on sex, completing a course in psychiatry, and having personal experience with mental problems. The mean MICA-2 score of 41.05 was higher in Polish students than in students from Spain (38.16) [15] and the Czech Republic (40.11) [16]. In contrast, students from Poland achieved lower scores than students from the U.S. state of Georgia (68.44) [17], Egypt (42.67) [12], Thailand (43.16) or India (46.56) [18]. However, it should be noted that this study is not representative of the group of Polish students of medical universities. The data obtained from this study are consistent with global reports [15,16,17,18], according to which men showed significantly higher levels of stigmatisation than women. This may be related to the fact that men are more likely to perceive mental disorders as a weakness of character, while women are more likely to associate the said disorders with traumatic experiences [19]. Moreover, individual experience with mental disorders was confirmed to reduce the level of stigmatisation of mental health problems [12,15,16,17,18].
The role of proper education is crucial in reducing the level of stigma among medical students [20]. This is why it is concerning that neither the stage of tertiary education nor the completion of the course in psychiatry had a significant effect on the final score of the questionnaire. Medical major students achieved significantly lower scores than students of other fields of medicine (40.09 vs. 42.56; p < 0.001). The reason for this disparity may be related to the greater time frame of classes, particularly in the face-to-face interaction with psychiatric patients in facilities related to mental health. Furthermore, it is useful to consistently practice the psychiatric history during clinical classes, as a significant number of respondents feel uncomfortable talking to someone with mental illness. This is particularly important as part of the training of future physicians of other specialisations who exhibit significantly higher levels of stigmatisation towards psychiatric patients than psychiatrists. Confrontation with psychiatric patients, who often visit university clinics in exacerbation states, is a strong emotional experience for students. If not preceded by appropriate education, clinical activities may not reduce stigma. Unfortunately, there are no direct anti-discrimination issues in the Polish psychiatry curriculum. According to one survey, which also included interns, found that they are more likely than medical students to say that mental illness is recurrent and that patients are prone to crime, which is not true [20].
In another study, general practitioners scored 44 points on average on the MICA-2 scale, while forensic psychiatry specialists scored 38 points and mental health care personnel 34.1 points [21]. In another survey, it was found that for students who declared their intent to achieve the specialisation in psychiatry, the MICA-2 score is significantly lower than that of students preferring other specialisations [22].
There are many reports concerning the beneficial effects of diversifying both the psychiatry course at medical schools and educational training on the reduction in stigmatisation. A decrease in MICA-2 scores from 48.2 to 43.5 points was observed in Australian students of medicine after 8-week psychiatry classes enriched with visits to both a health centre for individuals addicted to psychiatric substances and a geriatric clinic [10]. On the other hand, anti-discrimination training among British students of medicine had only a temporary effect on the improvement of MICA-2 scores, verified after 6 months [23]. A new training model for personnel working in the mental health field was implemented in a study conducted in China. The positive change was evident in both the scope of knowledge of mental health and a reduction in the level of negative attitudes towards the mentally ill. Moreover, the said change was sustained over time. The new model included more hours devoted to working with patients, providing training on health education by trainees, rehabilitation, and the long-term follow-up of patients, whereas the traditional course format focused mainly on clinical aspects of psychiatry [24]. The inclusion of elements of work and social education into the core psychiatry curriculum may be a promising factor contributing to the reduction in the stigmatisation of mental illness among students at medical schools. The reason is that it offers the opportunity to better understand patients’ needs and monitor the treatment process from a broader, all-inclusive perspective.
An optimistic sign is observations among future medical workers that psychiatry is widely considered to be equivalent to other fields of medicine and psychiatrists are considered to be “real physicians”. Furthermore, the use of pejorative terms towards patients, such as “nut” and “madman”, is viewed in a definitively negative way. In addition, the respondents’ answers indicate that the mentally ill are not excluded from social or professional groups. On the other hand, most respondents mistakenly view the mentally ill as more dangerous than the general population. Unfortunately, some respondents may overestimate the importance of psychosomatic aspects among the mentally ill and compromise their health due to neglecting somatic problems [25].
A significant statistical difference in MICA-2 mean scale values (42.47 vs. 39.86) was observed in the comparative analysis of the 2017 and 2020 survey groups. This relationship may result from various social campaigns related to anti-discrimination psychoeducation that are increasingly appearing in the public space, mainly in the context of depression [26]. This is especially true during the global COVID-19 pandemic, when an increasing part of the population is struggling with mental illness. This increase was also clearly demonstrated in the presented study, with as much as an 11% increase in the number of respondents who had personally experienced mental illness or observed it in their loved one [27,28]. However, a considerable cautiousness is required for final conclusions, as the second-round survey was not conducted on the same group of respondents. There is a need for further follow-up studies.
The authors are aware of the limitations of this study, which undoubtedly include the methodology of data collection using networks. However, given the current epidemiological situation prevailing in the country, online surveys are a safe and easily accessible form of study to reach the largest possible number of participants. On the other hand, there is no possibility to verify the data veracity, even if it is the respondents’ personal data, the estimation of the number of recipients who obtained the information about the survey, and the estimation of started and uncompleted survey sheets. An undoubted strength is the originality of the selected psychometric tool used for assessing both the level of stigmatisation of psychiatric patients and psychiatry as a medical field by students in Poland. It should also be noted that the group presented in this study is not representative of Polish medical students. The significant disparity between men and women should also be noted. Nevertheless, when analysing the data published by the Statistics Poland in 2019, there were 74.50% female students at medical schools and 25.5% male students, while in the presented study, the percentages are very similar—81% and 19%, respectively [29]. Additionally, the distribution of students of individual faculties differs from the actual distribution. For example, in official data from 2017, the percentage of medical students was 26%. At the time of writing this manuscript, there were no official data available for 2020. [30].
In recent decades, psychiatry has changed its image significantly. Certainly, many effective efforts have been made to destigmatise both this field of medicine and its patients. Despite this fact, the level of stigmatisation of psychiatric patients in Polish society is still rated as high. This is especially strongly expressed in economic aspects and the sense of visual and intellectual otherness [31].
The study of student groups and young physicians is of particular importance in the context of future changes in public perception of psychiatry. The reason is that the aforementioned two groups are those who will influence the mental health care system and create the image of psychiatry in patients in the near future. Meanwhile, it turns out that some harmful stereotypes still persist among Polish students at medical schools. In comparison with studies from other countries, the result can be assessed as moderate, although this does not alter the fact that it is still unsatisfactory. Undoubtedly, the psychiatry curriculum at medical schools and universities should put more emphasis on both understanding the problems faced by patients and the mental health care system. It is possible that students need better substantive preparation before their first clinical contact with patients, as the emotions aroused by the otherness of psychiatric patients compared to patients from other clinical areas may reinforce false beliefs and distort perception. Currently, a mental recovery assistant is being introduced in Poland. These are people who have survived a mental health crisis and received training to help others in need. An interesting solution would be meetings of such people with medical students. The combination of their experience and knowledge could let them effectively teach the attitude towards a psychiatric patient and reduce stigma [32]. The teacher has a huge influence on creating the attitudes of medical students, which is why complementary training in psychiatry would be worth considering for senior doctors trained in the prior system. It is apparent that their attitude to the subject of psychiatry based on obsolete knowledge may discourage younger adepts of medicine from choosing a specialization such as psychiatry [20]. Currently, psychiatry in Poland is being deeply remodelled. Service provision predominantly based on mental facilities with several hospital beds is still functioning in the country. Education and training in such a model do not cover the needs of students and rather support inequity. In the last two years, a new programme has been introduced with the strong support of the government aiming at the shift of mental services towards social psychiatry. Twenty-three centres of mental health were established across the country, each with a wide range of novel interventions, prevention programs, and supportive actions for mentally ill persons promoting their social inclusion. The authors strongly believe that such a model of treatment will benefit from better training for students and young doctors in the atmosphere of understanding, support, and humanity. The pilot program will end in December 2022, and the third stage of research in the field of stigma among students is planned [33].

5. Conclusions

Women are more favourably disposed to psychiatry and psychiatric patients than men. As there is a high level of stigmatisation, strategies need to be implemented to improve the quality of education and increase direct student–patient contact. Although there has been a significant change in the attitude towards both psychiatric patients and psychiatry over the years, a high level of stigmatisation can still be observed, and there is a need for a further increase in mental health awareness among young medical workers.

Author Contributions

Conceptualization, M.B. and P.P.; methodology, M.B. and P.P.; software, M.B.; validation, M.B., P.P., K.K. and B.B.; formal analysis, M.B. and K.K.; investigation, M.B., K.K. and B.B.; resources, B.B. and M.B.; data curation, M.B.; writing—original draft preparation, M.B., K.K., B.B. and P.P.; writing—review and editing M.B., K.K., B.B. and P.P.; visualization, M.B., K.K., B.B. and P.P.; supervision, P.P.; project administration, M.B.; funding acquisition, P.P. All authors have read and agreed to the published version of the manuscript.

Funding

The presented research results were obtained within the subject according to the records in the Simple system with the number SUB.C230.21.013.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Bioethics Committee of the Wroclaw Medical University, Poland (approval number: KB-178/2021).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Zdrowie Psychiczne w Unii Europejskiej. Opracowanie Tematyczne OT-674. Available online: https://www.senat.gov.pl/gfx/senat/pl/senatopracowania/175/plik/ot-674_zdrowie_psychiczne.pdf (accessed on 20 January 2021).
  2. Tyszkowska, M.; Podogrodzka-Niell, M. Stygmatyzacja na drodze zdrowienia w chorobach psychicznych—Czynniki bezpośrednio związane z leczeniem psychiatrycznym. Psychiatr. Pol. 2013, 47, 1011–1022. [Google Scholar] [CrossRef]
  3. Podogrodzka-Niell, M.; Tyszkowska, M. Stygmatyzacja na drodze zdrowienia w chorobach psychicznych—Czynniki związane z funkcjonowaniem społecznym. Psychiatr. Pol. 2014, 48, 1201–1211. [Google Scholar] [CrossRef]
  4. Thornicroft, G.; Rose, D.; Kassam, A.; Sartorius, N. Stigma: Ignorance, Prejudice or Discrimination? Br. J. Psychiatry 2007, 190, 192–193. [Google Scholar] [CrossRef]
  5. Suwalska, J.; Suwalska, A.; Neumann-Podczaska, A.; Łojko, D. Medical Students and Stigma of Depression. Part I. Stigmatization of Patients. Psychiatr. Pol. 2016, 51, 495–502. [Google Scholar] [CrossRef]
  6. Shields, G.; Ng, R.; Ventriglio, A.; Castaldelli-Maia, J.; Torales, J.; Bhugra, D. WPA Position Statement on Recruitment in Psychiatry. World Psychiatry 2017, 16, 113–114. [Google Scholar] [CrossRef]
  7. Brown, T.; Ryland, H. Recruitment to Psychiatry: A Global Problem. BJPsych Int. 2019, 16, 1–3. [Google Scholar] [CrossRef]
  8. Magliano, L.; Read, J.; Sagliocchi, A.; Patalano, M.; Oliviero, N. Effect of Diagnostic Labeling and Causal Explanations on Medical Students’ Views about Treatments for Psychosis and the Need to Share Information with Service Users. Psychiatry Res. 2013, 210, 402–407. [Google Scholar] [CrossRef]
  9. Farooq, K.; Lydall, G.J.; Malik, A.; Ndetei, D.M.; ISOSCCIP Group; Bhugra, D. Why Medical Students Choose Psychiatry—A 20 Country Cross-Sectional Survey. BMC Med. Educ. 2014, 14, 12. [Google Scholar] [CrossRef] [Green Version]
  10. Lyons, Z.; Janca, A. Impact of a Psychiatry Clerkship on Stigma, Attitudes towards Psychiatry, and Psychiatry as a Career Choice. BMC Med. Educ. 2015, 15, 34. [Google Scholar] [CrossRef] [Green Version]
  11. Korszun, A.; Dinos, S.; Ahmed, K.; Bhui, K. Medical Student Attitudes about Mental Illness: Does Medical-School Education Reduce Stigma? Acad. Psychiatry 2012, 36, 197–204. [Google Scholar] [CrossRef]
  12. Eksteen, H.-C.; Becker, P.J.; Lippi, G. Stigmatization towards the Mentally Ill: Perceptions of Psychiatrists, Pre-Clinical and Post-Clinical Rotation Medical Students. Int. J. Soc. Psychiatry 2017, 63, 782–791. [Google Scholar] [CrossRef]
  13. Gabbidon, J.; Clement, S.; van Nieuwenhuizen, A.; Kassam, A.; Brohan, E.; Norman, I.; Thornicroft, G. Mental Illness: Clinicians’ Attitudes (MICA) Scale-Psychometric Properties of a Version for Healthcare Students and Professionals. Psychiatry Res. 2013, 206, 81–87. [Google Scholar] [CrossRef]
  14. Kassam, A.; Glozier, N.; Leese, M.; Henderson, C.; Thornicroft, G. Development and Responsiveness of a Scale to Measure Clinicians’ Attitudes to People with Mental Illness (Medical Student Version): Clinicians’ Attitudes towards People with Mental Illness. Acta Psychiatr. Scand. 2010, 122, 153–161. [Google Scholar] [CrossRef]
  15. Queirós, R. Stigma towards Mental Illness among Medical Students of the Faculty of Medicine of the University of Coimbra. Master’s Thesis, University of Coimbra, Coimbra, Portugal, 23 May 2019. [Google Scholar]
  16. Janoušková, M.; Formánek, T.; Bražinová, A.; Mílek, P.; Alexová, A.; Winkler, P.; Motlová, L.B. Attitudes towards People with Mental Illness and Low Interest in Psychiatry among Medical Students in Central and Eastern Europe. Psychiatr. Q. 2020, 92, 407–418. [Google Scholar] [CrossRef]
  17. Foster, A.; Hilton, S.; Embry, F.; Pires, C.; Ahmed, A.O. Measuring Attitudes towards People with Mental Illness and People who are Homeless: Is a Joint Instrument Needed? In Homelessness: Prevalence, Impact of Social Factors and Mental Health Challenges; Clark, C., Ed.; Florida Mental Health Institute, University of South Florida: Tampa, FL, USA, 2014; pp. 223–250. [Google Scholar]
  18. Seera, G.; Arya, S.; Sethi, S.; Nimmawitt, N.; Ratta-Apha, W. Help-Seeking Behaviors for Mental Health Problems in Medical Students: Studies in Thailand and India. Asian J. Psychiatr. 2020, 54, 102453. [Google Scholar] [CrossRef]
  19. Wang, J.; Fick, G.; Adair, C.; Lai, D. Gender Specific Correlates of Stigma toward Depression in a Canadian General Population Sample. J. Affect. Disord. 2007, 103, 91–97. [Google Scholar] [CrossRef] [PubMed]
  20. Yadav, T.; Arya, K.; Kataria, D.; Balhara, Y.P.S. Impact of Psychiatric Education and Training on Attitude of Medical Students towards Mentally Ill: A Comparative Analysis. Ind. Psychiatry J. 2012, 21, 22–31. [Google Scholar] [PubMed]
  21. Gras, L.M.; Swart, M.; Slooff, C.J.; van Weeghel, J.; Knegtering, H.; Castelein, S. Differential Stigmatizing Attitudes of Healthcare Professionals towards Psychiatry and Patients with Mental Health Problems: Something to Worry about? A Pilot Study. Soc. Psychiatry Psychiatr. Epidemiol. 2015, 50, 299–306. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  22. ElGhamry, R.; Alaa El-Din, M.A.; Amen, G.; Mahmoud, D.M.; Kandel, H.A.H. Attitude of Medical Students toward Mentally Ill Patients: Impact of a Clinical Psychiatric Round. Egypt. J. Neurol. Psychiatr. Neurosurg. 2016, 53, 6. [Google Scholar] [CrossRef]
  23. Friedrich, B.; Evans-Lacko, S.; London, J.; Rhydderch, D.; Henderson, C.; Thornicroft, G. Anti-Stigma Training for Medical Students: The Education Not Discrimination Project. Br. J. Psychiatry Suppl. 2013, 55, 89–94. [Google Scholar] [CrossRef] [Green Version]
  24. Li, J.; Li, J.; Thornicroft, G.; Yang, H.; Chen, W.; Huang, Y. Training Community Mental Health Staff in Guangzhou, China: Evaluation of the Effect of a New Training Model. BMC Psychiatry 2015, 15, 263. [Google Scholar] [CrossRef] [Green Version]
  25. Piotrowski, P.; Gondek, T.M.; Królicka-Deręgowska, A.; Misiak, B.; Adamowski, T.; Kiejna, A. Causes of Mortality in Schizophrenia: An Updated Review of European Studies. Psychiatr. Danub. 2017, 29, 108–120. [Google Scholar] [CrossRef]
  26. Chotkowska, K. Choroby psychiczne. Edukacja antydyskryminacyjna. Ogrody Nauk i Sztuk. 2019, 9, 56–62. [Google Scholar] [CrossRef]
  27. Ettman, C.K.; Abdalla, S.M.; Cohen, G.H.; Sampson, L.; Vivier, P.M.; Galea, S. Prevalence of Depression Symptoms in US Adults before and during the COVID-19 Pandemic. JAMA Netw. Open 2020, 3, e2019686. [Google Scholar] [CrossRef] [PubMed]
  28. Salari, N.; Hosseinian-Far, A.; Jalali, R.; Vaisi-Raygani, A.; Rasoulpoor, S.; Mohammadi, M.; Rasoulpoor, S.; Khaledi-Paveh, B. Prevalence of Stress, Anxiety, Depression among the General Population during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Global. Health 2020, 16, 57. [Google Scholar] [CrossRef]
  29. Główny Urząd Statystyczny-Szkolnictwo Wyższe i Jego Finanse w 2019 r. Available online: https://stat.gov.pl/obszary-tematyczne/edukacja/edukacja/szkolnictwo-wyzsze-i-jego-finanse-w-2019-roku,2,16.html (accessed on 11 January 2021).
  30. GUS. Szkolnictwo Wyższe w Roku Akademickim 2018/2019 (Wyniki Wstępne). Available online: https://stat.gov.pl/obszary-tematyczne/edukacja/edukacja/szkolnictwo-wyzsze-w-roku-akademickim-20182019-wyniki-wstepne,8,6.html (accessed on 18 April 2021).
  31. Babicki, M.; Kotowicz, K.; Piotrowski, P.; Stramecki, F.; Kobyłko, A.; Rymaszewska, J. Areas of Stigma and Discrimination of Mentally Ill People among Internet Respondents in Poland. Psychiatr. Pol. 2018, 52, 93–102. [Google Scholar] [CrossRef] [PubMed]
  32. Zalewska-Łunkiewicz, K.; Chudzicka-Czupała, A. Wybrane Korelaty Dobrostanu Psychicznego Kandydatów Na Asystentów Zdrowienia. Czas. Psychol. Pychological J. 2018, 24, 3. [Google Scholar]
  33. Pilotaż Centrów Zdrowia Psychicznego—Pilotaż Centrów Zdrowia Psychicznego. Available online: https://czp.org.pl/ (accessed on 19 April 2021).
Table
Table 1. Characteristics of the study group.
Table 1. Characteristics of the study group.
Total AmountFirst-Round Survey—2017Second-Round Survey—2020
Sex
Female857(81%)386(80%)471(82%)
Male196(19%)94(20%)102(22%)
Major
Medicine645(61%)320(67%)325(57%)
Other408(39%)160(33%)248(43%)
Year of studies
I137(13%)32(7%)105(18%)
II177(17%)55(11%)122(21%)
III196(19%)108(23%)88(16%)
IV167(16%)99(20%)68(12%)
V196(19%)81(17%)115(20%)
VI122(11%)70(15%)52(9%)
Internship58(5%)35(7%)23(4%)
Mental health problems
Yes, me525 (50%)228(48%)297(52%)
Yes, a person close to me296 (28%)116(24%)180(31%)
No232 (22%)136(28%)96(17%)
Psychiatry classes undertaken
Yes523 (50%)276(57%)247(43%)
No530 (50%)204(43%)326(57%)
Table
Table 2. Mean MICA-2 score.
Table 2. Mean MICA-2 score.
VariableMean Score (SD)p
SexFemale40.39 ± 7.59<0.001
Male43.94 ± 9.44
MajorMedicine40.09 ± 8.38<0.001
Other42.56 ± 7.36
Psychiatry classes undertakenYes41.35 ± 8.280.105
No40.76 ± 7.90
Mental health problemsYes, me40.48 ± 7.37<0.001
Yes, a person close to me40.03 ± 8.34
No44.10 ± 7.65
Table
Table 3. The comparison of MICA-2 in relation to the major.
Table 3. The comparison of MICA-2 in relation to the major.
MedicineOther Majorsp
Sex
Female39.23 ± 7.70(n = 496)41.98 ± 7.15(n = 361)<0.001
Male42.96 ± 9.82(n = 149)47.06 ± 7.37(n = 47)0.002
Psychiatry classes undertaken
Yes40.01 ± 8.57(n = 321)43.46 ± 7.30(n = 203)<0.001
No40.17 ± 8.19(n = 324)41.67 ± 7.32(n = 205)0.013
Mental health problems
Yes, me38.93 ± 8.31(n = 331)41.90 ± 8.06(n = 194)<0.001
Yes, a person close to me39.59 ± 7.91(n = 178)41.83 ± 6.25(n = 117)0.005
No43.60 ± 8.22(n = 135)44.77 ± 6.71(n = 97)0.327
Table
Table 4. The analysis of individual questions addressed in the MICA-2 questionnaire.
Table 4. The analysis of individual questions addressed in the MICA-2 questionnaire.
QuestionI Strongly DisagreeI DisagreeI Rather DisagreeI Rather AgreeI AgreeI Strongly Agree
1 I just learn about psychiatry because it is in the exam and would not bother reading additional material on it.24%33%10%14%13%6%
2. People with a severe mental illness can never recover enough to have a good quality of life.22%42%12%15%7%2%
3. Psychiatry is just as scientific as other fields of medicine.1%1%1%3%23%71%
4. If I had a mental illness, I would never admit this to any of my friends because I would fear being treated differently.20%36%13%22%7%2%
5. People with a severe mental illness are dangerous more often than not.7%27%15%37%11%3%
6. Psychiatrists know more about the lives of people treated for a mental illness than do family members or friends.2%13%14%35%28%8%
7. If I had a mental illness, I would never admit this to my colleagues for fear of being treated differently.12%31%12%26%14%5%
8. Being a psychiatrist is not like being a real doctor.72%24%1%2%0.50%0.50%
9. If a consultant psychiatrist instructed me to treat people with a mental illness in a disrespectful manner, I would not follow their instructions5%7%2%4%27%55%
10. I feel as comfortable talking to a person with a mental illness as I do talking to a person with a physical illness.3%19%21%22%25%10%
11. It is important that any doctor supporting a person with a mental illness also assesses their physical health.0.10%0.40%0.50%6%45%48%
12. The public does not need to be protected from people with a severe mental illness.5%22%32%21%17%3%
13. If a person with a mental illness complained of physical symptoms (such as chest pain), I would attribute it to their mental illness.6%39%21%28%5.50%0.50%
14. General practitioners should not be expected to complete a thorough assessment for people with psychiatric symptoms because they can be referred to a psychiatrist.13%34%16%16%17%4%
15. I would use the terms ‘crazy’, ‘nutter’, ‘mad’, etc. to describe people with a mental illness who I have seen in my work51%34%6%5%3%1%
16. If a colleague told me they had a mental illness, I would still want to work with them6%13%14%10%33%24%
Table
Table 5. The percentage of positive responses (“I strongly agree”, “I agree”, and “I rather agree”) to each question addressed in the MICA-2 scale.
Table 5. The percentage of positive responses (“I strongly agree”, “I agree”, and “I rather agree”) to each question addressed in the MICA-2 scale.
QuestionSexPsychiatristPsychiatric DisordersMajor
FemaleMalepYesNopYesNopMedicineOtherp
1. I studied psychiatry only because I had an exam and I did not read any additional related materials.30390.024619<0.0012753<0.0012741<0.001
2. The seriously mentally ill will never recover enough to achieve a satisfying quality of life.23290.11426220.13623300.0161833<0.001
3. Psychiatry is part of science just like other fields of medicine.98940.01497970.55997970.60697980.451
4. If I suffered from mental illness, I would never tell any of my friends about it because I would be afraid that they would treat me differently.32320.92635290.0332941<0.00131340.231
5. The seriously mentally ill often pose a threat to others.50550.20247550.0114861<0.0014758<0.001
6. Psychiatrists know more about the life of patients being treated for mental illness than family members of those people.72700.72971710.9467173<0.47770730.353
7. If I suffered from mental illness, I would never tell any of my friends about it for fear that they would treat me differently.45400.21344430.841530.00143450.416
8. A psychiatrist is not a real doctor.27<0.001420.033330.83430.95
9. If a psychiatrist supervisor instructed me to treat a mentally ill person disrespectfully, I would not follow that instruction.8878<0.00186860.79187840.24987840.163
10. I feel equally comfortable talking to a mentally ill person as I am talking to a physically ill person.59490.01156590.2626146<0.00155620.014
11. It is important that any physician supporting the mentally ill person should also assess their physical health.99990.35799990.98199990.80399990.834
12. Society does not need to be protected from the seriously mentally ill.4430<0.00143400.35144320.00142410.804
13. If the mentally ill person complained of physical ailments (e.g., chest pain), I would link it to their mental illness.33400.04929390.00135310.1812843<0.001
14. General practitioners should not be expected to perform a comprehensive health assessment of individuals with psychiatric symptoms because they may be referred to psychiatrists.35460.0033042<0.00136400.29934410.005
15. I would use the terms “mad”, “madman”, “nut” to describe the mentally ill I have met in my work.718<0.0011180.1239130.0771090.706
16. If my coworker told me that they suffered from mental illness I would still want to work with them.96930.02895960.61595970.1596950.624
Significant effects (p < 0.05) are marked in bold.
Table
Table 6. Analysis of potential confounding factors.
Table 6. Analysis of potential confounding factors.
F-Valuep-Value
Sex4.370.036
Major0.610.652
Year of studies1.120.351
Psychiatry classes undertaken0.020.901
Mental health problems1.860.156
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Babicki, M.; Kowalski, K.; Bogudzińska, B.; Piotrowski, P. The Assessment of Attitudes of Students at Medical Schools towards Psychiatry and Psychiatric Patients—A Cross-Sectional Online Survey. Int. J. Environ. Res. Public Health 2021, 18, 4425. https://doi.org/10.3390/ijerph18094425

AMA Style

Babicki M, Kowalski K, Bogudzińska B, Piotrowski P. The Assessment of Attitudes of Students at Medical Schools towards Psychiatry and Psychiatric Patients—A Cross-Sectional Online Survey. International Journal of Environmental Research and Public Health. 2021; 18(9):4425. https://doi.org/10.3390/ijerph18094425

Chicago/Turabian Style

Babicki, Mateusz, Krzysztof Kowalski, Bogna Bogudzińska, and Patryk Piotrowski. 2021. "The Assessment of Attitudes of Students at Medical Schools towards Psychiatry and Psychiatric Patients—A Cross-Sectional Online Survey" International Journal of Environmental Research and Public Health 18, no. 9: 4425. https://doi.org/10.3390/ijerph18094425

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop