Outcomes of One-Time Contact Multi-Modal Educational Intervention on Mental Illness Stigma with Undergraduate Medical Students -Suez Canal University Hospital-Egypt
Ismail Dahshan1*, Menna Mohamed Saad1, Mohamed Mohamady Awad1, Hanan Abbas Abdo1, Omneya Youseef Ibrahim2 and Mohamed Abd El-Wahed1
1Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
2Department of Psychiatry, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
*Corresponding Author: Ismail Dahshan, Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
January 23, 2023; Published: February 06, 2023
Background: For mentally ill patients, stigma is a severe problem. Unfortunately, stigmatizing behaviors against patients suffering from mental diseases are frequent not only among the general population but also among healthcare practitioners. Medical students share the same stereotypical views and attitudes towards mental ill patients. The results from anti-stigma educational interventions with undergraduate medical students are mixed. One time contact educational interventions proven to be as effective as traditional education methods in several studies. This study looked at the outcomes of a one-time contact multi-modal educational intervention given to fourth-year medical undergraduate students at Suez Canal University in Ismailia, Egypt, prior to their medical school's curriculum psychiatric rotation.
Aim: To examine the effects of a one-time, multi-modal educational intervention on undergraduate medical students' attitudes, knowledge, and behavior on stigma associated to mental illness.
Subjects and methods: A pre-post quasi-experimental study was done on 120 fourth-year undergraduate medical students from the Faculty of Medicine at Suez Canal University. The participants completed anonymously self-administered three validated scales with response values reported on a 5-point Likert scale before and after implementation of a multi-modal educational intervention consisting of 4- hour education including didactic methods and experiential learning methods by contact with people with lived mental disorders experience. The scales included; The Mental Health Knowledge Schedule (MAKS) comprises of six items used to assess mental health knowledge. A higher score represents more knowledge; the range is from 6 to 30. Beliefs toward Mental Illness Scale (BMI), which consists of 21 items to measure negative stereotypical views of mental illness and has a score range of 21 to 105, and a higher score reflects a less negative belief toward the mentally ill, and Reported and Intended Behaviour Scale (RIBS), which has a score range of 4 to 20, and a higher score indicates more favourable intended behavior. The outcome measures were evaluated at three points: baseline, immediately after the intervention, and six months later. Participation was totally voluntary, and consents were obtained for all participants students. Data was obtained throughout November 2019 and May 2020.
Results: The outcome measures scores expressed as median values were statistically significantly higher at both immediate and 6 months reassessment, compared with baseline scores. Mental health-related knowledge scores ( MAKS) were 17, 24, and 23, Beliefs toward mental illness scores ( BMI) were 49.5, 83, and 76.5, while Intended behavior scores ( RIBS) were 7, 31, and 28 at baseline , immediate after the intervention , and at 6 months follow up assessment, respectively.
Conclusion: According to the findings of this study, a one-time contact multi-modal
educational intervention for mental illness stigma with medical undergraduate students resulted in
favorable changes in their knowledge, beliefs, and planned behavior toward mentally ill patients
immediately after the intervention, and these changes were maintained at a 6-month follow up. A
combination of different teaching techniques, including knowledge, contact-based education, and
paying attention to the student's personal experience of working with patients with mental illness, as well delivery during the right time of undergraduate medical curriculum, appear to be necessary for an effective educational intervention against mental illness stigma.
Keywords: Mental Illness; Stigmatization; Medical Education
- Thornicroft G. “Physical health disparities and mental illness: the scandal of premature mortality”. British Journal Psychiatry 199 (2011): 441-44
- World health organization. Mental health day: “Mental disorders” (2018).
- Disability Rights Commission, equal treatment. "Closing the Gap. A Formal Investigation into Physical Health Inequalities experienced by people with learning disabilities and mental health problems (2016).
- Lauber C., et al. “What about psychiatrists’ attitude to mentally ill people?” Europe Psychiatry 19 (2004): 423-42
- Nieuwhof MG., et al. “Students’ conceptions of the medical profession: an interview study”. Medical Teacher 27 (2008): 709-714.
- Korszun A., et al. “Medical attitudes about mental illness: does medical-school education reduce stigma?” Academic Psychiatry 36 (2012): 197-204.
- Thornicroft G., et al. “Stigma: ignorance, prejudice, or discrimination?” The British Journal of Psychiatry 190 (2007): 192-193.
- Abbey S., et al. “Stigma and discrimination [position paper]”. The Canadian Journal of Psychiatry 56.10 (2011): 1-9.
- Pinfold V., et al. “Active ingredients in anti-stigma programmes in mental health”. International Review of Psychiatry 17.2 (2005): 123-131.
- Arboleda-Florez J and Stuart H. “From sin to science: fighting the stigmatization of mental illnesses”. The Canadian Journal of Psychiatry 57.8 (2012): 457-463.
- Couture S and Penn DL. “Interpersonal contact and the stigma of mental illness: a review of the literature”. Journal About Mental Health 12.3 (2003): 291-303.
- Stefanovics EA., et al. “Medical student beliefs and attitudes toward mental illness across five nations”. The Journal of Nervous and Mental Disease 204.12 (2016): 909-915.
- Janoušková M., et al. “Attitudes towards People with Mental Illness and Low Interest in Psychiatry among Medical Students in Central and Eastern Europe”. Psychiatric Quarterly 92.1 (2021): 407-418.
- Time to Change. “Stigma Shout Survey (2008).
- “Can we end stigma and discrimination in mental health?” The Lancet 400.10361 (2022): 1381.
- Papish A., et al. “Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial”. BMC Medical Education 13 (2014):
- Shahrour TM and Rehmani RS. “Testing psychiatric stigma in a general hospital in Saudi Arabia”. Saudi Medical Journal 30.10 (2009): 1336-133
- Evans-Lacko S., et al. “Development and psychometric properties of the Mental Health Knowledge Schedule”. Canadian Journal of Psychiatry 55 (2010): 440-44
- Hirai M and Clum GA. “Development, Reliability, and Validity of the Beliefs Toward mental Illness Scale”. Journal of Psychopathology and Behavioral Assessment 22 (2000): 221-236.
- Evans-Lacko S., et al. “Development and psychometric properties of the reported and intended behavior scale (RIBS): a stigma-related behavior measure”. Epidemiology Psychiatry Science 20 (2011): 263-2
- Korszun A., et al. “Medical student attitudes about mental illness: does medical-school education reduce stigma?” Academic Psychiatry 36.3 (2011): 197-204.
- Zhu Y., et al. “Attitudes towards mental illness among medical students in China: Impact of medical education on stigma”. Asia-Pacific Psychiatry 10.2 (2018):
- da Rocha Neto HG., et al. “Attitudes of Brazilian Medical Students Towards Psychiatric Patients and Mental Illness: A Quantitative Study Before and After Completing the Psychiatric Clerkship”. Academic Psychiatry 41.3 (2017): 315-319.
- Poreddi V., et al. “Attitudes toward people with mental illness among medical students”. Journal of Neurosciences in Rural Practice 6.3 (2015): 349-3
- Ighodaro A., et al. “An assessment of attitudes towards people with mental illness among medical students and physicians in Ibadan, Nigeria”. Academic Psychiatry 39.3 (2015): 280-28
- Sandhu HS., et al. “Mental health stigma: explicit and implicit attitudes of Canadian undergraduate students, medical school students, and psychiatrists”. The Canadian Journal of Psychiatry 64.3 (2019): 209-217.
- Arora A., et al. “The Potential Effect of the Psychiatric Clerkship and Contact-Based Hypothesis on Explicit and Implicit Stigmatizing Attitudes of Canadian Medical Students Towards Mental Illness”. Academic Psychiatry 43.6 (2019): 605-609.
- Pal T and Singh S. “Impact of clinical posting in psychiatry on the attitude towards mental illness in undergraduate final year medical students”. Asian Journal of Psychiatry 69 (2022):
- Simon N and Verdoux H. “Impact of education program and clinical posting in psychiatry on medical students' stigmatizing attitudes towards psychiatry and psychiatric disorders”. Encephale 44.4 (2018): 329-336.
- Oliveira AM., et al. “Stigmatizing Attitudes Toward Patients with Psychiatric Disorders Among Medical Students and Professionals”. Frontiers in Psychiatry 11 (2020):
- Kochański A and Cechnicki A. “The attitudes of psychiatrists toward people suffering from mental illnesses”. Psychiatria Polska 51.1 (2017): 29-44.
- Corrigan PW., et al. “Challenging the public stigma of mental illness: a meta-analysis of outcomes studies”. Psychiatric Services 63.10 (2012): 963-9
- Mittal D., et al. “Targeting stigma of mental illness among primary care providers: Findings from a pilot feasibility study”. Psychiatry Research 284 (2020): 112641.
- Friedrich B., et al. “Anti-stigma training for medical students: The Education Not Discrimination project”. British Journal of Psychiatry 202.S55 (2011):
- Kassam A., et al. “A controlled trial of mental illness related stigma training for medical students”. BMC Medical Education 11 (2011):
- Papish A., et al. “Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial”. BMC Medical Education 141 (2013).