Acad Psychiatry 30:262-263, May-June 2006
doi: 10.1176/appi.ap.30.3.262
© 2006 Academic Psychiatry
Attitudes and Perceptions Toward Depression and Schizophrenia Among Residents in Different Medical Specialties
Steve H. Chin, M.D., Penn State Milton S. Hershey Medical Center College of Medicine, Hershey, PA and
Richard Balon, M.D., Wayne State University, Department of Psychiatry, Detroit, MI
To the Editor: The stigma attached to patients with mental illness remains a major obstacle, which prevents individuals from seeking appropriate help and improving the quality of their lives (1). The added burden that stigma imposes on the struggle to recovery can alter behavior, generate anxiety, and ultimately cause isolation from the mainstream culture (2).
Although stigmatization of mental illness among health care professionals has been studied less than it has in the wider population, existing evidence suggests that medical practitioners also hold a range of attitudes toward individuals with psychiatric diagnosis similar to those held by the general public. MIND’s survey in 1996 (3) reported that individuals with mental illness had been discriminated against by medical services. Their mental distress often had been dismissed, and comorbid physical problems were taken less seriously, though this is partly because their mental illness masked their physical illness. This lack of adequate health care contributes to the high rate of morbidity and mortality in individuals with mental illness (4).
A study was recently completed at Wayne State University School of Medicine on attitudes and perceptions toward depression and schizophrenia among residents in different medical specialties. All residents and interns in internal medicine, neurology, emergency medicine, pediatric medicine, anesthesiology, and psychiatry of all years of training were eligible to participate in the study (with the exception of the principal investigator—a PGY-5 internal medicine/psychiatry resident). A package containing the questionnaire, a supplemental data sheet (inquiring the following: year in training, gender, residency program, frequency of contact with patients with mental illness, and personal experience with mental illness), an information sheet for participating in the study, cover letter, and a postage-paid return envelope, were mailed or distributed directly to each resident. An AQ-SF (Attribution Questionnaire–Short Form—8 items) (5, 6) was used to examine attitudes toward mental illness. This questionnaire was originally devised for studying the stigma of mental illness.
In an attempt to increase the response rate, the questionnaires were sent out in three consecutive batches from December 2004 to February 2005. No monetary compensation was awarded to survey participants. To maintain confidentiality, the data were decoded and upon collection of data, all surveys were destroyed. The statistical differences in AQ-SF scores between various groups were analyzed using SPSS version 11.
Data from 67 residents (N = 59) were collected. Response rates differed among specialties, from psychiatry (57%) to anesthesiology (17%), with a combined response rate of 36%. Overall, psychiatry residents had a lower AQ-SF score for both schizophrenia (p = 0.002) and depression (p = 0.031) compared to nonpsychiatry residents.
No statistical difference could be found with year(s) in training, gender, or frequency of contact with psychiatric patients. However, in analyzing personal experience, the stigmatizing attitudes toward schizophrenia appeared to be significantly lower among the residents who had a family member (p value=0.031) with psychiatric illness (Table 1). As the proportion of respondents who had a family member with psychiatric illness may differ by specialty, a multivariate analysis was conducted. It confirmed that residents who had a family member with psychiatric illness were less likely to hold stigmatizing attitudes, even when controlling for residency program.
Previous studies (7, 8), have shown that education and improved understanding of mental illness are likely to have a positive effect on attitudes toward the mentally ill. This study showed that psychiatry residents had less stigmatizing attitudes toward both schizophrenia and depression than nonpsychiatry residents. A comparison between junior residents (PGY-1 and 2) and senior residents (PGY-3 or higher) did not show a significant difference in attitude. The result of this study was unable to demonstrate clearly that education/experience had a positive influence on attitudes toward psychiatric illness. This is certainly an area that needs further investigation.
In analyzing personal experience, stigmatizing attitudes toward schizophrenia appeared to be significantly lower among residents who had a family member(s) with a psychiatric illness; however, this did not hold true for residents who had a friend(s) with a psychiatric illness. This finding is consistent with an earlier study (9), which concluded that knowing someone who has a mental illness alone is not associated with decreased stigmatizing attitudes. Direct contact with a mentally ill individual who had a positive treatment experience is one factor responsible for reducing negative attitudes.
Our study was limited by the low response rate, which may have affected our findings. Given the time limitations of residents in general, it was difficult to get a sufficient number of participants. In addition, there may have been selection bias among those who responded. Residents interested in mental health issues who are less likely to be biased against mentally ill patients may have been the most likely to complete the questionnaire. Conversely, the residents who felt negatively toward mental illness were more likely not to respond. These factors certainly influenced the results of the study. In addition, due to confidentiality concerns, the validity of the responses may be questionable. Some respondents may not be completely open and honest about their personal experience or may harbor underlying biases against the mentally ill.
Understanding how attitudes toward mental illness can be changed in a favorable direction is an ongoing endeavor. Efforts to monitor stigmatizing attitudes help raise awareness among medical professionals and trainees and may prompt them to examine their own attitudes. Misperceptions may compromise health care providers’ ability to evaluate and manage individuals with mental illness. This awareness will provide motivation for change and have a positive impact on promoting a healthy clinical environment by reducing negative attitudes toward mental illness.
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