Medical student perceptions of mental illness: a cross-sectional transnational study in two medical schools

Abstract

Abstract Background: Despite shifting global attitudes, mental illness remains highly stigmatised amongst practicing doctors. This has wider implications on doctors’ training and preparation to care for patients with mental illness. Despite remaining under-researched in the literature, there is need for exploration of the presence and mitigation of stigma in early medical education to prevent such attitudes propagating into clinical practice. Thus, this study explores whether stigmatising attitudes are detectable amongst medical students in London and Singapore and examines whether they are ameliorated by specific curricular and welfare features of formal medical education, utilising the Mental Illness Stigma Framework. Methods: A mixed-methods approach was adopted. Medical students at Imperial College London (UK; n = 211) and Nanyang Technological University (Singapore; n = 141) completed a validated scale (the OMS-HC-15) to assess attitudes towards mental illness. Semi-structured interviews were conducted (Imperial: n = 12, NTU: n = 8) until theoretical saturation was reached. Quantitative data were analysed descriptively and comparatively using SPSS and interview data subjected to inductive thematic analysis. Results: No differences in overall stigma scores were found between the two schools, or when comparing the year groups within each school. Four themes were identified: student perceptions, impacts of medical school culture, university support, and curricular impacts on mental illness perceptions. Themes allowed identification of aspects of medical school that were well-received and warranted further emphasis by students, alongside areas student deemed important to consider in developing their holistic understanding of mental illness. Conclusion: Average stigma scores obtained were lower than those measured in prior literature assessing medical student stigma utilising the same scale, perhaps explained by cultural differences and improved social attitudes. Curricular improvements such as earlier psychiatric teaching and sharing of personal stories may improve future stigma scores as students’ progress through the course. Specific welfare-based changes to formal support systems were also deemed to be beneficial by students. Stigma scores were comparable between UK and Singapore medical students and demonstrated less prejudice compared to published literature on students in other countries in previous years. The impacts of welfare and curriculum in relation to societal influence on students’ attitudes warrants further investigation, as does medical students’ self-stigma.