|Year : 2017 | Volume
| Issue : 2 | Page : 102-108
Attitude toward mental illnesses among paramedical professionals and junior doctors
Chintan K Solanki1, Hemang M Shah2, Ganpat K Vankar3, Minakshi N Parikh4
1 Department of Psychiatry, GMERS Medical College, Civil Hospital, Gandhinagar, Gujarat, India
2 Department of Psychiatry, GMERS Medical College, Sola, Ahmedabad, Gujarat, India
3 Department of Psychiatry, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Wardha, Maharashtra, India
4 Department of Psychiatry, B.J. Medical College, Ahmedabad, Gujarat, India
|Date of Web Publication||8-Dec-2017|
Hemang M Shah
87, Laxmigruh, Near Mahadev Temple, Char Rasta, Maninagar, Ahmedabad - 380 008, Gujarat
Source of Support: None, Conflict of Interest: None
Context: Attitudes of paramedical and medical professionals to psychiatric illnesses are important for referral and use of mental health facilities by general people. Knowledge of psychiatric disorders and experience of working with psychiatric patients may be responsible for positive attitudes. Aims: The aim was to assess attitude toward different mental illnesses among different paramedical professionals and to know the impact of education and work experience on attitudes toward mental illnesses. Subjects and Methods: Study sample was nursing staff, nursing students, and junior doctors from tertiary care hospital and students of clinical psychology from a private deaddiction center. The study design was cross-sectional. Attitude to Mental Illness Questionnaire was used with modifications and addition of demographic details. Experience of working with psychiatric patients and attending mental health primary care (MHPC) program also were included for the evaluation of attitudes. Results: Attitudes toward drug abuse, depression, alcohol abuse, and schizophrenia were more negative while toward anxiety spectrum disorders, conversion, and dissociative disorders were more positive. Subjects with experience of working with psychiatric patients and experience of MHPC program showed more positive attitudes. Conclusions: There is need of, developing program containing knowledge of mental health, implementing practical experience of working with psychiatric patients in the curriculum of paramedical and medical profession and restructuring present curriculum to develop positive attitudes to mental illnesses for benefit of community.
Keywords: Attitude, junior doctors, mental illnesses, paramedical professionals
|How to cite this article:|
Solanki CK, Shah HM, Vankar GK, Parikh MN. Attitude toward mental illnesses among paramedical professionals and junior doctors. Ann Indian Psychiatry 2017;1:102-8
|How to cite this URL:|
Solanki CK, Shah HM, Vankar GK, Parikh MN. Attitude toward mental illnesses among paramedical professionals and junior doctors. Ann Indian Psychiatry [serial online] 2017 [cited 2019 Jan 22];1:102-8. Available from: http://www.anip.co.in/text.asp?2017/1/2/102/220244
| Introduction|| |
Attitude is readiness to react to an object in a certain way. Attitudes are learned throughout one's life and may include emotions and knowledge. It is commonly assumed that attitudes have an effect on behavior, but the relationship is complex. Many studies have shown that negative attitudes toward mental illness are widespread.,,,, Shame and secrecy associated with suffering from a mental illness may also delay seeking treatment. In particular, stigma and discrimination associated with mental illnesses are expressed by health professionals as well as the general public, results in the under - use of mental health services. For effective health care to be delivered, it is crucial that health professionals are not hampered by prejudiced attitudes.
Perception and knowledge of the nursing staff on this topic are important as they directly deal with patients and their relatives, and they are also involved in disseminating health information. A negative attitude is known hindrance for providing quality service to mentally or physically ill persons. In one survey of nurses, this revealed that attitudes were significantly more negative toward coworkers returning after psychiatric illnesses than to those with diabetes  while in another survey, nurses' attitudes were mainly positive., Junior doctors who completed the MBBS and are in postgraduate training in different medical branches play an important role in health services including mental health and their attitudes toward mental illnesses are apt to influence those of the general population.
With aim to assess the attitudes toward different mental illnesses in different professional groups and to assess impact of, work experience with mentally ill patients and attending mental health primary care (MHPC) program, on attitudes toward different mental illnesses; we targeted the people who are link between qualified mental health professionals and mentally ill patients.
| Subjects and Methods|| |
The 5-item Attitudes to Mental Illness Questionnaire (AMIQ) was used as a primary source of questionnaire for this study. It is a brief, self-completion questionnaire with good psychometric properties that can be used in most situations. The questionnaire was adapted from Cunningham et al. This questionnaire was validated by Lut et al. in 2006. Test-retest reliability at 2–4 weeks was P = 0.702 (n = 256), construct validity was a = 0.933 (n = 879) and alternate test reliability compared with Corrigan et al.'s attributions questionnaire was r = 0.704 (n = 102).
In this questionnaire, respondents were asked to read a short vignette describing an imaginary patient and then answer five questions. The individual questions were scored on a 5-point Likert scale (maximum +2, minimum −2; blank questions, “neutral” and “don't know” were scored 0). The scores for the five questions were added giving a total score for each vignette (between −10 and +10).
The same AMIQ was adapted containing vignettes of drug abuse, depression, alcohol dependence, and schizophrenia. It also contains vignettes describing highly stigmatized individuals (such as a convicted criminal) produce consistently negative scores and those describing nonstigmatized individuals (a diabetic and a Christian) produce positive scores. This indicates good face validity. Vignettes of obsessive-compulsive disorder, panic disorder, conversion disorder, dissociative disorder, and social anxiety disorder were added to this questionnaire. Names of vignette given were according to Indian culture. Demographic details such as age, sex, marital status; experience of mental illness in family or self; experience of working with mentally ill patients; and participation in 2 days program of MHPC were included in this study. We included these two factors in our study to know the impact of contact and knowledge of mental illnesses on attitudes. One was experience of working with mentally ill patients for at least 1 month and the second was experience of attending 2 days program of MHPC (run by the Department of Psychiatry in a tertiary care hospital affiliated with medical college). The aim of this program was to enable the person to identify common psychiatric symptoms and to provide primary care to the affected. MHPC was 2 days interactive training program cum workshop providing primary knowledge about mental health and common mental illnesses including mood disorders, schizophrenia, anxiety disorder, alcohol use disorder, and somatic disorder. Role play of different mental disorders was done, and participants were taught that how they can actually help the person who is suffering from mental disorder or the family member of patient in providing primary care.
The questionnaire was translated in Gujarati for nursing staff for easy understanding, validated with English version, and approved by four psychiatrist consultants at teaching hospital after retranslation.
Total four available groups were included in study sample. One group was of staff nurses working in tertiary care hospital affiliated to a medical college. In each ward after meeting the in-charge sister, study purpose was explained, and questionnaires given for staff nurses of wards and they were asked to return filled up questionnaire in 5 days. Totally 750 questionnaires were distributed to them. Most of them were holding degree of diploma in nursing, in which, subject of psychiatry was not given much weightage in their curriculum compared to B. Sc., nursing curriculum. Very few of them had attended MHPC program.
The second group was of B. Sc., nursing students of 3rd and 4th year who had experience of working with psychiatric patients for more than 1 month in the psychiatric ward of tertiary care hospital and also attended MHPC program. Totally 120 questionnaires given to them and completed questionnaires were collected on the spot in a session. The third group was of junior doctors of a tertiary care hospital affiliated with a medical college doing postgraduation in different medical branches other than psychiatry. They were explained about study in small groups and 250 questionnaires distributed to them and asked to return within 2 days. The fourth group was of the students of Diploma in Clinical Psychology (DCP) from a private institute affiliated with a private deaddiction center. Most of them also had attended MHPC program. Totally 80 questionnaires were given to them and collected immediately. They had more experience of working with patients of alcohol use disorder.
| Results|| |
Out of 1200 questionnaires distributed 741 were found appropriately filled up and considered for study, others which were not completely filled up, copied, or not filled up properly (by checking face value through response for a diabetic and a criminal) were discarded.
Response rate in nursing staff was 57.6% (n = 432), in B. Sc., nursing students, 94.1% (n = 113); in junior doctors; 50.8% (n = 127); in students of DCP, 86.25%, and overall response rate was 59.2% (n = 741) [Table 1].
|Table 1: Different demographic characteristics of subjects in study (n=741)|
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The sample was predominantly female (85%), 6.74% reported having history of mental illness in family, 1.48% reported history of mental illness in self; 41.16% of them have attended mental health first aid program, and 35.35% had experience of working with mentally ill patients for more than 1 month [Table 1].
Statistical analysis was done with sofastats-1.4.6 version which is free software. The analysis of outcome was done by calculating mean attitude for each vignette, and comparison was made taking various demographic factors, different professional groups, work experience with mentally ill patients and whether MHPC program attended or not; into consideration. Unpaired t-test of significance for comparison was applied. P ≤ 0.05 was considered to be statistically significant. An important outcome was as below mentioned in the tables.
Most of the younger population (age ≤30 years) belong to nursing students, junior doctors and DCP students, therefore, attitudes of younger age group were a reflection of attitude of these groups, and likewise, attitudes of married population were reflection of nursing staff's attitude. In B. Sc., nursing students, attitudes were positive toward all mental illnesses mentioned in the questionnaire except for drug and alcohol use disorder [Table 2], [Table 3], [Table 4].
|Table 2: Mean value of attitudes toward drug abuse, depression, alcohol abuse, and one criminal among different groups*|
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|Table 3: Mean value of attitudes toward schizophrenia, obsessive-compulsive disorder, diabetes, and strict Hindu among different groups*|
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|Table 4: Mean value of attitudes toward panic disorder, conversion disorder, dissociative disorder, and social anxiety disorder among different groups|
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In DCP students, attitudes were positive for alcohol use disorder while negative for schizophrenia and drug abuse [Table 2] and [Table 3]. Overall, negative attitudes were found toward drug abuse, depression, alcohol abuse and schizophrenia [Table 2] and [Table 3].
In obsessive-compulsive disorder, panic disorder, conversion disorder, and social anxiety disorder attitudes were found positive in all groups while in dissociative disorder both negative and positive attitudes observed among different groups [Table 4].
Due to demographic characteristics of the groups, we cannot make comment in differences in attitudes in relation to age, gender, and marital status. However, significant difference was found in attitudes between professional groups. In B. Sc., nursing students and junior doctors; attitude toward depression was significantly positive (P < 0.05) while in nursing staff attitude toward depression was significantly negative than others (P < 0.0001) [Table 5].
|Table 5: Comparison between different groups for difference in attitudes toward depression|
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Attitudes toward alcohol abuse were surprisingly different in subgroups. Among B. Sc., nursing students and junior doctors, attitude was significantly negative while in nursing staff it was positive though not statistically significant (P = 0.098) [Table 6].
|Table 6: Comparison between different groups for difference in attitudes toward alcohol abuse|
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For schizophrenia, attitude was negative for all subgroups except B. Sc., nursing students [Table 7].
|Table 7: Comparison between different groups for difference in attitudes toward schizophrenia|
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| Discussion|| |
There were significant variations in attitudes among subjects with different characteristics. Attitudes were more negative among all of the hospital staff and were more common among resident doctors and nurses., Attitudes of nursing staff were more negative for major psychiatric illnesses which is opposite to results found in studies done in other countries., Attitudes of junior doctors were more negative toward drug abuse, schizophrenia, and alcohol use disorder which are similar to study done in Pakistan. 5 years follow-up study in Japan among medical students concluded development of positive attitudes and improvement in believes regarding outcome of psychiatric illnesses after education in psychiatry.
In this study, finding was different from the study done by Lut et al. among general people of the UK with same questionnaire for attitude toward depression; in which it was more positive (mean = 2.35). It suggests that depression is still viewed negatively by paramedical persons. There was no major difference for drug abuse, alcohol abuse, and schizophrenia from the finding of Lut et al.
It can be concluded that subjects who had knowledge about patients with depression had positive attitudes, as also observed from the significant difference between who had work experience of working with mentally ill patients and who had not, as well as between who attended MHPC program and who did not attend. In DCP students though attitudes toward depression were positive, it was significantly lower than that of B. Sc., nursing students. It shows that working with patients more responsible for positive attitude than knowledge as both groups have attended MHPC program, but B. Sc., nursing students had more experience of working with patients of depression.
In DCP students, highest more positive attitude was found toward alcohol abuse (P = 0.0002) than others, showing that, working with patients with alcohol abuse disorder is an important factor responsible for making positive attitudes as DCP students were from the deaddiction center where they had much experience of working with patients of alcohol abuse disorder. One interesting finding was that subjects who had attended MHPC program had more significant positive attitude toward alcohol abuse disorder than who did not attend MHPC (P = 0.02) suggesting that methodical training also can impact to make attitude more positive.
Among all professional groups, B. Sc., nursing was the group who had experience of working with patients of schizophrenia the most and had more positive attitude than other groups (P < 0.0001). However, we did not observe significant difference for attitude toward schizophrenia between subjects who attended MHPC program and who did not attend, suggesting that practical experience of working with patient is an important factor for positive attitude toward schizophrenia.
In a study in Jordan of nursing students, positive attitudes toward mental illness were observed; the previous contact with psychiatric patients was associated with positive attitudes, and demographic characteristics were not. Our findings were consistent with above study for B. Sc., nursing students. One study in Korea found that nursing students' psychiatric nursing experience impact on their attitudes toward mental illnesses. The nursing students who had 3–4 weeks of psychiatric nursing experience had a significantly higher mean score for Benevolence (factor B) than nurses whose psychiatric nursing experience had been less than 1 week (P = 0.05); similar conclusion can be made from this study for subjects who had experience of working with mentally ill patients. While educational interventions can reduce stigma,, stigmatizing opinions are not closely related to knowledge. The main strategies for addressing psychiatric stigma and discrimination focus on protest, contact, and education., Short educational workshops can produce positive changes in participants' reported attitudes toward people with mental health problems. Many studies showed that education about, and experience of working with, mental illnesses may assist the development of more positive attitudes toward mental illness.,,,,, This study found similar results in relation to the Indian context.
| Conclusions|| |
This paper provides a baseline of attitudes of nursing staff, nursing students, clinical psychology students, and junior doctors toward mental illnesses in a city. It will enable future educational interventions to be evaluated and comparison to be made with other hospitals, states, and countries. An important finding, negative attitudes toward depression which were almost similar to schizophrenia, is an alarming conclusion. As incidence of depression and suicide rate are increasing day-by-day, plan should be made to change attitudes of baseline health professional such as nursing staff toward mentally ill patients which ultimately benefit the community. There is need of implementing practical psychiatric curriculum more thoroughly in undergraduate medical teaching to make future doctors more aware about psychiatric illnesses and their positive outcome. It also signifies the need of developing program to spread awareness of mental health and psychiatric illnesses among medical, paramedical, and general community.
Limitation and strength
Due to lack of resources, we reached to the limited size of sample. It is its own kind of study in India up to best of our knowledge.
Implications and future recommendations
A practical approach is more beneficial to change the attitudes. Mental health educational sessions with young medical and paramedical people are a useful approach for improving the attitudes toward mental illness.
Large number of sample from general population can be taken in the future study to obtain more data and plan the future strategy for changing the attitudes toward psychiatric illnesses and mentally ill patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Aydin N, Yigit A, Inandi T, Kirpinar I. Attitudes of hospital staff toward mentally ill patients in a teaching hospital, Turkey. Int J Soc Psychiatry 2003;49:17-26.
Crisp A, Gelder M, Goddard E, Meltzer H. Stigmatization of people with mental illnesses: A follow-up study within the changing minds campaign of the royal college of psychiatrists. World Psychiatry 2005;4:106-13.
Caldwell TM, Jorm AF. Mental health nurses' beliefs about interventions for schizophrenia and depression: A comparison with psychiatrists and the public. Aust N
Z J Psychiatry 2000;34:602-11.
Gureje O, Lasebikan VO, Ephraim-Oluwanuga O, Olley BO, Kola L. Community study of knowledge of and attitude to mental illness in Nigeria. Br J Psychiatry 2005;186:436-41.
Jorm AF, Korten AE, Jacomb PA, Rodgers B, Pollitt P, Christensen H, et al.
Helpfulness of interventions for mental disorders: Beliefs of health professionals compared with the general public. Br J Psychiatry 1997;171:233-7.
Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. Am J Public Health 1999;89:1328-33.
Byrne P. Stigma of mental illness and ways of diminishing it. Adv Psychiatr Treat 2000;6:65-72.
Esters IG, Cooker PG, Ittenbach RF. Effects of a unit of instruction in mental health on rural adolescents' conceptions of mental illness and attitudes about seeking help. Adolescence 1998;33:469-76.
Glozier N, Hough C, Henderson M, Holland-Elliott K. Attitudes of nursing staff towards co-workers returning from psychiatric and physical illnesses. Int J Soc Psychiatry 2006;52:525-34.
Chambers M, Guise V, Välimäki M, Botelho MA, Scott A, Staniuliené V, et al.
Nurses' attitudes to mental illness: A comparison of a sample of nurses from five European countries. Int J Nurs Stud 2010;47:350-62.
Hamaideh SH, Rola M. Attitudes of Jordanian nursing students towards mental illness: The effect of teaching and contact on attitudes change. Coll Stud J 2009;43:335-46.
Cunningham J A, Sobell L C, Chow V M. What's in a label? The effects of substance types and labels on treatment considerations and stigma. J Stud Alcohol 1993;54:693-9.
Lut YJ, Dan IE, Okon U, John GL. Validation of a short instrument to measure stigmatized attitudes towards mental illness. Psychiatr Bull 2006;30:257-260.
Corrigan P1, Markowitz FE, Watson A, Rowan D, Kubiak MA. An attribution model of public discrimination towards people with mental illness. J Health Soc Behav. 2003;44:162-79
Hugo M. Mental health professionals' attitudes toward people who have experienced a mental health disorder. J Psychiatr Ment Health Nurs 2001;8:419-25.
Farooq N, Muhammad A, Zahid J, Muhammad I, Fayyaz H, David K. Stigma and psychiatric illness. A survey of attitude of medical students and doctors in Lahore, Pakistan. J Ayub Med Coll Abbottabad 2006;18:46-9.
Mino Y, Yasuda N, Kanazawa S, Inoue S. Effects of medical education on attitudes towards mental illness among medical students: A five-year follow-up study. Acta Med Okayama 2000;54:127-32.
Park YS. A study of the attitudes of nonpsychiatric registered nurses towards mental illness and mental patients. J Nurs Acad Soc
Pinfold V, Toulmin H, Thornicroft G, Huxley P, Farmer P, Graham T, et al.
Reducing psychiatric stigma and discrimination: Evaluation of educational interventions in UK secondary schools. Br J Psychiatry 2003;182:342-6.
Wolff G, Pathare S, Craig T, Leff J. Public education for community care. A new approach. Br J Psychiatry 1996;168:441-7.
Corrigan PW, River LP, Lundin RK, Penn DL, Uphoff-Wasowski K, Campion J, et al.
Three strategies for changing attributions about severe mental illness. Schizophr Bull 2001;27:187-95.
Royal College of Psychiatrists, British Medical Association. Stigmatization within the Medical Profession. Council Report CR91. London: Royal College of Psychiatrists; 2001.
Emrich K, Thompson TC, Moore G. Positive attitude. An essential element for effective care of people with mental illnesses. J Psychosoc Nurs Ment Health Serv 2003;41:18-25.
Halter MJ. Stigma and help seeking related to depression: A study of nursing students. J Psychosoc Nurs Ment Health Serv 2004;42:42-51.
Tay SE, Pariyasami S, Ravindran K, Ali MI, Rowsudeen MT. Nurses' attitudes toward people with mental illnesses in a psychiatric hospital in Singapore. J Psychosoc Nurs Ment Health Serv 2004;42:40-7.
Read J, Law A. The relationship of causal beliefs and contact with users of mental health services to attitudes to the 'mentally ill'. Int J Soc Psychiatry 1999;45:216-29.
Kim F, Kim U, John AB, Sainimere G, Samsun A. Mental health workers' attitudes toward mental illness in Fiji. Aust J Adv Nurs 2008;25:72-9.
Aghanwa HS. Attitude toward and knowledge about mental illness in Fiji islands. Int J Soc Psychiatry 2004;50:361-75.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]