According to social worker Gretchen Grappone, individuals with mental ill-health are affected by seven kinds of stigma. Health provider stigma involves negative attitudes held by those in medical and allied health fields about those with mental health conditions. Reductions in this particular variety among medical students were the focus of a recent 2023 study published in GMS Journal for Medical Education. The researchers found that medical students who undertook week-long training in psychosomatic medicine scored significantly lower on a stigmatisation scale than a control group whose training focused on somatic medicine only. These promising results provide hope for stigma-reduction efforts.
Study participants were fourth-year students from Heinrich Heine University Düsseldorf in Germany. All participants completed the Mental Illness: Clinicians’ Attitudes Scale 4 (MICA-4) – viewable at this link – prior to and after instruction. They also filled out the Rosenberg Self-Esteem Scale and a questionnaire asking, among other questions, whether they had a relative or acquaintance with mental illness and about their general interest in psychiatry.
The intervention group (IG) completed a practical block on psychosomatic medicine. This holistic, interdisciplinary field examines the interplay between the biological, psychological, and social influences promoting health and/or illness. The IG’s training involved directly interacting with real and simulated psychiatric patients, observing patient/doctor interactions, and reflecting on these cases through detailed reports and feedback. Importantly, they were able to engage with individuals experiencing a range of mental illnesses (as prior anti-stigma research from Germany has only focused on depression and schizophrenia).
In contrast, the control group’s one-week block focused solely on the somatic, and involved cases within the ambit of ophthalmology, cardiology, urology, and gastroenterology. They had no interactions with patients presenting with mental health conditions.
At the start of the week, the two groups showed little difference in MICA-4 scores. But the researchers identified significant stigma reduction among the intervention group due to their psychosomatic training. (Nevertheless, the authors also noted that there was a “tendential difference” at the week’s end.) In line with previous studies from around the world (such as this 2019 meta-analysis), these findings suggest that contact with those with psychological illnesses aids in lowering stigma and prejudice against them.
Relatedly, as this research asked students whether they personally knew someone with mental ill-health, it was able to highlight whether this factor decreased stigma. Akin to previous empirical data, the present study revealed that participants with a family member or acquaintance experiencing mental illness held more accepting attitudes (thus, further supporting the conclusion that associating with those with mental illnesses lowers stigma). Students who expressed an interest in psychiatry or psychosomatics also displayed less stigmatisation.
In addition, the study also suggests that both men and participants scoring lower on the self-esteem scale tend to be more prone to negatively judging those with mental ill-health. The researchers reference the downward comparison theory, hypothesising that “this association could possibly be explained in that one’s self-esteem can be enhanced by diminishing or degrading others” (i.e., knocking out someone else’s light to make yours shine brighter, in other words). Further studies are needed to corroborate this observation.
Limitations include the relatively small size (143 participants), the lack of participant randomisation, and the fact that the German MICA-4 has not been validated through any studies. But as the medical students’ training lasted just one week, these results shed light on how even brief interventions and education programs can potentially reduce mental health stigma in future medical and healthcare professionals, and current ones.
Hopefully, future studies can address this question: If exposure to people with psychosocial conditions decreases prejudiced attitudes against them, why does the (highly prevalent) health provider stigma from psychiatrists, psychologists, mental health nurses, etc. exist in the first place? Also, we have to consider how common those with mental illnesses are in a wider range of healthcare settings. For instance, looking at the Australian context, a 2019 Health Direct article states that 2 out of 3 general practitioner survey respondents see more patients presenting about mental health than the common cold or flu.
One possible explanation for health practitioner stigma is the influence of public and institutional forms of stigma – we are all a product of our cultures, after all. Another reason could be that although those with greater exposure to mental ill-health exhibit less or fewer negative, stigmatised attitudes, this does not mean they are completely free of any prejudice (take self-stigma, for example). And returning to the discussed study, moreover, it may be the case that younger cohorts (mean age: 24) are likelier to demonstrate lowered stigma and greater empathy thanks to their more recent, modern education.
Monique Moate is a writer, editor, wife, cat mum, and night owl who enjoys writing about a wide range of topics. She cares about mental health awareness and destigmatisation.
