Increased Knowledge among Psychiatric Medical Interns does not Reduce the Stigmatization of Mental Disorders

ABSTRACT Introduction Considering the high prevalence of mental illnesses, it is essential for any physician to offer proper treatment and attention to people with these disorders. Nevertheless, the usual stigma and lack of knowledge regarding the management of mental disorders on the part of physicians can represent a significant barrier to treatment and inefficiency faced by patients in the health care system. Objective This study aimed to measure the gain of psychiatric knowledge and the reduction in the stigmatization of people with schizophrenia by medical students after exposure to the compulsory internship program at a public medical school in the Federal District. Methods Quasi-experimental study to evaluate the impact of the training program during medical internship in the final year of undergraduate medical training. The sample was 35 final-year medical students. Questionnaires were applied to measure the degree and type of stigma in relation to schizophrenia and self-perception regarding the drug management and treatment of psychiatric diseases. A three-point Likert scale was used to measure the results. The questionnaires were applied immediately before and after exposure to the four-week training program. The medical values of self-perception and stigma were compared between two moments using the Student’s t test. Results: There was no statistically significant difference found between stigmatization before and after the intervention (total stereotype, p = 0.230; perceived prejudice, p = 0.172; social distance, p = 0.209; civil rights, p = 0.837). Regarding self-perception of knowledge, the number of items reaching total confidence and the mean values after the training were significantly improved (p = 0.007 and p < 0.0001, respectively). There was no correlation with sociodemographic characteristics. Conclusion Despite the knowledge gain, medical students failed to show any improvement in the degree of stigma held after immersion in a 4-week practical psychiatric training program. The short duration of the intervention might have meant that the students’ contact with patients was insufficient to reduce stigma. More studies are needed with larger groups and experimental designs.

摘要
**引言** 鉴于精神疾病的高患病率，为精神障碍患者提供恰当的诊疗与照护是所有临床医师的必备职责。然而，临床医师普遍存在的病耻感以及精神障碍管理知识的匮乏，会成为阻碍患者获得有效治疗的重要障碍，同时也会加剧医疗体系中患者面临的诊疗低效问题。
**研究目的** 本研究旨在评估联邦区内某公立医学院的医学本科生完成精神科强制实习项目后，其精神医学知识的提升程度，以及对精神分裂症（schizophrenia）患者病耻感的改善情况。
**研究方法** 本研究为类实验研究（quasi-experimental study），旨在评估医学本科最后一年的精神科实习培训项目的干预效果。研究共纳入35名本科最后一年的医学生。采用调查问卷评估受试者针对精神分裂症的病耻感程度与类型，以及其对精神疾病药物管理与治疗的知识自我认知水平。研究使用三点李克特量表（three-point Likert scale）对结果进行量化，分别在为期4周的实习项目开展前后即刻发放调查问卷。采用学生t检验（Student’s t test）比较干预前后的知识自我认知与病耻感评分。
**研究结果** 干预前后的病耻感评分未发现统计学显著性差异（总刻板印象维度：p=0.230；感知偏见维度：p=0.172；社交距离维度：p=0.209；公民权利维度：p=0.837）。而在知识自我认知方面，实习培训后受试者达到完全自信的题目数量及平均评分均有显著提升（分别为p=0.007与p<0.0001）。受试者的病耻感与知识自我认知水平均与社会人口学特征无相关性。
**研究结论** 尽管本研究中医学生的精神医学知识得到了显著提升，但在完成为期4周的精神科临床实习培训后，其对精神分裂症患者的病耻感并未得到明显改善。分析认为，本次干预的时长过短，可能导致学生与患者的接触时长不足以有效降低病耻感。未来需开展更大样本量且采用实验性研究设计的相关研究。