O riginal A rticle

Impact of psychiatric education and training on

attitude of medical students towards mentally ill:
A comparative analysis
Tarun Yadav,
Kishore Arya,
Dinesh Kataria,
Yatan Pal Singh Balhara1
Department of Psychiatry and
De‑addiction, Lady Hardinge
Medical College and Smt
SK Hospital, 1National Drug
Dependence Treatment Centre
(NDDTC), All India Institute of
Medical Sciences (AIIMS),
New Delhi, India
Address for correspondence:
Dr. Yatan Pal Singh Balhara,
Department of Psychiatry,
National Drug Dependence
Treatment Centre (NDDTC), All
India Institute of Medical Sciences
(AIIMS), New Delhi, India.
E‑mail: ypsbalhara@gmail.com
A B S T R A C T
Background: A number of studies from the western world have explored the negative
beliefs held by individuals towards people with mental illness. The knowledge of attitude
and awareness of undergraduate medical students towards psychiatry, mental health
and mental disorders is of utmost importance. Objective: The current study aims at
assessment of attitudes of medical students towards mental illness and mentally ill.
Materials and Methods: The study used a cross‑sectional survey design. The instruments
used included Beliefs toward Mental Illness (BMI) scale, Attitudes to Mental Illness
Questionnaire (AMIQ). ANOVA was carried out to compare the in between group
differences for the four study groups. Additionally Bonferroni correction was used to
conduct the post hoc analysis. Results: The interns were significantly more likely to
agree with the statement that the mental disorders are recurrent; less likely to be of
thought that the behavior of people with mental disorders is unpredictable; more likely
to disagree with the fact that diagnosis of depression as described in the case vignette
was going to damage the career of the individual; more likely to agree with the option
of inviting a depressed person to a party; more likely to believe in fact that mentally ill
individuals are more likely to be criminals as compared to medical students in different
professional years. Conclusions: Adequate modifications to existing medical curriculum
would help improve attitude of medical students towards mentally ill.
Keywords: Psychiatry education, stigma and mental disorders, undergraduate training

A number of studies from the western world have

explored the negative beliefs held by individuals
towards people with mental illness.[1‑3] There is little work
in non‑western societies on psychiatric stigma. The need
to study the issue assumes a greater significance in these
societies as these have been dominated by non‑western
medical traditions. In most societies some supernatural,
religious, moralistic, and magical approaches to illness
and behavior exist. This can complicate the perception of
mental disorders even further. Stigmatization of people
with mental disorder not only affects the way people seek
help individually. It also has enormous implications on the
development of policy at a national level.
India, like most developing countries, has limited resources
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Website: www.industrialpsychiatry.org
DOI: 10.4103/0972-6748.110944
for health sector. The knowledge of the attitude and
awareness of the undergraduate medical students towards
psychiatry, mental health and mental disorders is of utmost
importance. This is because these individuals are going to
be involved in the care of the patients either directly or
indirectly during the later years of their careers.
People tend to have strong beliefs about the mentally
ill. Many of these concepts are based on prevailing
local systems of belief.[4] These attitudes have important
implications for planning of mental health policy and
mental health program for the country.[5] Many people
have prejudiced attitudes towards mentally ill individuals.
Social stigma and negative attitudes can affect the quality
of life for people with mental illness. There may be
various reasons for this negative attitude. Lack of accurate
information about mental illness, lack of contact with
individuals with mental illness and lack of familiarity might
be some of the most important reasons of these negative
attitudes.[6] Such negative attitudes may be detrimental not
only to the patient care but also to the society’s attitude
to mental disorders if they are present in the health

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 Yadav, et al.: Impact of psychiatric education and training
professionals. Studies looking into the impact of education
or information on attitudes of individuals towards mental
illness and mentally ill have shown that education may have
positive impact on the prejudice.[7]
Attitude of an individual determines orientation towards
environment. Maximum part of attitude building towards
different medical disciplines and the disorders takes place
during the initial medical training. Therefore, attitude of
medical students is of utmost importance. Most of the
literature has shown negative attitude of the students
towards psychiatry. [8] It has been seen that medical
practitioners hold similar views about those with mental
health problems as the population at large. Moreover these
views were shown not always to be positive. The concept
of iatrogenic stigma is used to describe the stigma caused
or perpetuated by mental health professionals.[9] There is
limited literature on the issue from India.
Role of education has been cited as integral to reduce
stigma towards mentally ill.[10] Agencies concerning medical
professional accreditation and training hold a key role in this
regard.[11] Research has demonstrated the positive effects
of completing undergraduate psychiatric training[12] and
of specific education program[13] on attitudes of medical
students. Use of experimental methods is recommended
over the instructional methods for this purpose.
The present aimed at assessment of the impact of psychiatric
education and training on attitude of medical students
towards mentally ill and mental disorders. There is limited
literature comparing medical students across different
professional years on this issue. Studies either explore
the attitudes towards mental illness or mentally ill. The
present study aimed at assessment of both these aspects.
A comparative study across successive training years would
help understand the impact of undergraduate learning on
attitude of medical students towards mentally ill and mental
disorders. The findings would help understand the strengths
and lacunae of the current undergraduate training in India.
MATERIALS AND METHODS
Participants
The study used a cross‑sectional survey design. It was
conducted among the medical students at a medical college
in India. It included students from all three professional
years and those doing their internship training. The study
included a total of 452 completed responses from medical
students and interns. It included 227 students from the
first and second professional years, 92 from the third
professional year part I, 57 from the third professional
year part II and 76 interns. Almost all the participants were
females (99%). This was so because the medical school
Industrial Psychiatry Journal 
enrolls only female students. It accepts male students only
during internship. Majority of them were unmarried (98%).
Procedure
The students were approached in their lecture theaters and
the clinical posting wards and were asked for their consent
to participate in the survey. Those refusing to participate
in the study were excluded.
Instruments
1. Semi structured proforma which included socio-
demographic data (age, sex, semester, marital status,
residence, religion, and socioeconomic status), family
history and past history
2. Beliefs towards Mental Illness scale (BMI). The
BMI is a 21‑item self‑report measure of negative
stereotypical views of mental illness. There is a Total
Score and three subscales based on factor analysis:
dangerousness, poor social and interpersonal skills,
and incurability. The poor social skills subscale also
taps feelings of shame about mental illness and the
perception that the mentally ill are untrustworthy.
Items are rated on a six‑point Likert scale ranging
from ‘completely disagree’ (0) to ‘completely agree’ (5),
with higher scores reflecting more negative beliefs. In
the primary validity study, Cronbach’s alpha was high
among American (0.89) and Asian students (0.91). The
measure holds promising evidence of validity[14]
3. Attitudes to Mental Illness Questionnaire (AMIQ).
The 5‑item AMIQ is a brief, self‑completion questionnaire
with good psychometric properties that can be used in
most situations. Content validity and reliability is high, as
indicated by Cronbach’s alpha score, factor analysis and
test–retest correlation coefficients. Vignettes describing
highly stigmatized individuals (such as a convicted criminal)
produce consistently negative scores and those describing
non‑stigmatized individuals produce positive scores. This
indicates good face validity.[6]
The survey forms were distributed to 500 medical students
and doctors. Those consenting to participate were recruited
in the study. The response rate was high at 90%. The survey
questionnaire was administered in an anonymous form
and no identifiable information was collected from the
participants. Conditions of anonymity and confidentiality
were observed throughout the course of the study.
Statistical analysis
The data were analyzed using SPSS ver 17.0 ANOVA was
carried out to compare the in between group differences for
the four study groups. These groups included first/ second
professional year students; third professional year part I
students; third professional year part II students and
23 Jan-Jun 2012 | Vol 21 | Issue 1
 Yadav, et al.: Impact of psychiatric education and training

interns. Additionally Bonferroni correction was used year part II and 76 interns. Almost all the participants were
to conduct the post hoc analysis. Perason’s correlation females (99%).
coefficient was used to calculate the correlation between
different questionnaires and the level of training and The mean scores (and standard deviation) of the four
education in terms of the professional years. study groups on the Belief Towards Mental Illness (BMI)
scale and Attitude to Mental Illness Questionnaire (AMIQ)
RESULTS have been presented in Tables 1 and 2 respectively. In
between group analysis for the different study groups using
The study included a total of 452 completed responses ANOVA with Post‑hoc analysis for the Belief towards
from medical students and interns. It included 227 students Mental Illness (BMI) scale and Attitude to Mental Illness
from the first and second professional years, 92 from the Questionnaire (AMIQ) has been presented in Tables 3
third professional year part I, 57 from the third professional and 4, respectively.
Table 1: Score of the four study groups on belief towards mental illness scale
Interns 1st and 2nd 3rd 3rd Total
professional professional professional
year year part I year part II
Mean SD Mean SD Mean SD Mean SD Mean SD
A mentally ill person is more likely to harm others than a 2.81 1.310 2.77 1.490 2.79 1.411 2.89 1.397 2.80 1.430
normal person
Mental disorders would require a much longer period of 3.24 1.149 3.42 1.459 3.33 1.541 3.34 1.587 3.36 1.443
time to be cured than would other general diseases
It may be a good idea to stay away from people who 1.87 1.212 1.56 1.355 1.59 1.476 1.89 1.397 1.66 1.366
have psychological disorder because their behaviour is
dangerous
The term ‘psychological disorder’ makes me feel 1.53 1.319 1.77 1.816 1.68 1.741 1.61 1.545 1.69 1.690
embarrassed
A person with psychological disorder should have a job 2.93 1.242 2.72 1.692 2.96 1.526 3.23 1.651 2.87 1.590
with only minor responsibilities
Mentally ill people are more likely to be criminals 2.59 1.453 1.57 1.566 1.57 1.492 1.68 1.491 1.75 1.564
Psychological disorder is recurrent 3.05 1.364 2.36 1.375 2.93 1.497 2.66 1.599 2.64 1.454
I am afraid of what my boss, friends and others would think 2.84 1.272 2.81 1.730 2.85 1.833 3.29 1.659 2.88 1.679
if I were diagnosed as having a psychological disorder
Individuals diagnosed as mentally ill suffer from its 2.09 1.327 1.51 1.464 1.80 1.632 1.70 1.705 1.69 1.521
symptoms throughout their life
People who have once received psychological treatment 2.59 1.264 2.24 1.496 2.53 1.544 2.55 1.548 2.40 1.480
are likely to need further treatment in the future
It might be difficult for mentally ill people to follow social 2.36 1.237 2.42 1.746 2.11 1.627 2.24 1.715 2.32 1.641
rules such as being punctual or keeping promises
I would be embarrassed if people knew that I dated a 1.93 1.473 1.54 1.657 1.91 1.873 1.64 1.637 1.70 1.677
person who once received psychological treatment
I am afraid of people who are suffering from 2.35 1.329 1.96 1.592 2.17 1.655 2.62 1.396 2.15 1.554
psychological disorder because they may harm me
A person with psychological disorder is less likely to 2.65 1.168 2.41 1.545 2.64 1.545 2.37 1.629 2.50 1.499
function well as a parent
I would be embarrassed if a person in my family became 1.45 1.339 1.20 1.576 1.38 1.759 1.02 1.243 1.26 1.543
mentally ill
I believe that psychological disorder can never be 1.68 1.357 1.20 1.573 1.50 1.633 1.70 1.705 1.40 1.578
completely cured
Mentally ill people are unlikely to be able to live 2.41 1.193 2.39 1.532 2.29 1.449 2.16 1.682 2.35 1.482
by themselves because they are unable to assume
responsibilities
Most people would not knowingly be friends with a 2.73 1.398 3.13 1.593 3.11 1.674 3.43 1.340 3.10 1.557
mentally ill person
The behaviour of people who have psychological 2.83 1.167 3.34 1.458 3.29 1.455 3.32 1.466 3.24 1.421
disorders in unpredictable
Psychological disorder is unlikely to be cured regardless 2.11 1.467 1.65 1.625 1.46 1.500 1.87 1.538 1.72 1.571
of treatment
I would not trust the work of a mentally ill person 2.29 1.075 2.03 1.535 1.78 1.475 2.21 1.604 2.05 1.469
assigned to my work team

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 Yadav, et al.: Impact of psychiatric education and training

Table 2: Score of the four study groups on attitudes to mental illness questionnaire
Interns 1st and 2nd 3rd 3rd Total
professional professional professional
year year part I year part II
Mean SD Mean SD Mean SD Mean SD Mean SD
Substance abuse case vignette
Do you think this would damage Mr. A’s career? ‑1.15 1.249 ‑1.45 .980 ‑1.52 0.691 ‑1.41 0.826 ‑1.41 0.968
I would be comfortable if Mr. A was my colleague at work? ‑0.52 1.005 ‑0.71 1.108 ‑0.54 1.040 ‑0.43 1.126 ‑0.61 1.081
I would be comfortable about inviting Mr. A to a dinner party? ‑0.61 1.064 ‑0.63 1.176 ‑0.49 1.144 ‑0.39 1.201 ‑0.57 1.154
How likely do you think it would be for Mr. A’s wife to leave him? ‑0.56 1.093 ‑0.52 1.273 ‑0.81 1.069 ‑0.87 0.810 ‑0.63 1.158
How likely do you think it would be for Mr. A to get in trouble with law? ‑0.92 1.088 ‑1.06 1.099 ‑1.08 1.096 ‑1.11 0.779 ‑1.05 1.059
Depression case vignette
Do you think this would damage Mr. A’s career? 0.19 1.159 ‑0.41 1.246 ‑0.62 1.186 ‑0.36 1.285 ‑0.34 1.247
I would be comfortable if Mr. A was my colleague at work? 0.12 0.936 0.47 1.000 0.47 1.001 0.58 1.049 0.43 1.003
I would be comfortable about inviting Mr. A to a dinner party? 0.17 0.978 0.70 0.943 0.70 1.033 0.43 1.142 0.57 1.012
How likely do you think it would be for Mr. A’s wife to leave him? 0.36 0.968 0.58 1.116 0.46 1.056 0.39 1.123 0.49 1.081
How likely do you think it would be for Mr. A to get in trouble with law? 0.36 0.849 0.51 1.047 0.76 1.056 0.30 1.008 0.51 1.020
Psychosis case vignette
Do you think this would damage Mr. A’s career? ‑0.87 1.082 ‑0.89 1.101 ‑1.22 0.863 ‑1.07 0.912 ‑0.98 1.036
I would be comfortable if Mr. A was my colleague at work? ‑0.55 1.004 ‑0.25 1.053 ‑0.38 0.911 ‑0.25 1.066 ‑0.33 1.022
I would be comfortable about inviting Mr. A to a dinner party? ‑0.53 1.055 ‑0.31 1.155 ‑0.38 1.061 ‑0.25 1.058 ‑0.36 1.107
How likely do you think it would be for Mr. A’s wife to leave him? ‑0.36 1.177 ‑0.08 1.232 ‑0.50 1.222 ‑0.78 0.762 ‑0.30 1.194
How likely do you think it would be for Mr. A to get in trouble with law? ‑0.37 1.088 ‑0.12 1.202 ‑0.24 1.141 ‑0.62 0.952 ‑0.25 1.150
OCD case vignette
Do you think this would damage Mr. A’s career? 0.44 0.933 0.55 1.212 0.43 1.201 0.18 1.188 0.46 1.165
I would be comfortable if Mr. A was my colleague at work? 0.27 0.905 0.56 1.046 0.55 1.071 0.71 0.956 0.52 1.022
I would be comfortable about inviting Mr. A to a dinner party? 0.44 0.986 0.60 1.003 0.72 0.994 0.75 0.927 0.61 0.990
How likely do you think it would be for Mr. A’s wife to leave him? 0.45 0.949 0.84 1.017 0.82 1.051 0.69 1.052 0.75 1.023
How likely do you think it would be for Mr. A to get in trouble with law? 0.65 0.951 0.70 1.836 1.11 0.890 0.80 1.145 0.79 1.473

Interns v/s first/second professional year students
Most significant differences were observed between the
interns and the first/second professional year students.
The interns were significantly more likely to agree with the
statement that the mental disorders are recurrent (mean
difference 1.02, SE±20, 95% CI 0.48‑1.56; P<.05). There
were significantly less likely to be of the thought that the
behavior of people with mental disorders is unpredictable
(mean difference .51, SE±.19, 95% CI ‑0.01‑1.01; P<0.05).
They were more likely to disagree with the fact that diagnosis
of depression as described in the case vignette was going to
damage the career of the individual (mean difference 0.60,
SE±0.16, 95% CI ‑0.16‑1.03; P<0.05) and they were more
likely to agree with the option of inviting a depressed person
to a party (mean difference 0.52, SE±0.13, 95% CI ‑0.17‑0.88;
P<0.05). They were also comparatively less likely to believe
that the wife of a person with OCD is going to leave him
because of his mental condition (mean difference 0.38,
SE±0.13, 95% CI ‑0.02‑0.74; P<0.05). The interns were more
likely to believe in the fact that the mentally ill persons are
more likely to be criminals (mean difference 0.21, SE±0.07,
95% CI ‑0.04‑0.39; P<0.05). They also found media reports to
be more favorable with regards to ‘projecting negative image
of those with depression and psychosis’ (mean difference
0.19, SE±0.06, 95% CI ‑0.02‑0.36; P<0.05).
Interns v/s third professional year part I students
Interns were more likely to disagree with the fact that
diagnosis of depression as described in the case vignette
was going to damage the career of the individual (mean
difference 1.021, SE:±0.24, 95% CI ‑0.39‑1.65; P<0.05)
and they were more likely to agree with the option of
inviting a depressed person to a party as compared to the
third professional year part I students (mean difference
0.81, SE±0.19, 95% CI ‑0.30‑1.32; P<0.05).The interns
were more likely to believe in the fact that the mentally ill
persons are more likely to be criminals (mean difference
0.53, SE±0.16, 95% CI ‑0.11‑.94; P<0.05).
Interns v/s third professional year part II students
The interns were more likely to believe in the fact that
the mentally ill persons are more likely to be criminals as
compared to the third professional year part II students
(mean difference 0.91, SE±0.27, 95% CI‑20‑1.62; P<0.05).
Pearson’s coefficient of correlation was calculated to find
out degree of correlation between the level of medical
education and different questions of the two scales used in
the study. Significant correlations were observed between
level of medical education and items ‘Likelihood of wife
of heroin user to leave him’ (r=‑0.116, P=0.02); ‘Likelihood

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Table  3: In between group comparisons for the belief towards mental illness scale
Variable Study Study group (J) Mean Std. Sig. 95% confidence
group (I) difference error interval
(I‑J) Lower Upper
bound bound
A mentally ill person is more likely to Interns 1st and 2nd professional year 0.038 0.192 1.000 ‑0.47 0.55
harm others than a normal person 3rd professional year part I 0.017 0.224 1.000 ‑0.58 0.61
3rd professional year part II ‑0.082 0.254 1.000 ‑0.76 0.59
Mental disorders would require a much Interns 1st and 2nd professional year ‑0.176 0.193 1.000 ‑0.69 0.33
longer period of time to be cured than 3rd professional year part I ‑0.086 0.225 1.000 ‑0.68 0.51
would other general diseases
3rd professional year part II ‑0.099 0.255 1.000 ‑0.78 0.58
It may be a good idea to stay away from Interns 1st and 2nd professional year 0.302 0.182 0.583 ‑0.18 0.78
people who have psychological disorder 3rd professional year part I 0.280 0.212 1.000 ‑0.28 0.84
because their behaviour is dangerous
3rd professional year part II ‑0.026 0.241 1.000 ‑0.66 0.61
The term ‘psychological disorder’ makes Interns 1st and 2nd professional year ‑0.241 0.226 1.000 ‑0.84 0.36
me feel embarrassed 3rd professional year part I ‑0.151 0.263 1.000 ‑0.85 0.55
3rd professional year part II ‑0.074 0.299 1.000 ‑0.87 0.72
A person with psychological disorder Interns 1st and 2nd professional year 0.208 0.213 1.000 ‑0.36 0.77
should have a job with only minor 3rd professional year part I ‑0.024 0.248 1.000 ‑0.68 0.63
responsibilities
3rd professional year part II ‑0.300 0.281 1.000 ‑1.04 0.44
Mentally ill people are more likely to be Interns 1st and 2nd professional year 1.020* 0.203 0.000 0.48 1.56
criminals 3rd professional year part I 1.021* 0.237 0.000 0.39 1.65
3rd professional year part II 0.908* 0.269 0.005 0.20 1.62
Psychological disorder is recurrent Interns 1st and 2nd professional year 0.691* 0.193 0.002 0.18 1.20
3rd professional year part I 0.120 0.224 1.000 ‑.047 0.71
3rd professional year part II 0.393 0.253 0.727 ‑0.28 1.06
I am afraid of what my boss, friends and Interns 1st and 2nd professional year 0.029 0.225 1.000 ‑0.57 0.62
others would think if I were diagnosed as 3rd professional year part I ‑0.010 0.262 1.000 ‑0.70 0.68
having a psychological disorder
3rd professional year part II ‑0.448 0.297 0.794 ‑1.24 0.34
Individuals diagnosed as mentally ill Interns 1st and 2nd professional year 0.582* 0.201 0.024 0.05 1.12
suffer from its symptoms throughout 3rd professional year part I 0.289 0.235 1.000 ‑0.33 0.91
their life
3rd professional year part II 0.397 0.267 0.825 ‑0.31 1.10
People who have once received Interns 1st and 2nd professional year 0.342 0.197 0.498 ‑0.18 0.86
psychological treatment are likely to 3rd professional year part I 0.054 0.230 1.000 ‑0.55 0.66
need further treatment in the future
3rd professional year part II 0.033 0.261 1.000 ‑0.66 0.72
It might be difficult for mentally ill people Interns 1st and 2nd professional year ‑0.059 0.219 1.000 ‑0.64 0.52
to follow social rules such as being 3rd professional year part I 0.251 0.256 1.000 ‑0.43 0.93
punctual or keeping promises
3rd professional year part II 0.119 0.293 1.000 ‑0.66 0.90
I would be embarrassed if people knew Interns 1st and 2nd professional year 0.395 0.224 0.472 ‑0.20 0.99
that I dated a person who once received 3rd professional year part I 0.020 0.260 1.000 ‑0.67 0.71
psychological treatment
3rd professional year part II 0.297 0.297 1.000 ‑0.49 1.08
I am afraid of people who are suffering Interns 1st and 2nd professional year 0.396 0.207 0.336 ‑0.15 0.94
from psychological disorder because they 3rd professional year part I 0.177 0.241 1.000 ‑0.46 0.82
may harm me
3rd professional year part II ‑0.274 0.273 1.000 ‑1.00 0.45
A person with psychological disorder is Interns 1st and 2nd professional year 0.241 0.200 1.000 ‑0.29 0.77
less likely to function well as a parent 3rd professional year part I 0.012 0.233 1.000 ‑0.61 0.63
3rd professional year part II 0.283 0.268 1.000 ‑0.43 0.99
I would be embarrassed if a person in my Interns 1st and 2nd professional year 0.256 0.206 1.000 ‑0.29 0.80
family became mentally ill 3rd professional year part I 0.073 0.240 1.000 ‑0.56 0.71
3rd professional year part II 0.435 0.272 0.663 ‑0.29 1.16
I believe that psychological disorder can Interns 1st and 2nd professional year 0.479 0.209 0.135 ‑0.08 1.03
never be completely cured 3rd professional year part I 0.182 0.245 1.000 ‑0.47 0.83
3rd professional year part II ‑0.016 0.277 1.000 ‑0.75 0.72
Mentally ill people are unlikely to be able Interns 1st and 2nd professional year 0.011 0.199 1.000 ‑0.52 0.54
to live by themselves because they are 3rd professional year part I 0.112 0.232 1.000 ‑0.50 0.73
unable to assume responsibilities
3rd professional year part II 0.245 0.263 1.000 ‑0.45 0.94

(Continued)

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 Yadav, et al.: Impact of psychiatric education and training

Table 3: (Continued)
Variable Study Study group (J) Mean Std. Sig. 95% confidence
group (I) difference error interval
(I‑J) Lower Upper
bound bound
Most people would not knowingly be Interns 1st and 2nd professional year ‑0.398 0.207 0.331 ‑0.95 0.15
friends with a mentally ill person 3rd professional year part I ‑0.375 0.241 0.723 ‑1.01 0.26
3rd professional year part II ‑0.693 0.277 0.076 ‑1.43 0.04
The behaviour of people who have Interns 1st and 2nd professional year ‑0.510* 0.189 0.043 ‑1.01 0.00
psychological disorders in unpredictable 3rd professional year part I ‑0.465 0.222 0.217 ‑1.05 0.12
3rd professional year part II ‑0.495 0.250 0.289 ‑1.16 0.17
Psychological disorder is unlikely to be Interns 1st and 2nd professional year 0.456 0.210 0.181 ‑0.10 1.01
cured regardless of treatment 3rd professional year part I 0.645 0.244 0.050 0.00 1.29
3rd professional year part II 0.232 0.276 1.000 ‑0.50 0.96
I would not trust the work of a mentally ill Interns 1st and 2nd professional year 0.262 0.196 1.000 ‑0.26 0.78
person assigned to my work team 3rd professional year part I 0.516 0.229 0.149 ‑0.09 1.12
3rd professional year part II 0.079 0.259 1.000 ‑0.61 0.76
* The mean difference is significant at the 0.05 level

Table  4: In between group comparisons for the attitudes to mental illness questionnaire scores
Variable (I) semester (J) semester Mean Std. Sig. 95% confidence
difference error interval
(I‑J) Lower Upper
bound bound
Substance Use case vignette
Do you think this would damage Mr. A’s Interns 1st and 2nd professional year 0.302 0.129 0.116 ‑0.04 0.64
career? 3rd professional year part I 0.376 0.151 0.078 ‑0.02 0.77
3rd professional year part II 0.264 0.170 0.729 ‑0.19 0.72
I would be comfortable if Mr. A was my Interns 1st and 2nd professional year 0.186 0.144 1.000 ‑0.20 0.57
colleague at work? 3rd professional year part I 0.024 0.169 1.000 ‑0.42 0.47
3rd professional year part II ‑0.091 0.191 1.000 ‑0.60 0.41
I would be comfortable about inviting Mr. A Interns 1st and 2nd professional year 0.017 0.154 1.000 ‑0.39 0.43
to a dinner party? 3rd professional year part I ‑0.124 0.181 1.000 ‑0.60 0.35
3rd professional year part II ‑0.220 0.204 1.000 ‑0.76 0.32
How likely do you think it would be for Mr. A’s Interns 1st and 2nd professional year ‑0.037 0.154 1.000 ‑0.45 0.37
wife to leave him? 3rd professional year part I 0.251 0.180 0 .987 ‑0.23 0.73
3rd professional year part II 0.315 0.204 0.736 ‑0.22 0.85
How likely do you think it would be for Mr. A Interns 1st and 2nd professional year 0.140 0.142 1.000 ‑0.24 0.52
to get in trouble with law? 3rd professional year part I 0.160 0.167 1.000 ‑0.28 0.60
3rd professional year part II 0.187 0.187 1.000 ‑0.31 0.68
Depression case vignette
Do you think this would damage Mr. A’s Interns 1st and 2nd professional year 0.595* 0.164 0.002 0.16 1.03
career? 3rd professional year part I 0.809* 0.191 0.000 0.30 1.32
3rd professional year part II 0.544 0.216 0.074 ‑0.03 1.12
I would be comfortable if Mr. A was my Interns 1st and 2nd professional year ‑0.353 0.134 0.053 ‑0.71 0.00
colleague at work? 3rd professional year part I ‑0.350 0.157 0.155 ‑0.77 0.07
3rd professional year part II ‑0.460 0.177 0.059 ‑0.93 0.01
I would be comfortable about inviting Mr. A Interns 1st and 2nd professional year ‑0.523* 0.133 0.001 ‑0.88 ‑0.17
to a dinner party? 3rd professional year part I ‑0.527* 0.155 0.005 ‑0.94 ‑0.11
3rd professional year part II ‑0.255 0.176 0.881 ‑0.72 0.21
How likely do you think it would be for Mr. A’s Interns 1st and 2nd professional year ‑0.221 0.145 0.769 ‑0.60 0.16
wife to leave him? 3rd professional year part I ‑0.101 0.169 1.000 ‑0.55 0.35
3rd professional year part II ‑0.033 0.191 1.000 ‑0.54 0.47
How likely do you think it would be for Mr. A Interns 1st and 2nd professional year ‑0.154 0.136 1.000 ‑0.51 0.21
to get in trouble with law? 3rd professional year part I ‑0.404 0.159 0.067 ‑0.82 0.02
3rd professional year part II 0.056 0.179 1.000 ‑0.42 0.53

(Continued)

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 Yadav, et al.: Impact of psychiatric education and training

Table 4: (Continued)
Variable (I) semester (J) semester Mean Std. Sig. 95% confidence
difference error interval
(I‑J) Lower Upper
bound bound
Psychosis case vignette
Do you think this would damage Mr. A’s Interns 1st and 2nd professional year 0.027 0.138 1.000 ‑0.34 0.39
career? 3rd professional year part I 0.358 0.161 0.163 ‑0.07 0.79
3rd professional year part II 0.205 0.182 1.000 ‑0.28 0.69
I would be comfortable if Mr. A was my Interns 1st and 2nd professional year ‑0.297 0.137 0.182 ‑0.66 0.07
colleague at work? 3rd professional year part I ‑0.165 0.160 1.000 ‑0.59 0.26
3rd professional year part II ‑0.297 0.180 0.600 ‑0.77 0.18
I would be comfortable about inviting Mr. A Interns 1st and 2nd professional year ‑0.221 0.150 0.848 ‑0.62 0.18
to a dinner party? 3rd professional year part I ‑0.152 0.175 1.000 ‑0.62 0.31
3rd professional year part II ‑0.280 0.198 0.948 ‑0.80 0.24
How likely do you think it would be for Mr. A’s Interns 1st and 2nd professional year ‑0.285 0.158 0.432 ‑0.70 0.13
wife to leave him? 3rd professional year part I 0.135 0.185 1.000 ‑0.35 0.62
3rd professional year part II 0.417 0.208 0.277 ‑0.14 0.97
How likely do you think it would be for Mr. A Interns 1st and 2nd professional year ‑0.256 0.153 0.573 ‑0.66 0.15
to get in trouble with law? 3rd professional year part I ‑0.132 0.180 1.000 ‑0.61 0.34
3rd professional year part II 0.245 0.203 1.000 ‑0.29 0.78
OCD case vignette
Do you think this would damage Mr. A’s Interns 1st and 2nd professional year ‑0.107 0.156 1.000 ‑0.52 0.31
career? 3rd professional year part I 0.008 0.183 1.000 ‑0.48 0.49
3rd professional year part II 0.258 0.207 1.000 ‑0.29 0.81
I would be comfortable if Mr. A was my Interns 1st and 2nd professional year ‑0.289 0.136 0.207 ‑0.65 0.07
colleague at work? 3rd professional year part I ‑0.279 0.160 0.491 ‑0.70 0.14
3rd professional year part II ‑0.442 0.181 0.088 ‑0.92 0.04
I would be comfortable about inviting Mr. A Interns 1st and 2nd professional year ‑0.158 0.134 1.000 ‑0.51 0.20
to a dinner party? 3rd professional year part I ‑0.278 0.157 0.462 ‑0.69 0.14
3rd professional year part II ‑0.307 0.177 0.496 ‑0.78 0.16
How likely do you think it would be for Mr. A’s Interns 1st and 2nd professional year ‑0.382* 0.137 0.032 ‑0.74 ‑0.02
wife to leave him? 3rd professional year part I ‑0.363 0.160 0.145 ‑0.79 0.06
3rd professional year part II ‑0.238 0.181 1.000 ‑0.72 0.24
How likely do you think it would be for Mr. A Interns 1st and 2nd professional year ‑0.051 0.197 1.000 ‑0.57 0.47
to get in trouble with law? 3rd professional year part I ‑0.460 0.231 0.280 ‑1.07 0.15
3rd professional year part II ‑0.147 0.261 1.000 ‑0.84 0.54
3rd professional year part I ‑0.009 0.078 1.000 ‑0.22 0.20
3rd professional year part II ‑0.168 0.089 0.359 ‑0.40 0.07
3rd professional year part I 0.004 0.068 1.000 ‑0.18 0.18
3rd professional year part II 0.039 0.077 1.000 ‑0.16 0.24
* The mean difference is significant at the 0.05 level

of depression damaging ones career’ (r=‑0.127, P<0.05);
‘Level of comfort having someone with depression as
colleague at work’ (r=0.097, P=0.04); ‘Likelihood of
schizophrenia damaging ones career’ (r=‑0.113, P=0.018);
‘ Likelihood of wife of patient with schizophrenia to leave
him’ (r=‑0.160, P=0.00); and ‘Likelihood of mentally ill to
be criminals’ (r=‑119, P=0.01) [Table 5].
was carried out between the students from different
professional years in order to assess the impact of the
medical education and training on these aspects.
There is limited information on the impact of the medical
education and training on the attitude towards mentally ill
among Indian students.[15] The assessment was done among
a total of 452 medical students.

DISCUSSION There were significant differences between the interns

and the students from different professional years. Overall
The current study made use of a survey based methodology interns were found to have more favorable attitudes
to study the attitude of medical students towards mental towards mentally ill as compared to the medical students
illness and mentally ill. Additionally, a comparative analysis from different professional years as assessed by BMI

Jan-Jun 2012 | Vol 21 | Issue 1 28 Industrial Psychiatry Journal

 Yadav, et al.: Impact of psychiatric education and training
Table  5: Items showing significant correlation
with the level of medical education/ training
Specific parameter Coefficient of
correlation (P values)
Likelihood of wife of heroin user to leave him ‑0.116 (0.02)
Likelihood of depression damaging ones career ‑0.127 (0.00)
Level of comfort having someone with 0.097 (0.04)
depression as colleague at work
Likelihood of schizophrenia damaging ones ‑0.113 (0.018)
career
Likelihood of wife of patient with ‑0.160 (0.00)
schizophrenia to leave him
Likelihood of mentally ill to be criminals ‑0.119 (0.01)
The negative sign indicates that there is a negative correlation between these
parameters
scale and AMIQ. They were more firm believer in the fact
that mentally ill is likely to find support from the spouse.
They were more comfortable in having interaction with
mentally ill in social and professional settings. Similarly a
negative correlation was observed between the stigmatizing
attitude and level of medical education and training with a
progressive increase in favorable attitudes along increasing
years of medical education.
Patients suffering from schizophrenia, alcohol and drug
problems were reported as dangerous, unpredictable and
different looking in another study.[8] Negative attitude
were also observed for those with depression, regarding
predictability, ability to talk to, and their ability to pull
themselves together and focus of blame in this study.
Negative attitudes towards blame and ability to pull oneself
together were also noticed for those with alcohol and drug
problems.
In a previous study from India, undergraduate medical
students were found to have multiple lacunae in their
knowledge toward psychiatry, psychiatric disorders,
psychiatric patients and psychiatric treatment. [16] The
interns are likely to have the maximum exposure to
psychiatric patients and mental disorders. Maximum
differences were observed between the interns and the
first/second professional year students‑ a finding reflective
of the fact that exposure to psychiatry teaching and training
can module the negative attitude towards the mentally
ill people. Since the first/second year students are not
exposed to any psychiatry lectures or ward postings their
understanding in to these conditions is expected to be
minimal. With gradual exposure to lectures (from third
professional year I onwards) and ward postings (from third
professional year part II onwards) there is a progressive
increase in the understanding and awareness of the
psychiatric conditions. This could be the detrimental factor
for reduction in negative attitude and biases of the medical
students. The findings of correlation between the level of
Industrial Psychiatry Journal 
psychiatry education/training and different parameters
assessed also corroborate this explanation. The favorable
impact of psychiatry posting on the attitude of medical
students towards mentally ill has been found in previous
studies from western countries.[17] Work by Mas and
Hatim (2002) from Malaysia found that final year MBBS
students had more favorable attitude towards mentally ill
as compared to the first year students.[18]
High levels of ignorance, prejudice and discrimination
towards mentally ill has been confirmed by studies among
health professionals in Australia, Brazil, Canada, Croatia,
England, Malaysia, Spain and Turkey.[17‑19] Studies among
medical students have also reported unfavorable attitudes
towards mentally ill.[20‑23]
Role of medical education in addressing stigma towards
mentally ill has been debated by certain authors.[24] A study
by Ay et al. (2006) failed to find a favorable impact of
medical education on stigmatizing attitudes of medical
students towards mental illness.[25]
Role of education has been cited as integral to reduce
stigma towards mentally ill.[11] Agencies concerning medical
professional accreditation and training hold a key role in this
regard.[11] Research has demonstrated the positive effects
of completing undergraduate psychiatric training[12] and
of specific education program[13] on attitudes of medical
students. Use of experimental methods is recommended
over the instructional methods for this purpose.
It has been recommended to design program for medical
students based on policy of ‘catch them young’.[26] The
clinical rotation in psychiatry has been found to be an
important factor influencing medical student attitudes
towards psychiatry. [27,28] A one hour supplementary
education program in addition to the traditional medical
curriculum led to significant improvement in attitude of
medical students towards mentally ill in Japan.[29,30]
The knowledge of the attitude and awareness of the
undergraduate medical students towards psychiatry, mental
health and mental disorders is of utmost importance
as these individuals are going to be involved in the care
of these patients either directly or indirectly during the
later years of their careers. An overwhelming majority
of patients with neurosis, depression, alcohol‑related
problems, sexual problems and psychosomatic disorders
have been found to seek treatment from general physicians
in India.[31] The need to impart adequate psychiatry training
to even those medicals students who might specialize in
other specialties later on has been expressed.[32]
Concerns have been expressed over the reduction in
29 Jan-Jun 2012 | Vol 21 | Issue 1
 Yadav, et al.: Impact of psychiatric education and training
funding for medical student education‑related roles and
positions within departments of psychiatry.[33] Psychiatry
as a discipline is felt to be given a step motherly treatment
at the undergraduate level which is reflected in the number
of lectures in psychiatry and number of hours of psychiatry
clinical posting. Very recently psychiatry rotation has been
made compulsory during the internship in India. This is a
welcome move. However, much more needs to be done in
this direction. Even a brief one hour orientation session of
the first year medical students helped improve their attitude
towards mental illness.[5]
Limited number of psychiatry trainees in the country make
the issue even more relevant. There are just 0.4 psychiatrists
and 0.02 psychologists per 100,000 people. The recent
publication by WHO and WPA title 'Atlas: Psychiatric
Education and Training Across the World 2005’ has
highlighted the limited mental health professionals in the
country.[34]
The current has certain strengths. We made use of
a survey based methodology. The survey had a high
response rate. Additionally we assessed students
across different professional years during the medical
school. The assessments were made using standardized
instruments and hence the findings are comparable with
those of the other studies. The reasons for studying
psychiatric stigma specifically among medical students
were twofold: (a) doctors can play an important role in
reduction of stigma; (b) the findings will help to focus
education and other strategies to change attitudes in
this group.
However, we made a cross sectional evaluation. It would
be interesting to follow up the cohort prospectively and
assess the change over time. Also impact of these attitudes
on behavior of these students can also be assessed when
they start their own clinical practice. Also we have assessed
only female students due to logistic reasons. Future studies
should include male students as well. It would be interesting
to compare the findings from other medical schools across
different regions and cultures. This would be important
before the findings could be generalized to other parts of
the country.
CONCLUSIONS
Attitude of medical students is detrimental to the care
of the mentally ill persons. The negative attitude of the
medical students is amenable to psychiatric education and
training. Hence, adequate modifications to the existing
medical curriculum would help improve the attitude of
medical students towards mentally ill.
Jan-Jun 2012 | Vol 21 | Issue 1 30
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Impact of psychiatric education and training on attitude of medical
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Source of Support: Nil. Conflict of Interest: None declared.

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