Medical student perceptions of psychiatric conditions and the impact of stigmatizing language

Mental health conditions have been subject to significant societal stigma, which impacts the self-perception of people with mental illness and can impact their decision to seek treatment. General practitioners in the United States report overall negative attitudes toward people with severe mental illness; however, there are few studies into the beliefs of medical students on people with mental illnesses as well as the impact of stigmatizing language on these beliefs.

The objectives of this survey were to evaluate the impact of stigmatizing language on medical students' responses to case presentations of mental illnesses, and to determine how these perceptions vary across the course of medical education.

We conducted an online survey wherein medical student participants reviewed psychiatric case vignettes, which varied in their use of either person-centered language (PCL) or stigmatizing language. All current students at the authors' institution were sent the survey link via email. Participants rated the case for symptom severity, their likelihood to recommend hospitalization, their level of comfort and safety when interviewing the patient, the trustworthiness of the patient's report, and the likelihood that the condition would improve over the next year. For analysis, these responses were summed to yield a Student Perception Index Score from 1 to 60, with 60 being the "most stigmatizing" perspective (i.e., lowest comfort, most likely to hospitalize, etc.).

There were 87 total respondents, of which 44 answered the Stigmatizing vignettes and 43 answered the PCL vignettes, with roughly even respondents per year in school. Overall, there was not a significant difference between the PCL and stigmatizing language versions (p=0.73 for the major depression case; p=0.29 for the schizophrenia case). However, compared to first-year medical students, third-year students had significantly higher Student Perception Index Scores for the stigmatizing depression case (p=0.002), and fourth-year students had significantly higher stigma scores for the PCL depression case (p=0.02).

Although there was no overall difference between the average Index Scores for the PCL and stigmatizing versions of the case presentations, significant differences in the Index Scores of certain presentations for students undergoing clinical education indicate that some targeted education on mental health stigma may be beneficial for third- and fourth-year medical students. Teaching empathetic approaches to patients with mental illness, regardless of whether their presentation was "stigmatizing," emphasizes the holistic care expected through the osteopathic tenet describing the interconnectedness of mind, body, and spirit.