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Effects of contact-based, short-term anti-stigma training for medical students

Results from a randomized controlled trial

Effektivität einer kontaktbasierten Kurzintervention zum Abbau stigmatisierender Einstellungen unter MedizinstudentInnen

Ergebnisse einer randomisierten, kontrollierten Studie

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Summary

Background

Mental health stigma (MHS) places a burden on those affected that far exceeds psychosocial harms. Contact-based anti-stigma work has been found effective for several target groups. For medical students however, its efficacy remains unclear.

Aim

The purpose of this study was to examine the efficacy of contact-based, trialogic anti-stigma training for medical students.

Methods

A randomized controlled trial (RCT) was conducted, controlling for standard clinical placement in psychiatry. External validity was maximized by including all students (n = 204) who started their 6‑week obligatory psychiatry course during the study period between March and July 2018. Assessments were conducted at the beginning of each of the two covered terms and immediately postintervention.

Results

Students who received the anti-stigma training displayed significantly less stigmatizing attitudes after the intervention, measured using the MICA (Mental Illness—Clinicians’ Attitudes) scale as primary outcome. Analogous findings were noted for social distance and stereotypes, whereas these could not be observed for emotional reactions. All significant changes were independent of gender and age.

Conclusion

The positive results underpin the research in this field and point towards the inclusion of comparable interventions in regular student curricula. Given the limitation of a missing late follow-up, however, further research regarding the persistence of stigma reduction is needed.

Zusammenfassung

Hintergrund

Stigmatisierung psychischer Erkrankungen stellt eine Belastung für Betroffene dar, deren Ausmaß die psychosozialen Folgen weit überschreitet. Kontaktbasierte Antistigma-Arbeit hat sich als effektiver Ansatz zum Abbau stigmatisierender Einstellungen für verschiedene Zielgruppen bewährt. Für die Wirksamkeit bei Medizinstudierenden fehlt jedoch ein empirischer Nachweis.

Ziel

Ziel der Studie war die Evaluation einer kontaktbasierten, trialogischen Antistigma-Kurzintervention für Medizinstudierende.

Methoden

Eine randomisierte, kontrollierte Studie (RCT) wurde durchgeführt mit regelhaftem praktischem Unterricht innerhalb der Psychiatrie als Kontrollbedingung. Zur Maximierung externer Validität erfolgte der Einschluss aller Studierenden (n = 204), welche im Studienzeitraum zwischen März und Juli 2018 ihr 6‑wöchiges Pflichtmodul in Psychiatrie belegten. Die Daten wurden zu Beginn beider eingeschlossener akademischer Phasen und direkt nach der Intervention erhoben.

Ergebnisse

Studierende zeigten nach Teilnahme an der Intervention ein signifikant geringeres Niveau stigmatisierender Einstellungen als vor der Intervention, gemessen anhand des MICA(Mental Illness – Clinicians’ Attitudes)-Fragebogens als „primary outcome“. Für soziale Distanz und die Zustimmung zu Stereotypen ergaben sich analoge Befunde, für emotionale Reaktionen dagegen ließ sich dieser Zusammenhang nicht nachweisen. Alle signifikanten Veränderungen traten unabhängig von Geschlecht und Alter auf.

Schlussfolgerung

Die positiven Ergebnisse untermauern die Forschungserkenntnisse in diesem Bereich und unterstreichen die Forderung nach Integration vergleichbarer Interventionen in das regelhafte Curriculum des Medizinstudiums. Angesichts der Limitation der Studie durch eine fehlende späte Follow-up-Phase ist jedoch weitere Forschung zur Persistenz der Stigmareduktion notwendig.

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Acknowledgements

The authors would like to thank the association “Irre Menschlich e. V.” and all its speakers. The involvement of service users is crucial to contact based anti-stigma work and made a successful implementation possible in the first place. This project is part of the dissertation process of D. Wechsler.

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Authors and Affiliations

  1. Centre for Psychosocial Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany

    Dominik Wechsler, Candelaria Mahlke & Thomas Bock

  2. Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany

    Georg Schomerus

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  1. Dominik Wechsler
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Contributions

D. Wechsler, C. Mahlke, G. Schomerus, and T. Bock conceived of the research question and/or designed the study. D. Wechsler oversaw the data acquisition. D. Wechsler and C. Mahlke analysed and interpreted the data. D. Wechsler drafted the report. All authors provided critical revisions to the report, important intellectual content and final approval.

Corresponding author

Correspondence to Dominik Wechsler.

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Conflict of interest

D. Wechsler, G. Schomerus, C. Mahlke, and T. Bock declare that they have no competing interests.

Ethical standards

An individual six-digit code was used for pseudonymization of participants and to match pre-and postquestionnaire scores. In agreement with the responsible department of research of the faculty of medicine, the study was conducted as part of the routinely administered evaluation of academic teaching and did not require additional ethical approval or written proof of consent exceeding the one given by students to the University of Hamburg for such purposes. Registration of this study was omitted as no patients were involved. The data that support this study’s findings are not uploaded due to legal restrictions.

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C. Mahlke and T. Bock equally share last authorship.

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Wechsler, D., Schomerus, G., Mahlke, C. et al. Effects of contact-based, short-term anti-stigma training for medical students. Neuropsychiatr 34, 66–73 (2020). https://doi.org/10.1007/s40211-020-00337-x

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  • DOI: https://doi.org/10.1007/s40211-020-00337-x

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