Department of Psychological Medicine, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
Aust N Z J Psychiatry. 2021 Sep;55(9):903-910. doi: 10.1177/0004867420987886. Epub 2021 Jan 17.
This study sought to investigate the impact of a service user-led anti-stigma and discrimination education programme, encompassing numerous interventions focused on facilitating multiple forms of social contact, the promotion of recovery, and respect for human rights, on medical student attitudes.
A comparison cohort study was used to compare the attitudes of two cohorts of medical students who received this programme as part of their fifth (the fifth-year cohort) or sixth (the sixth-year cohort) year psychological medical education attachment (programme cohorts) with two cohorts of equivalent students who received a standard psychological medical attachment (control cohorts). Attitudes to recovery (using the Recovery Attitudes Questionnaire) and stigma (using the Opening Minds Scale for Healthcare Providers) were measured at the beginning and end of the attachments for each year and compared both within and between the cohorts using Wilcoxon signed-rank or Wilcoxon rank-sum tests.
With sample sizes ranging from 46 to 70 across all cohorts, after their psychological medicine attachment both the programme and control cohorts showed more positive attitudes towards recovery and less stigmatising attitudes towards people with lived experience of mental distress. Significant differences between the programme cohorts and the control cohorts were found for recovery attitudes (median difference of 2, < 0.05 in both fifth and sixth year), with particularly large differences being found for the 'recovery is possible and needs faith' subdomain of the Recovery Attitudes Questionnaire. There were no significant between cohort differences in terms of stigmatising attitudes as measured by the Opening Minds Scale for Healthcare Providers.
The introduction of a comprehensive service user-led anti-stigma and education programme resulted in significant improvements in recovery attitudes compared to a control cohort. However, it was not found to be similarly superior in facilitating less stigmatising attitudes. Various possible reasons for this are discussed.
本研究旨在探讨以服务使用者为主导的反污名和反歧视教育计划对医学生态度的影响。该计划包含了多种干预措施，旨在促进多种形式的社会接触、促进康复和尊重人权。
采用对比队列研究，比较了两个队列的医学生的态度，他们在第五年（第五年队列）或第六年（第六年队列）的心理医学教育实习中接受了该计划，以及两个接受标准心理医学实习的队列（对照组）。在每个学年的实习开始和结束时，使用康复态度问卷（Recovery Attitudes Questionnaire）和医疗服务提供者开放心态量表（Opening Minds Scale for Healthcare Providers）测量对康复的态度和污名。使用 Wilcoxon 符号秩和检验或 Wilcoxon 秩和检验比较每个队列内和队列间的态度变化。
在所有队列中，样本量从 46 到 70 不等，在接受心理医学实习后，计划组和对照组对康复的态度都更加积极，对有精神困扰经历的人的污名化态度也有所减轻。在第五年和第六年，计划组和对照组在康复态度方面存在显著差异（中位数差异分别为 2，<0.05），特别是在康复态度问卷的“康复是可能的，需要信念”子领域。在医疗服务提供者开放心态量表测量的污名化态度方面，计划组和对照组之间没有显著的队列间差异。
与对照组相比，引入全面的以服务使用者为主导的反污名和教育计划，显著改善了康复态度。然而，在促进较少污名化态度方面，它并没有表现出同样的优越性。讨论了各种可能的原因。
