Date of Award

1-1-2019

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Robert Rosenheck

Abstract

BACKGROUND:

Mental health stigma is a worldwide problem that affects health care providers, as well as the general population. The current study used survey data from students and physicians in the Philippines to examine the association of higher levels of medical education with levels of

stigma. Further, attitudes among medical students in the Philippines were compared with levels among medical students in the US, Brazil, Ghana, Nigeria and China. Qualitative interviews were used to further understand these data.

METHODS:

A convenience sample was collected from medical students before and after medical school psychiatric training from the University of the Philippines Manila, as well as from graduate physicians from Philippine General Hospital and The Medical City hospital. Respondents completed a 43-item survey on attitudes toward mental health patients and the causes of mental illness. Factor analysis identified three de-stigmatized factors which were used to compare attitudes among medical students and graduate physicians. Stigma factor scores from Filipino students were also compared with re-analyzed responses to the same survey from medical students in the U.S., Brazil, Ghana, Nigeria, and China. In the qualitative component, medical students from the University of the Philippines Manila participated in in-depth interviews after completing the quantitative survey, until saturation of responses was reached.

RESULTS:

Surveys were completed by 76 medical students (31%) with no prior mental health training, 43 medical students (18%) with psychiatric classroom and/or clerkship experience, and 125 graduate physicians (51%). Exploratory factor analysis identified three de-stigmatizing factors representing acceptance of social integration of mental health patients into society, positive personal interactions with people experiencing mental illness, and rejection of a supernatural etiology of mental illness. Overall attitude scores for all de-stigmatizing attitude factors were relatively high among the sample (above 0.90s on 0-1 scale). On the social integration factor, both medical student groups reported higher (less stigmatized) scores than graduate physicians (F = 3.45, p = 0.033). On the personal socialization factor, medical students with no psychiatric experience had significantly higher scores in comparison to graduate physicians (F = 4.11, p = 0.018). International comparisons show that attitude scores among medical students from the Philippines were generally higher than scores from medical students sampled from the U.S., Brazil, Ghana, Nigeria, and China. Qualitative interviews (n=15) confirmed de-stigmatized attitudes among Philippine students as based in personal experience of mental illness, belief in a multifactorial etiology of mental illness, recognition of unjust barriers to mental health care, and hope for holistic solutions to improving care.

CONCLUSION:

This study revealed overall positive attitudes among Philippine medical students and graduate physicians, although stigma was seen to increase slightly with greater education and clinical experience. In comparison to the five other countries included in this analysis, less stigma was reported among the sample of Philippine medical students. Lastly, qualitative interviews confirmed low levels of stigma among the medical community, while identifying higher levels of stigma in the general population.

Comments

This is an Open Access Thesis.

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