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ORIGINAL ARTICLE
Attitude of Medical Students towards Psychiatry: The case of Jimma
University, Southwest Ethiopia
Hailemariam Hailesilassie1, Habtamu Kerebih1, Alemayehu Negash1, Eshetu
Girma1, Mathias Siebeck3, Markos Tesfaye1
ABSTRACT
DOI: http://dx.doi.org/10.4314/ejhs.v27i3.2
208 Ethiop J Health Sci. Vol. 27, No. 3 May 2017
DOI: http://dx.doi.org/10.4314/ejhs.v27i3.2
Attitude of Medical Students towards Psychiatry… Hailemariam H. et al. 209
rotation were attending class room lectures, psychiatry clinical rotation/attachment at Jimma
morning and ward round meeting sessions. University Specialized Teaching Hospital,
Besides, they were involved in patient history psychiatry ward in the year of 2012.
taking and presenting it to their clinical Statistical analysis: Data was analyzed to
supervisors (psychiatrists). Fourth year medical generate descriptive statistics such as means,
students who were repeating their psychiatry frequencies and percentages using statistical
course, due to various reasons, were excluded package for social sciences (SPSS version 20).
from the study. Independent samples t-test was used to compare
Measurement: The English version of the 30- the difference in the mean ATP-30 scores of the
item self-administered Attitude towards Psychiatry study participants. Bivariate and multivariable
(ATP-30) questionnaire was used to measure the logistic regression was used to identify factors
attitude of medical students. The scale of ATP-30 independently associated with positive attitude
was developed in Canada by Burra et al (1982) towards psychiatry. P-value less than 0.05 was
(27) and has a 5-ponit Likert type scale responses used to declare statistical significance. A total
for the 30 items measuring the respondents’ score was calculated by adding all the item scores.
attitude to psychiatric patients, psychiatric illness, While scores above 60 were indicative of a
psychiatrists, psychiatry career choice, psychiatric favorable or positive attitude towards psychiatry,
treatment, psychiatric institutions and psychiatry scores below 60 were used to show an unfavorable
teaching. This scale has been shown to have good attitude; a score of 60 indicated a neutral attitude.
psychometric properties among medical students Ethical Approval: The ethical approval was
(27). This scale previously was used in studies obtained from the Research Ethical Review Board
done in west and east African countries among of the College of Public Health and Medical
medical students (13,16). In this study, the ATP- Sciences of Jimma University. An information
30 had three Likert scales (1=Disagree, 2=Neutral sheet was attached with each questionnaire to
(no opinion), and 3=Agree) that generates a total provide the study details and the rights of the
score between 30 and 90 with a higher score study participants. Written informed consent was
indicating a positive attitude towards psychiatry. obtained from the study participants. Data were
Prior to actual data collection, the investigators kept anonymous and confidential during all stages
pre-tested the ATP-30 scale on 10% of the study of the study.
participants among third and fifth year medical
students of Jimma University. Accordingly, the RESULTS
reliability of the pre-tested ATP-30 was
Cronbach’s alpha of 0.80. Background characteristics: Data were obtained
from all 122 medical students who participated in
Attitude refers to the feeling or approach of the study. The age of the respondents ranged from
Jimma University fourth year medical 20 to 26 years with the mean age of 22.4 years
students towards psychiatry as measured by and standard deviation of ±1.2 years. The majority
the scale of ATP-30. Highest mean score on of the students were male (78.7%) and 82% and
ATP-30 indicated favorable or positive single. Of the total of the study participants,
attitude towards psychiatry and vice versa. 14.8%, 25.4% and 32.8% reported personal
history of mental illness, family or/close relatives
Medical students were fourth year students who
history of mental illness and close friends history
were expected to take psychiatry clinical rotation
of mental illness respectively. More than half
as one course of their undergraduate medicine
(52.5%) of the students were originally from urban
study in the academic year of 2012.
areas. Nearly 46% of the students had just
Psychiatry clinical rotation refers to Jimma completed psychiatry rotation (Table1).
University fourth year medical students’
DOI: http://dx.doi.org/10.4314/ejhs.v27i3.2
210 Ethiop J Health Sci. Vol. 27, No. 3 May 2017
Attitudes towards Psychiatry: The reliability of 0.002), which indicated medium effect size (i.e.
ATP-30 was Cronbach’s alpha of 0.84 with mean Cohen’s d= 0.71); based on Cohen’s (1988)
52.87, SD=13.57, minimum=32.00 and criteria. The Participants with personal history of
maximum= 88.00. The mean ATP-30 score of mental illness reported significantly higher mean
medical students who did not take psychiatry of ATP compared to their counter parts (p=
clinical rotation was significantly higher than <0.001). Besides, participants with family history
those who completed psychiatry clinical rotation of mental illness scored significantly higher ATP
with p=0.019. Female students scored mean compared to those participants without it
significantly higher mean on attitude towards (p=<0.001) (Table 2).
psychiatry (ATP) compared to male students (p=
DOI: http://dx.doi.org/10.4314/ejhs.v27i3.2
Attitude of Medical Students towards Psychiatry… Hailemariam H. et al. 211
Factors associated with Positive attitude of mental illness had 14.5 times more positive
towards psychiatry: Female medical students attitude towards psychiatry than those medical
were nine times more likely to have positive students without it (OR=14.53, 95%
attitude towards psychiatry than male students CI:3.08;68.59). Similarly, students with family
(OR=9.23, 95% CI: 2.32; 36.76). Younger history of mental illness were 8.9 times more
medical students had a marginally positive attitude likely to have positive attitude towards psychiatry
than older ones (OR=3.86, 95% CI: 1.00; 14.90). than those who had no family history of mental
Students who did not take their psychiatry clinical illness (OR=8.95, 95% CI: 2.50; 32.00). However,
rotation were 7.6 times more likely to have variables such as marital status, place of origin
positive attitude towards psychiatry than those and close friends’ history of mental illness of the
who had completed psychiatry clinical rotation study participants did not significantly account for
(OR=7.58, 95% CI: 2.02; 28.37) (Table 3). On the their difference on attitude towards psychiatry
other hand, medical students with personal history (P>0.05) (Table 3).
Table 3: Logistic regression analysis results on factors predicting attitudes towards psychiatry
DOI: http://dx.doi.org/10.4314/ejhs.v27i3.2
212 Ethiop J Health Sci. Vol. 27, No. 3 May 2017
finding suggests that the psychiatry clinical became marginally negative which might be a
rotation might have resulted in a more negative chance finding. Perhaps, a larger sample of
attitude towards psychiatry among the medical students from several representative medical
students. Nevertheless, the findings could have schools will help understand if a true relationship
been due to disparity between medical students’ exists between age and attitude towards
expectations of the clinical psychiatry and the psychiatry. The absence of association between
actual practice. The other possible reason could be marital status and medical students’ attitude
that the students’ ratio to very limited number of towards psychiatry was reported in another study
psychiatrists might have led medical students not (3).
to have adequate supervision time during their As psychiatry clinical rotation during medical
exposure to mentally ill patients. Further research school training provides a rare opportunity to
thus is needed to confirm this. In particular, a create a positive attitude among young doctors,
qualitative study of the medical students’ psychiatrists involved in teaching need to address
experience during their psychiatry clinical rotation the issue. Negative attitude towards the field of
will be useful to interpret the findings. psychiatry means that there will be fewer young
On the other hand, in this study, female doctors who wish to pursue their career in
medical students had significantly positive attitude psychiatry. It is thus a barrier to building mental
towards psychiatry than male ones, which is health manpower in this field of specialty in the
supported by a previous research done in Pakistan country.
(21) but contradicted with the study report done The study suffers the following limitations.
in UK (12) which found that both male and female Firstly, the participants were selected from one
students did not differ in their attitudes towards medical school, and the findings may not be
psychiatry. This could imply that female medical generalizable to all medical schools in Ethiopia.
students from developing countries have more As the study is cross-sectional in design, causal
favorable attitude towards psychiatry than males. association cannot be established based on the
The finding that medical students with family findings. The relatively small sample size might
history of mental illness were found to have have led to under-power. Also, social desirability
positive attitude towards psychiatry is supported bias might have influenced the response of the
by a previous study (11). Besides, participants participants although it is less likely as the
with personal history of mental illness reported questionnaire was self-administered.
significantly positive attitudes toward psychiatry. Despite the limitations, the findings shed
Perhaps, medical students who had personal light on the attitudes towards psychiatry of
experience of mental illness were likely to medical students in Ethiopia. The observation that
empathize with other patients with mental illness completing psychiatry clinical rotation is
and were able to witness the beneficial effect of associated with less favorable attitude towards
psychiatric interventions. A period of five or six psychiatry is alarming and requires further
weeks of clinical rotation in a psychiatry clinic investigation into the pedagogic aspects of
where there are frequent shortage of essential psychiatry training. Longitudinal studies with
psychotropic medications and lack of mixed methods approach will help understand if
rehabilitation services (28) does not offer the the current psychiatry teaching in the medical
opportunity for trainees to witness recovery of school influences the medical students’ attitude
patients with mental illness. towards psychiatry.
On the other hand, this study found that
young medical students had more favorable ACKNOWLEDGMENT
attitudes towards psychiatry than older ones;
which is similar with results of previous studies The investigators of this study pass their deepest
(17). This may indicate that as the age of medical thank to Jimma University for supporting the
students increases, attitude towards psychiatry research activities financially.
DOI: http://dx.doi.org/10.4314/ejhs.v27i3.2
Attitude of Medical Students towards Psychiatry… Hailemariam H. et al. 213
DOI: http://dx.doi.org/10.4314/ejhs.v27i3.2
214 Ethiop J Health Sci. Vol. 27, No. 3 May 2017
DOI: http://dx.doi.org/10.4314/ejhs.v27i3.2