Effect of clinical rotation on attitude of medical students towards psychiatry and mental patients: a cross-sectional study from Western Rajasthan

Aditi Agrawal, Sanjay Gehlot, Ashok Singhal, Amandeep .


Background: People with mental illnesses experience extreme stigmatization and discrimination despite their ubiquitous presentation. Studies have reported that these negative stereotypes are shared by health care professionals too. Attitude of undergraduate medical students towards psychiatry is vital as it reflects their willingness to deal with psychiatric and behavioral disorders in general practice.

Methods: A descriptive cross-sectional study was conducted in a government medical college in Rajasthan to explore the impact of sociodemographic variables and undergraduate psychiatry training on the attitude of medical students towards mental illness and psychiatry. 105 first year MBBS students and 75 interns participated in the study. Attitude towards mental illness (AMI) scale and attitude towards psychiatry-30 (ATP-30) scale were used to document AMI and ATP respectively. Data collected were analyzed using SPSS statistical software and appropriate tests were used to compare mean scores of both groups.

Results: There was no statistically significant difference on AMI and ATP scores between the undergraduate medical students and interns. Females, students belonging to urban setting and more educated families had a favorable attitude towards psychiatric patients. A notable shift in scores on ATP scale towards positive side was reflected between male MBBS students and interns and among students coming from rural background with exposure to medical curriculum.

Conclusions: No attitude change was observed in majority of participants indicating need for greater emphasis on mental health and psychiatry.



Attitude, Interns, Medical students, Mental illness, Psychiatry

Full Text:



The World Health Report: Mental Health: New Understanding, New Hope. Geneva: World Health Organization; 2001.

Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. National mental health survey of India, 2015-16: Summary. Bengaluru: National Institute of Mental Health and Neurosciences; 2016.

Rüsch N, Angermeyer MC, Corrigan PW. Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry. 2005;20(8):529-39.

Corrigan PW. On the stigma of mental illness: Practical strategies for research and social change. Am Psychol Assoc. 2005.

Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. Public conceptions of mental illness: labels, causes, dangerousness, and social distance. Am J Public Health. 1999;89(9):1328-33.

Loganathan S, Murthy SR. Experiences of stigma and discrimination endured by people suffering from schizophrenia. Indian J Psychiatry. 2008;50(1):39.

Thara R, Srinivasan TN. How stigmatising is schizophrenia in India? Int J Soc Psychiatry. 2000;46(2):135-41.

Schmitt MT, Branscombe NR, Postmes T, Garcia A. The consequences of perceived discrimination for psychological well-being: a meta-analytic review. Psychol Bull. 2014;140(4):921.

Henderson C, Noblett J, Parke H, Clement S, Caffrey A, Gale-Grant O, et al. Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry. 2014;1(6):467-82.

Lauber C, Nordt C, Falcato L, Rössler W. Factors influencing social distance toward people with mental illness. Community Ment Health J. 2004;40(3):265-74.

Schulze B. Stigma and mental health professionals: a review of the evidence on an intricate relationship. Int Rev Psychiatry. 2007;19(2):137-55.

Wahl O, Aroesty‐Cohen E. Attitudes of mental health professionals about mental illness: a review of the recent literature. J Community Psychol. 2010;38(1):49-62.

Office of the Surgeon General (US), Center for Mental Health Services (US), National Institute of Mental Health (US). Mental health: culture, race, and ethnicity. a supplement to mental health: a report of the surgeon general. Rockville: Substance Abuse and Mental Health Services Administration (US); 2001.

Schulze B, Angermeyer MC. Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals. Soc Sci Med. 2003;56(2):299-312.

Harangozo J, Reneses B, Brohan E, Sebes J, Csukly G, Lopez-Ibor JJ, et al. Stigma and discrimination against people with schizophrenia related to medical services. Int J Soc Psychiatry. 2014;60(4):359-66.

Adewuya AO, Oguntade AA. Doctors’ attitude towards people with mental illness in Western Nigeria. Soc Psychiatry Psychiatr Epidemiol. 2007;42(11):931-6.

Ay P, Save D, Fidanoglu O. Does stigma concerning mental disorders differ through medical education? Soc Psychiatry Psychiatr Epidemiol. 2006;41(1):63-7.

Naeem F, Ayub M, Javed Z, Irfan M, Haral F, Kingdon D. Stigma and psychiatric illness. A survey of attitude of medical students and doctors in Lahore, Pakistan. J Ayub Med Coll Abbottabad. 2006;18(3):46-9.

Singh SP, Baxter H, Standen P, Duggan C. Changing the attitudes oftomorrow's doctors' towards mental illness and psychiatry: a comparison of two teaching methods. Med Educ. 1998;32(2):115-20.

Curtis-Barton MT, Eagles JM. Factors that discourage medical students from pursuing a career in psychiatry. Psychiatrist. 2011;35(11):425-9.

Korszun A, Dinos S, Ahmed K, Bhui K. Medical student attitudes about mental illness: does medical-school education reduce stigma? Acad Psychiatry. 2012;36(3):197-204.

Malhi GS, Parker GB, Parker K, Carr VJ, Kirkby KC, Yellowlees P, et al. Attitudes toward psychiatry among students entering medical school. Acta Psychiatr Scand. 2003;107(6):424-9.

Dixon RP, Roberts LM, Lawrie S, Jones LA, Humphreys MS. Medical students’ attitudes to psychiatric illness in primary care. Med Educ. 2008;42(11):1080-7.

Economou M, Kontoangelos K, Peppou LE, Arvaniti A, Samakouri M, Douzenis A, et al. Medical students’ attitudes to mental illnesses and to psychiatry before and after the psychiatric clerkship: training in a specialty and a general hospital. Psychiatry Res. 2017;258:108-15.

Lyons Z, Janca A. Impact of a psychiatry clerkship on stigma, attitudes towards psychiatry, and psychiatry as a career choice. BMC Med Educ. 2015;15(1):34.

Markström U, Gyllensten AL, Bejerholm U, Björkman T, Brunt D, Hansson L, et al. Attitudes towards mental illness among health care students at Swedish universities-a follow-up study after completed clinical placement. Nurse Educ Today. 2009;29(6):660-5.

Yadav T, Arya K, Kataria D, Balhara YP. Impact of psychiatric education and training on attitude of medical students towards mentally ill: A comparative analysis. Ind Psychiatry J. 2012;21(1):22.

Fischel T, Manna H, Krivoy A, Lewis M, Weizman A. Does a clerkship in psychiatry contribute to changing medical students’ attitudes towards psychiatry? Acad Psychiatry. 2008;32(2):147-50.

Economou M, Peppou LE, Louki E, Stefanis CN. Medical students' beliefs and attitudes towards schizophrenia before and after undergraduate psychiatric training in Greece. Psychiatry Clin Neurosci. 2012;66(1):17-25.

Burra P, Kalin R, Leichner PW, Waldron JJ, Handforth JR, Jarrett FJ, et al. The ATP 30-a scale for measuring medical students' attitudes to psychiatry. Med Educ. 1982;16(1):31-8.

World Medical Association. Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. 2008.

Prathaptharyan TJ, Annatharyan D. Attitudes of 'tomorrow's doctors' towards psychiatry and mental illness. Natl Med J India. 2001;14:355-9.

Gulati P, Das S, Chavan BS. Impact of psychiatry training on attitude of medical students toward mental illness and psychiatry. Indian J Psychiatry. 2014;56(3):271.

Rajagopalan M, Kuruvilla K. Medical students' attitudes towards psychiatry: effect of a two week posting. Indian J Psychiatry. 1994;36(4):177.

Tan SM, Azmi MT, Reddy JP, Shaharom MH, Rosdinom R, Maniam T, et al. Does clinical exposure to patients in medical school affect trainee doctors' attitudes towards mental disorders and patients?-a pilot study. Med J Malaysia. 2005;60(3):328.

Al-Ansari A, Alsadadi AA. Attitude of Arabian Gulf University medical students towards psychiatry. Educ Health (Abingdon). 2002;15(2):180-8.

Gureje O, Lasebikan VO, Ephraim-Oluwanuga O, Olley BO, Kola L. Community study of knowledge of and attitude to mental illness in Nigeria. Br J Psychiatry. 2005;186(5):436-41.

Desai ND, Chavda PD. Attitudes of undergraduate medical students toward mental illnesses and psychiatry. J Educ Health Promot. 2018;7:50.

Mahto RK, Verma PK, Verma AN, Singh AR, Chaudhury S, Shantna K. Students’ perception about mental illness. Ind Psychiatry J. 2009;18(2):92.

Roberts LM, Wiskin C, Roalfe A. Effects of exposure to mental illness in role-play on undergraduate student attitudes. Fam Med. 2008;40(7):477-83.