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Abstract
Aim This current study was conducted with the intention of assessing
attitudes toward mental illness and correlating the same knowledge in
regards to the same among medical doctors.
Materials and methods A cross sectional study design was used with
the sample of doctors obtained from medical officers, postgraduates,
resident doctors and consultants from various specialties and subspecialities employed at various hospitals and clinics in Chennai via
simple purposive sampling. The AMIQ (Attitudes toward mental illness
questionnaire) was employed to assess attitudes. A modified version of
the knowledge questionnaire used by the NMHP (national mental health
programme) was utilized to assess knowledge. Demographic variables and
information in regard to experience and field of expertise were also
collected.
Results and conclusion we found that the attitude toward heroin use (6.61), and schizophrenia (-3.26) were predominantly negative, however
depression (3.14) was perceived better. The study also revealed sub
optimal knowledge levels especially in the management of mental illness.
Introduction
In the Indian perspective, it would be unrealistic to try and solve problems
in mental health delivery systems with the services of psychiatric
specialists alone
would help direct future training and intervention methods that would
eventually lead to effective mental health care.
Data was collected via a three part questionnaire. The first part recorded
socio demographic information that included age, sex, marital status,
religion, specialty and designation, years of experience and information on
prior psychiatric exposure. The knowledge questionnaire
consisted of
Statistical Analysis
Independent sample Mann-Whitney U test and the Independent sample
Kruskall-Wallis test by ranks were used to compare the distribution of
knowledge and attitude scores among groups. Spearmans rank order
correlation was used to draw parallels between the demographic variables
and the attitude and knowledge scores.
Results
Out of the participants in our study MPs who had completed or are
pursuing post-graduation contributed substantially to the study population
(N=111). Among those who had completed their post-graduation,
specialists in internal medicine were the most represented population
(N=15), there was a slight over representation on of junior consultants
(N=45) when compared to senior consultants (N=34). 52.8% (N=66) had
completed their post graduate training, 25.6% (N=32) were post graduate
trainees, 11.2% (N=14) had completed their MBBS and 10.4% (N=13) of
our participants were pursuing or had completed subspecialty degrees. A
majority of the MPs who participated in our study were middle aged
males; the mean age was 36.19 (8.169) years with the youngest
participant being 22 years old and the eldest being 57 years old. There
were more males (N=73) when compared to females (N=52).
Attitude Scores
Vignettes
Heroin Use
125
Mean
Std. Deviation
-6.6080 2.782
Depression
125
3.1440 3.318
Alcohol use
125
0.6640 3.775
Schizophrenia
125
-3.2560 2.833
125
-6.0560 8.883
Heroin use was the most negatively perceived (-6.6080 2.782) of the
represented mental illnesses, however participants displayed a neutral
attitude
toward
alcohol
use
(0.6640
3.775).
Attitude
towards
total
score
(-4.648.71)
when
compared
to
unmarried
Knowledge
The maximum obtainable score per vignette was 12. Out of the vignettes,
participants obtained least mean knowledge scores in mania (4.53 3.09)
and schizophrenia (4.50 2.09). The participants obtained highest mean
scores in vignettes describing seizures (9.24 1.33) and anaemia (7.28
4.29). Participants obtained a mean score of 6.932.24 in the anxiety
vignette and 6.821.94 in the intellectual disability vignette. All the
participants diagnosed seizure disorder correctly. Participants had trouble
diagnosing alcohol induced psychosis (52%) and mania (54.4%). It was
encouraging to see that schizophrenia was well recognized (82.4%), but
the responses to the other questions based on pharmacological and nonpharmacological management in the schizophrenia vignette were less
than average (16.8% and 17.6% respectively). The answers also reflected
poor knowledge about both pharmacological and non-pharmacological
management of other mental illnesses such as mania (26.4%). On
comparing age and knowledge scores, a correlation coefficient of 0.288
indicated that with increasing age, knowledge about mental illness will
also increase. Medical officers had the least mean knowledge score
(39.687.56). Postgraduate trainees (47.116.83) scored slightly higher
than junior consultants (44.208.18). Senior consultants had the highest
knowledge score (48.327.46). No gender differences were noticed .
Married participants had better knowledge scores when compared to
unmarried participants.
Correlation between knowledge and attitude scores
Discussion
As of 2005 the world health organization reported that 154 million people
worldwide, suffered from depression. Nearly 106 million people suffer from
alcohol and other substance use disorders52. Upto 25% of the global
population is said to develop one or more mental or behavioral disorders
during their lifetime53. Despite approaching a number of medical officers
and senior specialists and sub specialists, a majority of them did not
return questionnaires. Some medical officers felt that the knowledge
questionnaire was too extensive and lost interest in completing the
questionnaire. Our study revealed overall negative attitudes toward
mental illness (-6.0560 8.883) among MPs. This is in agreement to the
results obtained in other studies also26, 30, 37, and 70. Participants who
were married and those with a higher number of years of experience
displayed better attitudes toward mental illness. This relationship between
age and experience is in accord with earlier studies on attitudes among
physicians38, 35. However there have been other studies with
contradicting results72. The negative attitude among MPs in our study
reflects general societal attitudes about mental illness. Negative attitudes
also exist in regard to the course of illness and the efficacy of the
treatment and associated side effects of medications prescribed. This view
is supported by many Indian and western studies72, 73. The rapid onset
of heroin dependence, associated deterioration in personality, distressing
withdrawal symptoms and rapid deterioration in functioning confers a
predominantly negative tag to heroin use even among those with
adequate knowledge. Physicians generally perceive drug users as violent,
distrustful, and manipulative56, 57. Surprisingly alcohol use received a
more or less neutral score among MPs (0.66 3.7), furthermore there
were no gender differences in the same. The apparent neutral attitude
toward alcohol use is possibly secondary to the nature of the AMIQ
vignette which describes a previously dependent individual who is
currently attending AA (Alcoholics Anonymous) meetings. The legality of