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ATTITUDE TOWARDS PSYCHIATRY AND PSYCHIATRISTS AMONG MEDICAL STUDENTS IN TERTIARY HEALTH CARE HOSPITAL

Background . Psychiatry is a medical subject; many medical students ignore its importance in medicine. Regarding mental illness, many medical professionals and students are less aware as mental illness is very important in affecting the quality of care the patient receives and in choosing psychiatry as a career. This study specializes in psychiatry based on many factors, however undergraduate students’ attitude towards career choice is the most important. Objective. This study aims to explore attitude towards psychiatry subject among undergraduate medical students. Methods. This is a Descriptive cross-sectional study done at Vikhe Patil Medical College, Ahmednagar. The total of 295 volunteer students from all phases of MBBS (Bachelor of Medicine and Bachelor of Surgery) were enrolled by purposive sampling, a 30-item self-administered questionnaire, ATP-30 (Attitude towards Psychiatry) was used to measure the attitude of medical students. Data collected was analysed using SPSS version 24. The results were reported as percentage and frequencies. Results. In the study, 47.4% of the respondents were males and 52.6% were females. Out of total study participants 52.3% of our study respondents strongly agreed that psychiatry was a respected branch of medicine; 56.7% strongly agreed that psychiatry should be an important part of medical curriculum; 19.4% of study respondents considered it in the list of the career choice while the majority did not think that it should be in their career list options. Conclusions. In the study, the students from the later phases of MBBS showed positive attitude than that of the initial phases. Many students found it as respected subject and essential field of medicine for their choice of profession. However, shortcoming knowledge and awareness was observed in the responses pertaining to present available treatment and recent trends in the field.


Introduction
According to the World Health Organization (WHO), mental disorders and mental illness are today the most significant part of the global burden of diseases [1]. Psychiatric disorders affect 10% of adult population [2]. Whereas mental disorders are either ignored by majority of people in their life or hesitated to share having very few psychiatrists. Globally, psychiatry as a subject, psychiatrists as professionals, and patients with psychiatric disorders are subjected to cultural stereotypes and negative attitude by the general population. The alarming concern is that these prejudices exist within the medical community as well [3,4].
This information has serious implications on psychiatry.
Most mental illness in people are undiagnosed or underdiagnosed as people with mental disorders hesitate and remain silent to pursue medical care due to presenting stigma and discrimination to them [5].
Stigma exists even in the health care system and even students carry prejudices to choose and enter into psychiatry, which affects medicine. In this aspect, evaluation of undergraduate students for their attitude towards mental health issues is important as they are future of nation and going to influence directly or indirectly the health system [6]. Psychiatric teaching in the undergraduate medical curriculum appears negligible and short due to insufficient number of allotted lectures, no available qualified teaching staff as well as lack of proper clinical positions, which results to inadequate exposure of medical students to psychiatry [7, 8,9].
This study aims at evaluating the current attitudes towards psychiatry as a subject, which can further help in revising the curriculum, teaching and learning methods of undergraduates in order to improve the understanding of mental health issues in community and medical profession.

Methods
This descriptive study was done after approval from the ethical committee, was conducted at Vikhe Patil Medical College. Ahmednagar for 6 months duration from July to December 2019. The study includes 295 medical students from all phases of MBBS (Bachelor of Medicine and Bachelor of surgery) selected with purposive sampling. Purpose of the present study was informed to participants about research and voluntary participation was invited. Informed consent was taken and confidentiality was maintained and ensured for every participant though questionnaire did not included any information for identification. Those not giving consent and not willing to participate were excluded from study. Modified short ATP-30 (Attitude towards Psychiatry developed in Canada by Burra et al (1982) a 30 item self-administered questionnaire was used to measure the attitude of medical students in this study [10]. This scale measured the attitude of respondents such as towards psychiatry patients, psychiatry illness, psychiatry knowledge, psychiatry treatment including drugs, psy chiatrists, psychiatry career choice, and psychiatry training. The ATP Uses a 5-Point Likert type Scale: 1; Strongly Agree, 2; Agree, 3; Neutral Opinion, 4; Strongly Disagree, And 5; Disagree. Total score on the scale indicates positive or negative attitude, with a high total score indicating positive and low score indicating negative attitudes toward different aspects of psychiatry. Data was analysed using SPSS version 24.
Results were entered in Microsoft excel and were presented as frequencies and percentages.

Results
All 295 students were analysed in order to assess their attitude towards psychiatry by a questionnaire. The distribution of the respondents according to gender and professional year is presented in Table 1.
Among all 295 participants involved for the analysis, 53.98% (n=159) were males and 46.10% (n=136) were females. The highest number of participants were from final year of study (n=110, 37.2%), followed closely by the second professional phase (n=139, 34.4%) and the 1 st year of study (n=119, 29.45%). Apart from the 1 st year students, all other participants (n=212, 71.5%) had been exposed to psychiatry postings and lectures as per the current MBBS curriculum.
The majority of students (n=185, 63%) considered psychiatry to be a respected branch of medicine and 79.9% (n=230) thought that psychiatric illnesses deserve as much attention as physical illnesses. 240 respondents (81.1%) agreed that psychiatry should have been an important part of school curriculum (Table 2).

Discussion
The interlinking has always existed between mental and physical health in all individuals. Undergraduate attitude towards mental health has significant influence in their future medical practice and the quality of life of patients. All MBBS undergraduates of all phases of study were involved into the study fairly. The formal students of pre and para clinical subjects did not receive any formal introduction to psychiatry while the other students studied psychiatry either in the forms of lectures or clinical postings. The majority of our study respondents are from the final phase of study (37.2%) among the respondents involved. The analysis of the study results shows that the majority of students has positive attitude towards psychiatry. 47.5% of our study respondents strongly agree that psychiatry is a respected branch of medicine; 40.7% believe most patients do not go  to a psychiatrist even if they have mental health problems.
Many students strongly agree that psychiatry should be an important part of medical curriculum (81%).
In certain aspects of the study, positive outcomes were noted regarding positive attitude toward psychiatrists. Many of the students thought of psychiatry as an important stimulating discipline and psychiatric practice perceived to have promising prospects. Our study findings were positively surprising compare to previous ones, which had reported same numbers with fewer respondents viewing psychiatry and psychiatrists in a positive light [11,12]. However, a few studies in UK, Australia and France shows opposing results [13,14]. In fact, many students believe in magic, ghosts and family history [15].
Thus, the study results are consistent with the research findings of the respondents, who consider psychiatry as exciting specialty and in the list of their future career choice, while a few has neutral opinion and some students con-sider it in the list of top specialties that they will likely to choose in the future [16].

Conclusions
Even though lack of sufficient knowledge about the reasons behind mental problems students have positive attitude towards psychiatrists and psychiatry because of its importance in medicine. The study highlights the attitude of medical students towards psychiatry as their future preference of choice. This might be because a majority of students find psychiatry to be a respected and essential field of me dicine. The study also focuses on the need for further development of theoretical and clinical teaching of psychiatry at the undergraduate level to overcome these faults.

Conflicts of interest
The author declares no conflict of interest.

Acknowledgements
We thank all the participants for active participation of the study. The research did not have any financial support and sponsorship.