Attitude of Medical Students Towards Psychiatry in a Tertiary Care Hospital

: Background : Dearth of psychiatrist specialists is evident worldwide. Awareness of undergraduate students towards mental illness has an important role in affecting the quality of care the patient receives and in choosing psychiatry as a career . Decision to specialize in psychiatry based on many factors, however attitude of undergraduates towards career choice play most important role in this aspect. Objective : This study aims to explore attitude and towards psychiatry among medical undergraduates in tertiary care hospital and factors influencing this decision. Methodology: It was Descriptive cross sectional study done at Nishtar medical University, tertiary care hospital of Multan Pakistan from July to December 2019. The total 384 students from first to final year were enrolled by non probability convenient sampling technique. Participation was voluntary and ensured that response would be kept anonymous. ATP-30 (Attitude towards Psychiatry) a 30 item self-administered questionnaire was used to measure the attitude of medical students. Data collected on a pre defined questionnaire was analyzed using SPSS version 23. Results pertaining to rates were reported as frequencies and percentages. Result : 47.4% of study respondents were male and 52.6 % were female. 52.3% of our study respondents strongly agree that psychiatry was respected branch of medicine and 56.7% strongly agree that psychiatry should be an important part of medical curriculum. 19.4% of study


Introduction
According to the World Health Organization (WHO), mental disorders are now the most significant proportion of the global burden of disease. 1 Alarming figures indicate that more than 450 million people in the world suffering from psychiatric disorders. 2 . Furthermore, according to WHO report, in 2014, there is less than 1 psychiatrist who was serving 100,000 people in nearly half of the world's population and there were approximately 7.7 nurses per 100,000 people working in mental health settings worldwide . 3 These figures have serious implications on psychiatry. A shortage of specialists both in terms of psychiatrists and psychiatric nurses 5is evident 4,5 .
Most mental illness remain undiagnosed or under diagnosed as people with mental disorders hesitate to pursue medical care due to presenting stigma and discrimination. 6 Stigma exist even in the health care system 7,8 . 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 health delivery system .
Worldwide, studies show negative attitude among medical students toward psychiatry and mental illness. 9,10,11 There are many reasons for this negative attitude as lack of correct information regarding mental illness and insufficient contact with mentally ill patients. 12 Limited recent researches on attitudes towards psychiatry within the medical profession are available. 13 However present studies indicates unfavorable attitudes of undergraduates towards psychiatry as a career compared with other medical disciplines. 10 The need for positive role models and proactive career advice at this level to encourage undergraduate students to choose psychiatry as a career has been identified . 14 Moreover studies show that to encourage experiences during students' clerkship in psychiatry and their personal contact with psychiatric illness increase the possibility of a positive perception about the profession. 15 On the average, only 2% to 4% undergraduate medical students class choose psychiatry as a career. This problem is much more critical in developing countries like Pakistan, where current rates of psychiatric specialists is dreadfully short of the needs of the community. 16 This study aims at evaluating the current attitudes towards psychiatry which can further help in revising the curriculum ,modifying the teaching and training methods of undergraduates in order to improve the understanding of mental health issues in community and to improve positive perception about this profession.

Materials and Methods
After approval from the ethical committee, the descriptive cross-sectional study was conducted at Nishtar Medical University, Multan, Pakistan for 6 months duration from July to December 2019 . This medical university also offer specialist training in psychiatry. The study include 384 students from first to final year MBBS .The sample size was calculated by using formula; n= z 2 pq/d 2 Where z is 1.96 with 95 % confidence level , similar research has not been performed in our setting, so response distribution is considered to be 50% with margin of error 5% (0.05) 17 . Sample was selected through non probability convenient sampling technique. Participants were informed about the purpose of the research, that participation was voluntary. Informed consent was taken and confidentiality was ensured for every participant, for this purpose the students ,their responses would remain anonymous, since the questionnaire did not include any information by means of which they could be identified. Those who were on leave and not willing to participate were excluded from study.
ATP-30 (Attitude towards Psychiatry) a 30 item self-administered questionnaire was used to measure the attitude of medical students. This was developed in Canada by Burra et al (1982) 18 . This scale measured the attitude of respondents such as towards psychiatry patients, psychiatry illness, psychiatry knowledge, psychiatry treatment including drugs, psychiatrists, 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 analyzed using SPSS version 23. Results pertaining to rates were reported as frequencies and percentages.

Results
A total number of 384 students were interviewed to assess their attitude towards psychiatry. The distribution of the respondents according to gender and professional year is given in Table-I. Majority of the students (n=300, 780.2%) considered psychiatry to be a respected branch of medicine and 92.9% (n=357) thought that psychiatric illnesses deserve as much attention as physical illnesses.316 respondents (82.2%) agree that psychiatry should be an important part of school curriculum .Responses to other items in this section of the ATP are given in Table-II. Majority of respondents (297; 77.3%) are in opinion that genes and family history play an important role in etiology of mental illness. More than half of the participants of the study strongly disagree that the imam and spiritual healers had a role in the management of psychiatric patients and psychiatric illness as a result of punishment of sin. The response to other statements exploring the cultural beliefs surrounding psychiatry is given in Table-III  19.5% (n=75) of the students agreed to psychiatry being one of three most exciting specialties. While majority shows disagreement in considering it as their specialty in career choice. The response to other aspects of psychiatry as a career choice is given in Table -IV.

Discussion
Mental and physical health is interlinked. The attitude towards mental health among undergraduates has significant influence in future which directly or indirectly affect the quality of life of patients.
In this study, students from all five years of professional education (M.B.B.S) were fairly represented. The first and second-year students had not received any formal introduction to psychiatry while the remaining three years were exposed to psychiatry, either in the forms of lectures or clinical rotations.
Majority of our study respondents are from fourth year (23.2%) and final year MBBS (22.9%).47.4% of study respondents are male and 52.6 % are female. Our results show that majority of students has positive attitude towards psychiatry.52.3% of our study respondents strongly agree that psychiatry is respected branch of medicine and 56.7% strongly agree that psychiatry should be an important part of medical curriculum. A similar study conducted by Khan et  When interview regarding etiology of psychiatric diseases , majority of study participants attributed them to genetic and family history. Most of the participants shows disagreement to magic , ghosts and punishment from GOD as cause of psychiatric illness. A similar finding was also reported by G.Aruna and colleagues and shows consistency to our results. 23 Our results are in line with the research findings conducted among undergraduates in Gujarat. 24 19.4 %of study respondents considered psychiatry as exciting specialty and considered it in the list of their career choice in future while 25.5 % has neutral opinion and 54.9% not consider it in the list of top specialties that they will likely to chosen in their future. Our research corroborates with Samari et al who explore attitudes of undergraduates and nurses towards psychiatry and factors influencing this decision. 25

Conclusion
The attitudes of medical undergraduates towards various aspects of psychiatry show an eclectic mix. It is encouraging that a majority of students find psychiatry to be a respected and essential field of medicine reflecting the changing trends in society and the medical community. Yet a lack of knowledge and persisting cultural beliefs can be observed in the responses pertaining to the etiology and treatment of psychiatric disorders. The study highlights the need to further strengthen the theoretical and clinical teaching of psychiatry at the undergraduate level to overcome these shortcomings.