Physician Self-disclosure of Lived Experience Improves Mental Health Attitudes Among Medical Students: A Randomized Study

Abstract

Introduction: Depression and suicidal ideation are common among medical students, a group at higher risk for suicide completion than their age-normed peers. Medical students have health-seeking behaviors that are not commensurate with their mental health needs, a discrepancy likely related to stigma and to limited role-modeling provided by physicians. Methods: We surveyed second-year medical students using the Attitudes to Psychiatry (ATP-30) and Attitudes to Mental Illness (AMI) instruments. In addition, we asked questions about role-modeling and help-seeking attitudes at baseline. We then conducted a randomized trial of an intervention consisting of 2 components: (a) a panel of 2 physicians with personal histories of mental illness speaking about their diagnosis, treatment, and recovery to the students, immediately followed by (b) small-group facilitated discussions. We repeated the ATP-30 and AMI after the active/early group was exposed to the panel, but before the control/late group was similarly exposed. Results: Forty-three medical students participated (53% women). The majority of students (91%) agreed that knowing physicians further along in their careers who struggled with mental health issues, got treatment, and were now doing well would make them more likely to access care if they needed it. Students in the active group (n = 22) had more favorable attitudes on ATP-30 ( P = .01) and AMI ( P = .02) scores, as compared with the control group (n = 21). Conclusion: Medical students can benefit from the availability of, and exposure to physicians with self-disclosed histories of having overcome mental illnesses. Such exposures can favorably improve stigmatized views about psychiatry, or of patients or colleagues affected by psychopathology. This intervention has the potential to enhance medical students’ mental health and their health-seeking behaviors.

Shared Living Experiences by Physicians have a Positive Impact on Mental Health Attitudes and Stigma among Medical Students: A Mixed-Methods Study

“…In a previous study we showed that medical students can benefit from the availability of, and exposure to senior physicians sharing their experiences living with mental illnesses. 9 Theoretically informed by Allport’s contact hypothesis, 10 we found that exposure to candid sharing from trusted mentors and role models challenged medical students’ internalized stigma about mental illness and improved attitudes about their own struggles and human fallibility. We remain committed to our overarching philosophy that in order “to stem further stress-driven attrition from the profession and the tragedy of physician suicide, medical students must be shown from the time of matriculation that it is acceptable to struggle and seek help, that treatment works, and that imperfection is what makes us human, just like our patients”.…”

“…We remain committed to our overarching philosophy that in order “to stem further stress-driven attrition from the profession and the tragedy of physician suicide, medical students must be shown from the time of matriculation that it is acceptable to struggle and seek help, that treatment works, and that imperfection is what makes us human, just like our patients”. 9 …”

“…Although encouraging in its findings, our initial study, which we conducted in the spring of 2019, 9 had several limitations, including: (1) an exclusive focus on psychopathology; (2) a small pilot sample size; (3) outcome measures not optimally aligned with our target constructs of interest; and (4) no way of knowing which specific components of the intervention had proven effective. To address those limitations and build on this promising line of research, we conducted a study with a new cohort of medical students from the same institution and in which: (1) physician-instructors shared broader examples of overcoming missteps and hardship; (2) twice as many students participated; (3) we used a psychometric instrument that more accurately represented the students’ experience, invluding their willingness to seek psychological help; and (4) we explored the range of active components of our intervention using a qualitative approach.…”

“…In this new study we have opted for “sharing living experience” over “self-disclosure”, the term we had used in our earlier report. 9 “Sharing” emphasizes a relational component, whereas “disclosure” focuses on the one proffering the information. Moreover, liv ing highlights the ongoing nature of the shared experience, as opposed to a liv ed experience relegated to a past tense, which could give a misleading sense of finality and completion.…”

National Prevalence of Disability and Clinical Accommodations in Medical Education

“… 7 - 9 Indeed, one study suggests that when physician educators share stories of their struggles with mental health, students are more likely to engage in help seeking behaviors, which may include disability disclosure. 10 Finally, the Liaison Committee on Medical Education (LCME), the accreditation body for MD programs, requires schools to excuse students from clinical experiences to seek healthcare, which may contribute to the higher number of psychological disability disclosures and clinical accommodations in MD versus DO programs given the lack of an equivalent requirement from COCA. 11 It is important to note that despite the high prevalence of psychological disability and clinical accommodations in MD programs, the proportion of students reporting psychological disability remains small.…”