Anti-stigma training and positive changes in mental illness stigma outcomes in medical students in ten countries: A mediation analysis on pathways via empathy development and anxiety reduction

INDIGO READ study group, Laura C. Potts, Ioannis Bakolis, Tanya Deb, Heidi Lempp, Tushar Vince, Yasmin Benbow, William Waugh, San Kim, Syed Raza, Claire Henderson

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Abstract

Purpose
Studies of mental illness stigma reduction interventions have been criticised for failing to evaluate behavioural outcomes and mechanisms of action. This project evaluates training for medical students entitled ‘Responding to Experienced and Anticipated Discrimination’ (READ), developed to focus on skills in addition to attitudes and knowledge. We aimed to (i) evaluate the effectiveness of READ with respect to knowledge, attitudes, and clinical communication skills in responding to mental illness-related discrimination, and (ii) investigate whether its potential effectiveness was mediated via empathy or/and intergroup anxiety.

Methods
This is an international multisite non-randomised pre- vs post-controlled study. Eligible medical students were currently undertaking their rotational training in psychiatry. Thirteen sites across ten countries (n = 570) were included in the final analysis.

Results
READ was associated with positive changes in knowledge (mean difference 1.35; 95% CI 0.87 to 1.82), attitudes (mean difference − 2.50; 95% CI − 3.54 to − 1.46), skills (odds ratio 2.98; 95% CI 1.90 to 4.67), and simulated patient perceived empathy (mean difference 3.05; 95% CI 1.90 to 4.21). The associations of READ with knowledge, attitudes, and communication skills but not with simulated patient perceived empathy were partly mediated through student reported empathy and intergroup anxiety.

Conclusion
This is the first study to identify mediating effects of reduced intergroup anxiety and increased empathy in an evaluation of anti-stigma training that includes behavioural measures in the form of communication skills and perceived empathy. It shows the importance of both mediators for all of knowledge, skills, and attitudes, and hence of targeting both in future interventions.
Original languageEnglish
Pages (from-to)1861-1873
Number of pages13
JournalSocial Psychiatry and Psychiatric Epidemiology
Volume57
Issue number9
Early online date22 Apr 2022
DOIs
Publication statusPublished - Sept 2022

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