Occupational Therapy Students’ Stigmatizing Beliefs About People With Schizophrenia

PURPOSE: People with mental illness (MI) experience stigma that impedes community integration and self-efficacy (Overton & Medina, 2008). Health care providers’ negative attitudes toward people with schizophrenia may adversely affect health care access and participation (Mittal et al., 2014). Students in health care training programs, including occupational therapy (OT), have endorsed stigmatizing beliefs about people with MI (Boyle et al., 2010), especially students with less familiarity (Feeg, Prager, Moylan, Smith, & Cullinan, 2014). Mental health fieldwork may improve OT students’ attitudes (Beltran, Scanlan, Hancock, & Luckett, 2007). The present study assessed the stigmatizing beliefs of students across the 5 yr of an OT program. The research questions were (1) How does student familiarity with MI change based on year in program (YIP)? and (2) How do students’ beliefs about people with MI change?

DESIGN AND METHOD: A quantitative cross-sectional study was conducted. Participants were university students in all 5 yr of an OT program; they completed demographic surveys and two assessments (Corrigan, 2013): Level of Familiarity (LoF) and Attribution Questionnaire (AQ–27). The AQ–27 presents a vignette about a person with schizophrenia, followed by 27 questions with Likert-type responses. Responses yield nine attitude factors, which served as proxies for stigmatizing beliefs. Preliminary data analysis plan included analysis of variance (ANOVA) to examine students’ familiarity with MI across the 5 yr and multivariate analysis of variance (MANOVA) to examine the relationships among YIP and the nine attitude factors.

RESULTS: A total of 185 students participated in the study; number of participants per class ranged from 33 to 43. To answer the first research question, a one-way ANOVA examined the effect of YIP on students’ familiarity with MI. The independent variable was YIP (1–5), and the dependent variable was familiarity as measured by the LoF. Results revealed a significant LoF difference overall in the program, F(4, 180) = 5.22, p = .001. Bonferroni post hoc tests showed differences between years. Pearson’s correlation revealed a positive relationship between age and LoF (p = .01). Given the relationship between age and LoF, an analysis of covariance was conducted; robust effects were found between YIP and LoF, even with the covariate of age.

The second question of how students’ attitudes differed over the course of the program was answered using MANOVA, followed by ANOVAs to examine the different factors. Overall AQ–27 factors were significant by YIP, even when controlling for LoF, F(36, 678) = 1.89, p = .002. Follow-up ANOVAs found that five individual factors were significant by YIP: pity (p = .018), danger (p = .039), segregation (p = .033), fear (p = .047), and coercion (p = .000).

CONCLUSION: Students’ LoF increased overall during the 5 yr of the OT program. However, changes were significant only between some years and denoted a split in LoF between the first and second halves of the program (Yr 1–3 vs. Yr 4–5). At the time of data collection, Yr 3 students had only just begun their main mental health OT course and had not yet experienced fieldwork. Students’ attitudes toward MI changed in a positive direction overall; however, the positive outcome was driven by significant change in only five factors. Change by YIP was not significant for factors of blame, anger, help, and avoidance. Students continued to need guidance to change their stigmatizing beliefs about people with schizophrenia.

IMPACT STATEMENT: Occupational therapy educators have a responsibility to challenge students’ stigmatizing beliefs about people with MI. Fieldwork and classroom activities that share the lived experience of people with MI can help students develop empathy and positive attitudes. With educator guidance, this helps students grow into professionals who can work with diverse populations without bias.

References

Beltran, R., Scanlan, J., Hancock, N., & Luckett, T. (2007). The effect of first year mental health fieldwork on attitudes of OT students towards people with mental illness. Australian Occupational Therapy Journal, 54, 42–48. https://doi.org/10.1111/j.1440-1630.2006.00619.x

Boyle, M. J., Williams, B., Brown, T., Molloy, A., McKenna, L., Molloy E., & Lewis, B. (2010). Attitudes of undergraduate health science students towards patients with intellectual disability, substance abuse, and acute mental illness: A cross-sectional study. BMC Medical Education, 10, 71. https://doi.org/10.1186/1472-6920-10-71

Corrigan, P. (2013). A toolkit for evaluating programs meant to erase the stigma of mental illness. Retrieved from http://stigmaandempowerment.org/resources#Toolkit

Feeg, V., Prager, L., Moylan, L., Smith, K., & Cullinan, M. (2014). Predictors of mental illness stigma and attitudes among college students. Issues in Mental Health Nursing, 35, 694–703. https://doi.org/10.3109/01612840.2014.892551

Mittal, D., Sherman, M., Han, X., Reaves, C., Corrigan, P., Chekuri, L., . . . Sullivan, G. (2014). Healthcare providers’ attitudes toward persons with schizophrenia. Psychiatric Rehabilitation Journal, 37, 297–303.

Overton, S., & Medina, S. (2008). The stigma of mental illness. Journal of Counseling and Development, 86, 143–151.