Attitude of Syrian medical specialty trainees toward providing health care services to patients with mental disorders

Stigma is a mark of shame that separates the affected individual from others and often causes them to feel excluded. It is a multifaceted process that includes many elements, such as preconceptions, identified differences, status loss and discrimination, alienation, and emotional response [1]. Mental health disorders are one of the most common issues related to stigma, including public stigma and self-stigma [2]. People with mental health disorders may face segregation, such as when someone makes a critical remark about their psychological maladjustment or therapy. Mental health patients often struggle with the symptoms and cognitive limitations caused by these illnesses and the stigmatizing attitudes of others [3]. The stigma associated with mental disorders has been identified as a major impediment to treatment and rehabilitation, as well as poor quality physical care for those suffering from mental illnesses [4]. Feeling omitted from discussions, experiencing hidden threats of coercive treatment, being forced to wait unnecessarily long while seeking care, being provided inadequate information about one’s disease or possible treatments, being treated paternally or demandingly, being told they would never get better, and being talked to or about using stigmatizing language are vital themes. Additionally, stigma affects the behaviors of health professionals who seek treatment and adversely influences their working environment. Individuals with mental diseases, such as personality disorders, are often rejected by healthcare workers and are generally seen as difficult, and manipulative [5]. One of the most common causes of stigma-related behavior among medical staff is a lack of awareness and unconscious biases, which acknowledge the power of hidden beliefs and attitudes. On the other hand, it appears that there is a connection between stigma and inadequacy of training and expertise, where it is thought that it contributes to emotions of anxiety or dread, avoidance, and clinical distance among physicians, which may significantly affect patient-provider relationships and the quality of treatment [4, 6]. Over one million Syrians are thought to have significant mental health disorders, while five million are thought to have mild to moderate mental health issues [7]. The World Health Organization reports that 3 million Syrians sought psychosocial therapy for mental health disorders in 2013, and that proportion is expected to grow each year [3]. In Syria, the stigma associated with seeking treatment at a clinic for mental health disorders impedes mental health services [7]. Even though there was a considerable gap between mental problems and access to suitable care, a combination of challenges, such as stigma, denial, and inadequate mental health literacy, contributed to the fact that the real need for treatment was not recognized [8]. The widespread occurrence of mental illnesses in Syrian society and the detrimental effects of stigma toward this particular patient group on the evaluation and treatment of these illnesses, on the other hand, motivated us to perform this cross-sectional. We performed this cross-sectional study to assess the attitude of physicians in Syria towards individuals with mental health disorders and how they treat these vulnerable groups.

The social stigma that surrounds mental illness has a detrimental effect on both the detection and treatment of these conditions. Access to healthcare can be limited by stigma because some people may be unwilling to seek assistance despite having mental or emotional issues because of the perception that doing demonstrates a lack of strength or competence [2, 10]. It is essential that medical experts, who are on the front line of diagnosing and treating people with mental disorders, have the right mindset when it comes to mental diseases. Therefore, we decided to conduct this cross-sectional research in order to evaluate the attitudes of physicians in Syria towards patients with mental health disorders and the delivery of treatment to vulnerable populations. This research was motivated by the high prevalence of mental health disorders in the Syrian society as well as the negative effects that stigma toward this particular patient group has on the evaluation and treatment of mental illnesses. Being a part of the Middle Eastern population may account for higher stigma ratings in our research. These higher scores might be the result of a variety of variables, such as different response styles or distinct sociocultural backgrounds. The influence of public opinion and traditional attitudes, as well as the setting in which religion is practiced, are examples of important cross-cultural distinctions that call for more research [11, 12]. According to the findings of our research, psychiatric residents are found to have a stigmatizing attitude toward patients with mental problems that is significantly lower than that of residents in other medical specialties. In comparison to the results of an Iranian study, which found that psychiatric trainees have a more accepting attitude toward patients with mental problems than their counterparts in internal medicine and cardiology, our findings found the opposite to be true. On the other hand, this discovery was of little significance for the trainees in surgery and neurology [9]. Certain medical subspecialties, including cardiology and internal medicine, have more demanding patient loads, which can lead to burnout [13]. It is possible that a more stigmatizing attitude toward mental health is connected with increased levels of both workload and burnout. It’s also possible that this is one of the reasons why psychiatric residents have fewer stigmatizing views. It is often held that individuals with mental illnesses are seen more frequently in clinics specializing in cardiology and internal medicine than in surgical specialties [14‐16]. When looking at the various stigma subscales side by side, our research only demonstrates that psychiatric trainees are stigmatized less when it comes to societal duty compared to other groups. Previous research has demonstrated that a stigma attached to social duty has a detrimental impact on empathy [17]. An integrated relationship model has been proposed: physicians who have more experience, more excellent patient-to-physician contact, and more empathy toward patients with mental disorders feel less uneasy around those patients, and as a result, they tend to reduce the social distance that separates them from those patients [18]. There were a total of six different factors, however, only three of them (years of residential experience, marital status, and site of residence) had a meaningful association with the Recovery scale. In addition, while looking at the social responsibility scale, it was found that there was a substantial correlation between this scale and two other variables: location of residence and marital status. In contrast to the research carried out in Iran, it would appear that factors like age, gender, marital status, and the number of shifts had no significant bearing on the stigma associated with mental problems [9, 19]. When compared to residents in other medical specialties, those trained in psychiatry were more likely to agree that medication is the most effective form of therapy for mental illness. It was widely perceived to be more successful and valuable than pharmaceutical therapy, and in contrast to the study that was conducted in Nepal, many of the participants viewed psychoeducation and psychosocial counseling as practices that involved the offering of advice or suggestions. The use of less stigmatizing language, with counselors using terms such as "heart-mind problems" or focusing on the symptoms reported by patients rather than using the word "mental health" in the counseling sessions, is one of the possible reasons why people prefer psychological treatment over other types of treatment. Other possible reasons include the involvement of family members in the counseling sessions, home visits by the community counselors, which were less stigmatizing and more confidential, and the involvement of family members in the counseling sessions. After the treatment, significant improvements were reported in patients’ health conditions and outcomes. Subsequently, many participants were found to be engaged in their regular day-to-day activities, such as taking care of the domestic animals, involvement in farm-related activities, and other activities that generated income [20]. This is because there is a shortage of psychotropic medications in the healthcare facilities, which may be the consequence of a lengthy administrative procedure for the acquisition and distribution of medicines, which leads to frequent stock-outs of medicines. In addition, in 2015, there was a shortage of gasoline as a result of a blockage that occurred on the border between India and Nepal. This caused issues with the distribution of medications to the appropriate medical institutions for a period of several months. Problems with the regular supply of psychotropic drugs have also been observed in a variety of studies, and this is regarded as one of the most significant hurdles to the integration of mental health services into the primary health care system [20].

Internal medicine, pediatrics, surgery, dermatology, and ophthalmology residents have a more stigmatizing attitude, whereas psychiatric residents have a less stigmatizing attitude toward providing health care services for patients with mental illness. The attitude of medical specialty trainees toward providing health care services for patients with mental illness is not uniform. It would appear that not every encounter may be good for generating a better attitude about mental illness; however, this can only happen if certain preconditions are met, such as having an organized contact that results in favorable consequences. Anti-stigma interventions should be thought of as a way to change the way medical specialty trainees feel about helping people with mental illness get health care.