|Year : 2018 | Volume
| Issue : 3 | Page : 203-207
Doctors' perspective, knowledge, and attitude toward childhood psychiatric illnesses
Shaily Mina1, Satnam Goyal2, Rohit Verma3
1 Department of Psychiatry, Safdarjung Hospital, VMMC, New Delhi, India
2 Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
3 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||27-Sep-2018|
Dr. Shaily Mina
Safdarjung Hospital, VMMC, New Delhi
Source of Support: None, Conflict of Interest: None
Background: The main aim of this study was to evaluate the knowledge, management practices, and attitudes of a group of resident doctors in a tertiary care center toward children with psychiatric illness (CPI). Materials and Methods: This cross-sectional study was carried out in a training hospital and included 100 resident doctors. Data collection was done by self-administered semi-structured questionnaire. Analysis was done using SPSS version 17.0.1. Results: Many respondents had positive values about CPI and recognized prejudice in the population against them. The referral of CPI to the psychiatrist is a common practice among the doctors believing that primary intervention holds an important entity in management. The majority of the residents were unsatisfied not only with their but also their colleagues' knowledge, and familiarity with the variety and management of CPI. The residents were of the opinion that the undergraduate medical school training did not give enough importance to the study of CPI. Conclusions: The nonpsychiatrists do not feel confident in managing CPI complaining about the inadequate undergraduate medical training regarding CPI. There was not a clear relationship between the undergraduate medical training, referral practices, and satisfaction regarding the management of CPI. In this way, there are other barriers, perceived or not, to providing care to CPI by the doctors, and they need to be addressed in the medical undergraduate curriculum and continuing medical education.
Keywords: Attitude, childhood, doctor, knowledge, perspective
|How to cite this article:|
Mina S, Goyal S, Verma R. Doctors' perspective, knowledge, and attitude toward childhood psychiatric illnesses. Indian J Soc Psychiatry 2018;34:203-7
|How to cite this URL:|
Mina S, Goyal S, Verma R. Doctors' perspective, knowledge, and attitude toward childhood psychiatric illnesses. Indian J Soc Psychiatry [serial online] 2018 [cited 2018 Oct 17];34:203-7. Available from: http://www.indjsp.org/text.asp?2018/34/3/203/242360
| Introduction|| |
It is imperative to acknowledge child and adolescent mental disorders since it would facilitate the strengthening of current awareness, makes provision for the future research and also help in developing appropriate policies for better/cost effective mental health care for all. Inattentiveness toward this group could be detrimental as it could affect the life-long course of the mental illness, increase the overall cost of the care and hinder the progress of a mentally healthy society.
It forms a significant proportion of mental disorder worldwide with approximately 20% suffering from a disabling mental illness. The majority of the adult psychiatric illness has its root in childhood phase. Researchers have found coalition between adolescent anxiety disorder and young people's later risks of anxiety disorder, major depression, illicit drug dependence, and failure to attend college. Similar outcome has been demonstrated for eating disorders also, whereas increased severity and comorbidity in major depressive disorder.
Despite affecting such significant proportion of the population and having serious adverse outcome, there is a paucity in the field of effective intervention in children and adolescent group. The main barriers viewed are lack of resources (financial, human resources, and facilities), stigma, and others (lack of transportation, communication, and knowledge). Stigmatization acts as a major hindrance factor in understanding of mental illness. Despite an increase in understanding of neurobiological etiology of psychiatric disorders, stigmatization is prevailing not only in mentally ill families but also among treating doctors, in turn leading to neglect/compromise in the patients' care. It has adverse consequence on overall mental illness in form of recognition of symptoms, presentation, treatment adherence, and rehabilitation. This stigma could be due to undertraining of the residents in mental health leading to development of negative attitude toward mental illness. Feifel et al. suggest that the misconceptions associated with psychiatry and mental illness could be corrected by the medical teaching which would help residents in opting psychiatry field by choice and in proper care of the mentally ill patients. Training includes direct involvement in patients care, examining satisfactory response to treatment and direct interaction with staff and patients at psychiatric center which is still lacking in developing countries like India.
Perspective, knowledge, and attitude are interrelated terms which help in assessing what patients/doctors are familiar with about a particular situation/illness, and therefore, better care of the mental illness. Perspective is a way of regarding situations, facts, etc., and judging their relative importance; include familiarity with psychiatric symptoms and syndromes; psychological aspects of medical disorders (“psychological medicine”); and psychosocial issues, including stigma. Knowledge is considered as facts, information, and skills acquired through experience or education, the theoretical or practical understanding of a subject and attitude as an opinion about something, reflecting how favorable people are toward groups, people, ideas, or issues. Attitude can be understood as an organized and enduring set of beliefs and feelings, predisposing us to behave in a certain way.
The child psychiatric services are still in their infancy with most of the professionals lacking the training to deal with such patients. The current study attempts to evaluate the knowledge, attitude, and perception regarding the childhood mental illness among the residents of a medical college to emphasize the equivalent significance of training undergraduate students and residents in both nonpsychiatric and psychiatric field and also to highlight the current scenario of the child psychiatric illness so that adequate policies could be made accordingly.
| Materials and Methods|| |
This cross-sectional descriptive study was conducted at a tertiary care hospital in North India spreading over a month. All the junior and senior residents training at the hospital were approached for the assessment. All the residents signed the consent form before participating in the study. A semi-structured self-assessment questionnaire was prepared to assess the perspective, knowledge, and attitude toward children with psychiatric illness (CPI), which took about 10 min to administer. Before administration of the questionnaire, a pilot study was done on the residents who were not included in the final study, and corrections were made as per the comments received. To avoid peer group influence, residents were barred to discuss their statements among themselves. The questionnaire included 37 items under subheadings of identification, prevalence, cause, measures, attitudes and perception, nonpsychiatrist knowledge, reference and investigation pattern, and satisfaction. All participants had signed the written consent form before the initiation of the study. Responses were graded using a 5-point Likert scale for each question. Analysis was done using SPSS version 17.0.1.
| Results|| |
A total of 100 residents agreed to participate in the study. The mean age of the participants was 27.6 ± 2.5 years and the mean duration after completion of undergraduate degree was 2.72 ± 1.4 years. Among the participants, 79% were male and 73% belonged to an urban background. Nearly 22% of participants had a postgraduate degree (not in psychiatry), while remaining 78% participants were educated up to graduation (i.e., MBBS).
There was no significant difference among responses of doctors from different disciplines [Figure 1]. Many respondents had positive values about CPI, and 85% recognized prejudice in the population against them. The referral of CPI to the psychiatrist is a common practice among 51% doctors and 95% believe that primary intervention holds an important entity in management.
The majority of the residents were unsatisfied not only with their but also their colleagues' knowledge, and familiarity with the variety and management of CPI [Figure 2]. About 60% residents were of the opinion that the undergraduate medical school training did not give enough importance to the study of CPI.
There was significant undermining of the prevalence of various CPI while a major proportion did not know about it [Table 1].
|Table 1: Perception and attitude toward children with psychiatric illness|
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| Discussion|| |
A total of 100 residents participated in the study of which more than half were from the department of medicine, pediatrics, and general surgery, which is understandable as in comparison to other specialties these departments have more residents.
Overall, residents (postgraduate and undergraduate students) were not satisfied with their existing knowledge regarding CPI despite having exposure during undergraduate training [Table 2]. Therefore, it can be inferred that focused training in this area might be beneficial. It has also been seen in various studies that nonpsychiatrist professionals have negative attitude toward psychiatry and its treatment, therefore, tends to focus more on physical aspect of any condition and no attempt is made toward evaluation of its psychiatric aspect (though no direct comparison is done in the present study, but it was seen that 22% never attempted to evaluate any psychopathology in the child coming for the evaluation). This could also be an evidence for the need for more extensive undergraduate training to increase the interest and motivation toward psychiatric patient's right from the beginning. Indian researchers also confer such findings and mention about the inadequacy of medical training in developing interest and preparing the students to opt psychiatry in the future. In a critical analysis by Thirunavukarasu and Thirunavukarasu, it was found that only 1.4% of the lecture time has been devoted to psychiatry in undergraduate training and 3.8%–4.1% to interns training. Furthermore, the time needed for understanding psychiatry is far less, offering around 20 h of clinical lectures (in 5th semester), assessment in the form of short notes in paper two of General Medicine and only 2 weeks optional posting of 3 h/days in internship (Medical Council of India Guideline). Although now psychiatry has been deemed as a compulsory posting (for 2 weeks from year 2008), still there is need for improving the quality of clinical lectures provided to medical students and interns. Studies have shown that a 4-week attachment in psychiatry improves attitude toward psychiatry. Stigmatization plays a significant role in modulating the attitude of health professionals toward CPI. Predominance of stigma reflects faulty policies and practices which further burdens the health system.
It was seen in our study that though majority of the residents were receptive of the various contributory factors for CPI (history of trauma, abuse, family history, and role of environment) but very few agreed to be exploring these factors among the patients they encounter with. This could be explained by lack of practical experience with psychiatric patients. Another Indian study reported lack of awareness for treatment of psychiatric illness in comparison to other common medical conditions in medical students be it pharmacological or nonpharmacological treatment. The common reason studied for the same was lack of attention being given to making the diagnosis and applying practical aspects by professionals' specially nonpsychiatric doctors. One study done in CPI focusing on autism spectrum disorder reported that due to the lack of practical contact with such patients, delay in diagnosis was there as the medical professionals were unaware of the diagnostic criteria so were not confident to label the patient with any diagnosis. Similar findings were seen in a study on general practitioners evaluating attention-deficit hyperactivity disorder patients and found <5% to be correctly diagnosed. It can be inferred that more focused training on clinical posting should be there along with lectures, to be trained in the practical management of cases.
It is seen that in comparison to previous studies, better response is seen in the present study regarding the questions about different etiologies of mental disorder. It suggests better awareness and acceptance even among the nonpsychiatrist considering interaction of both biological and psychological in causing mental illness, but this study was restricted to childhood mental illness only. The present study was the preliminary study in children with findings replicating that of adult group. When findings of the present study were compared with the previous studies, it can be inferred that there is changing attitude toward psychiatric illness and the acceptance of biogenic etiological model as an attributing factor instead of blaming the patient him/herself.
In our study, two-third of the residents agreed regarding the unfamiliarity regarding the management of CPI, and therefore, agreed to rely on psychiatric treatment solely without any contribution from their side which could be due to pessimistic views regarding the recovery of mental illness, and therefore, not showing any interest in its management. Similar findings were noted in previous studies, with majority of the health professionals preferred to sort psychiatric referral instead of treating it themselves.
Almost half of the residents were not comfortable in starting treatment on their own. It has been seen that majority of the psychiatric patients irrespective of the age group consults physicians first due to inadequate knowledge and stigmatization. Incomplete knowledge regarding the psychiatric illness in turn leads to delay in proper treatment and affects the overall course of the illness. Similar finding is seen in children with stigma being the major factor for under treatment, almost 85% of children not receiving any treatment because of the perceived stigma associated with mental illness in their parents, but such findings are yet to be tested among mental health professionals.
On assessment of existing knowledge pertaining to the prevalence of common childhood psychiatric illness such as mental retardation, anxiety disorder, conduct disorder, and suicide; almost one-third of the responses were ‘do not know’ and the prediction regarding the prevalence was wrongly estimated by the residents. In the study conducted on adult psychiatric illness, also reported most common responses as being uncertain or unaware. Wolff et al., mentioned that lack of knowledge to be directly related to the development of negative attitude regarding the psychiatric illness, though this study was conducted among the community. The overall burden and prevalence of child psychiatric illness was under estimated in the present study. Similar finding was seen in the study by Chadda and Shome, showing doctors to be under estimating the psychiatric morbidity in adults.
The strength of the study is that it is the first study to evaluate the knowledge, perception, and attitude of medical professionals in childhood psychiatric illness.
Limitation of the current study which is to be considered before interpreting the results is the lack of the use of validated scale for the assessment. Furthermore, as the study was restricted to only one government institute of Delhi and also had smaller sample size, therefore, needs to be done at larger scale to replicate its findings.
| Conclusions|| |
It can be concluded that adequate training is needed among residents emphasizing on diagnosis and management of priority mental disorders. Training should be initiated from undergraduate time to make clear picture of psychiatry from the beginning. Liaison psychiatry needs to be strengthened for better understanding and timely management of psychiatric illness by frequent case discussions between various departments. Focus should be shifted to giving clinical lectures to MBBS students, interns, and doctors of other departments, especially medicine so that these lead to effective and relatively long-lasting changes in the attitude. There should be provision for the residents, especially pediatricians and physicians to visit to special schools as a part of their training.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
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