273
ORIGINAL SCIENTIFIC ARTICLE
Attitudes toward mental disorder among medical students
Copyright (c) 2022 Slovenian Medical Journal. This work is licensed under a
Creative Commons Attribution-NonCommercial 4.0 International License.
Attitudes toward mental disorder among medical students
Odnos študentov medicine do duševnih motenj
Špela Uplaznik,1 Klara Vaupotič,2 Hojka Gregorič Kumperščak,2,3 Anja Plemenitaš Ilješ4
Abstract
Background: People with mental disorders are among the most stigmatized and vulnerable members of society. Our re-
search study intended to determine the medical students’ attitude toward mental disorders, the presence of stigma, and 
whether either changed throughout their six-year medical education.
Methods: The sample included 200 medical students of the University of Maribor. Empirical data were collected using 
the CAMI scale (Community Attitudes Towards the Mentally Ill), the Comparison of Attitudes of Patients and Students in 
Slovenia questionnaire, and additional questions regarding specific mental disorders. The results were processed using 
the SPSS 25 program. Descriptive statistics methods were applied, including the ANOVA test. Statistically, significant cor-
relations and differences were checked at a 5% risk level.
Results: The students strongly agreed with the positive statements and disagreed with the negative statements on the 
CAMI scale (MV=3.93; SD=0.34; p=0.046). No significant discrepancies between individual undergraduate years were ob-
served; the sixth-year students expressed the most positive attitude among all students. The mean value of all statements 
was 3.9 (Y1-Y6 SD=0.5), indicating a low presence of stigma.
Conclusion: The students expressed a positive attitude toward mental disorders. In sixth-year students, the least stigma, 
and better knowledge and attitude towards mental disorders were observed. Education, clerkship, and hearing personal 
confessions about experiencing a mental disorder are needed as they improve attitudes toward them.
Izvleček
Izhodišča: Osebe z duševnimi motnjami so bolj stigmatizirani in ranljivi člani družbe. Namen naše raziskave je bil raziskati 
odnos študentov medicine do duševnih motenj, prisotnost stigmatiziranosti do teh bolnikov pri njih in spremembo odno-
sa do oseb z duševnimi težavami med 6-letnim izobraževanjem.
Slovenian Medical Journallovenian Medical Journal
1 University Medical Centre Ljubljana, Ljubljana, Slovenia
2 Faculty of Medicine, University of Maribor, Maribor, Slovenia
3 Department of Child and Adolescent Psychiatry, Division of Pediatrics, University Medical Centre Maribor, Maribor, Slovenia
4 Department of Psychiatry, University Medical Centre Maribor, Maribor, Slovenia
Correspondence / Korespondenca: Klara Vaupotič, e: vaupotic.klara21@gmail.com
Key words: attitude to mental health; stigma; medical education
Ključne besede: odnos do duševnega zdravja; stigma; študij medicine
Received / Prispelo: 10. 10. 2021 | Accepted / Sprejeto: 26. 3. 2022
Cite as / Citirajte kot: Uplaznik Š, Vaupotič K, Gregorič Kumperščak H, Plemenitaš Ilješ A. Attitudes toward mental disorder among 
medical students. Zdrav Vestn. 2022;91(7–8):273–84. DOI: https://doi.org/10.6016/ZdravVestn.3311
eng slo element
en article-lang
10.6016/ZdravVestn.3311 doi
10.10.2021 date-received
26.3.2022 date-accepted
Psychiatry, clinical psychology, psychosomat-
ics Psihiatrija, klinična psihologija, psihosomatika discipline
Original scientific article Izvirni znanstveni članek article-type
Attitudes toward mental disorder among 
medical students Odnos študentov medicine do duševnih motenj article-title
Attitudes toward mental disorder among 
medical students Odnos študentov medicine do duševnih motenj alt-title
attitude to mental health, stigma, medical 
education
odnos do duševnega zdravja, stigma, študij med-
icine kwd-group
The authors declare that there are no conflicts 
of interest present.
Avtorji so izjavili, da ne obstajajo nobeni 
konkurenčni interesi. conflict
year volume first month last month first page last page
2022 91 7 8 273 284
name surname aff email
Klara Vaupotič 2 vaupotic.klara21@gmail.com
name surname aff
Špela Uplaznik 1
Hojka Gregorič Kumperščak 2,3
Anja Plemenitaš Ilješ 4
eng slo aff-id
University Medical Centre Ljubljana, Ljubljana, 
Slovenia Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija 1
Faculty of Medicine, University of Maribor, Maribor, 
Slovenia
Medicinska fakulteta, Univerza v Mariboru, Maribor, 
Slovenija 2
Department of Child and Adolescent Psychiatry, 
Division of Pediatrics, University Medical Centre 
Maribor, Maribor, Slovenia
Enota za otroško in mladostniško psihiatrijo, Klinika za 
pediatrijo, Univerzitetni klinični center Maribor, Maribor, 
Slovenija
3
Department of Psychiatry, University Medical Centre 
Maribor, Maribor, Slovenia
Oddelek za psihiatrijo, Univerzitetni klinični center 
Maribor, Maribor, Slovenija 4
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1 Introduction
According to the World Health Organization 
(WHO) definition, health is not only the absence of 
disease but general well-being, which includes a sense 
of fulfillment and the utilization of all of an individual’s 
potentials (1). Mental health is composed of emotional, 
psychological, and social well-being (2). On the oth-
er hand, a mental disorder is a deviation in thinking, 
mood, or behaviour associated with distress and im-
paired functioning. Mental disorders are a significant 
global public health problem linked to other chronic 
illnesses, increasing their morbidity and mortality (3).
The WHO defines stigma as the presence of emo-
tions such as shame and disapproval, followed by re-
jection, discrimination, and exclusion from society 
(4). Stigma means being marked by some trait, setting 
an individual apart from most people so that they and 
the people around them find this trait as deviant (5). 
People with mental disorders are among the most stig-
matized and vulnerable members of society who suf-
fer from discrimination in various areas of life (6). The 
most common is a social or public stigma (7). The stig-
ma of mental illness among healthcare professionals 
is of utmost importance in the care of these patients 
(8). The causes of stigmatization of mental disorders 
are numerous and complex. One of the main reasons 
is ignorance and incognizance about mental disorders 
and general beliefs and stereotypes that people with 
mental disorders are dangerous, unpredictable, or vi-
olent (5). The consequences of stigma in patients with 
mental disorders can include shame, feelings of being 
different, inferiority, low self-esteem, feelings of rejec-
tion, and anxiety, resulting in a lower quality of life (9). 
The long-term consequences of stigmatization can lead 
Metode: Uporabljena je bila neeksperimentalna kvantitativna metoda zbiranja podatkov s strukturiranim vprašalnikom 
z lestvico CAMI (angl. Community Attitudes Towards the Mentally Ill), z vprašalnikom Primerjava stališč bolnikov in štu-
dentov v Sloveniji ter z dodatnimi vprašanji. V vzorec je bilo vključenih 200 študentov Medicinske fakultete Univerze v 
Mariboru. Rezultati so bili obdelani s programom SPSS 25 (IBM Corp., Armonk, NY). Uporabljene so bile metode opisne 
statistike in test ANOVA. Statistično značilna povezanost in razlike so bile preverjene pri 5-odstotni stopnji tveganja.
Rezultati: Pri preverjanju splošnega odnosa do duševnih motenj je bilo razvidno močno strinjanje s pozitivnimi in nestrin-
janje z negativnimi trditvami (PV=3,93; SO=0,34; p=0,046). Večjih odstopanj med letniki ni bilo, od vseh letnikov so najbolj 
pozitiven odnos izrazili študenti 6. letnika. Povprečna vrednost vseh trditev je bila 3,9 (L1–L6 SO=0,5), kar kaže na nizko 
prisotnost stigme.
Zaključek: Rezultati kažejo pozitiven odnos študentov medicine do duševnih motenj in stanje brez pomembnega stig-
matizirajočega odnosa do teh oseb. Pri študentih 6. letnika je bila zabeležena najmanjša prisotnost stigmatizirajočega 
odnosa. Izobraževanja, klinična praksa in poslušanje osebnih izkušenj ljudi z duševno motnjo so koristna, saj izboljšajo 
razumevanje duševnih motenj.
to difficulties in finding employment, education and an 
intimate partner (10). Stigma can affect the quality of 
mental health care as it creates barriers to seeking med-
ical help, interrupts treatment, and impairs mental and 
physical care (11).
The study of medicine serves as an educational path 
to starting a medical doctor’s career by providing es-
sential knowledge of all the medical specialties. Foreign 
studies examining how psychiatric clerkship affects 
attitudes toward mental disorders show somewhat in-
conclusive results. A meta-analysis on the influence 
of clerkship on students’ stigma toward mental illness 
clearly stated that there is a robust effect of clerkship 
on students’ stigma of mental illness and highlighted 
that curriculum is a crucial component in the battle 
against stigma. It emphasized the role of psychiatry as 
a critical component of the curriculum and experien-
tial learning as a necessary tool to combat stigma (12). 
An Irish study revealed that final year students who 
completed the clinical module demonstrated a positive 
attitudinal shift but found no significant difference in 
attitudes displayed by preclinical and clinical medical 
students before starting their respective modules on 
how to approach patients with mental illness (13). A 
British study showed that personal experience of men-
tal health treatment, or that among family and friends, 
were associated with less stigmatizing attitudes and that 
mental health problems were not perceived as ones that 
deserved the lowest regard (14), which was similarly 
reported by a study performed in Papua New Guinea 
(15). A Greek study reported that psychiatric clerkship 
had a positive effect in reducing stigma toward psychi-
atry and mental disorders (16), which was similarly 
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ORIGINAL SCIENTIFIC ARTICLE
Attitudes toward mental disorder among medical students
reported in a Chinese study (17), studies performed in 
South Africa (18,19), and France (20). An Australian 
study found that attitudes toward psychiatry were posi-
tive at the beginning of the clerkship, and that negative, 
as well as stigmatizing views toward mental disorders 
post-clerkship decreased. However, the overall view on 
mental disorders remained unchanged and, in some ar-
eas, became even more negative (6). A study from Ethi-
opia reported that medical students who did not take a 
clinical psychiatry rotation had a more positive attitude 
toward psychiatry than students who completed the 
clinical psychiatry rotation (21). A study performed in 
Brazil reported that participation in a psychiatric clerk-
ship was associated with greater social acceptance but 
not with improvement in other factors (22).
In line with other studies, both domestic (23) and 
foreign (12-14,16,24), we wanted to investigate the at-
titude toward mental disorders and the stigma among 
the students of the University of Maribor, Faculty of 
Medicine, and to examine how their attitudes change 
throughout the study of medicine.
2 Methods
2.1 Sample
To collect the sample, we used a non-random, ded-
icated pattern. The sample population for this study 
was recruited from the medical students studying in 
the academic year 2019/2020 at the University of Mari-
bor. Printed questionnaires were handed out personally 
to classrooms of students in year one to year six who 
were present at the compulsory lectures and agreed to 
participate in the research. The students returned their 
completed questionnaires and signed consent forms. 
The study design was approved by the local Medical 
Ethics Committee of the University Medical Centre 
Maribor (No. UKC-MB-KME-94-1/19). A non-exper-
imental quantitative data collection method was used 
for data collection.
2.2 Questionnaires
Empirical data were obtained using the following 
structured questionnaires: 
1. The CAMI scale (Community Attitudes Towards 
The Mentally Ill) (25). It contains 40 statements 
divided into four blocks: 1. authority (statements 
1–10; expressing inferiority/equality of people with 
mental illness and the need for forceful interven-
tion), 2. compassion (statements 11–20; express-
ing (mis)understanding of and being (in)consid-
erate toward people with mental illness), 3. social 
limitation (statements 21–30; expressing the belief 
that people with mental illness (do not) represent 
a threat to society and (do not) need to be steered 
clear of) and 4. ideology of mental health in the 
community (statements 31–38; expressing (the lack 
of) advantages of community presence and (the 
lack of) acceptance of care outside the institutions). 
Respondents indicated the level of agreement on a 
5-point Likert scale (1 – I completely disagree, 2 – I 
disagree, 3 – I neither agree nor disagree, 4 – I agree, 
5 – I completely agree). For a more straightforward 
overview of each dimension, we have changed the 
values of the mixed positive and negative statements 
accordingly and calculated the mean value (MV) of 
the four blocks – lower values represent a more neg-
ative attitude (Table 2).
2. The second questionnaire used was from the Stigma 
of Mental Illness study: Comparison of Attitudes of 
Patients and Students in Slovenia (23) to determine 
mental illness stigma. The questionnaire contains 14 
statements comparing stereotypical and discrimina-
tory beliefs, and the social distance of the respon-
dents involved. It also includes a 5-point Likert 
scale, where higher values indicate a more negative 
attitude toward people with mental disorders.
3. Additionally, questions on demographic data (age, 
gender, year of study) and questions that determine 
whether the students understand the definition of 
individual mental disorders.
4. Lastly, we added two specific statements that in-
terested us (‘’A person with a mental disorder can-
not be a doctor.’’ and ‘’After completing my clinical 
practice and passing the psychiatry exam, my view 
of mental disorders has changed. ‘’), the second one 
referred only to sixth-year students.
2.3 Analysis
The results were statistically processed using the 
statistical computer program SPSS 25 (IBM Corp., Ar-
monk, NY). We used descriptive statistics methods, 
the ANOVA test to compare the mean value of several 
groups, and the chi-square test due to some categori-
cal clinical features. Statistically significant correlations 
and differences were checked at a 5% risk level. The re-
sults were presented in text and figures.
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3 Results
Two hundred medical students were included. Of 
250 questionnaires handed out, 214 were returned, and 
200 were fully completed. Of these, 7.5% were first-
year students, 23.5% second- and fourth-year students 
each, 20.5% were third year students, 12.0% fifth-year, 
and 13.0% sixth-year students. Seventy-six percent of 
the questionnaires were completed by female students 
and 24% by male students. The gender distribution also 
matches the actual representation of women and men 
in the faculty. Students were aged from 19 to 39 years 
(mean age 22.16, SD 2.226).
Students’ general attitude toward people with men-
tal disorders is shown in Table 1 and Table 2. The Cron-
bach’s alpha value was 0.90.
Table 1: General attitude toward mental disorder.
Statements Y1 
n=15
Y2 
n=47
Y3 
n=41
Y4 
n=47
Y5 
n=24
Y6 
n=26
Y1−Y6 
n=200
MV SD MV SD MV SD MV SD MV SD MV SD MV SD
*1. One of the main reasons for mental 
disorder is a lack of self-discipline and 
willpower.
1.8 0.6 2.2 1.0 2.1 0.7 2.2 1.0 2.3 0.7 1.7 0.9 2.1 0.9
*2. The best way to treat people 
with mental disorders is inpatient 
treatment.
2.1 0.8 2.0 0.7 1.8 0.7 1.8 0.8 1.9 0.7 1.6 0.7 1.9 0.7
*3. There is something special about 
people with mental disorders that 
makes them easily distinguishable 
from normal people.
2.4 1.0 2.1 0.7 2.1 0.9 2.2 0.9 2.3 0.8 1.9 0.8 2.2 0.8
*4. As soon as someone shows signs 
of mental disorder, they should be 
hospitalized.
1.9 0.8 1.6 0.7 1.7 0.7 1.6 0.6 2.0 0.9 1.6 0.7 1.7 0.7
*5. People with mental disorders need 
the same supervision and discipline as 
young children.
2.2 0.7 2.4 0.9 2.3 0.9 1.9 0.8 2.3 0.8 1.8 0.7 2.2 0.8
6. Mental disorder is like all other 
illnesses. 2.7 1.0 2.7 1.2 3.3 1.2 3.1 1.2 3.3 1.2 3.3 1.3 3.1 1.2
7. People with mental disorders 
shouldn’t be social outcasts. 4.3 0.6 4.3 1.1 4.5 0.8 4.5 0.7 4.4 0.8 4.5 0.8 4.4 0.8
8. Protecting the public from people 
with mental disorders should be less 
emphasized.
3.3 0.9 3.1 0.8 3.3 0.8 3.3 1.0 3.4 0.8 3.3 1.1 3.3 0.8
*9. Psychiatric hospitals are an 
outdated way of treating people with 
mental disorders.
2.4 0.8 3.0 0.9 2.7 0.9 2.6 1.0 2.5 0.8 2.4 1.0 2.7 0.3
10. Almost anyone can get a mental 
disorder. 4.1 0.9 4.1 0.9 4.3 0.8 4.3 0.7 3.9 1.0 4.3 0.7 4.2 0.8
11. People with mental disorders have 
been the target of ridicule for too long. 4.1 0.9 4.3 0.7 4.4 0.6 4.3 0.8 4.3 0.8 4.6 0.6 4.3 0.8
12. The state should allocate more 
funds for the care and treatment of 
people with mental disorders.
3.9 0.6 4.1 0.7 4.0 0.7 4.1 0.7 4.0 1.0 4.4 0.8 4.1 0.7
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Attitudes toward mental disorder among medical students
Statements Y1 
n=15
Y2 
n=47
Y3 
n=41
Y4 
n=47
Y5 
n=24
Y6 
n=26
Y1−Y6 
n=200
MV SD MV SD MV SD MV SD MV SD MV SD MV SD
13. As a society. we should be much 
more tolerant of people with mental 
disorders.
4.3 0.6 4.5 0.5 4.3 0.6 4.3 0.5 4.3 0.6 4.3 0.8 4.3 0.6
*14. Our psychiatric hospitals are more 
like prisons than a place where people 
with mental disorders are treated.
3.1 1.1 3.1 0.8 3.1 0.9 3.0 0.9 1.7 0.6 2.4 0.9 2.8 1.0
15. It is our responsibility to provide 
the best care possible for people with 
mental disorders.
4.4 0.6 4.3 0.6 4.5 0.6 4.4 0.6 4.5 0.5 4.4 0.8 4.4 0.6
*16. People with mental disorders do 
not deserve our empathy. 1.1 0.3 1.3 0.6 1.4 0.8 1.3 0.5 1.3 0.5 1.2 0.5 1.3 0.6
*17. People with mental disorders are 
a burden to our society. 2.1 0.9 2.2 0.9 2.3 1.0 2.3 1.1 2.6 0.7 2.1 1.1 2.3 1.0
*18. Increasing funding for the 
treatment of people with mental 
disorders means spending taxpayers’ 
money.
2.2 1.1 1.6 0.7 1.9 0.8 1.8 0.8 2.0 0.8 1.5 0.7 1.8 0.8
*19. Sufficient services are already 
available for people with mental 
disorders.
2.4 0.9 2.4 0.7 2.6 0.7 2.4 0.7 2.4 0.6 2.0 0.8 2.4 0.7
*20. It is best to avoid people with 
mental health problems. 1.9 0.7 1.6 0.7 1.9 0.9 1.8 0.7 1.8 0.6 1.6 0.7 1.7 0.7
*21. People with mental disorders 
should have no responsibility. 1.9 0.9 2.0 0.8 2.0 0.6 1.8 0.7 2.0 0.7 1.8 0.8 1.9 0.7
*22. People with mental disorders 
should be separated from the rest of 
the community.
1.6 0.9 1.4 0.5 1.8 0.7 1.7 0.7 1.8 0.7 1.7 0.7 1.7 0.7
*23. A person would be foolish to 
engage in a serious relationship with a 
partner (person) who has had a mental 
disorder, even if he or she has already 
fully recovered.
1.5 0.5 1.7 0.8 1.5 0.8 1.7 0.7 1.8 0.8 1.5 0.7 1.6 0.8
*24. I wouldn’t want to have someone 
who had a mental disorder as a 
neighbor.
1.8 0.9 1.8 0.8 1.8 1.1 2.0 0.9 2.1 0.9 1.8 0.9 1.9 0.9
*25. Anyone who has had a mental 
disorder should not be in the civil 
service.
1.9 0.8 1.8 0.7 1.8 0.8 2.0 0.8 2.3 0.8 1.5 0.7 1.9 0.8
26. People with mental disorders 
should not be denied their personal 
rights.
4.4 0.6 4.1 1.1 4.4 0.9 3.9 1.3 4.4 0.6 4.6 0.6 4.3 1.0
27. People with mental disorders 
need to be encouraged to take on the 
responsibilities of a normal life.
4.2 0.6 4.1 0.7 4.2 0.7 4.4 0.8 4.3 0.6 4.4 0.7 4.3 0.7
28. No one has the right to exclude 
people with mental disorders from 
their housing community.
4.2 0.8 4.1 0.8 3.8 0.9 4.1 0.9 3.9 0.8 4.1 0.8 4.0 0.9
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The values show an overall positive attitude for the 
authority block, compassion block, social limitation 
block, ideology of mental health in the community 
block, and all of the blocks combined. Regardless of 
the year of study, the students showed a predominantly 
positive attitude regarding the following two state-
ments: The statement ‘’People with mental disorders 
shouldn’t be social outcasts.’’ encourages the integration 
of people with mental disorders into the community 
(statement 7) and the statement ‘’It is our responsibility 
Legend: Y1 – 1st year; Y2 – 2nd year; Y3 – 3rd year; Y4 – 4th year; Y5 – 5th year; Y6 – 6th year; Y1−Y6 – 1st−6th year; n – sample size; 
MV – mean value; SD – standard deviation; Values on the scale: 1 – I completely disagree; 2 – I disagree; 3 – I neither agree nor 
disagree; 4 – I agree; 5 – I completely agree. Low values in cells marked with the * sign represent a more positive attitude, while 
low values of unmarked cells’ statements represent a more negative attitude.
Statements Y1 
n=15
Y2 
n=47
Y3 
n=41
Y4 
n=47
Y5 
n=24
Y6 
n=26
Y1−Y6 
n=200
MV SD MV SD MV SD MV SD MV SD MV SD MV SD
29. People with mental disorders pose 
a much lower risk than most people 
think.
4.1 0.6 3.7 0.9 3.9 0.8 3.6 0.9 3.8 0.9 4.2 0.8 3.8 0.8
30. Most women who were once 
treated in a psychiatric hospital can 
perform the work of a nanny.
3.3 0.5 2.9 0.8 3.2 0.9 3.0 0.8 3.1 0.7 3.3 0.9 3.1 0.8
31. Local citizens should accept the 
location of mental health facilities in 
their neighborhood as these serve the 
needs of the local community.
3.3 0.8 3.3 0.8 3.6 0.7 3.5 1.0 3.3 0.9 3.9 0.8 3.5 0.9
32. The best therapy for most people 
with mental disorders is to be involved 
in the community.
3.9 0.7 4.0 0.6 3.9 0.6 3.9 0.8 3.9 0.8 4.0 0.8 4.0 0.7
33. As much as possible. services for 
patients with mental disorders should 
be provided in community-based 
facilities.
3.6 0.9 3.9 0.5 4.0 0.7 4.0 0.8 4.0 0.6 4.2 0.6 4.0 0.7
34. Providing care for people with 
mental disorders in residential 
neighborhoods does not endanger 
other residents.
3.5 1.0 3.6 0.7 3.4 0.8 3.4 0.9 3.3 0.7 3.7 0.9 3.5 0.8
35. There is no reason for residents 
to be afraid of people coming to their 
neighborhood for mental disorder 
services.
3.3 1.2 3.6 0.8 3.5 0.8 3.5 0.9 3.6 0.8 3.8 1.0 3.6 0.9
*36. There should be no facilities 
for people with mental disorders in 
residential neighborhoods.
2.2 1.0 2.0 0.8 1.9 0.6 2.3 0.9 2.1 0.5 1.8 0.8 2.1 0.8
*37. Residents of the local community 
are rightly reluctant to allow the 
treatment of people with mental 
disorders in their community.
2.6 0.9 2.3 0.8 2.1 0.8 2.4 0.8 2.3 0.8 2.0 0.8 2.3 0.8
*38. It may really be beneficial from 
a therapy standpoint for people 
with mental disorders to live in local 
communities. but this poses too great 
a risk to residents.
2.6 0.9 2.6 0.9 2.3 0.9 2.5 1.0 2.3 0.7 2.1 0.8 2.4 0.9
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ORIGINAL SCIENTIFIC ARTICLE
Attitudes toward mental disorder among medical students
to provide the best care possible for people with mental 
disorders.’’ encourages an active approach to treating 
and helping them (statement 15).
Table 3 shows results regarding stereotypical dis-
criminatory beliefs and social distance toward people 
with mental disorders. The students’ MV of all state-
ments indicates a low presence of stigma.
All fifth- and sixth-year students enrolled in the 
subject Psychiatry (Table 4) and have thus encountered 
people with mental disorders in the clinical environ-
ment. Most fourth-year students also have clinical 
experience with people with mental disorders, while 
the lower-year students have considerably less clini-
cal experience (Table 4). However, most students have 
Table 2: General attitude towards mental disorder – statement blocks.
Statements 
blocks
Y1 
n=15
Y2 
n=47
Y3 
n=41
Y4 
n=47
Y5 
n=24
Y6 
n=26
Y1−Y6 
n=200
F p*
MV SD MV SD MV SD MV SD MV SD MV SD MV SD
1.-10. 
(authority)
3.75 0.34 3.71 0.39 3.87 0.33 3.89 0.36 3.79 0.30 4.05 0.41 3.84 0.37 3.504 0,005
11.-20. 
(compassion)
3.98 0.35 4.09 0.35 4.00 0.33 4.06 0.37 4.13 0.36 4.30 0.45 4.09 0.37 2.592 0,027
21.-30. 
(social 
limitation)
4.15 0.45 4.03 0.43 4.08 0.47 3.97 0.49 3.96 0.39 4.22 0.49 4.05 0.46 1.383 0,232
31.-38. 
(ideology 
of mental 
health in the 
community)
3.53 0.71 3.68 0.43 3.76 0.45 3.65 0.64 3.67 0.43 3.96 0.60 3.71 0.54 1.713 0,133
1.-38. 3.87 0.37 3.89 0.31 3.94 0.30 3.91 0.35 3.90 0.30 4.14 0.42 3.93 0.34 2.305 0,046
Legend: Y1 – 1st year; Y2 – 2nd year; Y3 – 3rd year; Y4 – 4th year; Y5 – 5th year; Y6 – 6th year; Y1−Y6 – 1st−6th year; n – sample size; MV – 
mean value; SD – standard deviation; F – F-test value; p* – one-factor analysis of variance (significant values are in bold); Values 
on the scale: 1 – I completely disagree; 2 – I disagree; 3 – I neither agree nor disagree; 4 – I agree; 5 – I completely agree. Lower 
values represent a more negative attitude.
Table 3: Comparison of Attitudes of Medical Students in Slovenia to determine mental disorder stigma.
Statements Y1 
n=15
Y2 
n=47
Y3 
n=41
Y4 
n=47
Y5 
n=24
Y6 
n=26
Y1−Y6 
n=200
F P*
MV SD MV SD MV SD MV SD MV SD MV SD MV SD
1. People with mental 
disorders are more 
dangerous than other 
people.
3.1 0.8 3.4 0.9 3.3 0.8 3.3 0.7 3.1 0.8 3.7 1.0 3.3 0.8 1.487 0.196
2. People with mental 
disorders can attack 
someone.
2.2 0.7 2.4 0.8 2.8 0.9 2.5 0.7 2.2 0.7 2.8 0.9 2.5 0.8 2.783 0.019
3. Mental disorder is 
contagious.
4.8 0.4 4.7 0.8 4.8 0.6 4.7 0.8 4.8 0.5 4.9 0.3 4.8 0.6 0.634 0.674
4. People with mental 
disorders do not know 
how to behave.
3.9 0.6 3.9 0.8 3.9 0.9 3.8 0.9 3.6 0.7 3.9 0.8 3.8 0.8 0.462 0.804
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Legend: Y1 – 1st year; Y2 – 2nd year; Y3 – 3rd year; Y4 – 4th year; Y5 – 5th year; Y6 – 6th year; Y1−Y6 – 1st−6th year; n – sample size; 
MV – mean value; SD – standard deviation; p* – one-factor analysis of variance (significant values are in bold); Values on the 
scale: 1 – I completely agree; 2 – I agree; 3 – I neither agree nor disagree; 4 – I disagree; 5 – I completely disagree. Lower values 
represent a higher presence of stigma toward mental disorder.
Statements Y1 
n=15
Y2 
n=47
Y3 
n=41
Y4 
n=47
Y5 
n=24
Y6 
n=26
Y1−Y6 
n=200
F P*
MV SD MV SD MV SD MV SD MV SD MV SD MV SD
5. People with mental 
disorders are less 
capable than other 
people.
4.2 0.8 3.8 0.9 3.8 0.9 3.6 1.0 3.4 0.7 3.7 0.7 3.7 0.9 2.021 0.077
6. People with mental 
disorders are to blame 
for their illness.
4.4 0.7 4.5 0.6 4.5 0.7 4.4 0.7 4.4 0.6 4.7 0.5 4.5 0.7 0.963 0.442
7. I am afraid to live next 
door to a person who 
has a mental disorder.
4.1 0.9 4.0 0.8 4.0 0.9 4.0 0.8 3.7 0.7 4.0 0.9 4.0 0.8 0.656 0.657
8. If my roommate had a 
mental disorder, I would 
move out.
4.1 0.8 4.1 0.9 4.3 0.7 3.9 0.8 4.1 0.7 4.0 0.8 4.1 0.8 1.161 0.330
9. If my boyfriend / 
girlfriend had a mental 
disorder, I would end 
the relationship.
4.3 0.7 3.9 1.0 4.1 0.8 4.0 1.0 3.9 0.9 4.0 0.9 4.0 0.9 0.724 0.606
10. It is better for society 
that people with mental 
disorders do not have 
a child.
3.9 0.7 3.9 1.0 3.9 1.0 3.7 0.9 3.3 0.9 3.5 0.7 3.7 0.9 2.517 0.031
11. It is better for society 
that people with mental 
disorders do not work 
with children and 
adolescents.
3.7 1.0 3.4 0.9 3.5 1.0 3.4 1.0 3.3 0.8 3.5 0.8 3.5 0.9 0.582 0.714
12. I can recognize 
people with mental 
disorders at first sight.
4.3 0.8 4.3 0.8 4.3 0.9 4.1 0.9 4.0 0.7 4.3 0.7 4.2 0.8 0.992 0.424
13. If I could decide, I 
would keep people with 
mental disorders in a 
psychiatric hospital for 
as long as possible.
4.2 0.9 4.3 0.8 4.3 0.7 4.1 0.9 4.1 0.8 4.4 0.7 4.2 0.8 0.470 0.798
14. I would feel 
ashamed if my friends 
found out that someone 
in my family has a 
mental disorder.
4.4 0.9 4.1 0.9 4.5 0.9 4.4 0.8 4.3 0.9 4.5 0.8 4.4 0.9 0.893 0.487
1.−14. 4.0 0.4 3.9 0.5 4.0 0.4 3.8 0.5 3.7 0.4 4.0 0.4 3.9 0.5
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ORIGINAL SCIENTIFIC ARTICLE
Attitudes toward mental disorder among medical students
already encountered a person with a mental illness in 
their private environment (Table 4).
Most students were familiar with depression, mania, 
and anxiety disorders (Table 4). Fewer students knew 
of psychotic disorders and personality disorders (Table 
4). Statistical significance was observed in the statistical 
analysis (Table 4) indicating that fifth- and sixth-year 
students have better knowledge about personality dis-
orders than other students.
Table 5 Shows data of 2 statements that are very 
specific to medical students that interested us. Results 
showed a significant dispersion of data, SD of the state-
ments exceeds or equals 0.9.
4 Discussion
Our study investigated the attitude of medical stu-
dents toward patients with mental disorders and men-
tal disorders in the general population. We explored 
whether stigma changes throughout medical school 
education and whether clinical clerkship may impact 
attitudes toward mental disorders.
We found a generally positive attitude toward men-
tal disorders in students regardless of the year of their 
medical studies. The students who completed the psy-
chiatry course and exam agreed that the experience 
improved their attitude; however, they were not wholly 
convinced and answered indecisively. Sixth-year stu-
dents showed the most positive attitude, which might 
be because they have already completed the psychiatry 
course and are thus educated adequately about mental 
disorders.
To the best of our knowledge, this is the first study 
in Slovenia assessing medical students’ attitudes to-
ward mental disorders. The only study performed in 
Slovenia compared stigmatizing attitudes from six dif-
ferent faculties, including medical students, with pa-
tients with severe mental illness. They reported that 
patients expressed higher stigmatization scores toward 
people with severe mental disorders than the students 
(23). Other foreign studies examining how psychiat-
ric clerkship affects attitudes toward mental disorders 
show inconclusive results. Still, most of them showed 
a more positive attitude toward mental disorders after 
Table 4: Familiarity with, and knowledge of mental disorder definitions.
Q A Y1 
n=15
Y2 
n=47
Y3 
n=41
Y4 
n=47
Y5 
n=24
Y6 
n=26
Y1−Y6 
n=200
Chi- 
square
P*
% % % % % % %
Have you attended a Psychiatry 
course yet?
NO 100.0 100.0 92.7 95.7 0.0 0.0 72.5
YES 0.0 0.0 7.3 4.3 100.0 100.0 27.5
Have you ever met someone with 
a mental disorder in a clinical 
setting?
NO 80.0 87.2 65.9 14.9 0.0 0.0 43.5
YES 20.0 12.8 34.1 85.1 100.0 100.0 56.5
Have you ever met someone with 
a mental disorder in a private 
setting?
NO 0.0 8.5 17.1 17.0 12.5 11.5 12.5
YES 100.0 91.5 82.9 83.0 87.5 88.5 87.5
Do you know what it means if 
someone has depression or mania?
NO 0.0 8.5 0.0 6.4 0.0 0.0 3.5
8.784 0.118
YES 100.0 91.5 100.0 93.6 100.0 100.0 96.5
Do you know what it means if 
someone has an anxiety disorder?
NO 0.0 8.5 2.4 14.9 4.2 0.0 6.5
9.954 0.077
YES 100.0 91.5 97.6 85.1 95.8 100.0 93.5
Do you know what it means if 
someone has a psychotic disorder?
NO 13.3 27.7 12.2 21.3 4.2 7.7 16.5
9.062 0.107
YES 86.7 72.3 87.8 78.7 95.8 92.3 83.5
Do you know what it means 
if someone has a personality 
disorder?
NO 20.0 34.0 34.1 12.8 0.0 3.8 20.0
22.147 <0.001
YES 80.0 66.0 65.9 87.2 100.0 96.2 80.0
Legend: Y1 – 1st year; Y2 – 2nd year; Y3 – 3rd year; Y4 – 4th year; Y5 – 5th year; Y6 – 6th year; Y1−Y6 – 1st−6th year; n – sample size; 
Q – question; A – answer; p* – one-factor analysis of variance (significant values are in bold).
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Table 5: Specific statements.
Statement Y1 
n=15
Y2 
n=47
Y3 
n=41
Y4 
n=47
Y5 
n=24
Y6 
n=26
Y1−Y6 
n=200
F p*
MV SD MV SD MV SD MV SD MV SD MV SD MV SD
1. A person 
with a mental 
disorder cannot 
be a doctor.
2.5 1.0 2.9 1.0 2.8 0.9 2.9 1.2 2.6 1.0 2.4 0.9 2.8 1.0 1.243 0.291
2. (ONLY FOR 
SIXTH-YEAR 
STUDENTS) After 
completing my 
clinical practice 
and passing 
the psychiatry 
exam, my view of 
mental disorders 
has changed.
/ / / / / / / / / / 3.6 1.0 / /
Legend: Y1 – 1st year; Y2 – 2nd year; Y3 – 3rd year; Y4 – 4th year; Y5 – 5th year; Y6 – 6th year; Y1−Y6 – 1st−6th year; n – sample 
size; MV  –  mean value; SD – standard deviation; F – F-test value; p* – one-factor analysis of variance; values on the scale: 
1 – I completely disagree; 2 – I disagree; 3 – I neither agree nor disagree; 4 – I agree; 5 – I completely agree.
completing their clerkship, and that curriculum is a 
crucial component of the battle against stigma (12-
17,20). On the other hand, some studies did not prove 
this connection (6,21,22).
The perspective of the interviewed medical students 
seemed to be multidimensional; since they reported that 
they do support deinstitutionalization and that inclusion 
and involvement in the community are appropriate for 
treating people with mental disorders. The majority of 
the students agreed that mentally ill people should be 
provided with community services. A study performed 
in the University Psychiatric Hospital Ljubljana showed 
that patients in psychiatric community treatment re-
ported having better quality or satisfaction with their 
lives. They function better in all areas, although psy-
chopathological symptoms persist at the same level as 
in hospitalized patients (26). The WHO has encouraged 
the development of public health policies worldwide to 
reduce the number of psychiatric beds and replace them 
with facilities where patients would be treated within 
the community (27), which is an effortful step towards 
deinstitutionalization.
Results showed slight stigma regarding violent be-
havior in the mentally ill. However, the fear of mentally 
ill people being violent and unpredictable is still present, 
as discovered in many studies. A Swedish study found 
that attitudes toward mental disorders did not change 
significantly from 1976 to 2014. In 2014, nearly a quarter 
of the population still believed that mentally ill people 
committed more violent acts (28). Similarly, a study 
from China also reported encountering a stigma related 
to fear of violent behavior by people with mental disor-
ders (29). The cause for misconception could be, to some 
extent, the media, as they commonly emphasize crimes 
even further when a perpetrator is a person with a men-
tal disorder. It is also detrimental that, in general, many 
of the symptoms and (socially unusual) behaviors of the 
mentally ill are considered antisocial and criminal; this 
can consequently lead to a misconception of the causal 
links between mental disorders and crimes (30). A liter-
ature review showed that people with a properly treated 
mental disorder do not pose a greater risk of violence 
than the general population (31).
The limitations of our study were a small number 
of participating medical students. In the study, female 
students were represented more frequently. The gender 
distribution also matches the actual representation of 
women and men in the faculty, so we could not influ-
ence this bias. Additionally, sixth-year students were less 
represented in the study since they attended the lectures 
less frequently according to the faculty’s education plan. 
We could not motivate them to participate in the survey 
in higher numbers. Questions about understanding the 
definition of individual mental disorders were not part 
of standardized questionnaires, so they have less power. 
In today’s challenging COVID-19 pandemic 
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ORIGINAL SCIENTIFIC ARTICLE
Attitudes toward mental disorder among medical students
situation, when mental health is an important issue, the 
results of our study are even more compelling. Despite 
a positive attitude toward mental disorders, the sixth-
year students were somewhat undecided about whether 
a person with a mental illness can be a physician, reveal-
ing some degree of stigma. On the other hand, it is a 
known fact that physicians had high rates of suicide and 
depression (32) even before the pandemic. This fact is 
particularly relevant to medical students – future phy-
sicians, since presently the prevalence of stress, anxiety, 
and depression among front-line healthcare workers 
caring for COVID-19 patients is even higher (33). In the 
pandemic and post-pandemic time, it would make sense 
to pay greater attention to the students’ and physicians’ 
mental health henceforward and provide safe environ-
ments where they can express their issues without fear 
and be treated appropriately. Among other solutions, the 
use of stigmatizing language should change, and support 
for each other should be prominent (34). In 2020, the 
National Institute of Public Health in Slovenia started to 
prepare for the implementation of the National Mental 
Health Program (NMHP) from 2021 to 2023, which in-
cludes a crisis plan regarding the COVID-19 pandem-
ic. Improved accessibility was recognized as an essen-
tial factor in reducing the mental health burden in the 
COVID-19 crisis, and a general recommendation was 
made to organize services in the community. A Slovene 
study carried out mid-pandemic found that the Delphi 
method for constructing emergency mental health ac-
tivities during a pandemic is needed, as it could help 
overcome many challenges (35).
Studies on anti-stigma programs for physicians and 
medical students found that the confessions of a physi-
cian or medical student with personal experience of a 
mental disorder represent an essential part of immedi-
ate positive effects on stigma-related stress (19,36). A 
stable mental state of medical staff can lead to better 
treatment outcomes; therefore, this aspect is essential 
for future improvements (37). The COVID-19 pandem-
ic has heightened interest in how physicians’ mental 
health can be protected and optimized. New initiatives 
to reduce uncertainty and misinformation regarding 
mental disorders with evidence-based information are 
proposed at different levels - medical schools, health-
care settings, and professional colleagues - to protect the 
mental health and wellbeing of physicians (38). Medical 
school and education is the foundation; therefore, it is 
crucial to implement a clerkship alongside psychiatry 
lectures, allowing students to meet patients with mental 
disorders, hear their personal experiences, and actively 
minimize mental disorder stigma; and our results also 
support this.
5 Conclusion
We can conclude that the attitude toward mental 
disorders improves with education. Regardless of years 
of education, medical students expressed a positive at-
titude toward people with mental disorders. Sixth-year 
students showed the most positive attitude, as they have 
already completed the psychiatry clerkship and are thus 
most educated about mental disorders. However, the 
participants expressed slight stigma regarding violent 
behavior in the mentally ill, and there was some doubt 
regarding a physician having a mental disorder. Addi-
tionally, with the present COVID-19 pandemic, we face 
even more significant challenges and burdens. Now, 
more than ever, reducing mental health stigma is need-
ed, as it might improve health-seeking in medical work-
ers. Better mental healthcare accessibility, organized 
community services, and new initiatives are warranted 
to protect the mental health and wellbeing of students 
and physicians.
Conflict of interest
None declared.
Ethical approval
Our study was approved by the Medical Ethics Com-
mittee of the University Medical Centre Maribor (No. 
UKC-MB-KME-94-1/19). All procedures performed in 
our study were under the Declaration of Helsinki (1964) 
and its later amendments. The nature and purpose of the 
study were explained to the participants. Informed con-
sent was obtained from all participants after the nature 
of the study had been fully explained.
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