Resumen de Actitudes de mujeres estudiantes de psicología hacia las personas con esquizofrenia: relación con la percepción de agresividad y peligrosidad
Ana Fresán Orellana, Rebeca Robles García, Marisol Cota, Carlos Berlanga, Dolores Lozano, Antonio Tena Suck
- español
El temor y el rechazo han sido las principales actitudes negativas hacia las personas con trastornos mentales graves como la esquizofrenia. Éstas surgen de la percepción pública de que los pacientes no tienen control sobre su comportamiento y son agresivos, violentos y/o peligrosos; tienen un impacto directo en las personas que padecen esquizofrenia y sus familiares, y aun cuando podría esperarse lo contrario, diversos estudios han mostrado que los profesionales de la salud en general, y de la salud mental en lo particular, muestran actitudes negativas hacia los pacientes con esquizofrenia. Diversos estudios internacionales han demostrado que las campañas dirigidas a incrementar la alfabetización en salud mental (ASM) son efectivas para modificar las actitudes negativas hacia las personas con trastornos mentales. Sin embargo, las necesidades de ASM pueden tener variaciones locales, por lo que resulta necesario conocer las actitudes hacia la enfermedad mental y los factores asociados a las mismas en las poblaciones blanco a las que se dirigirán las campañas antiestigma en una región particular. En esta dirección, el objetivo principal del presente estudio fue comparar las actitudes de mujeres estudiantes de psicología hacia las personas con trastornos mentales graves de acuerdo a la agresividad y peligrosidad percibida de un paciente con esquizofrenia. Adicionalmente, las actitudes hacia las personas con trastornos mentales graves así como las variables relacionadas con la alfabetización en salud mental se comparan entre las mujeres que cursaban la primera mitad de la licenciatura en psicología y aquellas que cursaban la segunda mitad. Método Se incluyó un total de 110 mujeres con una edad promedio de 21.6±1.7 años, estudiantes de la licenciatura en psicología de una universidad de la zona metropolitana de la Ciudad de México que aceptaron participar en el estudio de forma voluntaria y anónima. El 59.1% (n=65) se encontraba cursando la primera mitad de la licenciatura (del 1° al 5° semestre) y el 40.9% (n=45) restante, la segunda mitad (del 6° al 10° semestre). El total de la muestra completó la Escala de Opiniones sobre la Enfermedad Mental en Población Mexicana (OMI-M) para determinar las actitudes hacia las personas con trastornos mentales graves, así como el Cuestionario de Concepto Público de Agresividad (CPA), que valora el concepto público de agresividad del paciente con esquizofrenia con base en la presentación de una viñeta clínica de un paciente con esquizofrenia paranoide. Resultados El 95.5% (n=105) de las estudiantes reconocieron la presencia de una enfermedad mental en la viñeta clínica. No obstante, tan sólo el 70.9% (n=78) consideró las intervenciones psiquiátricas como las más adecuadas para el control de los síntomas. El 59.1% (n=65) de las estudiantes consideró que el sujeto descrito en la viñeta podría ser agresivo de alguna forma y tan sólo 12.7% (n=14) lo calificó como peligroso para la sociedad. Las estudiantes que percibieron agresivo al paciente de la viñeta mostraron mayores puntajes en las áreas de restricción, predicción pesimista y en la puntuación total del OMI-M. De forma similar, aquellas que consideraron peligroso al paciente tuvieron mayores actitudes negativas en términos de separatismo, estereotipos y puntuación total del OMI-M. No se encontraron diferencias en las variables de alfabetización en salud mental (reconocimiento de la enfermedad, causas atribuibles y tratamiento sugerido), ni en la percepción de agresión y peligrosidad, ni en cuanto a las diferentes áreas evaluadas por el OMI-M entre alumnas que cursaban la primera mitad de la licenciatura en psicología y aquellas que cursaban la segunda mitad. Discusión Un alto porcentaje de estudiantes de psicología consideró agresivo al paciente descrito en la viñeta, y tal como se esperaba, esta concepción se relacionó con mayores actitudes negativas, tales como mayor nivel de restricción y de predicción pesimista. Adicionalmente, la percepción de la persona con enfermedad mental como alguien con capacidades limitadas y comportamiento extraño parece promover la distancia social. Tanto la percepción de agresión como la de peligrosidad y las actitudes negativas asociadas en esta muestra nos hablan del poco entendimiento que pudieran tener los estudiantes de psicología en relación con las experiencias vividas por los pacientes. Aun cuando nuestros resultados no pueden ser generalizados al total de los estudiantes de psicología del país, es posible sugerir la inclusión al currículo educativo de información clara y objetiva sobre aspectos psicosociales de la enfermedad –estigma y actitudes hacia la enfermedad– y no sólo aspectos teóricos sobre la fisiopatología del trastorno y características sintomáticas del padecimiento; así como el contacto regular, tanto hospitalario como comunitario, con los pacientes
- English
Perception of environment and reality stems mainly from factors determined by social and cultural influences. Several socialization processes promote the development of relations that endorse or reject certain values or identities. Unfortunately, many of these relations arise from prejudiced values that generate negative attitudes such as stigmatization or discrimination toward some persons.
According to psychosocial models, generation of stigma is a consequence of three aspects: lack of knowledge about the person’s condition (ignorance); development of negative attitudes (prejudice) and a tendency to exclude or reject some individuals (discrimination).
Particularly, in mental health problems, general public knowledge of severe mental illnesses such as schizophrenia frequently develops in accordance to myths and misconceptions. For example, schizophrenics are commonly viewed as mad and incompetent individuals that produce fear and rejection. These erroneous conceptions originate from considering that they are incapable of controlling their acts, thus giving rise to aggressive, violent or dangerous conducts. Stigmatization impacts patients increasing depressive symptoms, anxiety and social withdrawal. Stigma also has a negative impact on diagnosis and treatment; timely diagnostic interventions and specialized treatments are frequently delayed in stigmatized individuals.
Although it is reasonable to anticipate that stigmatization attitudes are more common among persons with low cultural levels, many studies have demonstrated that unfortunately this problem is also present in many health professionals, including those who work with the mentally ill. For these reasons different attempts have developed to reduce stigma by means of mental health literacy interventions oriented to modify and eliminate misconceptions about mental patients and their illness. In this sense, mental health literacy is defined as any educational intervention aimed to increase recognition, management and prevention of mental illness. Many studies have demonstrated that this type of interventions have a positive impact in reducing negative attitudes toward patients, diminishing in consequence treatment gap.
In accordance to this theoretical framework, the principal objective of this study was to evaluate in a group of female psychology students, their attitudes toward mental illness determining their perception of danger and aggressiveness in a schizophrenic patient. We hypothesized that perception of dangerousness and aggressiveness will correlate with more negative attitudes to mental illness. Additionally, we compared attitudes to severe mental illness according to other variables related to mental health literacy such as knowledge of etiology of illness and treatment options, among female student in their first half of their career and female student in their second half. We hypothesized that advanced student will have a higher level of mental health literacy and less negative attitudes to mental illness.
Method A total of 110 female psychology students from a university in Mexico City were included in the study. Group’s mean age (±SD) was 21.6 (1.7) years (range 19-33 years). All subjects gave their consent to participate in a voluntary and anonymous manner. Sixty five students (59.1%) were at the initial half-stage of their career (1st to 5th semester), and forty five (40.9%) were at their last half-stage (6th to 10th semester). The study was approved by the Institutional Research and Ethical Committees (Instituto Nacional de Psiquiatría Ramón de la Fuente), and by the university´s authorities.
The Opinions about Mental Illness Scale (OMI), previously translated and standardized in our country (OMI-M), was used to evaluate personal attitudes toward severe mentally ill persons. OMI-M is a 34-item self-report questionnaire which evaluates attitudes utilizing a 5-points Liker scale procedure (1 = totally disagree; 5=totally agree). Evaluation includes six factors:
1. Separatism, which emphasizes the persons’ perceived differences about a mental disorder and the desire of keeping a distance to be safe;
2. Stereotyping, defined as conceiving mentally ill persons in accordance to certain behavioral and intellectual patterns; 3. Restrictiveness, which includes items that uphold an uncertain notion regarding the rights of mentally ill persons; 4. Benevolence, which evaluates compassion to the mentally ill; 5. Pessimistic prediction, referring to the perception that mentally ill persons are incapable of improving on their symptoms and how society is also not optimistic in this respect; 6. Stigmatization, build upon items that perceive mental illness as a cause of shame.
The Public Aggressiveness Concept Questionnaire, a self-rated instrument was also applied in the study. This questionnaire evaluates the perception of aggressiveness after reviewing a standardized clinical vignette of a patient with an active paranoid schizophrenia.
The reviewer is asked to answer questions regarding the identification of aggressive conduct in the vignette, including the presence and intensity of verbal and physical violence. In another section, the way symptoms could be controlled is evaluated. Additional questions are included in the final section of the questionnaire aimed to evaluate concepts such as if the reviewer considers that the person in the vignette has a mental illness, what causes might originate this condition, and if he or she perceives the subject as socially dangerous.
Data analysis was carried utilizing the SPSS, version 17.0, statistical program. Categorical variables description was done with rates and percentages; continuous variables were analyzed with means and standard deviation.
Results Ninety-five percent of students (n=105) recognized the presence of a mental illness in the vignette. However, only seventy-eight (70.9%) considered psychiatric treatment (medication and/or hospitalization) as the most adequate intervention. Twenty-seven students (24.5%) determined that a non-psychiatric/non-restrictive intervention was the best treatment. Finally, only five subjects (4.5%) considered a restrictive intervention (restrain, isolation) as necessary to treat the condition. With respect to etiological aspects, students could choose one or more options that they considered were causing the illness. Global biopsychosocial etiologies as well as single medical, psychological and even familiar problems were attributed by a high percentage of the students as the cause of the condition.
Sixty-five students (59.1%) determined that the individual described in the vignette could be aggressive in some way but only 14 (12.7%) considered the patient dangerous to society. Students that perceived agressiveness qualified higher in restriction, pessimistic prediction and global scores of the OMI-M, indicating more negative attitudes to mental illness. No differences in mental health literacy and perception of aggression and dangerousness were found among students in the first and second stages of their studies.
Discussion These findings show that a high percentage of psychology students considered the patient depicted in the vignette as aggressive. This conception, as expected, related to more negative attitudes and a prediction of a negative outcome. Also, many students perceived the patient as someone with limited capacities and a rare behavior generating thus the necessity of social isolation. Although these findings are impossible to be generalized to other groups of students, they suggest the need to include an educational program in the curricula to provide clear and objective information about aspects related to mental illness and stigma.
