Sri Lankan doctors’ and medical undergraduates’ attitudes towards mental illness

  • Sunera Mayanthi FernandoEmail author
  • Frank P. Deane
  • Hamish J. McLeod
Original Paper



Stigmatizing attitudes towards mental illness can impede help-seeking and adversely affect treatment outcomes, especially if such attitudes are endorsed by medical personnel. In order to help identify targets for anti-stigma interventions, we comprehensively examined negative attitudes towards mental illness displayed by Sri Lankan doctors and medical students and compared these with equivalent UK and other international data.


A self-report questionnaire originally developed in the UK was completed by medical students (n = 574) and doctors (n = 74) from a teaching hospital in Colombo. The questions assessed the presence and intensity of stigmatizing attitudes towards patients with schizophrenia, depression, panic disorder, dementia and drug and alcohol addiction.


The study revealed higher levels of stigma towards patients with depression, alcohol and drug addiction in this Sri Lankan sample compared to UK data but attitudes towards schizophrenia were less stigmatized in Sri Lanka. Blaming attitudes were consistently high across diagnoses in the Sri Lankan sample. Sri Lankan medical students displayed more negative attitudes than doctors (P < 0.001). Overall stigma was greatest towards patients with drug addiction, followed by, alcohol addiction, schizophrenia, depression, panic disorder and dementia.


Sri Lankan doctors and undergraduates endorse stigmatizing attitudes towards mental illnesses and are especially prone to see patients as blameworthy. As such attitudes are likely to affect the engagement of patients in treatment and specific interventions that modify negative attitudes towards people with mental illnesses are needed. Ensuring that medical students have contact with recovered patients in community psychiatry settings may be one way of decreasing stigmatizing attitudes.


Stigma Mental illness Medical students Doctors Medical education 



The study team thanks the Sri Lankan medical students and doctors who gave their time to participate in this study. Funding for this study was supported by the “Developing Australia’s Capacity in South Asia” (DACSA) Scholarship (sponsored by AusAID and the Australian Research Council’s Asia Pacific Futures Research Network) that funded the PhD.


  1. 1.
    Adewuya AO, Oguntade AA (2007) Doctors’ attitude towards people with mental illness in Western Nigeria. Soc Psychiatry Psychiatr Epidemiol 42:931–936CrossRefPubMedGoogle Scholar
  2. 2.
    Arvaniti A, Samakouri M, Kalamara E et al (2008) Health service staff’s attitudes towards patients with mental illness. Soc Psychiatry Psychiatr Epidemiol Published online 12 December. doi:10.1007/s00127-008-0481-3
  3. 3.
    Arkowitz H, Miller WR (2008) Learning, applying and extending motivational interviewing. In: Arkowitz H, Westra HA, Miller WR, Rollnick S (eds) Motivational interviewing in the treatment of psychological problems. Guildford Press, New York, p 5Google Scholar
  4. 4.
    Ay P, Save D, Fidanoglu O (2006) Does stigma concerning mental disorders differ through medical education? A survey among medical students in Istanbul. Soc Psychiatry Psychiatr Epidemiol 41(1):63–67CrossRefPubMedGoogle Scholar
  5. 5.
    Baxter H, Singh SP, Standen P et al (2001) The attitudes of ‘tomorrow’s doctors’ towards mental illness and psychiatry: changes during the final undergraduate year. Med Educ 35:381–383CrossRefPubMedGoogle Scholar
  6. 6.
    Bell JS, Aaltonen SE, Bronstein E et al (2008) Attitudes of pharmacy students toward people with mental disorders, a six country study. Pharm World Sci 30:595–599CrossRefPubMedGoogle Scholar
  7. 7.
    Bell JS, Johns R, Chen TF (2006) Pharmacy students’ and graduates’ attitudes towards people with schizophrenia and severe depression. Am J Pharm Educ 70(4):77Google Scholar
  8. 8.
    Burti L, Mosher LR (2003) Attitudes values and beliefs of mental health workers. Epidemiol Psychiatr Soc 12:227–231Google Scholar
  9. 9.
    Byrne P (1997) Psychiatric stigma: past passing and to come. J R Soc Med 90:618–621PubMedGoogle Scholar
  10. 10.
    Coodin S, Chisholm F (2001) Teaching in a new key: effects of a co-taught seminar on medical students’ attitudes towards schizophrenia. Psychiatr Rehabil J 24(3):299–302PubMedGoogle Scholar
  11. 11.
    Corrigan PW (2005) On the stigma of mental illness; practical strategies for research and social change. American Psychological Association, Washington DCCrossRefGoogle Scholar
  12. 12.
    Corrigan PW, Penn DL (1999) Lessons from social psychology on discrediting psychiatric stigma. Am Psychol 54:765–776CrossRefPubMedGoogle Scholar
  13. 13.
    Couture S, Penn DL (2003) Interpersonal contact and the stigma of mental illness: a review of the literature. J Ment Health 12:291–305CrossRefGoogle Scholar
  14. 14.
    Crisp AH, Gelder MG, Rix S et al (2000) Stigmatisation of people with mental illness. Br J Psychiatry 177:4–7CrossRefPubMedGoogle Scholar
  15. 15.
    Department of Healthcare and Nutrition Sri Lanka (2007) Annual health statistics 2007. Sri Lanka Department of Health Services, Sri LankaGoogle Scholar
  16. 16.
    Gelder MG, Lopez-Ibor JJ, Andreason N (eds) (2004) New oxford textbook of psychiatry, vol 1. Oxford University Press, New York, p 837Google Scholar
  17. 17.
    Hickie I (2004) Can we reduce the burden of depression? The Australian experience with Beyondblue: The national depression initiative. Australas Psychiatry 12:S38–S46CrossRefPubMedGoogle Scholar
  18. 18.
    Jayawardana R, Fernando WDD (2005) Psychiatric stigma among medical teachers (eletter). Psychiatr Bull.
  19. 19.
    Kerby J, Calton T, Dimambro B et al (2008) Anti-stigma films and medical students’ attitudes towards mental illness and psychiatry: randomized control trial. Psychiatr Bull 32:345–349CrossRefGoogle Scholar
  20. 20.
    Kitchener BA, Jorm AF (2006) Mental health first aid training: review of evaluation studies. Aust N Z J Psychiatry 40:6–8PubMedGoogle Scholar
  21. 21.
    Lauber C, Rossler W (2007) Stigma towards people with mental illness in developing countries in Asia. Int Rev Psychiatry 19(2):157–178CrossRefPubMedGoogle Scholar
  22. 22.
    Leff J, Sartorius N, Jablensky A et al (1992) The international pilot study of schizophrenia: five-year follow-up findings. Psychol Med 22(1):131–145CrossRefPubMedGoogle Scholar
  23. 23.
    Link BG, Phelan JC, Bresnahan M et al (1999) Public conceptions of mental illness: labels, causes, dangerousness and social distance. Am J Public Health 89(9):1328–1333CrossRefPubMedGoogle Scholar
  24. 24.
    Littlewood R (1998) Cultural variation in the stigmatization of mental illness. Lancet 352:1056–1057CrossRefPubMedGoogle Scholar
  25. 25.
    Mental Health Foundation (2000) Pull yourself together: a survey of the stigma and discrimination faced by people who experience mental distress. Mental Health Foundation, LondonGoogle Scholar
  26. 26.
    Mukherjee R, Fialho A, Wijetunge A et al (2002) The stigmatisation of psychiatric illness: the attitudes of medical students and doctors in a London teaching hospital. Psychiatr Bull 26:178–181CrossRefGoogle Scholar
  27. 27.
    Naeem F, Ayub M, Javed Z et al (2006) Stigma and psychiatric illness: a survey of attitude of medical students and doctors in Lahore, Pakistan. J Ayub Med Coll Abbottabad 18(3):46–49PubMedGoogle Scholar
  28. 28.
    Penn DL, Chamberlin C, Mueser T (2003) The effects of a documentary film about schizophrenia on psychiatric stigma. Schizophr Bull 29:383–391PubMedGoogle Scholar
  29. 29.
    Pinfold V, Toulmin H, Thornicroft G et al (2003) Reducing psychiatric stigma and discrimination: evaluation of educational interventions in UK secondary schools. Br J Psychiatry 182:342–346CrossRefPubMedGoogle Scholar
  30. 30.
    Reddy JP, Tan SMK, Azmi MT et al (2005) The effect of a clinical posting in psychiatry on the attitudes of medical students towards psychiatry and mental illness in a Malaysian medical school. Ann Acad Med Singapore 34:505–510PubMedGoogle Scholar
  31. 31.
    Sadow D, Ryder M (2008) Reducing stigmatizing attitudes held by future health professionals: the person is the message. Psychol Serv 5:362–372CrossRefGoogle Scholar
  32. 32.
    Sartorius N, Schulze H (2005) Reducing the stigma of mental illness: a report from a Global Programme of the World Psychiatric Association. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  33. 33.
    Schulze B, Angermeyer MC (2003) Subjective experiences of stigma: a focus group study of schizophrenic patients, their relatives and mental health professionals. Soc Sci Med 56(2):299–312CrossRefPubMedGoogle Scholar
  34. 34.
    Thornicroft G, Brohan E, Kassam A et al (2008) Reducing stigma and discrimination: candidate interventions. Int J Ment Health Syst 2:2–3CrossRefGoogle Scholar
  35. 35.
    United States Department of Health and Human Services (1999) Mental health: a report of the surgeon general. United States Department of Health and Human Services, Rockville, MDGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Sunera Mayanthi Fernando
    • 1
    • 2
    Email author
  • Frank P. Deane
    • 3
  • Hamish J. McLeod
    • 3
  1. 1.Department of Psychological Medicine, Faculty of MedicineUniversity of ColomboColomboSri Lanka
  2. 2.School of Health SciencesUniversity of WollongongWollongongAustralia
  3. 3.Illawara Institute for Mental Health and School of PsychologyUniversity of WollongongWollongongAustralia

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