Medical student attitudes toward mental illness: a cross-sectional study from the Gaza Strip, Palestine

Medical student attitudes toward mental illness: a cross-sectional study from the Gaza Strip, Palestine | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Medical student attitudes toward mental illness: a cross-sectional study from the Gaza Strip, Palestine Belal Aldabbour, Nasser Abu-El-Noor, Ahmed Elhissi, Jamil Wafi, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4586206/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Mental illness is highly stigmatized compared to physical illness, often due to false beliefs and a lack of knowledge. Negative attitudes harbored by healthcare providers reflect on the care they provide and impact their patients’ outcomes and may tailor their future preferences away from the psychiatric practice. This cross-sectional study used a stratified, randomized sampling to survey the beliefs and attitudes of students at a Palestinian medical school toward mental illness using the Beliefs Toward Mental Illness (BMI) scale. Results Overall, 79.1% of 282 participants demonstrated overall positive attitudes toward mentally ill patients (BMI score <43). The highest mean score (more negative attitude) was received by the ‘dangerousness’ domain (2.75 ± 0.75), while the ‘poor social and interpersonal skills’ domain received the lowest mean score (2.47 ± 0.82). Male sex (p=0.031) and having a friend (p=0.035) or a family member (p=0.033) suffering from a mental illness predicted a more positive attitude toward mental illness, while age, study level, and having undergone the clinical psychiatry rotation did not impact attitude significantly. Conclusions The study shows that medical students in the Gaza Strip are not absolved from the negative stereotypes of their community toward mentally ill patients, which should be addressed systematically by health educators and medical schools in the country. Educational Psychology Psychiatry Social Stigmas Attitude of Health Personnel Mental Illness discrimination Low Income Countries Background Mental illness is a major public health concern globally. It affects approximately 25% of the world's population at some point in their lives, with an estimated one billion people suffering from some form of mental illness in the year 2019 ( 1 ). In 2022, there were 24765 mentally ill patients in the Gaza Strip, with a ratio of 11.3/1000 population ( 2 ). Further, a psychological conditions survey in November of 2022 showed that depressive symptoms are common among Palestinian adults (18 years and over), with a higher prevalence rate in the Gaza Strip than in the West Bank (50% and 71%, respectively)( 3 ). Post-traumatic stress disorder is also more common in the Gaza Strip compared to the West Bank according to the Palestinian Central Bureau of Statistics (PCBS)( 4 ). The stigma associated with mental illness can have significant negative consequences for individuals with mental health conditions, including discrimination, social isolation and limited access to healthcare services ( 5 ). Negative attitudes and beliefs about mentally ill patients are common, often due to a lack of knowledge and understanding of mental illness ( 6 – 8 ). False beliefs and myths about mental illness can also lead to patients being viewed as outcasts or "bewitched" ( 6 , 9 , 10 ). This stigmatization may result in patients being treated poorly or isolated from their communities. Furthermore, stigmatization can also impact healthcare professionals' ability to provide high-quality care to patients with mental health conditions. As future healthcare professionals, medical students' attitudes towards mental illness and mentally ill patients are crucial and will reflect on the quality of care they will provide. Several studies have examined the attitudes of medical students from different regions and cultures towards mental illness, with varying findings. Nonetheless, there is a dearth of literature on Palestinian medical students’ attitudes toward mental illness. Medical schools should impart proper attitudes toward mental illness and psychiatric patients and practice. This is especially significant because negative attitudes conveyed by healthcare professionals may impact how well they relate to, communicate with, and care for their patients ( 11 , 12 ) and may hinder patients' efforts to get help ( 13 ). Additionally, harboring such negative attitudes may result in prolonged waiting times, subpar treatment, verbal or physical abuse ( 14 ), and worse prognoses ( 15 ). Therefore, this study aimed to assess the attitudes of Palestinian medical students toward mental illness and to identify factors influencing their attitudes. Methods Study Design: This descriptive, cross-sectional study surveyed the beliefs and attitudes of Palestinian medical students toward mental illness. Target Population and Setting: This study surveyed undergraduate medical students at our institution from June to July 2022. It included students from the first to sixth year. The total number of the target population was 994 at the time of data collection. A stratified, randomized sample was used to be representative of sex and study level. Using the Raosoft free sample size calculator ( http://www.raosoft.com/samplesize.html ), the sample size was 278 participants. An additional 30 students were added to account for anticipated dropouts. Study Instrument: The study instrument consisted of two parts. The first part included sociodemographic data (i.e., age, sex, year of study) and other relevant information about the participants (i.e., if any family member or a friend has a mental illness, if they had previously dealt with mentally ill patients). The second part of the instrument employed the Beliefs Toward Mental Illness (BMI) Scale ( 16 ). Developed by Hirai and Clum, BMI measures negative stereotypes about mental illness and it includes 21 items distributed into three domains [dangerousness (five items), poor social and interpersonal skills (10 items), and incurability (six items)]. The BMI uses a six-point Likert scale ranging from zero (completely disagree) to 5 (completely agree). Higher scores represent a more negative attitude toward mental illness. Previous studies from different cultures and countries reported that BMI was a valid and reliable scale ( 16 – 22 ). The Cronbach’s alpha result for the scale was 0.845. Ethical and administrative considerations: Ethical approval for the study was obtained from the research ethics committee at the institution. Written consent was obtained before data collection, and participant anonymity was maintained throughout data collection and data analysis. Students were assured that their academic records would not be impacted if they declined to participate. Data analysis: After data entry and data cleaning, data analysis was done using the Statistical Package for Social Sciences (SPSS) software. Descriptive statistics were used to describe variables, while t-test and ANOVA were used for inferential statistics. To determine the attitude toward mental illness, scores ranging between 0–42 were considered positive attitudes, while scores of 43 and above were considered negative. Statistical significance was set at p ≤ 0.05. Results Socio-demographics of participating students A total of 282 medical students returned the completed questionnaires. Table 1 depicts the participants’ demographic data and other related information. The age of participants ranged between 18 and 25 years (mean 20.66 (± 1.62) years. Just above half (53.5%, n = 151) of the participants were males. Table 2 shows further information pertinent to participants’ experience with mentally ill patients and mental illness. At the time of data collection, 62.1% (n = 175) of the students had not yet studied the clinical psychiatry rotation. The great majority of students had no family members (90.8%, n = 256), relatives (82.3%, n = 232), or friends (77.3%, n = 218) suffering from a mental illness. Furthermore, only 5.7% (n = 16) have visited a psychiatrist for counselling or treatment, and only 42.6% (n = 130) reported previously dealing with mentally ill patients in any setting. Table 1 Socio-demographic data of medical students Variable n % Age Range 18–25 Mean 20.66 ± 1.62 Sex Male 151 53.5 Female 131 46.5 Governorate Rafah 21 9.3 Khanyounis 62 22.0 Middle Governorate 45 16.0 Gaza 130 46.1 North Gaza 30 10.6 Type of residence City 222 78.7 Refugee Camp 43 15.2 Village 17 6.0 Academic Level First year 52 18.4 Second year 49 17.4 Third year 52 18.4 Fourth year 49 17.4 Fifth year 49 17.4 Sixth year 31 11.0 Study Phase Basic (years 2 or 3) 152 53.9 Clinical (years 4–6) 130 46.1 Table 2 Participants’ experience with psychiatry and mental illness Variable n % Had the psychiatry course Yes 107 37.9 No 175 62.1 A family member suffers from a mental illness Yes 26 9.2 No 256 90.8 A relative suffers from a mental illness Yes 50 17.7 No 232 82.3 A friend suffers from a mental illness Yes 64 22.7 No 218 77.3 Suffered from a mental illness Yes 47 16.7 No 235 83.3 Visited a psychiatrist for counseling or treatment Yes 16 5.7 No 266 94.3 Dealt with mentally ill patients Yes 120 42.6 No 162 57.4 Beliefs of medical students about mental illness Table 3 represents the means for BMI scale domains, and the mean for each item ranked in a descending order. The highest mean score was received by the ‘dangerousness’ domain (2.75 ± 0.75), while the ‘poor social and interpersonal skills’ domain received the lowest mean score (2.47 ± 0.82). The item “mental disorder would require a much longer time to be cured than would other general diseases” received the highest mean (3.65 ± 1.08) within the ’dangerousness’ domain. In contrast, the statement “It may be a good idea to stay away from people who have a psychological disorder because their behavior is dangerous” received the lowest mean (2.01 ± 1.26) in the same domain. In the ‘poor social and interpersonal skills’ domain, the item “a person with a psychological disorder is less likely to function well as a parent.” received the highest mean (2.98 ± 1.22) and the item “I would be embarrassed if a person in my family became mentally ill” received the lowest mean (1.83 ± 1.58). In the ‘incurability’ domain, the statement “the behavior of people who have psychological disorders is unpredictable” received the highest mean (3.13 ± 1.13) while the statement “psychological disorder is unlikely to be cured regardless of treatment” received the lowest mean (1.94 ± 1.28). The mean of total score of all BMI items was 2.58 (± 0.65). Most participating medical students (79.1% n = 223) demonstrated overall positive attitudes toward mentally ill patients, as they had a total score of less than 42 (Table 3 ). Table 3 Mean score for BMI domains and individual items, and the overall attitude of medical students towards mental illness Statement Mean Std. Deviation Dangerousness 2.75 0.75 1. Mental disorder would require a much longer period of time to be cured than would other general diseases. 3.65 1.08 2. A mentally ill person is more likely to harm others than a normal person. 3.25 1.16 3. Mentally ill people are more likely to be criminals. 2.5 1.18 4. I am afraid of people who are suffering from psychological disorder because they may harm me. 2.3 1.33 5. It may be a good idea to stay away from people who have psychological disorder because their behavior is dangerous. 2.01 1.26 Poor social and interpersonal skills 2.47 0.82 1. A person with psychological disorder is less likely to function well as a parent. 2.98 1.22 2. A person with psychological disorder should have a job with minor responsibilities. 2.93 1.35 3. Most people would not knowingly be friends with a mentally ill person. 2.85 1.33 4. It might be difficult for mentally ill people to follow social rules such as being punctual or keeping promises. 2.76 1.25 5. Mentally ill people are unlikely to be able to live by themselves because they are unable to assume responsibilities. 2.55 1.31 6. I am afraid of what my boss, friends, and others would think if I were diagnosed as having a psychological disorder. 2.50 1.57 7. The term ‘‘Psychological disorder’’ makes me feel embarrassed. 2.16 1.53 8. I would not trust the work of a mentally-ill person assigned to my work team. 2.07 1.26 9. I would be embarrassed if people knew that I married a person who once received psychological treatment. 2.04 1.56 10. I would be embarrassed if a person in my family became mentally ill. 1.83 1.58 Incurability 2.61 0.72 1. The behavior of people who have psychological disorders is unpredictable. 3.13 1.13 2. Psychological disorder is recurrent. 3.03 1.26 3. People who have once received psychological treatment are likely to need further treatment in the future. 2.74 1.23 4. Individuals diagnosed as mentally ill will suffer from its symptoms throughout their life. 2.72 1.27 5. I do not believe that psychological disorder is ever completely cured. 2.09 1.46 6. Psychological disorder is unlikely to be cured regardless of treatment 1.94 1.28 Mean Total BMI 2.58 0.65 Overall attitude Negative attitude n (%) Mean score (SD) p value < 0.001 59 (20.9%) 59.17 (9.90) Positive attitude n (%) Mean score (SD) 223 (79.1%) 34.92 (8.02) Factors associated with attitude of medical students toward mental illness Pearson’s correlation test revealed no correlation between participants’ age and BMI total scores (r = 0.027, p = 0.696). However, the results of t-test results (Table 4 ) showed that sex and having a friend or a family member suffering from a mental illness significantly impacted participants' attitudes toward mental illness. On the other hand, results of the one-way ANOVA test revealed that none of the multivariate variables, including year of study, type of residence, or governorate, impacted students’ attitudes toward mental illness (Table 5 ). Table 4 Means and results of t-test of bivariate variables Variable Total score SD p value Sex Male 52.43 12.65 0.031 Female 56.01 14.68 Study Phase Basic 53.87 12.87 0.76 Clinical 54.36 14.71 Had the psychiatry course Yes 55.00 14.88 0.403 No 53.54 12.98 A family member suffers from a mental illness Yes 47.83 15.06 0.033 No 54.73 13.45 A relative suffers from a mental illness Yes 51.48 12.52 0.115 No 54.66 13.93 A friend suffers from a mental illness Yes 50.61 15.32 0.035 No 55.12 13.08 Dealt with psychiatric patients during training Yes 53.78 15.05 0.0744 No 54.33 12.70 Table 5 Means and results of one-way ANOVA test of multivariate variables Variable Mean SD p value Academic Level First Year 55.67 14.07 0.757 Second Year 53.41 11.37 Third Year 52.62 12.21 Fourth Year 53.09 17.22 Fifth Year 54.76 14.92 Sixth Year 55.55 11.11 Type of residence City 54.32 13.21 0.264 Village 54.94 13.34 Camp 52.58 16.46 Governorate North of Gaza 54.70 14.14 0.472 Gaza 53.68 11.96 Middle Governorate 55.27 16.80 Khanyounis 53.96 14.64 Rafah 53.47 14.84 Discussion Attitude is a theoretical construct that describes a person’s learned tendency to evaluate or perceive something or someone in a certain way ( 23 ). It has affective, behavioral, and cognitive components rooted in individual experiences and cultural exposures. Medical students' attitudes, accumulated throughout their medical education, shape how they interact with mentally ill patients during their careers and the quality of care they can offer. Negative attitudes toward mentally ill people contribute to their feeling of stigma and discrimination ( 24 ), which in turn leads to several unwanted psychological outcomes ( 25 , 26 ) such as withdrawal behavior ( 26 ), low self-esteem ( 26 , 27 ), increasing level of depressive symptoms ( 26 , 28 ), and reducing their self-efficacy ( 28 , 29 ). Furthermore, some studies found that stigma leads to delaying seeking treatment ( 30 , 31 ) and lowering their quality of life ( 27 , 32 , 33 ). Moreover, Pinheiro and colleagues added that mental illness and stigmatization have a negative economic effect as it is one of the leading causes of work losses since it increases rates of absenteeism, presenteeism and number of sick-leave days ( 34 ). The current study is the first from Palestine to examine medical students' attitudes toward people with mental illness. Researchers found that four out of five participants fell closer to the positive end of the attitude towards mental illness spectrum. The lack of similar local studies limits the scope for comparisons. Internationally, however, a study from India found that medical students had better attitudes toward mentally ill patients and against separatism and stigmatization than nursing students ( 35 ). Meanwhile, another study from the same country, demonstrated neutral attitudes toward psychiatry and mental illness among medical students ( 23 ). On the other hand, other studies from different regions have demonstrated high rates of negative attitudes toward mental illness among medical students. For instance, a recent study among students of health sciences faculty in Istanbul found high rates of negative beliefs and stigmatization ( 36 ). Another study from southwestern Nigeria also found significant stigmatizing attitudes among medical students towards individuals with mental health conditions ( 37 ). Similarly, Kihumuro ( 38 ) and Chukwujekwu ( 39 ) reported poor attitudes toward mental illness among medical students in Uganda and Nigeria, respectively. Meanwhile, a comparative study from Qatar and the United States revealed that medical students from Qatar demonstrated less positive attitudes towards mental illness than medical students from the United States who received the same curriculum ( 40 ). Medical schools and health education institutions globally should address this cultural issue and design programs that facilitate a shift towards more favorable attitudes. In our study, male sex and having a friend or a family member suffering from mental illness were significantly correlated with better attitudes. The association with sex is not unusual and other studies have previously demonstrated correlations with male ( 36 ) or female sex ( 41 ), although others found no such correlations ( 23 ). Similarly, familiarity with mental illness, such as having a personal experience or a friend or relative with a history of mental illness, has also been linked to better attitudes in other studies ( 41 ). This is not unexpected since, as mentioned earlier, personal experiences play a central role in shaping future perceptions and modifying attitudes. Results revealed no significant difference in attitude between students from the basic science versus clinical phases. Also, the results did not show significant differences in medical students’ attitude between students who have had the clinical psychiatry course and those who had not. In this regard, a study from Australia reported a significant decrease in negative views towards mental illness among fourth-year medical students after the psychiatry clerkship ( 42 ). Similar findings were reported in India ( 41 ). On the other hand, a study on 1372 students from 12 Chinese medical schools found that education did not increase non-stigmatizing attitudes among participants ( 43 ). Stigma is a byproduct of the triad of ignorance, discrimination, and prejudice ( 44 ). Medical schools are tasked with ameliorating the third component (prejudice) by addressing the lack of knowledge and the culture of discrimination at the individual and systematic levels. They also have the advantage of instilling positive attitudes in younger generations. The absence of a significant correlation between students having undergone the psychiatry rotation and developing more positive attitudes calls for revising current medical curricula and teaching methods to address this lacune in training. Mental health is an indispensable aspect of contemporary medical services. Thus, it is imperative that adequate numbers of well-trained and skilled personnel are available to guarantee high-quality services. In this regard, the Gaza Strip is particularly poorly equipped, as there is a single psychiatric hospital and only a handful of psychiatrists ( 45 , 46 ). Stigmatization towards mental illness may negatively impact future preferences of medical students. While a recent meta-analysis of studies from seven Eastern Mediterranean countries found that medical students demonstrated an overall positive attitude towards the psychiatry discipline, psychiatry was absent from the list of preferred specialties for medical doctors and students from Gaza who were surveyed in 2018 ( 47 , 48 ). This further underscores the need for a fundamental change, starting with appropriate knowledge and leading to better practice and proper culture. The strengths of this study include its stratified random sampling method, large sample size, and meticulous data collection with minimal missing information. Additionally, it is the first such study from Palestine, and it employed a well-validated tool in assessing medical students’ beliefs towards mental illness. This study is not without limitations, however. It surveyed students from a single university, limiting the generalizability of the results. Additionally, the cross-sectional design prevents inferring causal associations for the findings. Conclusion Medical students are not absolved from the negative stereotypes of the community towards mentally ill patients, and they may carry these convictions into their professional lives. Medical schools should seek to systematically mitigate this cultural and ethical issue and equip students with the appropriate knowledge and exposure to ensure higher levels of healthy attitudes. Abbreviations Palestinian Central Bureau of Statistics (PCBS) Beliefs Toward Mental Illness (BMI) References WHO. World mental health report: transforming mental health for all: World Health Organization; 2022 [Available from: https://apps.who.int/iris/rest/bitstreams/1433523/retrieve. Ministry of Health. Health Anual Report, Palestine 2022. 2023. World Bank. Mental Health in the West Bank and Gaza. Washington, D.C. : World Bank Group; 2022. PCBS. 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An overview of the mental health system in Gaza: an assessment using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). Int J Ment Health Syst. 2015;9:4. Mohebbi M, Nafissi N, Ghotbani F, Khojasteh Zonoozi A, Mohaddes Ardabili H. Attitudes of medical students toward psychiatry in Eastern Mediterranean Region: A systematic review. Front Psychiatry. 2022;13:1027377. Abukmail E, Albarqouni L. Postgraduate training abroad and migration intentions of medical doctors and students in Gaza: a cross-sectional survey. Lancet. 2021;398 Suppl 1:S6. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4586206","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":314782179,"identity":"894fef81-a8e3-4d45-b6b6-a45b03dc1fb4","order_by":0,"name":"Belal Aldabbour","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYBACAwbmBoYHFRIMDMcbQFwLYrQwNjAknLFhYDhzAMSVIFJLYlsaA8ONBBCfCC3m7I2NHxLbDkfz3Xx+dcOPAgkG/vbuBLxaLHsONksknDucO/N2TtnNHqDDJM6c3YDfYTcSGyQSyg7nbridk3aDB6jFQCKXgJb7D5t/JLABtdw8k3bzD1FabjC2SSS0peVuuMF+7DZRtlj2JLZZAAM5d+aZHLbbMgYSPAT9Ys5++PCNDxUSuX3Hjz+7+eaPjRx/ey9+LUiAxwBMEqscBNgfkKJ6FIyCUTAKRhAAAL1OU9ob40CnAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-9186-4039","institution":"Islamic University of Gaza","correspondingAuthor":true,"prefix":"","firstName":"Belal","middleName":"","lastName":"Aldabbour","suffix":""},{"id":314782243,"identity":"9691aba9-1273-4479-b31b-ae713e3bbe0e","order_by":1,"name":"Nasser Abu-El-Noor","email":"","orcid":"","institution":"Islamic University of Gaza","correspondingAuthor":false,"prefix":"","firstName":"Nasser","middleName":"","lastName":"Abu-El-Noor","suffix":""},{"id":314782244,"identity":"fb46c61d-1c8a-4346-bfd5-f5f0f74f6349","order_by":2,"name":"Ahmed Elhissi","email":"","orcid":"","institution":"Islamic University of Gaza","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Elhissi","suffix":""},{"id":314782245,"identity":"8936e827-dd22-4a76-9bee-6cf00a78a1ba","order_by":3,"name":"Jamil Wafi","email":"","orcid":"","institution":"Islamic University of Gaza","correspondingAuthor":false,"prefix":"","firstName":"Jamil","middleName":"","lastName":"Wafi","suffix":""},{"id":314782246,"identity":"e00a649a-d636-4bae-a087-31f5ec95fa4f","order_by":4,"name":"Mohammad Dabour Asad","email":"","orcid":"","institution":"Islamic University of Gaza","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Dabour","lastName":"Asad","suffix":""},{"id":314782247,"identity":"d5f2c94e-b680-4287-99e9-24b8dac92fa7","order_by":5,"name":"Osama Aldabbour","email":"","orcid":"","institution":"Islamic University of Gaza","correspondingAuthor":false,"prefix":"","firstName":"Osama","middleName":"","lastName":"Aldabbour","suffix":""},{"id":314782248,"identity":"9e6732b7-14c5-49a5-98cd-f1cc993adef6","order_by":6,"name":"Amal Abuabada","email":"","orcid":"","institution":"Gaza Community Mental Health Program","correspondingAuthor":false,"prefix":"","firstName":"Amal","middleName":"","lastName":"Abuabada","suffix":""},{"id":314782249,"identity":"59d3785b-5e62-4e30-8118-352b19f6d9ae","order_by":7,"name":"Abedelrahman Rizq Diab","email":"","orcid":"","institution":"Islamic University of Gaza","correspondingAuthor":false,"prefix":"","firstName":"Abedelrahman","middleName":"Rizq","lastName":"Diab","suffix":""},{"id":314782250,"identity":"6eae061e-c5fc-41d3-9f0a-a08922e1c7e6","order_by":8,"name":"Mysoon Khalil Abu-El-Noor","email":"","orcid":"","institution":"Islamic University of Gaza","correspondingAuthor":false,"prefix":"","firstName":"Mysoon","middleName":"Khalil","lastName":"Abu-El-Noor","suffix":""}],"badges":[],"createdAt":"2024-06-15 10:55:23","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4586206/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4586206/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58544987,"identity":"32487825-1599-4711-ad58-5841eafd99d5","added_by":"auto","created_at":"2024-06-18 05:28:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":667767,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4586206/v1/7acd8c7a-73e5-4f70-9ebc-e934d0d1204c.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eMedical student attitudes toward mental illness: a cross-sectional study from the Gaza Strip, Palestine\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eMental illness is a major public health concern globally. It affects approximately 25% of\u003c/p\u003e \u003cp\u003ethe world's population at some point in their lives, with an estimated one billion people\u003c/p\u003e \u003cp\u003esuffering from some form of mental illness in the year 2019 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In 2022, there were 24765 mentally ill patients in the Gaza Strip, with a ratio of 11.3/1000 population (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Further, a psychological conditions survey in November of 2022 showed that depressive symptoms are common among Palestinian adults (18 years and over), with a higher prevalence rate in the Gaza Strip than in the West Bank (50% and 71%, respectively)(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Post-traumatic stress disorder is also more common in the Gaza Strip compared to the West Bank according to the Palestinian Central Bureau of Statistics (PCBS)(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe stigma associated with mental illness can have significant negative consequences for individuals with mental health conditions, including discrimination, social isolation and limited access to healthcare services (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Negative attitudes and beliefs about mentally ill patients are common, often due to a lack of knowledge and understanding of mental illness (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). False beliefs and myths about mental illness can also lead to patients being viewed as outcasts or \"bewitched\" (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). This stigmatization may result in patients being treated poorly or isolated from their communities.\u003c/p\u003e \u003cp\u003eFurthermore, stigmatization can also impact healthcare professionals' ability to provide high-quality care to patients with mental health conditions. As future healthcare professionals, medical students' attitudes towards mental illness and mentally ill patients are crucial and will reflect on the quality of care they will provide.\u003c/p\u003e \u003cp\u003eSeveral studies have examined the attitudes of medical students from different regions and cultures towards mental illness, with varying findings. Nonetheless, there is a dearth of literature on Palestinian medical students\u0026rsquo; attitudes toward mental illness. Medical schools should impart proper attitudes toward mental illness and psychiatric patients and practice. This is especially significant because negative attitudes conveyed by healthcare professionals may impact how well they relate to, communicate with, and care for their patients (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and may hinder patients' efforts to get help (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Additionally, harboring such negative attitudes may result in prolonged waiting times, subpar treatment, verbal or physical abuse (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), and worse prognoses (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Therefore, this study aimed to assess the attitudes of Palestinian medical students toward mental illness and to identify factors influencing their attitudes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design:\u003c/h2\u003e \u003cp\u003eThis descriptive, cross-sectional study surveyed the beliefs and attitudes of Palestinian medical students toward mental illness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eTarget Population and Setting:\u003c/h2\u003e \u003cp\u003eThis study surveyed undergraduate medical students at our institution from June to July 2022. It included students from the first to sixth year. The total number of the target population was 994 at the time of data collection. A stratified, randomized sample was used to be representative of sex and study level. Using the Raosoft free sample size calculator (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.raosoft.com/samplesize.html\u003c/span\u003e\u003cspan address=\"http://www.raosoft.com/samplesize.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), the sample size was 278 participants. An additional 30 students were added to account for anticipated dropouts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy Instrument:\u003c/h2\u003e \u003cp\u003eThe study instrument consisted of two parts. The first part included sociodemographic data (i.e., age, sex, year of study) and other relevant information about the participants (i.e., if any family member or a friend has a mental illness, if they had previously dealt with mentally ill patients). The second part of the instrument employed the Beliefs Toward Mental Illness (BMI) Scale (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Developed by Hirai and Clum, BMI measures negative stereotypes about mental illness and it includes 21 items distributed into three domains [dangerousness (five items), poor social and interpersonal skills (10 items), and incurability (six items)]. The BMI uses a six-point Likert scale ranging from zero (completely disagree) to 5 (completely agree). Higher scores represent a more negative attitude toward mental illness. Previous studies from different cultures and countries reported that BMI was a valid and reliable scale (\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The Cronbach\u0026rsquo;s alpha result for the scale was 0.845.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eEthical and administrative considerations:\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for the study was obtained from the research ethics committee at the institution. Written consent was obtained before data collection, and participant anonymity was maintained throughout data collection and data analysis. Students were assured that their academic records would not be impacted if they declined to participate.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis:\u003c/h2\u003e \u003cp\u003eAfter data entry and data cleaning, data analysis was done using the Statistical Package for Social Sciences (SPSS) software. Descriptive statistics were used to describe variables, while t-test and ANOVA were used for inferential statistics. To determine the attitude toward mental illness, scores ranging between 0\u0026ndash;42 were considered positive attitudes, while scores of 43 and above were considered negative. Statistical significance was set at p\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographics of participating students\u003c/h2\u003e \u003cp\u003eA total of 282 medical students returned the completed questionnaires. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e depicts the participants\u0026rsquo; demographic data and other related information. The age of participants ranged between 18 and 25 years (mean 20.66 (\u0026plusmn;\u0026thinsp;1.62) years. Just above half (53.5%, n\u0026thinsp;=\u0026thinsp;151) of the participants were males.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows further information pertinent to participants\u0026rsquo; experience with mentally ill patients and mental illness. At the time of data collection, 62.1% (n\u0026thinsp;=\u0026thinsp;175) of the students had not yet studied the clinical psychiatry rotation. The great majority of students had no family members (90.8%, n\u0026thinsp;=\u0026thinsp;256), relatives (82.3%, n\u0026thinsp;=\u0026thinsp;232), or friends (77.3%, n\u0026thinsp;=\u0026thinsp;218) suffering from a mental illness. Furthermore, only 5.7% (n\u0026thinsp;=\u0026thinsp;16) have visited a psychiatrist for counselling or treatment, and only 42.6% (n\u0026thinsp;=\u0026thinsp;130) reported previously dealing with mentally ill patients in any setting.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic data of medical students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eRange 18\u0026ndash;25 Mean 20.66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eGovernorate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRafah\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKhanyounis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle Governorate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGaza\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorth Gaza\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eType of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRefugee Camp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVillage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eAcademic Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFourth year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFifth year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSixth year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eStudy Phase\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBasic (years 2 or 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical (years 4\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; experience with psychiatry and mental illness\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHad the psychiatry course\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eA family member suffers from a mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eA relative suffers from a mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eA friend suffers from a mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSuffered from a mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVisited a psychiatrist for counseling or treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDealt with mentally ill patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eBeliefs of medical students about mental illness\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e represents the means for BMI scale domains, and the mean for each item ranked in a descending order. The highest mean score was received by the \u0026lsquo;dangerousness\u0026rsquo; domain (2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75), while the \u0026lsquo;poor social and interpersonal skills\u0026rsquo; domain received the lowest mean score (2.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82). The item \u0026ldquo;mental disorder would require a much longer time to be cured than would other general diseases\u0026rdquo; received the highest mean (3.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08) within the \u0026rsquo;dangerousness\u0026rsquo; domain. In contrast, the statement \u0026ldquo;It may be a good idea to stay away from people who have a psychological disorder because their behavior is dangerous\u0026rdquo; received the lowest mean (2.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26) in the same domain.\u003c/p\u003e \u003cp\u003eIn the \u0026lsquo;poor social and interpersonal skills\u0026rsquo; domain, the item \u0026ldquo;a person with a psychological disorder is less likely to function well as a parent.\u0026rdquo; received the highest mean (2.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22) and the item \u0026ldquo;I would be embarrassed if a person in my family became mentally ill\u0026rdquo; received the lowest mean (1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58). In the \u0026lsquo;incurability\u0026rsquo; domain, the statement \u0026ldquo;the behavior of people who have psychological disorders is unpredictable\u0026rdquo; received the highest mean (3.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13) while the statement \u0026ldquo;psychological disorder is unlikely to be cured regardless of treatment\u0026rdquo; received the lowest mean (1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28). The mean of total score of all BMI items was 2.58 (\u0026plusmn;\u0026thinsp;0.65).\u003c/p\u003e \u003cp\u003eMost participating medical students (79.1% n\u0026thinsp;=\u0026thinsp;223) demonstrated overall positive attitudes toward mentally ill patients, as they had a total score of less than 42 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean score for BMI domains and individual items, and the overall attitude of medical students towards mental illness\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eStatement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStd. Deviation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eDangerousness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.75\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e1. Mental disorder would require a much longer period of time to be cured than would other general diseases.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e2. A mentally ill person is more likely to harm others than a normal person.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e3. Mentally ill people are more likely to be criminals.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e4. I am afraid of people who are suffering from psychological disorder because they may harm me.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e5. It may be a good idea to stay away from people who have psychological disorder because their behavior is dangerous.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePoor social and interpersonal skills\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.47\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.82\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e1. A person with psychological disorder is less likely to function well as a parent.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e2. A person with psychological disorder should have a job with minor responsibilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e3. Most people would not knowingly be friends with a mentally ill person.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e4. It might be difficult for mentally ill people to follow social rules such as being punctual or keeping promises.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e5. Mentally ill people are unlikely to be able to live by themselves because they are unable to assume responsibilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e6. I am afraid of what my boss, friends, and others would think if I were diagnosed as having a psychological disorder.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e7. The term \u0026lsquo;\u0026lsquo;Psychological disorder\u0026rsquo;\u0026rsquo; makes me feel embarrassed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e8. I would not trust the work of a mentally-ill person assigned to my work team.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e9. I would be embarrassed if people knew that I married a person who once received psychological treatment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e10. I would be embarrassed if a person in my family became mentally ill.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncurability\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.72\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e1. The behavior of people who have psychological disorders is unpredictable.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e2. Psychological disorder is recurrent.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e3. People who have once received psychological treatment are likely to need further treatment in the future.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e4. Individuals diagnosed as mentally ill will suffer from its symptoms throughout their life.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e5. I do not believe that psychological disorder is ever completely cured.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e6. Psychological disorder is unlikely to be cured regardless of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean Total BMI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.58\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.65\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eOverall attitude\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eNegative attitude\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMean score (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c7\" namest=\"c6\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003ep value\u003c/b\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e59.17 (9.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePositive attitude\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMean score (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223 (79.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e34.92 (8.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with attitude of medical students toward mental illness\u003c/h2\u003e \u003cp\u003ePearson\u0026rsquo;s correlation test revealed no correlation between participants\u0026rsquo; age and BMI total scores (r\u0026thinsp;=\u0026thinsp;0.027, p\u0026thinsp;=\u0026thinsp;0.696). However, the results of t-test results (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) showed that sex and having a friend or a family member suffering from a mental illness significantly impacted participants' attitudes toward mental illness. On the other hand, results of the one-way ANOVA test revealed that none of the multivariate variables, including year of study, type of residence, or governorate, impacted students\u0026rsquo; attitudes toward mental illness (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeans and results of t-test of bivariate variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStudy Phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBasic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHad the psychiatry course\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.403\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eA family member suffers from a mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eA relative suffers from a mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eA friend suffers from a mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDealt with psychiatric patients during training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.0744\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeans and results of one-way ANOVA test of multivariate variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eAcademic Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.757\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFourth Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFifth Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSixth Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eType of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVillage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCamp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eGovernorate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorth of Gaza\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.472\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGaza\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle Governorate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKhanyounis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRafah\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAttitude is a theoretical construct that describes a person\u0026rsquo;s learned tendency to evaluate or perceive something or someone in a certain way (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). It has affective, behavioral, and cognitive components rooted in individual experiences and cultural exposures. Medical students' attitudes, accumulated throughout their medical education, shape how they interact with mentally ill patients during their careers and the quality of care they can offer. Negative attitudes toward mentally ill people contribute to their feeling of stigma and discrimination (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), which in turn leads to several unwanted psychological outcomes (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) such as withdrawal behavior (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), low self-esteem (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), increasing level of depressive symptoms (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), and reducing their self-efficacy (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Furthermore, some studies found that stigma leads to delaying seeking treatment (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) and lowering their quality of life (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Moreover, Pinheiro and colleagues added that mental illness and stigmatization have a negative economic effect as it is one of the leading causes of work losses since it increases rates of absenteeism, presenteeism and number of sick-leave days (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current study is the first from Palestine to examine medical students' attitudes toward people with mental illness. Researchers found that four out of five participants fell closer to the positive end of the attitude towards mental illness spectrum. The lack of similar local studies limits the scope for comparisons. Internationally, however, a study from India found that medical students had better attitudes toward mentally ill patients and against separatism and stigmatization than nursing students (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Meanwhile, another study from the same country, demonstrated neutral attitudes toward psychiatry and mental illness among medical students (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). On the other hand, other studies from different regions have demonstrated high rates of negative attitudes toward mental illness among medical students. For instance, a recent study among students of health sciences faculty in Istanbul found high rates of negative beliefs and stigmatization (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Another study from southwestern Nigeria also found significant stigmatizing attitudes among medical students towards individuals with mental health conditions (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Similarly, Kihumuro (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) and Chukwujekwu (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) reported poor attitudes toward mental illness among medical students in Uganda and Nigeria, respectively. Meanwhile, a comparative study from Qatar and the United States revealed that medical students from Qatar demonstrated less positive attitudes towards mental illness than medical students from the United States who received the same curriculum (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Medical schools and health education institutions globally should address this cultural issue and design programs that facilitate a shift towards more favorable attitudes.\u003c/p\u003e \u003cp\u003eIn our study, male sex and having a friend or a family member suffering from mental illness were significantly correlated with better attitudes. The association with sex is not unusual and other studies have previously demonstrated correlations with male (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) or female sex (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), although others found no such correlations (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Similarly, familiarity with mental illness, such as having a personal experience or a friend or relative with a history of mental illness, has also been linked to better attitudes in other studies (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). This is not unexpected since, as mentioned earlier, personal experiences play a central role in shaping future perceptions and modifying attitudes.\u003c/p\u003e \u003cp\u003eResults revealed no significant difference in attitude between students from the basic science versus clinical phases. Also, the results did not show significant differences in medical students\u0026rsquo; attitude between students who have had the clinical psychiatry course and those who had not. In this regard, a study from Australia reported a significant decrease in negative views towards mental illness among fourth-year medical students after the psychiatry clerkship (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Similar findings were reported in India (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). On the other hand, a study on 1372 students from 12 Chinese medical schools found that education did not increase non-stigmatizing attitudes among participants (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Stigma is a byproduct of the triad of ignorance, discrimination, and prejudice (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Medical schools are tasked with ameliorating the third component (prejudice) by addressing the lack of knowledge and the culture of discrimination at the individual and systematic levels. They also have the advantage of instilling positive attitudes in younger generations. The absence of a significant correlation between students having undergone the psychiatry rotation and developing more positive attitudes calls for revising current medical curricula and teaching methods to address this lacune in training.\u003c/p\u003e \u003cp\u003eMental health is an indispensable aspect of contemporary medical services. Thus, it is imperative that adequate numbers of well-trained and skilled personnel are available to guarantee high-quality services. In this regard, the Gaza Strip is particularly poorly equipped, as there is a single psychiatric hospital and only a handful of psychiatrists (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Stigmatization towards mental illness may negatively impact future preferences of medical students. While a recent meta-analysis of studies from seven Eastern Mediterranean countries found that medical students demonstrated an overall positive attitude towards the psychiatry discipline, psychiatry was absent from the list of preferred specialties for medical doctors and students from Gaza who were surveyed in 2018 (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). This further underscores the need for a fundamental change, starting with appropriate knowledge and leading to better practice and proper culture.\u003c/p\u003e \u003cp\u003eThe strengths of this study include its stratified random sampling method, large sample size, and meticulous data collection with minimal missing information. Additionally, it is the first such study from Palestine, and it employed a well-validated tool in assessing medical students\u0026rsquo; beliefs towards mental illness. This study is not without limitations, however. It surveyed students from a single university, limiting the generalizability of the results. Additionally, the cross-sectional design prevents inferring causal associations for the findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMedical students are not absolved from the negative stereotypes of the community towards mentally ill patients, and they may carry these convictions into their professional lives. Medical schools should seek to systematically mitigate this cultural and ethical issue and equip students with the appropriate knowledge and exposure to ensure higher levels of healthy attitudes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePalestinian Central Bureau of\u0026nbsp;Statistics (PCBS)\u003c/p\u003e\n\u003cp\u003eBeliefs Toward Mental Illness (BMI)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWHO. World mental health report: transforming mental health for all: World Health Organization; 2022 [Available from: https://apps.who.int/iris/rest/bitstreams/1433523/retrieve.\u003c/li\u003e\n \u003cli\u003eMinistry of Health. Health Anual Report, Palestine 2022. 2023.\u003c/li\u003e\n \u003cli\u003eWorld Bank. Mental Health in the West Bank and Gaza. Washington, D.C. : World Bank Group; 2022.\u003c/li\u003e\n \u003cli\u003ePCBS. On the occasion of the World Health Day, 07/04/2023 2023 [cited 2023 5/9]. 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Validity and reliability of beliefs towards Mental Illness Scale. Anadolu Psikiyatri Dergisi-Anatolian Journal of Psychiatry 2008;9(2).\u003c/li\u003e\n \u003cli\u003eDesai ND, Chavda PD. Attitudes of undergraduate medical students toward mental illnesses and psychiatry. J Educ Health Promot. 2018;7:50.\u003c/li\u003e\n \u003cli\u003ePawar A, Peters A, Rathod J. Stigma of mental illness: A study in the Indian Armed Forces. Medical Journal Armed Forces India. 2014;70(4):354-9.\u003c/li\u003e\n \u003cli\u003eBennett J, Stennett R. Attitudes towards mental illness of nursing students in a Baccalaureate programme in Jamaica: a questionnaire survey Journal of Psychiatric and Mental Health Nursing. 2015;22:599\u0026ndash;605.\u003c/li\u003e\n \u003cli\u003eOw C-Y, Lee B-O. Relationships between perceived stigma, coping orientations, self-esteem, and quality of life in patients with schizophrenia. Asia Pacific Journal of Public Health. 2015;27(2):NP1932-NP41.\u003c/li\u003e\n \u003cli\u003ePicco L, Pang S, Lau YW, Jeyagurunathan A, Satghare P, Abdin E, et al. Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem. Psychiatry research. 2016;246:500-6.\u003c/li\u003e\n \u003cli\u003eLivingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social science \u0026amp; medicine. 2010;71(12):2150-61.\u003c/li\u003e\n \u003cli\u003eHill K, Startup M. The relationship between internalized stigma, negative symptoms and social functioning in schizophrenia: the mediating role of self-efficacy. Psychiatry research. 2013;206(2-3):151-7.\u003c/li\u003e\n \u003cli\u003eClement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, et al. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological medicine. 2015;45(1):11-27.\u003c/li\u003e\n \u003cli\u003eCrowe A, Averett P, Glass JS. Mental illness stigma, psychological resilience, and help seeking: What are the relationships? Mental Health \u0026amp; Prevention. 2016;4(2):63-8.\u003c/li\u003e\n \u003cli\u003eShimotsu S, Horikawa N. Self-stigma in depressive patients: Association of cognitive schemata, depression, and self-esteem. Asian journal of psychiatry. 2016;24:125-9.\u003c/li\u003e\n \u003cli\u003eKao Y-C, Lien Y-J, Chang H-A, Wang S-C, Tzeng N-S, Loh C-H. Evidence for the indirect effects of perceived public stigma on psychosocial outcomes: The mediating role of self-stigma. Psychiatry research. 2016;240:187-95.\u003c/li\u003e\n \u003cli\u003ePinheiro M, Ivandic I, Razzouk D. The economic impact of mental disorders and mental health problems in the workplace. Mental health economics: the costs and benefits of psychiatric care. 2017:415-30.\u003c/li\u003e\n \u003cli\u003ePoreddi V, Thimmaiah R, BadaMath S. Medical and nursing students\u0026rsquo; attitudes toward mental illness: An Indian perspective. Investigacion y educacion en enfermeria. 2017;35(1):86-94.\u003c/li\u003e\n \u003cli\u003eMurat M, Oz A, Guner E, Kose S. The Relationship between University Students\u0026apos; Beliefs toward Mental Illness and Stigmatization. Florence Nightingale J Nurs. 2020;28(2):194-204.\u003c/li\u003e\n \u003cli\u003eIssa B, Adegunloye O, Yussuf A, Oyewole O, Fatoye F. Attitudes of Medical Students to Psychiatry at a Nigerian Medical School. Hong Kong Journal of Psychiatry. 2009;19(2).\u003c/li\u003e\n \u003cli\u003eKihumuro RB, Kaggwa MM, Kintu TM, Nakandi RM, Muwanga DR, Muganzi DJ, et al. Knowledge, attitude and perceptions of medical students towards mental health in a university in Uganda. BMC Medical Education. 2022;22(1):730.\u003c/li\u003e\n \u003cli\u003eChukwujekwu C. Knowledge and Attitude about Mental Illness of Students in a University in Southern Nigeria. Journal of Biosciences and Medicines. 2018;06:95-104.\u003c/li\u003e\n \u003cli\u003eTuna Burgut F, Jonathan Polan H. Influence of clerkship on attitudes of medical students toward psychiatry across cultures: United States and Qatar. Academic Psychiatry. 2013;37:187-90.\u003c/li\u003e\n \u003cli\u003ePoreddi V, Thimmaiah R, Math SB. Attitudes toward people with mental illness among medical students. J Neurosci Rural Pract. 2015;6(3):349-54.\u003c/li\u003e\n \u003cli\u003eLyons Z, Janca A. Impact of a psychiatry clerkship on stigma, attitudes towards psychiatry, and psychiatry as a career choice. BMC Med Educ. 2015;15:34.\u003c/li\u003e\n \u003cli\u003eZhu Y, Zhang H, Yang G, Hu X, Liu Z, Guo N, et al. Attitudes towards mental illness among medical students in China: Impact of medical education on stigma. Asia Pac Psychiatry. 2018;10(2):e12294.\u003c/li\u003e\n \u003cli\u003eOgunsemi OO, Odusan O, Olatawura MO. Stigmatising attitude of medical students towards a psychiatry label. Ann Gen Psychiatry. 2008;7:15.\u003c/li\u003e\n \u003cli\u003eMarie M, Shaabna Z, Saleh M. Schizophrenia in the context of mental health services in Palestine: a literature review. Int J Ment Health Syst. 2020;14:44.\u003c/li\u003e\n \u003cli\u003eSaymah D, Tait L, Michail M. An overview of the mental health system in Gaza: an assessment using the World Health Organization\u0026apos;s Assessment Instrument for Mental Health Systems (WHO-AIMS). Int J Ment Health Syst. 2015;9:4.\u003c/li\u003e\n \u003cli\u003eMohebbi M, Nafissi N, Ghotbani F, Khojasteh Zonoozi A, Mohaddes Ardabili H. Attitudes of medical students toward psychiatry in Eastern Mediterranean Region: A systematic review. Front Psychiatry. 2022;13:1027377.\u003c/li\u003e\n \u003cli\u003eAbukmail E, Albarqouni L. Postgraduate training abroad and migration intentions of medical doctors and students in Gaza: a cross-sectional survey. Lancet. 2021;398 Suppl 1:S6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Islamic University of Gaza","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Social Stigmas, Attitude of Health Personnel, Mental Illness, discrimination, Low Income Countries","lastPublishedDoi":"10.21203/rs.3.rs-4586206/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4586206/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMental illness is highly stigmatized compared to physical illness, often due to false beliefs and a lack of knowledge. Negative attitudes harbored by healthcare providers reflect on the care they provide and impact their patients’ outcomes and may tailor their future preferences away from the psychiatric practice. This cross-sectional study used a stratified, randomized sampling to survey the beliefs and attitudes of students at a Palestinian medical school toward mental illness using the Beliefs Toward Mental Illness (BMI) scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 79.1% of 282 participants demonstrated overall positive attitudes toward mentally ill patients (BMI score \u0026lt;43). The highest mean score (more negative attitude) was received by the ‘dangerousness’ domain (2.75 ± 0.75), while the ‘poor social and interpersonal skills’ domain received the lowest mean score (2.47 ± 0.82). Male sex (p=0.031) and having a friend (p=0.035) or a family member (p=0.033) suffering from a mental illness predicted a more positive attitude toward mental illness, while age, study level, and having undergone the clinical psychiatry rotation did not impact attitude significantly.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study shows that medical students in the Gaza Strip are not absolved from the negative stereotypes of their community toward mentally ill patients, which should be addressed systematically by health educators and medical schools in the country.\u003c/p\u003e","manuscriptTitle":"Medical student attitudes toward mental illness: a cross-sectional study from the Gaza Strip, Palestine","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-18 05:20:09","doi":"10.21203/rs.3.rs-4586206/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e47210d2-2210-4fe9-9283-f644c94a9c6a","owner":[],"postedDate":"June 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33293000,"name":"Educational Psychology"},{"id":33293001,"name":"Psychiatry"}],"tags":[],"updatedAt":"2024-06-18T05:20:09+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-18 05:20:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4586206","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4586206","identity":"rs-4586206","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}