Reducing mental health-related stigma among medical and nursing students in low- and middle-income countries: a systematic review.
Abstract
AimsThis systematic review compiled evidence on interventions to reduce mental health-related
stigma among medical and nursing students in low- and middle-income countries (LMICs).
Primary outcomes were stigmatising attitudes and discriminatory behaviours. METHODS:Data
collection included two strategies. First, previous systematic reviews were searched
for studies that met the inclusion criteria of the current review. Second, a new search
was done, covering the time since the previous reviews, i.e. January 2013 to May 2017.
Five search concepts were combined in order to capture relevant literature: stigma,
mental health, intervention, professional students in medicine and nursing, and LMICs.
A qualitative analysis of all included full texts was done with the software MAXQDA.
Full texts were analysed with regard to the content of interventions, didactic methods,
mental disorders, cultural adaptation, type of outcome measure and primary outcomes.
Furthermore, a methodological quality assessment was undertaken. RESULTS:A total of
nine studies from six countries (Brazil, China, Malaysia, Nigeria, Somaliland and
Turkey) were included. All studies reported significant results in at least one outcome
measure. However, from the available literature, it is difficult to draw conclusions
on the most effective interventions. No meta-analysis could be calculated due to the
large heterogeneity of intervention content, evaluation design and outcome measures.
Studies with contact interventions (either face-to-face or video) demonstrated attitudinal
change. There was a clear lack of studies focusing on discriminatory behaviours. Accordingly,
training of specific communication and clinical skills was lacking in most studies,
with the exception of one study that showed a positive effect of training interview
skills on attitudes. Methods for cultural adaptation of interventions were rarely
documented. The methodological quality of most studies was relatively low, with the
exception of two studies. CONCLUSIONS:There is an increase in studies on anti-stigma
interventions among professional students in LMICs. Some of these studies used contact
interventions and showed positive effects. A stronger focus on clinical and communication
skills and behaviour-related outcomes is needed in future studies.
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https://hdl.handle.net/10161/18630Published Version (Please cite this version)
10.1017/s2045796019000167Publication Info
Heim, E; Henderson, C; Kohrt, BA; Koschorke, M; Milenova, M; & Thornicroft, G (2019). Reducing mental health-related stigma among medical and nursing students in low- and
middle-income countries: a systematic review. Epidemiology and psychiatric sciences. pp. 1-9. 10.1017/s2045796019000167. Retrieved from https://hdl.handle.net/10161/18630.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Brandon A. Kohrt
Adjunct Associate Professor in the Department of Psychiatry and Behavioral Sciences
Brandon Kohrt is a medical anthropologist and psychiatrist who completed his MD-PhD
at Emory University in 2009. He is currently Assistant Professor of Psychiatry, Global
Health, and Cultural Anthropology at Duke University. Dr. Kohrt has worked in Nepal
since 1996 researching and aiding victims of war including child soldiers. Since 2006
has worked with Transcultural Psychosocial Organization (TPO) Nepal. Dr. Kohrt has
been a consultant to The Carter Center Mental Health Program Liberia Init

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