In this study, we aimed to explore the outcomes and factors of stigma toward mental disorders or people with mental disorders in Chinese medical students. Overall, medical students showed stigma toward mental disorders or people with mental disorders. We found that stigma was significantly associated with the student’s education, area of residence, marital status, economic status, history of mental disorders and contact with people with mental disorders.
The study revealed that medical students experienced stigma toward mental disorders or people with mental disorders. Similar to a previous study, medical students held a somewhat negative attitude toward mental disorders . In the study, authoritarianism was the lowest-scoring subscale of the CAMI. Authoritarianism refers to the view that people with mental disorders are inferior to people without mental disorders. The results suggested that medical students believe that people with mental disorders are inferior. A previous study also confirmed that 43.8% of the students agreed that one of the main causes of mental illness is a lack of self-discipline and willpower . The benevolence score was the highest-scoring subscale of the CAMI (M = 3.93, SD = 0.94), which suggested that most students could hold a sympathetic view toward people with mental disorders. In total, stigma toward mental disorders is high in medical students. In addition to the arranged psychological and psychiatric curriculums, schools could organize seminars about stigma and play short videos about stigma to decrease students’ stigma toward mental illness .
The study confirmed the relationship between stigma and an individual’s socioeconomic status. In the past literature, researchers have usually considered education and income as indicators of socioeconomic status [28, 29]. First, the study revealed that college students showed more positive attitudes toward mental disorders than students in junior college or below. This result is consistent with another study showing that people with higher education showed a more favorable attitude toward people with mental disorders . In contrast, one study pointed out that years of medical education was not significantly associated with medical students’ attitudes toward mental illness . This result may be due to a ceiling effect. In the first year of training, students show a positive attitude in social acceptance . Hence, in Chiles’s study, education level was not a factor of stigma. In addition, better economic status was related to less stigma toward mental disorders. This result was similar to Letovancova’s  result that socioeconomic status influenced attitudes toward people with mental illness. Overall, students with better socioeconomic status showed more positive attitudes toward mental disorders. A possible reason is that higher socioeconomic status means higher health literacy . Schools could provide more accessible ways (such as websites and films) to provide abundant knowledge about mental disorders to students, especially students with low education levels and incomes.
The study also revealed that urban medical students hold more positive attitudes toward mental disorders than rural medical students. Another study also pointed out that the level of stigma toward mental illness was significantly higher in rural areas than in urban areas . Ndetei  also found that living in rural areas was a stigma marker related to adolescent cannabis use. What cannot be ignored is that levels of access to mental health care services are vastly different between urban and rural residents . People living in rural areas showed lower mental health literacy than people living in urban areas . The study confirmed that the important issue of improving health literacy in rural areas in China is urgent and challenging.
In our study, a single marital status was associated with a positive attitude toward mental disorders. This result was inconsistent with another study showing that married people have a more tolerant attitude toward people with mental disorders than single people . However, marital status had no significant relationship with attitude toward people with mental illness among medical students in Oman. The discrepancy is interesting and worthy of further exploration. Although marriage is beneficial to people in promoting them to progressively accept different and unique people , it cannot explain the relationship between marital status and stigma in our study. A possible reason may be that participants were younger in our study, resulting in a shorter marriage experience. Reviewing previous literature, few studies have focused on the relationship between marital status and stigma in medical students. In our study, the number of married students was small. In the future, researchers could recruit more married students to confirm the relationship between marital status and stigma.
Similar to a previous study, medical students’ stigma was related to familiarity with people with mental disorders. Compared with students who had suffered from mental disorders, students who had not presented higher stigma. Compared with students who had come into contact with people with mental disorders, students who had not showed a higher stigma. This result agreed with our earlier observations, which showed that people with higher familiarity were related to less stigma [38, 39]. However, a few studies have pointed out that more familiarity is positively associated with a higher level of stigma [40, 41]. A paper that reviewed previous literature pointed out a new opinion that familiarity is associated with stigma in a U-shaped curve . According to this paper, in the low range of familiarity, familiarity was negatively associated with stigma, but once familiarity increased over an inflection point, familiarity was positively associated with stigma . These results suggested that for many students, stigma may decline with increased contact with mental disorders or people with mental disorders. Furthermore, for students with high familiarity, such as children of people with mental disorders, contact may not have a significant impact on students’ stigma.
The study has several limitations. The participants were recruited by convenience sampling online. There may be a selective bias resulting from the nonresponse of students with heavy stigma toward mental disorders or students with mental disorders. Moreover, the majority of the sample was female students and college or below students. Therefore, the current sample may not reflect the reality of medical students. Random sampling and the inclusion of more male students will be considered in future studies. Another limitation is that the study is a cross-sectional study, which cannot determine the protective or risk factors for stigma toward mental disorders. Last, the study only focused on sociodemographic characteristics and familiarity with people with mental disorders as potential factors of stigma toward mental disorders. In future studies, researchers could explore more factors of stigma in medical students, such as whether they have an experience of rotation or internship in psychiatric departments.