To the Editor: Stigma and discrimination are associated with psychiatric disorders throughout the world. Several surveys have shown that the general population has limited knowledge about mental illness and holds unfavorable attitudes toward people with mental disorders (1,2). In the July issue, Wahl and colleagues (3) reported that attitudes toward individuals with psychiatric disorders seemed to be more favorable among middle school students than among adults. Nevertheless, they also concluded that stigma may persist as a problem for the next generation of citizens, and youths with a mental illness remain likely to experience misunderstanding and exclusion by peers.

We would like to join the emerging debate about this topic, giving our personal point of view as medical students. Many surveys have shown that physicians endorse stereotypical views and negative attitudes toward patients with psychiatric disorders (4). For this reason, as medical students and likely caregivers of tomorrow, we feel that the schools of medicine and health-related sciences must redouble their efforts to design targeted antistigma interventions to train true caregivers who will be able to serve as a resource to increase health literacy about this topic. Recently, Economou and colleagues (2) analyzed data from 158 final-year medical students before and after their four-week undergraduate psychiatric placement, assessing the students' beliefs and attitudes about people with schizophrenia. They found that the students did not endorse stereotypes commonly attached to people affected by this condition—for example, that they are dangerous, lazy, or of lower intelligence. However, they held the view that people with schizophrenia are unpredictable and suffer from split personality. In this student cohort, the impact of undergraduate psychiatric education on beliefs and attitudes about schizophrenia and social distance regarding people with the disorder was mixed. In brief, the training improved certain beliefs; after the training, fewer students believed that schizophrenia is the result of poor parenting or that people with schizophrenia have multiple personality disorder and are unpredictable. Nevertheless, the placement experience seemed to intensify stigma overall. Thus the authors suggested that inclusion of a specific antistigma training module as part of the undergraduate training course in psychiatry may be a valid tool.

Psychiatric disorders are a major disease burden worldwide, and they are often first treated by nonpsychiatrist health workers in general health facilities. Therefore it is important to acknowledge that these individuals play a pivotal role in the diagnosis and management of patients with mental illness. For this reason, the education of medical students as caregivers of tomorrow and their attitudes toward people with psychiatric disorders play a crucial role and may represent a further step in creating clinical practices with an antistigma orientation.

Further studies investigating medical students' beliefs and attitudes about people with psychiatric disorders are needed to develop such evidence-based antistigma interventions.