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Background <p>Mental disorders pose a major global health burden, with stigma hindering treatment access. In Iran, stigma persists despite integration efforts. This study assessed explicit and implicit stigma toward psychiatric disorders among medical students and introduced the first culturally adapted Implicit Association Test (IAT) for measuring mental health stigma in Iran.</p> Method <p>This cross-sectional study was conducted between 2023 and 2024 among 71 medical students completing their psychiatry rotation at the Iran University of Medical Sciences (Tehran, Iran). Explicit stigma was measured using the Social Distance Scale (SDI), Perceived Dangerousness of Mental Patients Inventory (PDMPI), and Opening Minds Scale for Healthcare Providers (OMs-HC). Implicit stigma was evaluated using a culturally adapted IAT programmed in MATLAB. Statistical analyses (R v4.4.1) examined correlations between explicit and implicit stigma and demographic variables.</p> Results <p>Male students reported higher explicit stigma on the PDMPI (<i>p</i> = 0.030). Longer psychiatry rotation duration was associated with lower implicit stigma both in the regression model (<i>p</i> = 0.036) and within the mediation framework (total effect <i>p</i> = 0.050; direct effect <i>p</i> = 0.047), and this association was not explained by perceived dangerousness (PDMPI); explicit stigma remained unaffected by demographic variables. A significant positive correlation was found between implicit and explicit stigma measured by the OMs-HC (<i>r</i> = 0.36, <i>p</i> = 0.002).</p> Conclusion <p>This study implemented the first Persian-language IAT for mental health stigma, providing a validated tool for future research. Findings indicate that unconscious and conscious biases coexist among medical students. Longer clinical exposure was associated with lower implicit stigma, an effect that held within a mediation framework once direct and indirect pathways were estimated, while explicit attitudes remained stable; this highlights the need for structured educational programs that integrate empathy-based learning to promote stigma-free care.</p>

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Explicit and implicit stigma toward psychiatric disorders among medical students in Iran: an adapted Implicit Association Test (IAT) study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月23日

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  • Fahimeh Bakhshijoybari,
  • Seyed Vahid Shariat,
  • Mohammadreza Shalbafan,
  • Fatemeh Sadat Mirfazeli,
  • Masoumeh Ghelichkhani,
  • Mahdieh Saeidi,
  • Atiye Sarabi-Jamab

摘要

Background

Mental disorders pose a major global health burden, with stigma hindering treatment access. In Iran, stigma persists despite integration efforts. This study assessed explicit and implicit stigma toward psychiatric disorders among medical students and introduced the first culturally adapted Implicit Association Test (IAT) for measuring mental health stigma in Iran.

Method

This cross-sectional study was conducted between 2023 and 2024 among 71 medical students completing their psychiatry rotation at the Iran University of Medical Sciences (Tehran, Iran). Explicit stigma was measured using the Social Distance Scale (SDI), Perceived Dangerousness of Mental Patients Inventory (PDMPI), and Opening Minds Scale for Healthcare Providers (OMs-HC). Implicit stigma was evaluated using a culturally adapted IAT programmed in MATLAB. Statistical analyses (R v4.4.1) examined correlations between explicit and implicit stigma and demographic variables.

Results

Male students reported higher explicit stigma on the PDMPI (p = 0.030). Longer psychiatry rotation duration was associated with lower implicit stigma both in the regression model (p = 0.036) and within the mediation framework (total effect p = 0.050; direct effect p = 0.047), and this association was not explained by perceived dangerousness (PDMPI); explicit stigma remained unaffected by demographic variables. A significant positive correlation was found between implicit and explicit stigma measured by the OMs-HC (r = 0.36, p = 0.002).

Conclusion

This study implemented the first Persian-language IAT for mental health stigma, providing a validated tool for future research. Findings indicate that unconscious and conscious biases coexist among medical students. Longer clinical exposure was associated with lower implicit stigma, an effect that held within a mediation framework once direct and indirect pathways were estimated, while explicit attitudes remained stable; this highlights the need for structured educational programs that integrate empathy-based learning to promote stigma-free care.