Medical Students Turn Stigma Inward: Landmark Review Finds Only Three Studies Worldwide

Medical students are among the most psychologically vulnerable populations in higher education, yet a sweeping new analysis suggests that one of the most powerful forces keeping them from seeking help has been almost entirely ignored by researchers. A scoping review published in Current Psychology by Molly E. Hacker and Ryan E. Flinn of the University of North Dakota set out to map everything science knows about self-stigma of mental illness among medical students, and the result is startling: after screening more than 3,500 records, only three studies worldwide met the criteria for rigorous quantitative measurement of the construct. The finding exposes a gaping hole in the literature on a population already known to experience elevated depression, suicidal ideation, and death by suicide compared with age-equivalent peers.

The distinction at the heart of the review is subtle but consequential. Stigma researchers differentiate between several dimensions of mental illness stigma, including structural stigma, which manifests in unjust policies and institutional practices; public stigma, the negative perceptions society holds toward people with mental illness; personal stigma, an individual’s own negative attitudes; and affiliate stigma, the negative perceptions directed at those associated with someone living with mental illness. Self-stigma, sometimes called internalized stigma, refers to the process by which a person applies the public’s negative stereotypes to themselves, producing shame, diminished self-esteem, and reduced self-efficacy. Crucially, researchers distinguish self-stigma of mental illness, applying negative perceptions to oneself for experiencing symptoms, from self-stigma of help-seeking, applying them for seeking treatment. Most existing work on medical students has measured the latter, leaving the former largely uncharted.

The cultural environment of medical school may actively cultivate this internalization. The review’s authors point to a so-called hidden curriculum that perpetuates negative attitudes toward mental illness among future providers, alongside a training culture that prizes competition and perfectionism and can inadvertently equate help-seeking with personal weakness. Medical students, physicians, and researchers have repeatedly described the pressure to embody an idealized, invulnerable physician identity. Some researchers have even proposed that medical school culture attracts a particular type of student, individuals with perfectionistic and self-critical tendencies, who may be more vulnerable to depression in the first place. Stigma is among the most frequently cited reasons medical students give for not pursuing formal mental health support, despite distress that persists across all years of training and carries into professional practice.

To determine what is actually known, the researchers preregistered their review with the Open Science Foundation and conducted it in alignment with the PRISMA Extension for Scoping Reviews. Working with a medical school librarian, they searched four databases, CINAHL, ERIC, PsycINFO, and PubMed, on November 13, 2023, using tailored search strings and Medical Subject Headings to capture literature on self-stigma, mental illness, and medical students. A follow-up Google Scholar search on August 20, 2024, added ten more records, bringing the total to 3,567 articles. The team managed the records in CADIMA, an online platform for systematic and scoping reviews, where duplicate removal, including manual corrections for software transcription errors, yielded 3,335 unique records.

The screening process was unusually rigorous for a two-person team. The authors collaboratively built a list of eligibility criteria and then performed repeated consistency checks: each independently reviewed 25 randomly selected articles and applied the criteria, revising and repeating the exercise four times until they reached 100 percent agreement. They then split the remaining records and screened abstracts, with 210 articles advancing to full-text review. Both authors examined every full text for explicit mention of self-stigma as a quantitatively measured variable, in some cases contacting original researchers for copies of their measures. They again reached complete agreement, ultimately retaining three studies and excluding 207. Eligibility rules were strict: studies had to sample people explicitly identified as medical students, excluding residents and fellows, and had to measure self-stigma of mental illness or internalized stigma specifically, not merely self-stigma of help-seeking.

The first retained study, led by Chiu and colleagues, examined a strikingly simple intervention: renaming schizophrenia. Among 123 first- and fourth-year medical students in Taiwan assessed between October 2014 and February 2015, statistically significant reductions emerged across public stigma, self-stigma, and social distance when the old Taiwanese term for schizophrenia was replaced with a new one, with p-values below 0.001. Self-stigma was measured with the Perceived Psychiatric Stigma Scale, and every subscale, including social ostracism, marital preclusion, and self-deprecation, dropped significantly under the new name. The finding suggests that the language attached to a diagnosis is not cosmetic; it can measurably shift how future physicians perceive the condition and, by extension, how they might internalize their own psychiatric experiences.

The second study, by Kassam and colleagues, was a mixed-methods investigation of medical learners across 17 Canadian schools between August 2021 and August 2022. Among 125 learners, 67 medical students and 58 resident physicians, all of whom self-reported having experienced mental illness, stigma was quantified using the Opening Minds Scale for Healthcare Providers and Corrigan’s Self Stigma of Mental Illness Scale, while well-being was measured with the WHO-5 Well-Being Index. The results revealed troubling patterns: male participants held more negative attitudes toward disclosing mental illness than female participants, resident physicians reported more negative attitudes than medical students toward both those experiencing mental illness and disclosure itself, and participants of color reported higher self-stigma scores than White participants, specifically on the application subscale. The sample’s well-being was rated poor. Qualitative interviews with 13 learners identified fear and stigma as the dominant barriers to self-disclosure, with residents fearing career consequences and students fearing judgment, yet participants surprisingly reported positive outcomes from disclosure, countering pervasive narratives of severe professional fallout.

The third study evaluated the Crisis-management, Anti-stigma, Mental Health Literacy Program for University Students, or CAMPUS, among 136 medical students at one Japanese university. Takahashi and colleagues measured suicidal behaviors, depression, help-seeking intentions, gatekeeper self-efficacy, and self-stigmatizing attitudes using a self-acceptance scale and the Japanese Self-Concealment Scale. With a Bonferroni-adjusted significance threshold of 0.0083, the program produced significant main effects on intentions to seek help from formal resources, gatekeeper self-efficacy, and the self-acceptance component of self-stigma. However, no significant changes appeared in depression or in self-concealment, and, importantly, the program failed to reduce suicidal ideation among many participants who reported high levels before the intervention. The pattern suggests that anti-stigma interventions can effectively target underlying constructs such as self-acceptance and self-efficacy, while other components, like self-concealment, may require more specialized approaches.

Taken together, the three studies form a foundation that is strikingly thin. Each was conducted in a different country, each used a different instrument to measure self-stigma, including one scale assembled from existing measures, and each relied on either a cross-sectional design or a single post-intervention data collection. The earliest data collection among the retained studies dates only to 2014, indicating that quantitative investigation of this construct in medical students is barely a decade old. Because different instruments may not assess the same psychological construct across different audiences, the review’s authors caution that all findings remain tentative and unreplicated, and they call for validation of measurement equivalence in diverse samples, including medical students in the United States, which no retained study represented.

The stakes of this research gap extend well beyond campus walls. In the general population, self-stigma of mental illness predicts self-esteem, life satisfaction, and psychiatric symptoms in clinical samples, and the review’s authors argue that understanding it in medical students represents a potentially missed opportunity to promote student, physician, and ultimately patient well-being. They recommend that future research test associations between mental illness self-stigma and related outcomes such as help-seeking attitudes, actual receipt of services, and peer referral, while incorporating the construct into the development and evaluation of interventions. Certain phases of medical training may even serve as critical periods when self-stigma takes root, making them strategic windows for protective factors. The authors also acknowledge their review’s limitations, including a search restricted to four databases, English-language studies, and a two-person screening team. Still, their conclusion is unambiguous: psychometrically validated, widely available instruments could invigorate research in this neglected field, and medical institutions that investigate self-stigma during training could generate knowledge to better support the future physicians on whom patient care depends.

Subject of Research: Self-stigma of mental illness among medical students

Article Title: A scoping review of self-stigma of mental illness among medical students

Article References: Hacker, M. E., & Flinn, R. E. (2026). A scoping review of self-stigma of mental illness among medical students. Current Psychology, 45(17), Article 1433. https://doi.org/10.1007/s12144-026-09979-6

Image Credits: AI Generated

DOI: 10.1007/s12144-026-09979-6

Keywords: self-stigma, mental illness, medical students, scoping review, internalized stigma, help-seeking, physician well-being, psychological distress, stigma interventions, medical education, mental health, PRISMA