Psychiatry is a field of medicine that focuses on the diagnosis, treatment and prevention of mental illnesses. These are prevalent, significant health illnesses that have a detrimental effect on a person’s capacity to live a fruitful, meaningful life and build profound relationships with family, friends and other people. ^{Reference Lyons and Janca1} As a physician, the psychiatrist can perform the necessary medical and psychological tests to evaluate the case, reach a proper diagnosis and choose the best treatment plan. ²

According to a 2019 Global Burden of Diseases (GBD) study, mental illness – particularly depression and anxiety – ranks among the top 10 primary causes of disease burden, with an estimated incidence of 654.8 million cases in 1990 and 970.1 million in 2019, representing a 48.1% increase over these 3 decades. ³ In the absence of medical intervention, mental health disorders can have devastating impacts on both the individual and society. Suicide, unwarranted incarceration, substance misuse, homelessness, undeserved handicapping and low quality of life are all consequences of untreated mental health disorders. ⁴

The Eastern Mediterranean Region (EMR) of the World Health Organization (WHO), which includes Saudi Arabia, suffers greatly from mental illnesses, with depression and anxiety being the most common illnesses, particularly in nations affected by conflicts and other adverse events. ^{Reference Zuberi, Waqas, Naveed, Hossain, Rahman and Saeed5} In Saudi Arabia, the prevalence and risk of depression are relatively high compared with other Gulf countries, affecting more than a third of the population, with females being more at risk than males. ^{Reference Nour, Alharbi, Hafiz, Alshehri, Alyamani and Alharbi6} Moreover, this risk has increased following the COVID-19 pandemic. ^{Reference BinDhim, Althumiri, Basyouni, Alageel, Alghnam and Al-Qunaibet7} As people have struggled with the ensuing health, social and economic consequences, their mental health has suffered significantly. The pandemic triggered or exacerbated much more serious mental health issues. According to WHO, many people have reported psychological suffering, including symptoms of sadness, anxiety or post-traumatic stress. ⁸

Unexpectedly, despite the high prevalence of mental illness, psychiatry has one of the most significant shortages among medical disciplines. ^{Reference Mohebbi, Nafissi, Ghotbani, Khojasteh Zonoozi and Mohaddes Ardabili9} According to the Saudi Ministry of Health (MOH), there are only 1565 psychiatrists (486 per 100 000 population), amounting to 1.5% of all physicians (105 332), including those within the MOH, other public sectors and private sectors. ¹⁰ This is significantly lower than the 1306 psychiatrists per 100 000 persons reported in high-income countries. ^{Reference Zhang, Yuan, Chang, Yan, Que and Deng11} Saudis in need of mental health treatment would therefore suffer from a lack of psychiatrists. Therefore, training of psychiatrists is crucial and, as numerous studies have consistently demonstrated, psychiatry is not the most popular speciality among medical students worldwide. ^{Reference Li, Ai, Chen, Gan, He and Tian12,Reference Veliki13}

The choice to become a psychiatrist is impacted by numerous considerations, one of which is the individual’s perception of the profession. ^{Reference Mohebbi, Nafissi, Ghotbani, Khojasteh Zonoozi and Mohaddes Ardabili9} One study of international medical students’ opinions on psychiatry found an unfavourable perception of the profession. ^{Reference Veliki13} These students viewed psychiatry as not being part of mainstream medicine, having poor public status and indicating a lack of academic strength in those who show interest in the profession. ^{Reference Eksteen, Becker and Lippi14} Nevertheless, research has indicated that being exposed to psychiatric services can potentially foster a favourable outlook on psychiatry, and the quality of experience of, and exposure to, psychiatry as a medical undergraduate in medical school could be the most crucial factor influencing recruitment into the field of psychiatry. ^{Reference El-Gilany, Amr and Iqbal15–Reference Alzahrani17}

Stigma, encompassing cultural, personal and professional aspects, has the potential to adversely influence perceptions of psychiatry and individuals with mental health conditions. ^{Reference Farooq, Lydall, Malik, Ndetei, Bhugra and Alemu18} Medical students’ poor perceptions of psychiatry have been linked to stigma surrounding mental illness, because they hold stigmatising beliefs about mental illness that are comparable to those expressed in public surveys. ^{Reference Lyons19} For instance, subjects with mental illness tend to be viewed as dangerous, unstable, unreliable and unappealing. ^{Reference Samari, Seow, Chua, Ong, Lau and Mahendran20}

This study seeks to explore medical students’ perceptions of the field of psychiatry, which is critical given their future role in healthcare provision. It is essential to consider that unfavourable views of psychiatry can significantly impact the well-being of individuals receiving psychiatric care. ^{Reference Alzahrani17} To the best of our knowledge, few studies have been conducted in Saudi Arabia to explore the factors that influence medical students in choosing psychiatry as a future career, and their views of the speciality.

Results

A total of 430 medical students were included, with age ranging from 18 to 26 years and a median of 21. A total of 298 (69.3%) were female, most of whom (410, 95.3%) were Saudi. A total of 413 (96%) were unmarried. In regard to academic year, 259 (60.2%) were in their preclinical years (1st to 3rd), 163 (37.9%) in their clinical years (4th to 6th) and 8 (1.9%) were medical interns (Table 1).

Table 1 Demographics of participants (N = 430)

A total of 389 (90.5%) students did not have a family member working as a psychiatrist. In regard to the original source of their awareness of psychiatry, the most frequently reported were medical school (55.3%), social media (42.1%), hospital training (23.3%), mentor (21.9%) and friends (19.8%). When asked about when they were first inspired about psychiatry, the most frequent responses were before medical school (23.3%), at year 2 of medical school (10.5%) and at year 3 of medical school (7.2%), while 222 (51.6%) were not inspired about psychiatry (Table 2).

Table 2 Medical students’ awareness of, and exposure to, the psychiatry speciality

A total of 280 (65.1%) students considered psychiatry a mentally demanding speciality (i.e. perceived it as psychologically draining or exhausting); 188 (43.7%) reported that the personality and attitude of a psychiatric professional are not significantly different from those of any other physician; but 136 (31.6%) considered that such a personality is seen as strange behaviour. In addition, 288 (67%) thought that there are learning and academic opportunities in psychiatry, and 210 (48.8%) viewed psychiatry as an interesting speciality; 148 (45.1%) rated their level of interest as 1–4 out of 10, and 51 (15.5%) rated it as 8–10. A total of 143 (33.3%) rated psychiatry as 4 out of 5 in terms of challenge, and 103 (24%) rated it as 3 out of 5, based on a Likert scale where 1 represents ‘not challenging at all’ and 5 represents ‘extremely challenging’. This scale assessed perceived emotional intensity, cognitive demands and the complexity of patient interactions inherent in psychiatry. In regard to stigma surrounding the profession of psychiatry, 168 (39.1%) considered that it to have a bad reputation and poor prestige, but 213 (49.5%) reported an acceptable satisfaction rate, 42 (9.8%) showed high satisfaction and 64 (14.9%) reported low satisfaction (Table 3).

Table 3 Medical students’ perception and understanding of psychiatry speciality, stigma and satisfaction

A total of 184 (42.8%) students were of the opinion that their income following completion of psychiatric residency training would be acceptable, but 140 (32.6%) were unsure. In addition, 180 (41.9%) thought that the rate at which applicants are accepted into residency programmes was average, but 161 (37.4%) were unsure. In regard to on-call responsibilities and scheduling for psychiatric residents, 187 (43.5%) considered this acceptable while 200 (46.5%) were unsure. With regard to opinions on the probable duration of psychiatric residency training, 212 (49.3%) of the students stated 4 years, 94 (21.9%) stated 3 years and 84 (19.5%) stated 5 years or more (Table 4).

Table 4 Psychiatric speciality residency perception and understanding among medical students

A total of 162 students (37.7%) considered the career opportunities in the field of psychiatry following residency as good, and 141 (32.8%) as limited. Likewise, 205 (47.7%) were of the opinion that there were good opportunities for research in psychiatry while 232 (54%) were unsure about pursuing a fellowship in psychiatry; 99 (23%) thought that there were many fellowships available in psychiatry, but an identical number thought the opposite. In regard to the duration of patient–physician relationships in the field of psychiatry, 245 (57%) thought it should be a lifetime relationship while 134 (31.2%) were unsure. In addition, 258 (60%) were of the opinion that there is a good life–work balance in psychiatry, but 113 (26.3%) were unsure (Table 5).

Table 5 Medical students’ perception and understanding of psychiatry as a future career

When asked about their interest in a career in psychiatry, 34.6% of female students and 22.7% of male students replied in the affirmative, with a recorded statistical significance of P = 0.014. In addition, 50% of non-Saudi students showed an interest in psychiatry as a future career compared with 30% of Saudi students (P = 0.049). A proportion of 73.2% of students who had a family member working as a psychiatrist showed an interest in the speciality, compared with 26.5% who did not (P = 0.001). Likewise, 87.5% of students who were inspired about the speciality in their 4th medical year showed an interest, compared with 3.2% of those who were not inspired (P = 0.001) (Table 6).

Table 6 Factors associated with medical students’ interest in psychiatry as a future speciality

P, Pearson’s X ² test.

a Exact probability test.

* P < 0.05 considered significant.