Original Article Modified Attitudes to Psychiatry Scale Created Using Principal-Components Analysis Rohit Shankar, MRCPsych, Richard Laugharne, FRCPsych Colin Pritchard, Ph.D., Pallavi Joshi, M.D. Romika Dhar, M.D. Objective: The Attitudes to Psychiatry Scale (APS) is a tool used to assess medical students’ attitudes toward psychiatry. This study sought to examine the internal validity of the APS in order to identify dimensions within the questionnaire. Method: Using data collected from 549 medical students from India and Ghana, the authors analyzed 28 questions of the APS independently of the original five dimensions defined by Balon et al. in the original APS questionnaire, using principal-compo- nents analysis to test whether questions correlated to form di- mensions within the questionnaire. The data were further tested for redundancy by Cronbach alpha. Results: The investigation yielded five dimensions, but, on fil- tering the information, there was good independent correlation in four of the five dimensions emerging from the analysis. These were 1) inspiration from medical school; 2) the stigma of psy- chiatry; 3) the merits of psychiatry as scientific medicine; and 4) the effectiveness of treatment, from which a suggested edited scale emerged. Conclusion: On examining the APS scale using principal-com- ponents analysis, the authors found clusters of questions around four themes that do seem intuitively relevant for attitudes toward psychiatry. They are not the same as Balon et al. ’s original subscales, although there are similarities. Using the questions in the emerging themes, the authors have suggested a modified questionnaire that appears to have good internal validity. Academic Psychiatry 2011; 35:360 –364 R ecruitment into psychiatry resident programs, as compared with most other medical fields, has been declining over the last two decades (1). This is not unique to the western world, but is also true for developing coun- tries (2). The difficulty in recruiting psychiatrists from the medical workforce poses a problem for all healthcare sys- tems, as psychiatric disorders rank high in the health mor- bidity of all countries (3). Attitudes toward psychiatry may affect recruitment, although this is by no means a simple relationship (4). These attitudes may also have an impact on the treatment of mentally ill patients by other doctors, especially general practitioners. It may also be appropriate to measure the attitude toward psychiatry among medical students as an outcome measure of the effectiveness of undergraduate training in psychiatry, because the stigma- tization of mental illness among doctors is a real concern (5). There is therefore a need to be able to measure the attitude toward psychiatry among medical students and junior doctors in training. There has been a limited amount of research into the attitudes of medical students toward a prospective career in psychiatry. Our literature search did not reveal any globally-accepted tool used to elicit medical students’ at- titudes toward psychiatry. Some studies have used their own scales, whereas others have used one of two estab- lished questionnaires (e.g., Muga and Hagali (6)). Burra et al. (7) developed the Attitudes Toward Psychiatry–30 scale (ATP–30). They proposed eight attitudinal objects: psychiatric patients, psychiatric illness, psychiatrists, psy- chiatric knowledge, psychiatric career choice, psychiatric treatment, psychiatric institutions, and psychiatric teach- ing. They designed their questionnaire around these atti- tudinal objects, but, on factor analysis, did not find that dimensions correlated around these attitudinal objects, nor did they find other dimensional subscales emerging from the data. Received July 25, 2009; revised November 20, 2009, January 15, 2010; accepted January 27, 2010. From the Cornwall Partnership NHS Trust, Learning Disabilities, Developmental Neuropsychiatry; Dept. of Research and Development, Royal Cornwall Hospital, Truro, Cornwall; Dept. of Psychiatry, Grants Medical College, Mumbai, Maharashtra, India; and the Dept. of Psychiatry, Amritsar Medical College, Punjab, India. Correspondence: haritsa@doctors.net.uk (e-mail). Copyright © 2011 Academic Psychiatry 360 http://ap.psychiatryonline.org Academic Psychiatry, 35:6, November-December 2011