William B, Healy D
Department of Epidemiology and Public Health, Ninewells Hospital and Medical School, Dundee, UK.
Soc Sci Med. 2001 Aug;53(4):465-76. doi: 10.1016/s0277-9536(00)00349-x.
The health beliefs of people suffering from mental health problems are important. Such beliefs have been identified as key factors in models of health and illness behaviour, and may therefore indirectly influence clinical outcome. In addition, the increasing move towards patient-centred health care suggests that such beliefs need to be identified if a patient's perspective of his or her illness is to be addressed in the care process. Past research on health beliefs surrounding depression have concentrated on identifying "explanatory models" among the general community or among people who already have an established diagnosis of depression. This paper describes the content and status of health beliefs among people who are in the process of receiving a diagnosis. In-depth interviews were carried out with new referrals to a community mental health team (CMHT). Individuals expressed a variety of perceived causes throughout the interview. Beliefs were therefore characterised as changeable. It is argued that the concept of an "explanatory model" is too fixed to fully convey the fluid status of beliefs among this patient group. The concept of an "exploratory map" is suggested as a replacement. Such maps outline the avenues of thought which individuals explored when attempting to understand why they were currently experiencing particular psychological problems. The strength and persistence of beliefs is discussed in relation to both theoretical and clinical implications.
患有心理健康问题的人们的健康观念很重要。这类观念已被确定为健康与疾病行为模型中的关键因素，因此可能会间接影响临床结果。此外，向以患者为中心的医疗保健的转变日益明显，这表明如果要在护理过程中考虑患者对自身疾病的看法，就需要识别这类观念。过去围绕抑郁症的健康观念研究主要集中在识别普通人群或已确诊抑郁症的人群中的“解释模型”。本文描述了正在接受诊断的人群的健康观念的内容和状况。对新转介到社区心理健康团队（CMHT）的患者进行了深入访谈。在整个访谈过程中，个体表达了各种感知到的病因。因此，观念被认为是可变的。有人认为，“解释模型”的概念过于固定，无法充分传达该患者群体中观念的动态状况。建议用“探索性地图”的概念取而代之。这类地图勾勒出个体在试图理解自己为何目前正经历特定心理问题时所探索的思维路径。本文从理论和临床意义两方面讨论了观念的强度和持续性。
