Golden Jeannette, Conroy Ronán Michael, O'Dwyer Ann Marie, Golden Daniel, Hardouin Jean-Benoit
Psychological Medicine Service, St James's Hospital, Dublin, Ireland.
Soc Sci Med. 2006 Dec;63(12):3188-98. doi: 10.1016/j.socscimed.2006.08.005. Epub 2006 Sep 28.
We examined stigma in persons with hepatitis C and its relationship with mood and adjustment to illness. We studied 87 persons awaiting interferon treatment for hepatitis C at St James's Hospital, Dublin. Stigma was assessed using Fife's Experience of Illness scale. A structured clinical interview was used to establish DSM-IV diagnosis. The Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI) were also used as measures of mood. Factor analysis and clustering around latent variables analysis were used to assess scale structure and reliability. The stigma scale had an overall reliability of 0.94. A strong dimension of fear of disclosure emerged, from item analysis, together with dimensions of social isolation and social rejection. Stigma was higher in those in manual occupations and the unemployed than in those in non-manual occupation. There were high levels in those with disease associated with injecting drug use and iatrogenic disease caused by transfusion or anti-D blood products, and low levels in those who had been treated for haemophilia with contaminated products or whose hepatitis was of unknown origin. Adjusted for confounders, a 1-decile increase in stigma score had an odds ratio of 1.4 for DSM-IV depression and similar associations with depression on the HADS and BDI. Stigma was also associated with poorer work and social adjustment, lower acceptance of illness, higher subjective levels of symptoms and greater subjective impairment of memory and concentration. These associations were replicated in the non-depressed subsample. The results underline the strong link between stigma and well-being in hepatitis C. However, they also suggest that stigma is a complex construct that will require further research to elucidate.
我们研究了丙型肝炎患者的耻辱感及其与情绪和疾病适应的关系。我们对都柏林圣詹姆斯医院等待干扰素治疗丙型肝炎的87人进行了研究。使用法伊夫疾病体验量表评估耻辱感。采用结构化临床访谈来确定DSM-IV诊断。医院焦虑抑郁量表（HADS）和贝克抑郁量表（BDI）也被用作情绪测量工具。使用因子分析和围绕潜在变量分析的聚类来评估量表结构和信度。耻辱感量表的总体信度为0.94。通过项目分析，出现了一个强烈的对披露的恐惧维度，以及社会隔离和社会排斥维度。体力劳动者和失业者的耻辱感高于非体力劳动者。与注射吸毒相关疾病以及输血或抗-D血液制品引起的医源性疾病患者的耻辱感较高，而因使用受污染产品接受血友病治疗或肝炎病因不明的患者耻辱感较低。在对混杂因素进行校正后，耻辱感得分每增加1个十分位数，DSM-IV抑郁的优势比为1.4，在HADS和BDI上与抑郁也有类似关联。耻辱感还与较差的工作和社会适应、对疾病较低的接受度、较高的主观症状水平以及较大的主观记忆和注意力损害相关。这些关联在非抑郁亚样本中也得到了验证。结果强调了丙型肝炎耻辱感与幸福感之间的紧密联系。然而，它们也表明耻辱感是一个复杂的概念，需要进一步研究来阐明。
