Gonzalez Jodi M, Perlick Deborah A, Miklowitz David J, Kaczynski Richard, Hernandez Melissa, Rosenheck Robert A, Culver Jenifer L, Ostacher Michael J, Bowden Charles L
Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
Psychiatr Serv. 2007 Jan;58(1):41-8. doi: 10.1176/ps.2007.58.1.41.
Little is known about the factors contributing to mental illness stigma among caregivers of people with bipolar disorder.
A total of 500 caregivers of patients participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study were interviewed in a cross-sectional design on measures of stigma, mood, burden, and coping. Relatives and friends with bipolar disorder were assessed on measures of diagnosis and clinical status, determined by a days-well measure derived from psychiatrist ratings of DSM-IV episode status. Because patients' clinical status varied widely, separate models were run for patients who were euthymic for at least three-fourths of the past year (well group) and for those who met criteria for an affective episode for at least one-fourth of the previous year (unwell group). Stepwise multiple regression was used to identify patient, illness, and caregiver characteristics associated with caregiver stigma.
In the unwell group, greater mental illness stigma was associated with bipolar I (versus II) disorder, less social support for the caregiver, fewer caregiver social interactions, and being a caregiver of Hispanic descent. In the well group, greater stigma was associated with being a caregiver who is the adult child of a parent with bipolar disorder, who has a college education, who has fewer social interactions, and who cares for a female bipolar patient.
Mental illness stigma was found to be prevalent among caregivers of persons with bipolar disorder who have active symptoms as well as for caregivers of those who have remitted symptoms. Stigma is typically associated with factors identifying patients as "different" during symptomatic periods. Research is needed to understand how the stigma experienced by caregivers during stable phases of illness differs from the stigma experienced during patients' illness states.
关于双相情感障碍患者照料者中导致精神疾病污名化的因素，人们所知甚少。
采用横断面设计，对参与双相情感障碍系统治疗强化项目（STEP - BD）研究的500名患者照料者进行访谈，了解其污名化、情绪、负担和应对措施等情况。通过精神科医生对《精神疾病诊断与统计手册》第四版发作状态的评分得出的“健康天数”指标来评估双相情感障碍患者亲属和朋友的诊断及临床状况。由于患者的临床状况差异很大，因此分别针对过去一年中至少四分之三时间处于心境正常状态的患者（健康组）和过去一年中至少四分之一时间符合情感发作标准的患者（非健康组）建立了独立模型。采用逐步多元回归分析来确定与照料者污名化相关的患者、疾病及照料者特征。
在非健康组中，较高的精神疾病污名化与双相I型（而非II型）障碍、照料者获得的社会支持较少、照料者的社交互动较少以及照料者为西班牙裔血统有关。在健康组中，较高的污名化与照料者是患有双相情感障碍父母的成年子女、拥有大学学历、社交互动较少以及照料女性双相情感障碍患者有关。
研究发现，在有活动症状的双相情感障碍患者照料者以及症状已缓解患者的照料者中，精神疾病污名化现象普遍存在。污名化通常与在症状期将患者视为“异类”的因素相关。需要开展研究以了解照料者在疾病稳定期所经历的污名化与患者患病状态下所经历的污名化有何不同。
