Ssebunnya Joshua, Kigozi Fred, Lund Crick, Kizza Dorothy, Okello Elialilia
Department of Mental Health and Community Psychology, Makerere University, Makerere, Uganda.
BMC Int Health Hum Rights. 2009 Mar 31;9:5. doi: 10.1186/1472-698X-9-5.
World wide, there is plentiful evidence regarding the role of stigma in mental illness, as well as the association between poverty and mental illness. The experiences of stigma catalyzed by poverty revolve around experiences of devaluation, exclusion, and disadvantage. Although the relationship between poverty, stigma and mental illness has been documented in high income countries, little has been written on this relationship in low and middle income countries.The paper describes the opinions of a range of mental health stakeholders regarding poverty, stigma, mental illness and their relationship in the Ugandan context, as part of a wider study, aimed at exploring policy interventions required to address the vicious cycle of mental ill-health and poverty.
Semi-structured interviews and focus group discussions (FGDs) were conducted with purposefully selected mental health stakeholders from various sectors. The interviews and FGDs were audio-recorded, and transcriptions were coded on the basis of a pre-determined coding frame. Thematic analysis of the data was conducted using NVivo7, adopting a framework analysis approach.
Most participants identified a reciprocal relationship between poverty and mental illness. The stigma attached to mental illness was perceived as a common phenomenon, mostly associated with local belief systems regarding the causes of mental illness. Stigma associated with both poverty and mental illness serves to reinforce the vicious cycle of poverty and mental ill-health. Most participants emphasized a relationship between poverty and internalized stigma among people with mental illness in Uganda.
According to a range of mental health stakeholders in Uganda, there is a strong interrelationship between poverty, stigma and mental illness. These findings re-affirm the need to recognize material resources as a central element in the fight against stigma of mental illness, and the importance of stigma reduction programmes in protecting the mentally ill from social isolation, particularly in conditions of poverty.
在全球范围内，有大量证据表明耻辱感在精神疾病中所起的作用，以及贫困与精神疾病之间的关联。由贫困引发的耻辱感经历主要围绕着被贬低、被排斥和处于不利地位的经历。尽管贫困、耻辱感和精神疾病之间的关系在高收入国家已有记载，但在低收入和中等收入国家，关于这种关系的著述却很少。本文描述了一系列心理健康利益相关者对乌干达背景下贫困、耻辱感、精神疾病及其关系的看法，这是一项更广泛研究的一部分，该研究旨在探索应对精神健康不佳和贫困恶性循环所需的政策干预措施。
对来自不同部门的经过有目的挑选的心理健康利益相关者进行了半结构化访谈和焦点小组讨论（FGD）。访谈和FGD进行了录音，并根据预先确定的编码框架对转录内容进行编码。使用NVivo7对数据进行主题分析，采用框架分析方法。
大多数参与者指出贫困与精神疾病之间存在相互关系。人们认为与精神疾病相关的耻辱感是一种常见现象，主要与当地关于精神疾病病因的信仰体系有关。与贫困和精神疾病相关的耻辱感加剧了贫困和精神健康不佳的恶性循环。大多数参与者强调了乌干达贫困与精神疾病患者内化耻辱感之间的关系。
根据乌干达一系列心理健康利益相关者的观点，贫困、耻辱感和精神疾病之间存在紧密的相互关系。这些发现再次证实，需要认识到物质资源是消除精神疾病耻辱感斗争的核心要素，以及减少耻辱感计划对于保护精神疾病患者免受社会孤立的重要性，特别是在贫困状况下。
