Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rüsch N, Brown J S L, Thornicroft G
Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK.
Department of Psychiatry II,University of Ulm,Germany.
Psychol Med. 2015 Jan;45(1):11-27. doi: 10.1017/S0033291714000129. Epub 2014 Feb 26.
Individuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic review addressed the overarching question: What is the impact of mental health-related stigma on help-seeking for mental health problems? Subquestions were: (a) What is the size and direction of any association between stigma and help-seeking? (b) To what extent is stigma identified as a barrier to help-seeking? (c) What processes underlie the relationship between stigma and help-seeking? (d) Are there population groups for which stigma disproportionately deters help-seeking?
Five electronic databases were searched from 1980 to 2011 and references of reviews checked. A meta-synthesis of quantitative and qualitative studies, comprising three parallel narrative syntheses and subgroup analyses, was conducted.
The review identified 144 studies with 90,189 participants meeting inclusion criteria. The median association between stigma and help-seeking was d = - 0.27, with internalized and treatment stigma being most often associated with reduced help-seeking. Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier. A detailed conceptual model was derived that describes the processes contributing to, and counteracting, the deterrent effect of stigma on help-seeking. Ethnic minorities, youth, men and those in military and health professions were disproportionately deterred by stigma.
Stigma has a small- to moderate-sized negative effect on help-seeking. Review findings can be used to help inform the design of interventions to increase help-seeking.
人们常常回避或推迟为心理健康问题寻求专业帮助。耻辱感可能是阻碍寻求帮助的一个关键因素，但尚未对此进行系统的综述。我们的系统综述探讨了一个总体问题：与心理健康相关的耻辱感对寻求心理健康问题帮助有何影响？子问题包括：(a) 耻辱感与寻求帮助之间的关联大小和方向是什么？(b) 耻辱感在多大程度上被视为寻求帮助的障碍？(c) 耻辱感与寻求帮助之间的关系背后有哪些过程？(d) 是否存在某些人群，耻辱感对其寻求帮助的阻碍尤为严重？
检索了1980年至2011年的五个电子数据库，并检查了综述的参考文献。对定量和定性研究进行了元综合分析，包括三个平行的叙述性综合分析和亚组分析。
该综述确定了144项研究，90189名参与者符合纳入标准。耻辱感与寻求帮助之间的中位关联为d = -0.27，内化耻辱感和治疗耻辱感最常与寻求帮助减少相关。耻辱感是寻求帮助的第四大障碍，对披露的担忧是最常报告的耻辱感障碍。得出了一个详细的概念模型，描述了导致耻辱感对寻求帮助产生威慑作用以及抵消这种作用的过程。少数族裔、年轻人、男性以及军事和卫生专业人员受耻辱感的阻碍尤为严重。
耻辱感对寻求帮助有小到中等程度的负面影响。综述结果可用于为增加寻求帮助的干预措施设计提供参考。
