Illinois Institute of Technology, Chicago, IL, USA.
VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, AR, USA; Department of Psychiatry Division of Health Services Research, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Psychiatry Res. 2014 Aug 15;218(1-2):35-8. doi: 10.1016/j.psychres.2014.04.028. Epub 2014 Apr 18.
People with serious mental illness have higher rates of mortality and morbidity due to physical illness. In part, this occurs because primary care and other health providers sometimes make decisions contrary to typical care standards. This might occur because providers endorse mental illness stigma, which seems inversely related to prior personal experience with mental illness and mental health care. In this study, 166 health care providers (42.2% primary care, 57.8% mental health practice) from the Veteran׳s Affairs (VA) medical system completed measures of stigma characteristics, expected adherence, and subsequent health decisions (referral to a specialist and refill pain prescription) about a male patient with schizophrenia who was seeking help for low back pain due to arthritis. Research participants reported comfort with previous mental health interventions. Path analyses showed participants who endorsed stigmatizing characteristics of the patient were more likely to believe he would not adhere to treatment and hence, less likely to refer to a specialist or refill his prescription. Endorsement of stigmatizing characteristics was inversely related to comfort with one׳s previous mental health care. Implications of these findings will inform a program meant to enhance VA provider attitudes about people with mental illness, as well as their health decisions.
患有严重精神疾病的人因身体疾病而导致死亡率和发病率更高。部分原因是初级保健和其他卫生服务提供者有时会做出违背常规护理标准的决策。这可能是因为提供者认可精神疾病的污名，而这种污名似乎与先前个人的精神疾病和精神卫生保健经历成反比。在这项研究中，来自退伍军人事务部（VA）医疗系统的 166 名卫生保健提供者（42.2%的初级保健，57.8%的精神卫生实践）完成了对污名特征、预期的遵医嘱程度以及随后对一名患有精神分裂症的男性患者的健康决策（转介给专家和续开止痛药处方）的评估，该患者因关节炎导致腰痛寻求帮助。研究参与者报告对之前的心理健康干预措施感到满意。路径分析表明，认可患者具有污名化特征的参与者更有可能认为他不会遵守治疗，因此不太可能转介给专家或续开他的处方。对污名化特征的认可与对自己之前的心理健康护理的舒适度呈反比。这些发现的意义将为一个旨在增强退伍军人事务部服务提供者对精神疾病患者的态度以及他们的健康决策的项目提供信息。
