Sharp Marie-Louise, Fear Nicola T, Rona Roberto J, Wessely Simon, Greenberg Neil, Jones Norman, Goodwin Laura
Epidemiol Rev. 2015;37:144-62. doi: 10.1093/epirev/mxu012. Epub 2015 Jan 16.
Approximately 60% of military personnel who experience mental health problems do not seek help, yet many of them could benefit from professional treatment. Across military studies, one of the most frequently reported barriers to help-seeking for mental health problems is concerns about stigma. It is, however, less clear how stigma influences mental health service utilization. This review will synthesize existing research on stigma, focusing on those in the military with mental health problems. We conducted a systematic review and meta-analysis of studies between 2001 and 2014 to examine the prevalence of stigma for seeking help for a mental health problem and its association with help-seeking intentions/mental health service utilization. Twenty papers met the search criteria. Weighted prevalence estimates for the 2 most endorsed stigma concerns were 44.2% (95% confidence interval: 37.1, 51.4) for "My unit leadership might treat me differently" and 42.9% (95% confidence interval: 36.8, 49.0) for "I would be seen as weak." Nine studies found no association between anticipated stigma and help-seeking intentions/mental health service use and 4 studies found a positive association. One study found a negative association between self-stigma and intentions to seek help. Counterintuitively, those that endorsed high anticipated stigma still utilized mental health services or were interested in seeking help. We propose that these findings may be related to intention-behavior gaps or methodological issues in the measurement of stigma. Positive associations may be influenced by modified labeling theory. Additionally, other factors such as self-stigma and negative attitudes toward mental health care may be worth further attention in future investigation.
约60%有心理健康问题的军事人员不寻求帮助，然而他们中的许多人能从专业治疗中受益。在各项军事研究中，寻求心理健康问题帮助时最常被报告的障碍之一是对污名化的担忧。然而，污名化如何影响心理健康服务的利用尚不清楚。本综述将综合关于污名化的现有研究，重点关注有心理健康问题的军人。我们对2001年至2014年期间的研究进行了系统综述和荟萃分析，以检验因心理健康问题寻求帮助时污名化的患病率及其与寻求帮助的意图/心理健康服务利用之间的关联。20篇论文符合检索标准。对于“我的部队领导可能会区别对待我”这一最常被认可的污名化担忧，加权患病率估计为44.2%（95%置信区间：37.1, 51.4），对于“我会被视为软弱”，这一比例为42.9%（95%置信区间：36.8, 49.0）。9项研究发现预期污名与寻求帮助的意图/心理健康服务使用之间无关联，4项研究发现存在正相关。1项研究发现自我污名与寻求帮助的意图之间存在负相关。与直觉相反的是，那些认可高预期污名的人仍会利用心理健康服务或有寻求帮助的意愿。我们认为这些发现可能与意图 - 行为差距或污名化测量中的方法学问题有关。正相关可能受修正标签理论影响。此外，自我污名和对心理保健的消极态度等其他因素在未来研究中可能值得进一步关注。
