与心理健康相关的歧视作为心理健康服务参与度低的预测因素。

Mental health-related discrimination as a predictor of low engagement with mental health services.

作者信息

Clement Sarah, Williams Paul, Farrelly Simone, Hatch Stephani L, Schauman Oliver, Jeffery Debra, Henderson R Claire, Thornicroft Graham

机构信息

Except for Dr. Hatch, the authors are with the Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom (e-mail:

出版信息

Psychiatr Serv. 2015 Feb 1;66(2):171-6. doi: 10.1176/appi.ps.201300448. Epub 2014 Nov 1.

DOI:10.1176/appi.ps.201300448

PMID:25642612

Abstract

OBJECTIVE

This study aimed to test the hypothesis that mental health-related discrimination experienced by adults receiving care from community mental health teams is associated with low engagement with services and to explore the pathways between these two variables.

METHODS

In this cross-sectional study, 202 adults registered with inner-city community mental health teams in the United Kingdom completed interviews assessing their engagement with mental health services (service user-rated version of the Service Engagement Scale), discrimination that they experienced because of mental illness, and other variables. Structural equation modeling was conducted to examine the relationship of experienced discrimination and service engagement with potential mediating and moderating variables, such as anticipated discrimination (Questionnaire on Anticipated Discrimination), internalized stigma (Internalized Stigma of Mental Illness Scale), stigma stress appraisal (Stigma Stress Appraisal), mistrust in services, the therapeutic relationship (Scale to Assess Therapeutic Relationships), difficulty disclosing information about one's mental health, and social support. Analyses controlled for age, race-ethnicity, and symptomatology.

RESULTS

No evidence was found for a direct effect between experienced discrimination and service engagement. The total indirect effect of experienced discrimination on service engagement was statistically significant (coefficient=1.055, 95% confidence interval [CI]=.312-2.074, p=.019), mainly via mistrust in mental health services and therapeutic relationships (coefficient=.804, CI=.295-1.558, p=.019). A 1-unit increase in experienced discrimination via this pathway resulted in .804-unit of deterioration in service engagement.

CONCLUSIONS

Findings indicate the importance of building and maintaining service users' trust in mental health services and in therapeutic relationships with professionals and countering the discrimination that may erode trust.

摘要

目的

本研究旨在验证以下假设，即接受社区心理健康团队护理的成年人所经历的与心理健康相关的歧视与服务参与度低有关，并探索这两个变量之间的关联路径。

方法

在这项横断面研究中，202名在英国市中心社区心理健康团队登记的成年人完成了访谈，评估他们对心理健康服务的参与度（服务参与量表的服务使用者评分版本）、因精神疾病所经历的歧视以及其他变量。进行结构方程建模，以检验所经历的歧视和服务参与度与潜在中介和调节变量之间的关系，这些变量包括预期歧视（预期歧视问卷）、内化耻辱感（精神疾病内化耻辱感量表）、耻辱压力评估（耻辱压力评估）、对服务的不信任、治疗关系（治疗关系评估量表）、披露心理健康信息的困难程度以及社会支持。分析对年龄、种族和症状进行了控制。

结果

未发现所经历的歧视与服务参与度之间存在直接影响。所经历的歧视对服务参与度总的间接影响具有统计学意义（系数=1.055，95%置信区间[CI]=.312 - 2.074，p=.019），主要通过对心理健康服务和治疗关系的不信任来实现（系数=.804，CI=.295 - 1.558，p=.019）。通过该路径，所经历的歧视每增加1个单位，服务参与度就会恶化.804个单位。