Mahajan Abhishek, Banerjee Amitav
Department of Community Medicine, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India.
Ind Psychiatry J. 2015 Jan-Jun;24(1):70-5. doi: 10.4103/0972-6748.160938.
Stigma associated with psychiatric disorders and few somatic disorders such as sexually transmitted diseases (STDs), tuberculosis and leprosy, adversely effects treatment seeking behavior, leads to concealment, and poor compliance with treatment. In busy outpatient departments (OPDs), the issue of stigma is likely to be overlooked.
We carried out a cross-sectional study collecting data on an 8-item stigma scale from patients attending psychiatry and other OPDs of a Tertiary Care Teaching Hospital in an industrial township. Information was collected by face to face interview from 400 patients attending psychiatry OPD and 401 patients attending other OPDs. Validations of the scale were done by face, content, and construct validity. Reliability was appraised by Cronbach's alpha and Guttmann split-half coefficients. Significant differences in answers to the 8-item questionnaire were explored by Chi-square test for individual responses and Kruskal-Wallis test for difference in total stigma score.
Patients attending psychiatry OPD consistently gave responses indicating a greater degree of perceived stigma than those attending OPD for somatic disorders. This difference was almost 3-4 times more on most of the items (P < 0.001). Among somatic disorders, stigma was highest (even higher than psychiatric disorders) among STDs, tuberculosis and leprosy patients among these and psychiatric disorders the score was almost 3 times more compared to other somatic disorders (P < 0.001). The scale demonstrated good face, content, and construct validity. Reliability was also very high with Cronbach's alpha coefficient and Guttmann split-half reliability coefficient 0.932 and 0.901 indicating very good internal consistency of the 8-item scale.
Stigma was higher among STD patients, tuberculosis, leprosy, and psychiatry patients as compared to patients suffering from somatic disorders. Assessment of stigma among these groups of patients can help in planning management and intervention to deal with stigma. This in turn can improve patient compliance.
与精神疾病以及少数躯体疾病（如性传播疾病、结核病和麻风病）相关的污名化，对寻求治疗的行为产生不利影响，导致隐瞒病情以及对治疗的依从性差。在繁忙的门诊部，污名化问题很可能被忽视。
我们开展了一项横断面研究，从一家位于工业城镇的三级护理教学医院的精神科及其他门诊部的患者中收集关于一个8项污名量表的数据。通过面对面访谈收集了400名精神科门诊部患者和401名其他门诊部患者的信息。通过表面效度、内容效度和结构效度对该量表进行验证。通过克朗巴哈系数和古特曼折半系数评估信度。通过卡方检验分析个体对8项问卷回答的显著差异，通过克鲁斯卡尔 - 沃利斯检验分析总污名得分的差异。
与躯体疾病门诊部的患者相比，精神科门诊部的患者一致给出的回答表明他们感知到的污名程度更高。在大多数项目上，这种差异几乎是3至4倍（P < 0.001）。在躯体疾病中，性传播疾病、结核病和麻风病患者的污名感最高（甚至高于精神疾病患者），在这些疾病中，精神疾病患者的得分与其他躯体疾病患者相比几乎高出3倍（P < 0.001）。该量表显示出良好的表面效度、内容效度和结构效度。信度也非常高，克朗巴哈系数和古特曼折半信度系数分别为0.932和0.901，表明该8项量表具有非常好的内部一致性。
与躯体疾病患者相比，性传播疾病、结核病、麻风病患者以及精神科患者中的污名感更高。对这些患者群体的污名感进行评估有助于规划管理和干预措施以应对污名化。这反过来可以提高患者的依从性。
