Centre for Global Mental Health, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Lancet. 2016 Mar 12;387(10023):1123-1132. doi: 10.1016/S0140-6736(15)00298-6. Epub 2015 Sep 22.
Stigma and discrimination in relation to mental illnesses have been described as having worse consequences than the conditions themselves. Most medical literature in this area of research has been descriptive and has focused on attitudes towards people with mental illness rather than on interventions to reduce stigma. In this narrative Review, we summarise what is known globally from published systematic reviews and primary data on effective interventions intended to reduce mental-illness-related stigma or discrimination. The main findings emerging from this narrative overview are that: (1) at the population level there is a fairly consistent pattern of short-term benefits for positive attitude change, and some lesser evidence for knowledge improvement; (2) for people with mental illness, some group-level anti-stigma inventions show promise and merit further assessment; (3) for specific target groups, such as students, social-contact-based interventions usually achieve short-term (but less clearly long-term) attitudinal improvements, and less often produce knowledge gains; (4) this is a heterogeneous field of study with few strong study designs with large sample sizes; (5) research from low-income and middle-income countries is conspicuous by its relative absence; (6) caution needs to be exercised in not overgeneralising lessons from one target group to another; (7) there is a clear need for studies with longer-term follow-up to assess whether initial gains are sustained or attenuated, and whether booster doses of the intervention are needed to maintain progress; (8) few studies in any part of the world have focused on either the service user's perspective of stigma and discrimination or on the behaviour domain of behavioural change, either by people with or without mental illness in the complex processes of stigmatisation. We found that social contact is the most effective type of intervention to improve stigma-related knowledge and attitudes in the short term. However, the evidence for longer-term benefit of such social contact to reduce stigma is weak. In view of the magnitude of challenges that result from mental health stigma and discrimination, a concerted effort is needed to fund methodologically strong research that will provide robust evidence to support decisions on investment in interventions to reduce stigma.
精神疾病相关的污名化和歧视的后果被描述为比疾病本身更为严重。这一研究领域的大多数医学文献都是描述性的，主要关注人们对精神疾病患者的态度，而不是减少污名化的干预措施。在这篇叙述性综述中，我们总结了全球已发表的系统评价和旨在减少与精神疾病相关的污名化或歧视的原始数据中已知的情况。从这篇叙述性综述中得出的主要发现是：（1）在人群层面上，积极态度改变的短期获益相当一致，而知识改善的证据则较少；（2）对于精神疾病患者，一些群体层面的反污名发明显示出希望，值得进一步评估；（3）对于特定目标群体，如学生，基于社交接触的干预措施通常会在短期内（但不太清楚长期内）实现态度改善，而很少产生知识收益；（4）这是一个异质性的研究领域，很少有大样本量的强有力研究设计；（5）来自低收入和中等收入国家的研究相对较少；（6）需要谨慎，不要将从一个目标群体中得出的经验过度推广到另一个目标群体；（7）需要进行具有长期随访的研究，以评估初始收益是否持续或减弱，以及是否需要干预措施的加强剂量来维持进展；（8）世界上几乎没有任何地方的研究关注服务使用者对污名化和歧视的看法，也没有关注行为变化领域，无论是患有还是没有精神疾病的人在污名化的复杂过程中。我们发现，社交接触是改善短期与污名相关的知识和态度的最有效干预措施。然而，社交接触在长期减少污名方面的获益证据较弱。鉴于精神健康污名化和歧视带来的挑战巨大，需要集中精力为减少污名化的干预措施提供强有力的证据，以支持投资决策。
