1 Bowdoin Sq, 6th Floor, Boston, MA 02114.
Massachusetts General Hospital Depression Clinical and Research Program, Boston, Massachusetts, USA.
J Clin Psychiatry. 2016 Oct;77(10):e1287-e1292. doi: 10.4088/JCP.15m10225.
Stigma has been proposed to be a major underlying factor contributing to lower rates of mental health service utilization among racial/ethnic minorities in the United States. Yet, surprisingly little research has specifically explored associations between stigma, race/ethnicity, and psychiatric morbidity. This study aims to assess the impact of stigmatizing attitudes on depression outcomes among a psychiatrically underserved, immigrant Chinese population.
Between 2009 and 2012, 190 Chinese immigrants with major depressive disorder as diagnosed by the Mini International Neuropsychiatric Interview were enrolled in a trial of culturally sensitive collaborative care for depression. Participants' self-reported stigma regarding their symptoms was assessed at study entry using the Explanatory Model Interview Catalogue, and depressive symptoms were assessed with the Hamilton Depression Rating Scale (HDRS) at baseline and follow-up. Hierarchical linear regression was used to assess the association between baseline stigma score and change in HDRS score, adjusting for potential confounders.
Higher stigma scores at baseline were significantly associated with attenuated improvement in both HDRS score and quality of life at 6 months (P < .05 for both).
Stigma has a directly harmful effect on depression outcomes, even after individuals have been accurately diagnosed within a culturally sensitive community health center and agreed to treatment. These results support further research into interventions targeting stigma to improve mental health outcomes among minority populations.
This study is a secondary analysis of prospectively collected data from the randomized controlled trial registered by ClinicalTrials.gov identifier: NCT00854542.
在美国，种族/民族少数群体心理健康服务利用率较低的一个主要潜在因素被认为是污名。然而，令人惊讶的是，很少有研究专门探讨污名、种族/民族与精神疾病之间的关系。本研究旨在评估歧视性态度对精神卫生服务不足的移民华裔人群中抑郁结果的影响。
在 2009 年至 2012 年期间，190 名被 Mini 国际神经精神访谈诊断为重度抑郁症的中国移民参加了一项文化敏感的合作护理抑郁症试验。在研究开始时，参与者使用解释模型访谈目录报告他们对自己症状的污名感，基线和随访时使用汉密尔顿抑郁评定量表（HDRS）评估抑郁症状。使用分层线性回归来评估基线污名评分与 HDRS 评分变化之间的关联，同时调整潜在混杂因素。
基线时较高的污名评分与 HDRS 评分和 6 个月时生活质量的改善幅度降低显著相关（均 P <.05）。
即使在文化敏感的社区卫生中心对个体进行了准确诊断并同意接受治疗后，污名也会对抑郁结果产生直接的有害影响。这些结果支持进一步研究针对污名的干预措施，以改善少数民族人群的心理健康结果。
本研究是对前瞻性收集的数据进行的二次分析，这些数据来自在美国国立卫生研究院注册的随机对照试验，注册号为：NCT00854542。
