Sarfo Fred Stephen, Nichols Michelle, Qanungo Suparna, Teklehaimanot Abeba, Singh Arti, Mensah Nathaniel, Saulson Raelle, Gebregziabher Mulugeta, Ezinne Uvere, Owolabi Mayowa, Jenkins Carolyn, Ovbiagele Bruce
Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Medical University of South Carolina, USA.
J Neurol Sci. 2017 Apr 15;375:270-274. doi: 10.1016/j.jns.2017.02.018. Epub 2017 Feb 9.
Disability-adjusted life-years lost after stroke in Low & Middle-Income Countries (LMICs) is almost seven times those lost in High-income countries. Although individuals living with chronic neurological and mental disorders are prone to stigma, there is a striking paucity of literature on stroke-related stigma particularly from LMICs.
To assess the prevalence, severity, determinants and psycho-social consequences of stigma among LMIC stroke survivors.
Between November 2015 and February 2016, we conducted a cross-sectional survey of 200 consecutive stroke survivors attending a neurology clinic in a tertiary medical center in Ghana. The validated 8-Item Stigma Scale for Chronic Illness (SSCI-8) questionnaire was administered to study participants to assess internalized and enacted domains of stigma at the personal dimension with further adaptation to capture family and community stigma experienced by stroke participants. Responses on the SSCI-8 were scored from 1 to 5 for each item, where 1=never, 2=rarely, 3=sometimes, 4=often and 5=always with a score range of 8-40. Demographic and clinical data on stroke type and severity as well as depression and Health-Related Quality of Life indicators were also collected. Predictors of stroke-related stigma were assessed using Linear Models (GLM) via Proc GENMOD in SAS 9.4.
105 (52.5%) subjects recruited were males and the mean±SD age of stroke survivors in this survey was 62.0±14.4years. Mean SSCI-8 score was highest for personal stigma (13.7±5.7), which was significantly higher than family stigma (11.9±4.6; p=0.0005) and social/community stigma (11.4±4.4; p<0.0001). Approximately 80% of the cohort reported experiencing mild-to-moderate degrees of stigma. A graded increase in scores on the Geriatric Depression Scale and Centre for Epidemiological Studies-Depression scale was observed across the three categories. Living in an urban setting was associated with higher SSCI-8 scores. Moreover, stroke subjects with more severe post-stroke residual symptom deficits reported a significantly higher frequency of stigma.
Four out of five stroke survivors in this Ghanaian cohort reported experiencing some form of stigma. Stigmatized individuals were also more likely to be depressed and have lower levels of quality of life. Further studies are required to assess the consequences of stigma from stroke in LMIC.
低收入和中等收入国家（LMICs）中风后损失的伤残调整生命年几乎是高收入国家的七倍。尽管患有慢性神经和精神障碍的个体容易受到污名化，但关于中风相关污名化的文献却极为匮乏，尤其是来自LMICs的相关文献。
评估LMIC中风幸存者中污名化的患病率、严重程度、决定因素及心理社会后果。
在2015年11月至2016年2月期间，我们对加纳一家三级医疗中心神经科门诊连续就诊的200名中风幸存者进行了横断面调查。使用经过验证的8项慢性病污名量表（SSCI - 8）问卷对研究参与者进行调查，以评估个人层面污名化的内化和表现领域，并进一步调整以捕捉中风参与者所经历的家庭和社区污名化。SSCI - 8问卷的每个项目得分从1到5分，其中1 = 从不，2 = 很少，3 = 有时，4 = 经常，5 = 总是，得分范围为8 - 40分。还收集了关于中风类型和严重程度的人口统计学和临床数据，以及抑郁和健康相关生活质量指标。使用SAS 9.4中的Proc GENMOD通过线性模型（GLM）评估中风相关污名化的预测因素。
招募的105名（52.5%）受试者为男性，本次调查中中风幸存者的平均年龄±标准差为62.0±14.4岁。个人污名化的平均SSCI - 8得分最高（13.7±5.7），显著高于家庭污名化（11.9±4.6；p = 0.0005）和社会/社区污名化（11.4±4.4；p < 0.0001）。约80%的队列报告经历了轻度至中度的污名化。在这三个类别中，老年抑郁量表和流行病学研究中心抑郁量表的得分呈梯度增加。居住在城市环境与较高的SSCI - 8得分相关。此外，中风后残留症状缺陷更严重的中风受试者报告的污名化频率显著更高。
在这个加纳队列中，五分之四的中风幸存者报告经历了某种形式的污名化。受到污名化的个体也更有可能抑郁且生活质量较低。需要进一步研究来评估LMIC中风污名化的后果。
