Büchter Roland Brian, Messer Melanie
Institute for Quality and Efficacy in Health Care (IQWiG), Cologne, Germany.
Faculty for Health Sciences, Health Services Research and Nursing Science, University of Bielefeld, Germany.
Ger Med Sci. 2017 Apr 24;15:Doc07. doi: 10.3205/000248. eCollection 2017.
Self-stigma occurs when people with mental illnesses internalize negative stereotypes and prejudices about their condition. It can reduce help-seeking behaviour and treatment adherence. The effectiveness of interventions aimed at reducing self-stigma in people with mental illness is systematically reviewed. Results are discussed in the context of a logic model of the broader social context of mental illness stigma. Medline, Embase, PsycINFO, ERIC, and CENTRAL were searched for randomized controlled trials in November 2013. Studies were assessed with the Cochrane risk of bias tool. Five trials were eligible for inclusion, four of which provided data for statistical analyses. Four studies had a high risk of bias. The quality of evidence was very low for each set of interventions and outcomes. The interventions studied included various group based anti-stigma interventions and an anti-stigma booklet. The intensity and fidelity of most interventions was high. Two studies were considered to be sufficiently homogeneous to be pooled for the outcome self-stigma. The meta-analysis did not find a statistically significant effect (SMD [95% CI] at 3 months: -0.26 [-0.64, 0.12], I=0%, n=108). None of the individual studies found sustainable effects on other outcomes, including recovery, help-seeking behaviour and self-stigma. The effectiveness of interventions against self-stigma is uncertain. Previous studies lacked statistical power, used questionable outcome measures and had a high risk of bias. Future studies should be based on robust methods and consider practical implications regarding intervention development (relevance, implementability, and placement in routine services).
当患有精神疾病的人将对自身状况的负面刻板印象和偏见内化时，就会出现自我污名化。它会减少寻求帮助的行为和治疗依从性。本研究系统评价了旨在减少精神疾病患者自我污名化的干预措施的有效性。研究结果将在精神疾病污名化更广泛社会背景的逻辑模型中进行讨论。2013年11月，检索了Medline、Embase、PsycINFO、ERIC和CENTRAL数据库，以查找随机对照试验。使用Cochrane偏倚风险工具对研究进行评估。有五项试验符合纳入标准，其中四项提供了统计分析数据。四项研究存在高偏倚风险。每组干预措施和结果的证据质量都非常低。所研究的干预措施包括各种基于团体的反污名化干预措施和一本反污名化手册。大多数干预措施的强度和保真度都很高。两项研究被认为具有足够的同质性，可以合并用于自我污名化这一结果。荟萃分析未发现具有统计学意义的效果（3个月时的标准化均数差[95%可信区间]：-0.26[-0.64,0.12]，I²=0%，n=108）。没有一项个体研究发现对包括康复、寻求帮助行为和自我污名化在内的其他结果有可持续的影响。针对自我污名化的干预措施的有效性尚不确定。先前的研究缺乏统计学效力，使用了有问题的结果测量方法，且存在高偏倚风险。未来的研究应基于稳健的方法，并考虑干预措施开发的实际意义（相关性、可实施性以及在常规服务中的应用）。
