Department of Psychiatry, University Medicine Greifswald, Ellernholzstraße 2, 17475, Greifswald, Germany.
Department Health and Prevention, University Greifswald, Greifswald, Germany.
Eur Arch Psychiatry Clin Neurosci. 2019 Jun;269(4):469-479. doi: 10.1007/s00406-018-0896-0. Epub 2018 Apr 20.
It is unclear to what extent failure to recognize symptoms as potential sign of a mental illness is impeding service use, and how stigmatizing attitudes interfere with this process. In a prospective study, we followed a community sample of 188 currently untreated persons with mental illness (predominantly depression) over 6 months. We examined how lack of knowledge, prejudice and discrimination impacted on self-identification as having a mental illness, perceived need, intention to seek help, and help-seeking, both with respect to primary care (visiting a general practitioner, GP) and specialist care (seeing a mental health professional, MHP). 67% sought professional help within 6 months. Fully saturated path models accounting for baseline depressive symptoms, previous treatment experience, age and gender showed that self-identification predicted need (beta 0.32, p < 0.001), and need predicted intention (GP: beta 0.45, p < 0.001; MHP: beta 0.38, p < 0.001). Intention predicted service use with a MHP after 6 months (beta 0.31, p < 0.01; GP: beta 0.17, p = 0.093). More knowledge was associated with more self-identification (beta 0.21, p < 0.01), while support for discrimination was associated with lower self-identification (beta - 0.14, p < 0.05). Blaming persons with mental illness for their problem was associated with lower perceived need (beta - 0.16, p < 0.05). Our models explained 37% of the variance of seeking help with a MHP, and 33% of help-seeking with a GP. Recognizing one's own mental illness and perceiving a need for help are impaired by lack of knowledge, prejudice, and discrimination. Self-identification is a relevant first step when seeking help for mental disorders.
目前尚不清楚未能将症状识别为潜在精神疾病迹象在多大程度上阻碍了服务的利用，以及污名化态度如何干扰这一过程。在一项前瞻性研究中，我们对 188 名目前未经治疗的精神疾病患者（主要为抑郁症）进行了为期 6 个月的随访。我们研究了缺乏知识、偏见和歧视如何影响自我认同为患有精神疾病、感知需求、寻求帮助的意图以及寻求帮助，包括初级保健（看全科医生，GP）和专科保健（看心理健康专家，MHP）。67%的人在 6 个月内寻求专业帮助。完全饱和的路径模型考虑了基线抑郁症状、以前的治疗经验、年龄和性别，表明自我认同预测需求（β0.32，p<0.001），需求预测意图（GP：β0.45，p<0.001；MHP：β0.38，p<0.001）。意图预测 6 个月后使用 MHP 的服务利用（β0.31，p<0.01；GP：β0.17，p=0.093）。更多的知识与更多的自我认同相关（β0.21，p<0.01），而支持歧视与较低的自我认同相关（β-0.14，p<0.05）。将精神疾病归咎于个人问题与感知需求降低相关（β-0.16，p<0.05）。我们的模型解释了寻求 MHP 帮助的 37%的方差和寻求 GP 帮助的 33%的方差。识别自己的精神疾病和感知帮助的需求受到缺乏知识、偏见和歧视的阻碍。自我认同是寻求精神障碍帮助的一个相关的第一步。
