Africa Mental Health Foundation,Nairobi,Kenya.
Global Mental Health Program,Columbia University,New York,USA.
Epidemiol Psychiatr Sci. 2019 Apr;28(2):156-167. doi: 10.1017/S2045796018000264. Epub 2018 Jun 4.
AimsStigma can have a negative impact on help-seeking behaviour, treatment adherence and recovery of people with mental disorders. This study aimed to determine the feasibility of the WHO Mental Health Treatment Gap Interventions Guidelines (mhGAP-IG) to reduce stigma in face-to-face contacts during interventions for specific DSM-IV/ICD 10 diagnoses over a 6-month period.
This study was conducted in 20 health facilities across Makueni County in southeast Kenya which has one of the poorest economies in the country and has no psychiatrist or clinical psychologist. We recruited 2305 participants from the health facilities catchment areas that had already been exposed to community mental health services. We measured stigma using DISC-12 at baseline, followed by training to the health professionals on intervention using the WHO mhGAP-IG and then conducted a follow-up DISC-12 assessment after 6 months. Proper management of the patients by the trained professionals would contribute to the reduction of stigma in the patients.
There was 59.5% follow-up at 6 months. Overall, there was a significant decline in 'reported/experienced discrimination' following the interventions. A multivariate linear mixed model regression indicated that better outcomes of 'unfair treatment' scores were associated with: being married, low education, being young, being self-employed, higher wealth index and being diagnosed with depression. For 'stopping self' domain, better outcomes were associated with being female, married, employed, young, lower wealth index and a depression diagnosis. In regards to 'overcoming stigma' domain; being male, being educated, employed, higher wealth index and being diagnosed with depression was associated with better outcomes.
The statistically significant (p < 0.05) reduction of discrimination following the interventions by trained health professionals suggest that the mhGAP-IG may be a useful tool for reduction of discrimination in rural settings in low-income countries.
歧视可对精神障碍患者的求治行为、治疗依从性和康复产生负面影响。本研究旨在确定世卫组织《精神卫生治疗差距干预指南》（mhGAP-IG）是否可在 6 个月期间通过面对面干预减少特定 DSM-IV/ICD-10 诊断患者的歧视。
本研究在肯尼亚东南部马库埃尼县的 20 个卫生机构进行，该县是该国经济最贫困的地区之一，没有精神科医生或临床心理学家。我们从已接触社区精神卫生服务的卫生机构服务范围内招募了 2305 名参与者。我们在基线时使用 DISC-12 测量歧视，然后对卫生专业人员进行干预培训，采用世卫组织 mhGAP-IG，6 个月后进行后续 DISC-12 评估。经过培训的专业人员对患者进行妥善管理，有助于减少患者的歧视。
6 个月时的随访率为 59.5%。总体而言，干预后“报告/经历的歧视”显著减少。多变量线性混合模型回归表明，“不公平待遇”评分的更好结果与已婚、低教育程度、年轻、个体经营、较高的财富指数和诊断为抑郁症有关。对于“自我停止”领域，更好的结果与女性、已婚、就业、年轻、较低的财富指数和抑郁症诊断有关。关于“克服歧视”领域，男性、受教育程度高、就业、较高的财富指数和诊断为抑郁症与更好的结果相关。
经过培训的卫生专业人员干预后歧视显著减少（p < 0.05），表明 mhGAP-IG 可能是在低收入国家农村地区减少歧视的有用工具。
