对伴有或不伴有酒精及其他药物问题的抑郁症和精神病患者的认知及态度：澳大利亚护理人员全国调查结果
Recognition of, and attitudes towards, people with depression and psychosis with/without alcohol and other drug problems: results from a national survey of Australian paramedics.
作者信息
McCann Terence V, Savic Michael, Ferguson Nyssa, Cheetham Alison, Witt Katrina, Emond Kate, Bosley Emma, Smith Karen, Roberts Louise, Lubman Dan I
机构信息
Department of Nursing and Midwifery, Institute of Health and Sport, Victoria University, Melbourne, Victoria, Australia.
Turning Point, Eastern Health, Melbourne, Victoria, Australia.
出版信息
BMJ Open. 2018 Dec 4;8(12):e023860. doi: 10.1136/bmjopen-2018-023860.
OBJECTIVE
Continuing stigma towards mental health problems means that many individuals-especially men-will first present in crisis, with emergency services often the first point of call. Given this situation, the aims of this paper were to assess paramedics' ability to recognise, and their attitudes towards, males with clinically defined depression and psychosis with and without comorbid alcohol and other drug (AOD) problems.
METHODS
A cross-sectional national online survey of 1230 paramedics throughout Australia. The survey was based on four vignettes: depression with suicidal thoughts, depression with suicidal thoughts and comorbid alcohol problems, and psychosis with and without comorbid AOD problems.
RESULTS
Just under half of respondents recognised depression, but this decreased markedly to one-fifth when comorbid AOD problems were added to the vignette. In contrast, almost 90% recognised psychosis, but this decreased to just under 60% when comorbid AOD problems were added. Respondents were more likely to hold stigmatising attitudes towards people in the vignettes with depression and psychosis when comorbid AOD problems were present. Respondents endorsed questionnaire items assessing perceived social stigma more strongly than personal stigma. Desire for social distance was greater in vignettes focusing on psychosis with and without comorbid AOD problems than depression with and without comorbid AOD problems.
CONCLUSIONS
Paramedics need a well-crafted multicomponent response which involves cultural change within their organisations and more education to improve their recognition of, and attitudes towards, clients with mental health and AOD problems. Education should focus on the recognition and care of people with specific mental disorders rather than on mental disorders in general. It is essential that education also focuses on understanding and caring for people with AOD problems. Educational interventions should focus on aligning beliefs about public perceptions with personal beliefs about people with mental disorders and AOD problems.
目的
对心理健康问题持续存在的污名化意味着许多人——尤其是男性——会在危机中首次就诊，紧急服务部门往往是他们的首个求助点。鉴于这种情况，本文旨在评估护理人员识别患有临床定义的抑郁症和精神病的男性的能力，以及他们对这些男性的态度，这些男性伴有或不伴有酒精和其他药物（AOD）问题。
方法
对澳大利亚各地的1230名护理人员进行全国性横断面在线调查。该调查基于四个病例描述：伴有自杀念头的抑郁症、伴有自杀念头和酒精问题的抑郁症，以及伴有和不伴有AOD问题的精神病。
结果
不到一半的受访者能识别出抑郁症，但当病例描述中增加AOD问题时，这一比例显著降至五分之一。相比之下，近90%的受访者能识别出精神病，但当增加AOD问题时，这一比例降至略低于60%。当存在AOD问题时，受访者对病例描述中患有抑郁症和精神病的人更有可能持有污名化态度。受访者对评估感知到的社会污名的问卷项目的认同程度高于个人污名。与伴有和不伴有AOD问题的抑郁症相比，关注伴有和不伴有AOD问题的精神病的病例描述中，对社会距离的渴望更大。
结论
护理人员需要精心制定多方面的应对措施，这包括其组织内部的文化变革以及更多教育，以提高他们对有心理健康和AOD问题的客户的识别能力和态度。教育应侧重于识别和护理患有特定精神障碍的人，而不是一般的精神障碍。同样至关重要的是，教育还应侧重于理解和护理有AOD问题的人。教育干预应侧重于使关于公众认知的信念与关于患有精神障碍和AOD问题的人的个人信念保持一致。
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