Department of Psychiatry, Queen Mary Hospital, Hong Kong Special Administrative Region.
Department of Psychiatry, University of Hong Kong, Hong Kong Special Administrative Region.
Gen Hosp Psychiatry. 2019 Mar-Apr;57:7-12. doi: 10.1016/j.genhosppsych.2018.12.007. Epub 2018 Dec 18.
Stigma has a deleterious effect on functioning in individuals with bipolar disorder (BD). However, there has been no research investigating how stigma coping predicts self-stigma and functioning in BD. Furthermore, how different stages of self-stigma might affect functioning is unclear. The following hypotheses were examined: (1) Stigma coping by withdrawal and secrecy was associated with more self-stigma; (2) Stigma coping by withdrawal and secrecy was associated with worse social functioning; and (3) Later stages of self-stigma were associated with worse social functioning.
A random sample of remitted BD in a regional psychiatric clinic was examined using a cross-sectional design (n = 115). Self-stigma was measured using the Chinese versions of Self-Stigma of Mental Illness Scale (C-SSMIS). Social functioning was assessed using the Functional Assessment Short Test (FAST). Stigma coping was evaluated using the Stigma Coping Orientation Scale (SCOS).
Multiple regression analysis revealed that coping by secrecy was associated with the stereotype agreement subscale of C-SSMIS, while coping by withdrawal was associated with the C-SSMIS self-concurrence and self-esteem decrement subscales. Another regression analysis showed that FAST total score was associated with the self-esteem decrement subscale of C-SSMIS and the severity of depressive and manic symptoms.
We showed that self-esteem decrement, the final stage of self-stigma, was the most crucial stage in determining psychosocial functioning. Our findings suggested that stigma-reduction intervention should be arranged during the early stage of BD and targeted at various dysfunctional stigma coping.
耻辱感会对双相情感障碍（BD）患者的功能产生有害影响。然而，目前还没有研究调查耻辱应对如何预测 BD 患者的自我耻辱感和功能。此外，不同阶段的自我耻辱感如何影响功能尚不清楚。本研究提出了以下假设：（1）退缩和保密的耻辱应对方式与更高的自我耻辱感相关；（2）退缩和保密的耻辱应对方式与更差的社会功能相关；（3）自我耻辱感的后期阶段与更差的社会功能相关。
采用横断面设计，对某地区精神科诊所的缓解期 BD 随机样本（n=115）进行了检查。使用中文版精神疾病自我污名量表（C-SSMIS）测量自我污名。使用功能评估简短测试（FAST）评估社会功能。使用耻辱应对取向量表（SCOS）评估耻辱应对方式。
多元回归分析显示，保密应对与 C-SSMIS 的刻板印象一致子量表相关，而退缩应对与 C-SSMIS 的自我一致性和自尊下降子量表相关。另一项回归分析显示，FAST 总分与 C-SSMIS 的自尊下降子量表和抑郁和躁狂症状的严重程度相关。
我们表明，自尊下降是自我耻辱感的最后阶段，是决定心理社会功能的最关键阶段。我们的发现表明，应在 BD 的早期阶段安排减少耻辱感的干预措施，并针对各种功能失调的耻辱应对方式。
