Budhwani Henna, De Prabal
Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Economics, Colin Powell School, City College, New York, New York.
Health Equity. 2019 Mar 21;3(1):73-80. doi: 10.1089/heq.2018.0079. eCollection 2019.
Addressing perceived and enacted stigma in clinical settings is critical to ensuring delivery of high-quality patient-centered care, reducing health disparities, and improving population health outcomes. Data from the Behavioral Risk Factor Surveillance System's (2012-2014) Reaction to Race module were analyzed to test the hypothesis that perceived stigma in health care settings would be associated with poorer physical and mental health. Poor health was measured by (1) the number of days the respondent was physically or mentally ill over the past month and (2) depressive disorder diagnosis. Multivariate linear and logistic regression models were employed. Effects of stigma on physical and mental health were significant. Perceived stigma was associated with additional 2.79 poor physical health days (β=2.79, confidence interval [CI]=1.84-3.75) and 2.92 more days of poor mental health (β=2.92, CI=1.97-3.86). Moreover, perceived stigma in health care settings was associated with 61% higher odds of reporting a depressive disorder (adjusted odds ratio=1.61, CI=1.29-2.00). Among other findings, individuals who were married, younger, had higher income, had college degrees, and were employed reported significantly fewer poor physical and mental health days and had lower odds of self-reported depressive disorder. Reducing stigma against people of color in health care settings (environments that should be pro-patient) must be a top priority for population health scholars and clinicians. Reducing perceived stigma in clinical settings may produce better mental and physical health outcomes in minority patients thereby reducing health disparities. In addition, fewer days lost to poor health could positively influence the health care system by decreasing utilization and may improve economic productivity through increasing days of good health.
在临床环境中应对感知到的和实际存在的污名化现象，对于确保提供高质量的以患者为中心的护理、减少健康差距以及改善人群健康结果至关重要。对行为风险因素监测系统（2012 - 2014年）“对种族的反应”模块的数据进行了分析，以检验以下假设：医疗环境中感知到的污名化现象会与较差的身心健康状况相关。健康状况不佳通过以下方式衡量：（1）受访者在过去一个月内身体或精神患病的天数；（2）抑郁症诊断情况。采用了多元线性和逻辑回归模型。污名化对身心健康的影响显著。感知到的污名化与额外2.79天的身体不健康天数相关（β = 2.79，置信区间[CI] = 1.84 - 3.75）以及多2.92天的精神不健康天数相关（β = 2.92，CI = 1.97 - 3.86）。此外，医疗环境中感知到的污名化与报告患抑郁症的几率高出61%相关（调整后的优势比 = 1.61，CI = 1.29 - 2.00）。在其他研究结果中，已婚、年轻、收入较高、拥有大学学位且有工作的个体报告的身体和精神不健康天数显著较少，且自我报告患抑郁症的几率较低。减少医疗环境（本应是支持患者的环境）中对有色人种的污名化，必须成为人群健康学者和临床医生的首要任务。减少临床环境中感知到的污名化现象，可能会使少数族裔患者获得更好的身心健康结果，从而减少健康差距。此外，因健康不佳而损失的天数减少，可能会通过降低利用率对医疗系统产生积极影响，并可能通过增加健康天数提高经济生产力。
