Department of Global Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
Health Alliance International, Seattle, WA, USA.
Soc Psychiatry Psychiatr Epidemiol. 2019 Nov;54(11):1391-1410. doi: 10.1007/s00127-019-01708-8. Epub 2019 Apr 30.
This study describes patterns of community-level stigmatizing attitudes towards mental illness (MI) in central Mozambique.
Data for this study come from a representative community household survey of 2933 respondents ≥ 18 years old in Manica and Sofala Provinces, Mozambique. Six MI stigma questions represented primary research outcomes. Bivariate and multivariable analyses examined the relationship between key explanatory factors and each stigma question. Spatial analyses analyzed the smoothed geographic distribution of responses to each question and explored the association between geographic location and MI stigma controlling for individual-level socio-demographic factors.
Stigmatizing attitudes towards MI are prevalent in central Mozambique. Analyses showed that males, people who live in urban places, divorced and widowed individuals, people aged 18-24, people with lower education, people endorsing no religion, and people in lower wealth quintiles tended to have significantly higher levels of stigmatizing attitudes towards MI. Individuals reporting depressive symptoms scored significantly higher on stigmatizing questions, potentially indicating internalized stigma. Geographic location is significantly associated with people's response to five of the stigma questions even after adjusting for individual-level factors.
Stigmatizing attitudes towards MI are common in central Mozambique and concentrated amongst specific socio-demographic groups. However, geographic analyses suggest that structural factors within communities and across regions may bear a greater influence on MI stigma than individual-level factors alone. Further implementation science should consider focusing on identifying the most significant modifiable structural factors associated with MI stigma in LMICs to inform the development, testing, and optimization of multi-level stigma prevention interventions.
本研究描述了莫桑比克中部社区层面针对精神疾病（MI）的污名化态度模式。
本研究的数据来自莫桑比克马尼卡省和索法拉省的一项具有代表性的社区家庭调查，共有 2933 名年龄≥18 岁的受访者。6 个 MI 污名问题代表了主要的研究结果。单变量和多变量分析检验了关键解释因素与每个污名问题之间的关系。空间分析分析了对每个问题的平滑地理分布，并在控制个体社会人口因素的情况下，探索了地理位置与 MI 污名之间的关联。
在莫桑比克中部，针对 MI 的污名化态度普遍存在。分析表明，男性、居住在城市地区的人、离婚和丧偶的人、18-24 岁的人、受教育程度较低的人、不信仰宗教的人以及财富水平较低的人，往往对 MI 持有更高水平的污名化态度。报告抑郁症状的人在污名化问题上的得分显著更高，这可能表明存在内化的污名。即使在调整了个体因素后，地理位置与人们对 5 个污名问题的反应仍然显著相关。
针对 MI 的污名化态度在莫桑比克中部很常见，且集中在特定的社会人口群体中。然而，地理分析表明，社区内和跨地区的结构性因素对 MI 污名的影响可能大于个体因素。进一步的实施科学应考虑集中识别与 LMIC 中的 MI 污名相关的最显著的可改变结构性因素，为制定、测试和优化多层次污名预防干预措施提供信息。
