Caqueo-Urízar Alejandra, Urzúa Alfonso, Habib Julia, Loundou Anderson, Boucekine Mohamed, Boyer Laurent, Fond Guillaume
Instituto de Alta Investigación, Universidad de Tarapacá, Arica, Chile.
Universidad Católica del Norte, Avda. Angamos 0610, Antofagasta, Chile.
Eur Arch Psychiatry Clin Neurosci. 2020 Aug;270(5):513-520. doi: 10.1007/s00406-019-01035-8. Epub 2019 Jun 25.
The relationships between stigma and quality of life in schizophrenia (QoL) have been extensively explored but have mostly focused on self-stigma and self-esteem and have never been explored in Latin-America. The objective of this study was to determine which stigma dimensions were associated with QoL in a sample of community-dwelling SZ subjects of three Latin-American countries. Stabilized outpatients with SZ were recruited in three Mental Health Services in three Latin-American countries: Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). Stigma and Qol-SZ were evaluated by self-administered questionnaires, the Internalized Stigma of Mental Illness scale (ISMI-12) and the SQoL-18. 253 participants were included. In multivariate analyses, QoL has been associated with each stigma dimension (social stigma, stigma experience and self-stigma), independently of age, gender, education level, ethnicity, age at illness onset, illness symptomatology and mental health treatment. More specifically, social stigma was significantly associated with impaired psychological and physical well-being, self-esteem and friendship. Self-stigma was significantly associated with impaired psychological well-being, self-esteem and autonomy. The present results confirm the importance of stigma in QoL of SZ subjects and identify new targets to develop stigma-orientated programs. Most of the previous programs have focused on self-stigma while social stigma has shown to be associated with a wide range of impaired QoL areas. Stigma and QoL may have a bidirectional relationship and targeting some specific QoL areas (like autonomy through self-empowerment approaches) may also improve the effectiveness of these programs to reduce stigma impact on the quality of life of subjects with schizophrenia. Future studies should also explore differences across countries as subjects from Bolivia were more frequently Aymara and reported higher stigma and lower QoL than SZ subjects from other countries.
精神分裂症的污名与生活质量（QoL）之间的关系已得到广泛研究，但大多集中在自我污名和自尊方面，且从未在拉丁美洲进行过探索。本研究的目的是确定在三个拉丁美洲国家的社区居住精神分裂症患者样本中，哪些污名维度与生活质量相关。在三个拉丁美洲国家的三个心理健康服务机构招募了病情稳定的精神分裂症门诊患者：玻利维亚（N = 83）、智利（N = 85）和秘鲁（N = 85）。通过自我管理问卷、精神疾病内化污名量表（ISMI - 12）和精神分裂症生活质量量表（SQoL - 18）对污名和精神分裂症生活质量进行评估。共纳入253名参与者。在多变量分析中，生活质量与每个污名维度（社会污名、污名经历和自我污名）相关，与年龄、性别、教育水平、种族、发病年龄、疾病症状和心理健康治疗无关。更具体地说，社会污名与心理和身体健康受损、自尊和友谊显著相关。自我污名与心理幸福感受损、自尊和自主性显著相关。目前的结果证实了污名在精神分裂症患者生活质量中的重要性，并确定了开发以污名为导向项目的新目标。以前的大多数项目都集中在自我污名上，而社会污名已被证明与广泛的生活质量受损领域相关。污名和生活质量可能存在双向关系，针对一些特定的生活质量领域（如通过自我赋权方法实现自主性）也可能提高这些项目减少污名对精神分裂症患者生活质量影响的有效性。未来的研究还应探索不同国家之间的差异，因为玻利维亚的患者中艾马拉人更为常见，且报告的污名程度高于其他国家的精神分裂症患者，生活质量也更低。
