Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN, USA.
Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
J Ment Health. 2020 Apr;29(2):182-190. doi: 10.1080/09638237.2019.1644494. Epub 2019 Aug 2.
Stigma is one of several barriers to seeking mental health care. However, few studies have examined how stigma relates to other common barriers (e.g. attitudes about treatment, cost, time). This study investigated whether depression stigma (internalized or perceived) was related to other treatment-seeking barriers (attitudinal, structural) and whether depression severity influenced the strength of the association. We used multivariable-adjusted linear regression to model barrier outcomes as a function of internalized and perceived stigma in an undergraduate population (=2551). We evaluated potential effect modification by depression severity using likelihood-ratio tests. Internalized stigma displayed a stronger association with overall barriers to care (including perceived need, negative treatment expectations, and structural barriers) than did perceived stigma. Higher internalized stigma predicted a stronger emphasis on each barrier to treatment measured. Sub-components of internalized stigma (e.g. alienation, stereotype endorsement) uniquely predicted a greater emphasis on distinct barriers. Internalized stigma is strongly linked to greater perception of barriers to mental health care. It may be necessary to address stigma and barriers concurrently rather than independently.
污名是寻求心理健康护理的障碍之一。然而,很少有研究探讨污名与其他常见障碍(例如对治疗、费用和时间的态度)之间的关系。本研究调查了抑郁污名(内化或感知)是否与其他寻求治疗的障碍(态度、结构)有关,以及抑郁严重程度是否会影响关联的强度。我们使用多变量调整的线性回归模型,在大学生群体(n=2551)中,将障碍结果作为内化和感知污名的函数进行建模。我们使用似然比检验评估了抑郁严重程度的潜在调节作用。与感知污名相比,内化污名与整体护理障碍(包括感知需求、消极治疗期望和结构性障碍)的关联更强。更高的内化污名预示着对所测量的每种治疗障碍的强调程度更强。内化污名的亚成分(例如疏远、刻板印象认可)独特地预测了对不同障碍的更大强调。内化污名与对心理健康护理障碍的更大感知密切相关。可能需要同时解决污名和障碍问题,而不是分别解决。