Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Psychology, Rhodes University, Grahamstown, South Africa.
Soc Psychiatry Psychiatr Epidemiol. 2020 Dec;55(12):1679-1686. doi: 10.1007/s00127-020-01875-z. Epub 2020 May 14.
Over the past three decades, a range of international stakeholders have highlighted the possibility that genomic research may impact stigma associated with psychiatric disorders. Limited research has been conducted in Africa to investigate this relation.
In the present study, using focus group discussions, we explored the relation between genetic attribution and stigma among 36 Xhosa people with schizophrenia. We addressed three main questions: (1) What causal beliefs do Xhosa people with schizophrenia use to explain their illness and to what extent do genetic explanations play a role in these beliefs? (2) What are the internalised stigma experiences of Xhosa people with schizophrenia? (3) How do genetic explanations relate to stigma experiences, if at all?
Most participants were able to define genetics and some linked genetics to disease causation. Despite adequate knowledge of genetics and an emphasis on genetic explanations of schizophrenia in the study, most participants held a multitude of causal explanations including: psychosocial, environmental, and cultural. Moreover, participants rarely mentioned disease cause when describing their stigma experiences.
For this population group, there was no straight-forward relation between a genetic attribution and stigma. Therefore, we did not find evidence that genetic attribution may significantly increase stigma. Although North American and European literature provides conflicting evidence regarding this relation, there is increased consensus that biomedical explanations for psychiatric disorders may reduce blame. This study found evidence supporting that consensus. This study provides an empirical foundation to inform ongoing work on the psychosocial implications of psychiatric genomics research in non-Western contexts.
在过去的三十年中,一系列国际利益相关者强调了基因组研究可能会影响与精神障碍相关的污名。在非洲,已经开展了有限的研究来调查这种关系。
在本研究中,我们通过焦点小组讨论,调查了 36 名患有精神分裂症的科萨人之间遗传归因与污名之间的关系。我们解决了三个主要问题:(1)患有精神分裂症的科萨人使用哪些因果信念来解释他们的疾病,以及遗传解释在这些信念中起到什么作用?(2)患有精神分裂症的科萨人有哪些内化的污名体验?(3)如果有的话,遗传解释与污名体验有何关系?
大多数参与者能够定义遗传学,并且有些人将遗传学与疾病的病因联系起来。尽管参与者对遗传学有足够的了解,并且在研究中强调了精神分裂症的遗传解释,但大多数参与者持有多种因果解释,包括:心理社会、环境和文化。此外,参与者在描述污名体验时很少提到疾病的病因。
对于这群人来说,遗传归因与污名之间没有直接的关系。因此,我们没有发现遗传归因可能显著增加污名的证据。尽管北美和欧洲的文献对这种关系提供了相互矛盾的证据,但越来越多的共识是,精神障碍的生物医学解释可能会减少责备。本研究提供了支持这一共识的证据。本研究为在非西方背景下开展精神科基因组学研究的社会心理影响提供了实证基础。