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精神疾病患者家庭照顾者中精神疾病的耻辱感和负担及其相关因素。

Stigma and burden of mental illness and their correlates among family caregivers of mentally ill patients.

作者信息

Ebrahim Omnya S, Al-Attar Ghada S T, Gabra Romany H, Osman Doaa M M

机构信息

Department of Community, Occupational and Environmental Medicine, Faculty of Medicine, Helwan University, Helwan, Egypt.

Department of Public Health & Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.

出版信息

J Egypt Public Health Assoc. 2020 Nov 9;95(1):31. doi: 10.1186/s42506-020-00059-6.

Abstract

BACKGROUND AND OBJECTIVES

Family caregivers play a curial role in supporting and caring for their mentally ill relatives. Their struggle for facing stigma and shouldering caregiving burden is marginalized, undervalued, and invisible to medical services. This study assessed the stigma and burden of mental illnesses, and their correlates among family caregivers of mentally ill patients.

METHODS

A cross-sectional study design was used to collect data from 425 main family caregivers of mentally ill patients at Assiut University Hospital. A structured interview questionnaire was designed to collect socio-demographic data of both patients and their caregivers. Stigma scale for caregivers of people with mental illness (CPMI) was used to assess the affiliate stigma, while the associative stigma was assessed by the explanatory model interview catalogue stigma scale (EMIC-Stigma scale). The caregivers' burden was assessed using Zarit burden Interview, and Modified Attitude toward Mental Illness Questionnaire was used to assess caregivers' knowledge and attitude towards mental illness.

RESULTS

Bipolar disorder (48%) and schizophrenia/other related psychotic disorders (42.8%) were the most common mental illnesses among the study patients. The mean scores of CPMI total scale, EMIC-Stigma scale, and Zarit Burden scale were 56.80 ± 7.99, 13.81 ± 5.42, and 55.20 ± 9.82, respectively. The significant correlates for affiliate stigma were being parents of patients (ß = 4.529, p < 0.001), having higher associate stigma (ß = 0.793, p < 0.001), and aggressive behavior of mentally ill patients (ß = 1.343, p = 0.038). The significant correlates for associate stigma of the study caregivers were being caregivers' relatives other than parents (ß = 1.815, p = 0.006), having high affiliate stigma (ß = 0.431, p < 0.001), having poor knowledge and negative attitude towards mental illness (ß = - 0.158, p = 0.002), and aggressive behavior of mentally ill relatives (ß = 1.332, p = 0.005). The correlates for the high burden were being male (ß = 3.638, p = 0.006), non-educated caregiver (ß = 1.864, p = 0.045), having high affiliate stigma (ß = 0.467, p < 0.001), having high associative stigma (ß = 0.409, p < 0.001), having poor knowledge and negative attitude toward mental illness (ß = - 0.221, p = 0.021), seeking traditional healers and non-psychiatrist's care from the start (ß = 2.378, p = 0.018), and caring after young mentally ill relatives (ß = - 0.136, p = 0.003).

CONCLUSION

The studied caregivers suffered from stigma and a high level of burden. Psycho-educational programs directed toward family caregivers are highly recommended.

摘要

背景与目的

家庭照顾者在支持和照料患有精神疾病的亲属方面发挥着至关重要的作用。他们在面对污名化以及承担照料负担时的挣扎被边缘化、低估,且医疗服务对此视而不见。本研究评估了精神疾病的污名和负担,以及精神疾病患者家庭照顾者中它们的相关因素。

方法

采用横断面研究设计,从阿斯尤特大学医院的425名精神疾病患者的主要家庭照顾者中收集数据。设计了一份结构化访谈问卷,以收集患者及其照顾者的社会人口学数据。使用精神疾病患者照顾者污名量表(CPMI)评估附属污名,而关联污名则通过解释模型访谈目录污名量表(EMIC - 污名量表)进行评估。使用扎里特负担访谈评估照顾者的负担,并使用修订后的对精神疾病态度问卷评估照顾者对精神疾病的知识和态度。

结果

双相情感障碍(48%)和精神分裂症/其他相关精神障碍(42.8%)是研究患者中最常见的精神疾病。CPMI总量表、EMIC - 污名量表和扎里特负担量表的平均得分分别为56.80±7.99、13.81±5.42和55.20±9.82。附属污名的显著相关因素包括是患者的父母(β = 4.529,p < 0.001)、有较高的关联污名(β = 0.793,p < 0.001)以及精神疾病患者的攻击行为(β = 1.343,p = 0.038)。研究照顾者关联污名的显著相关因素包括是父母以外的照顾者亲属(β = 1.815,p = 0.006)、有较高的附属污名(β = 0.431,p < 0.001)、对精神疾病知识了解不足且态度消极(β = - 0.158,p = 0.002)以及精神疾病亲属的攻击行为(β = 1.332,p = 0.005)。高负担的相关因素包括男性(β = 3.638,p = 0.006)、未受过教育的照顾者(β = 1.864,p = 0.045)、有较高的附属污名(β = 0.467,p < 0.001)、有较高的关联污名(β = 0.409,p < 0.001)、对精神疾病知识了解不足且态度消极(β = - 0.221,p = 0.021)、从一开始就寻求传统治疗师和非精神科医生的治疗(β = 2.378,p = 0.018)以及照料年轻的精神疾病亲属(β = - 0.136,p = 0.003)。

结论

所研究的照顾者遭受污名且负担水平较高。强烈建议针对家庭照顾者开展心理教育项目。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bc0f/7649189/44388ce71998/42506_2020_59_Fig1_HTML.jpg

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