Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France.
Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.
Psychol Med. 2022 Aug;52(11):2155-2165. doi: 10.1017/S0033291720004055. Epub 2020 Nov 16.
Stigma resistance (SR) is defined as one's ability to deflect or challenge stigmatizing beliefs. SR is positively associated with patient's outcomes in serious mental illness (SMI). SR appears as a promising target for psychiatric rehabilitation as it might facilitate personal recovery.
The objectives of the present study are: (i) to assess the frequency of SR in a multicentric non-selected psychiatric rehabilitation SMI sample; (ii) to investigate the correlates of high SR.
A total of 693 outpatients with SMI were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluation included standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, and personal recovery and a large cognitive battery. SR was measured using internalized stigma of mental illness - SR subscale.
Elevated SR was associated with a preserved executive functioning, a lower insight into illness and all recovery-related outcomes in the univariate analyses. In the multivariate analysis adjusted by age, gender and self-stigma, elevated SR was best predicted by the later stages of personal recovery [rebuilding; = 0.004, OR = 2.89 (1.36-4.88); growth; = 0.005, OR = 2.79 (1.30-4.43)). No moderating effects of age and education were found.
The present study has indicated the importance of addressing SR in patients enrolled in psychiatric rehabilitation. Recovery-oriented psychoeducation, metacognitive therapies and family interventions might improve SR and protect against insight-related depression. The effectiveness of psychiatric rehabilitation on SR and the potential mediating effects of changes in SR on treatment outcomes should be further investigated in longitudinal studies.
抗污名（SR）被定义为一个人转移或挑战污名化信念的能力。SR 与严重精神疾病（SMI）患者的预后呈正相关。由于 SR 可能促进个人康复，因此它似乎是精神康复的一个有前途的目标。
本研究的目的是：（i）评估多中心非选择性精神康复 SMI 样本中的 SR 频率；（ii）探讨高 SR 的相关性。
共招募了 693 名来自法国国家精神康复参考中心队列（REHABase）的 SMI 门诊患者。评估包括用于临床严重程度、生活质量、生活满意度、幸福感和个人康复的标准化量表以及大型认知测试。使用内化的精神疾病污名-SR 子量表来衡量 SR。
在单变量分析中，较高的 SR 与执行功能保留、对疾病的洞察力降低以及所有与康复相关的结果有关。在调整年龄、性别和自我污名的多变量分析中，较高的 SR 最佳地由个人康复的后期阶段来预测[重建； = 0.004，OR = 2.89（1.36-4.88）；成长； = 0.005，OR = 2.79（1.30-4.43）]。未发现年龄和教育的调节作用。
本研究表明，在参加精神康复的患者中，解决 SR 问题非常重要。以康复为导向的心理教育、元认知疗法和家庭干预可能会提高 SR 并预防与洞察力相关的抑郁。应在纵向研究中进一步探讨精神康复对 SR 的有效性以及 SR 变化对治疗结果的潜在中介作用。
