Modelli Arlete, Candal Setti Viviane P, van de Bilt Martinus Theodorus, Gattaz Wagner Farid, Loch Alexandre Andrade, Rössler Wulf
Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
Psychology and Neuropsychology Service, Department and Institute of Psychiatry, Universidade de São Paulo Medical School, São Paulo, Brazil.
Front Psychiatry. 2021 Feb 10;11:582180. doi: 10.3389/fpsyt.2020.582180. eCollection 2020.
The public stigma and self-stigma contribute to the dilemma of disclosing or not one's own mental illness diagnosis. Studies suggest that revealing it diminishes stress, besides helping with self-esteem. Honest, Open, Proud (HOP) is a group program that aids in the process of deciding on it, reducing its impact. Considering the relevance of this issue, the present study aimed to apply a HOP-based intervention in a group of patients diagnosed with mood disorders. A randomized controlled clinical trial was used, including 61 patients with mood disorders, of whom 31 were diagnosed with depression and 30 were diagnosed with bipolar disorder. They were randomly placed on the intervention (HOP) or the control group (unstructured psychoeducation). The evaluations occurred before (T0) and after (T1) the sessions. We administered eight scales, from which three presented relevant results: Coming Out with Mental Illness Scale (COMIS), Cognitive Appraisal of Stigma as a Stressor (CogApp), and Authenticity Scale. The intervention groups (depression and bipolar) did not present a significant change regarding the decision to disclose their diagnostics. However, the depression group showed a decrease on the perception of stigma as a stressor (T0 = 0.50 vs. T1 = -1.45; = 0.058). Improvements in post-intervention results were seen for both groups (depression and bipolar) on the Authenticity Scale-self-alienation subscale (T0 = 10.40 vs. T1 = 12.37, = 0.058). Our HOP-based intervention appeared to be an important program to aid patients in facing stigma stress, showing positive effects, whether helping to diminish stress or to improve self-conscience, both of which have indirect effects on self-stigma. As it is a compact program, it can bring benefits when applying to public health institutions.
公众污名和自我污名导致了是否披露自身精神疾病诊断的两难困境。研究表明，披露病情除了有助于提升自尊外，还能减轻压力。“坦诚、开放、自豪”（HOP）是一个团体项目，有助于做出披露病情的决定，并减少其影响。鉴于此问题的相关性，本研究旨在对一组被诊断为情绪障碍的患者实施基于HOP的干预措施。采用随机对照临床试验，纳入61名情绪障碍患者，其中31名被诊断为抑郁症，30名被诊断为双相情感障碍。他们被随机分为干预组（HOP）或对照组（非结构化心理教育）。在疗程前后（T0和T1）进行评估。我们使用了八个量表，其中三个呈现出相关结果：精神疾病披露量表（COMIS）、作为压力源的污名认知评估量表（CogApp）和真实性量表。干预组（抑郁症和双相情感障碍组）在披露诊断的决定方面没有显著变化。然而，抑郁症组在将污名视为压力源的认知上有所下降（T0 = 0.50 vs. T1 = -1.45；P = 0.058）。两组（抑郁症和双相情感障碍组）在真实性量表的自我疏离子量表上干预后的结果均有改善（T0 = 10.40 vs. T1 = 12.37，P = 0.058）。我们基于HOP的干预措施似乎是帮助患者面对污名压力的重要项目，显示出积极效果，无论是有助于减轻压力还是改善自我意识，这两者对自我污名都有间接影响。由于它是一个紧凑的项目，应用于公共卫生机构时可以带来益处。
