Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Zochonis Building, Oxford Road, Manchester M13 9PL, UK.
Clin Psychol Rev. 2021 Apr;85:102003. doi: 10.1016/j.cpr.2021.102003. Epub 2021 Feb 27.
People with psychosis are reported to be one of the most stigmatised minority groups in society. Mental health stigma can have a detrimental impact on quality of life (QoL), which is a meaningful outcome for service users experiencing psychosis and using mental health services. This paper provides the first systematic literature review, meta-analysis and quality appraisal of studies examining the association between stigma and subjective QoL in non-affective psychosis. An electronic database search identified 45 articles for inclusion. A random-effects meta-analysis of 37 independent samples (n = 5795) found a statistically significant association between higher stigma and lower subjective QoL of medium strength (r = -0.40, 95% CI: -0.45, -0.35). Separate meta-analyses demonstrated medium-to-large negative pooled effects for self-stigma (k = 25, r = -0.44, 95% CI:-0.49, -0.38), perceived stigma (k = 10, r = -0.32, 95% CI:-0.42, -0.21) and experienced stigma (k = 6, r = -0.30, 95% CI:-0.35, -0.24). A narrative summary of 12 studies suggested psychological mechanisms relating to self-concept and social networks may play an important mediating role in the association between stigma and QoL in psychosis. Psychological interventions should target improvements in these psychological processes to reduce the negative impact of stigma on QoL in psychosis. Further longitudinal research is needed to test theoretical models of causal pathways and explanatory mechanisms.
据报道，精神病患者是社会上受歧视最严重的少数群体之一。心理健康方面的耻辱感会对生活质量（QoL）产生不利影响，而生活质量是经历精神病和使用心理健康服务的服务使用者的一个有意义的结果。本文提供了首次对非情感性精神病患者的耻辱感与主观生活质量之间的关联进行的系统文献综述、荟萃分析和质量评估。电子数据库检索确定了 45 篇符合纳入标准的文章。对 37 个独立样本（n=5795）的随机效应荟萃分析发现，耻辱感越高，主观生活质量越低，两者之间存在中等强度的关联（r=-0.40，95%置信区间：-0.45，-0.35）。单独的荟萃分析表明，自我耻辱感（k=25，r=-0.44，95%置信区间：-0.49，-0.38）、感知耻辱感（k=10，r=-0.32，95%置信区间：-0.42，-0.21）和体验耻辱感（k=6，r=-0.30，95%置信区间：-0.35，-0.24）存在中等至较大的负向综合效应。12 项研究的叙述性总结表明，与自我概念和社交网络相关的心理机制可能在精神病患者的耻辱感与生活质量之间的关联中发挥重要的中介作用。心理干预应针对这些心理过程的改善，以减轻耻辱感对精神病患者生活质量的负面影响。需要进一步进行纵向研究，以检验因果路径和解释机制的理论模型。
