影响印度精神疾病求医行为的因素：泰米尔纳德邦的情境分析。
Factors influencing care-seeking behaviour for mental illness in India: a situational analysis in Tamil Nadu.
机构信息
Oxford Martin School, University of Oxford, Oxford, OX1 3BD, UK.
Oxford India Centre for Sustainable Development, Somerville College, University of Oxford, Oxford, OX2 6HD, UK.
出版信息
J Public Health (Oxf). 2021 Oct 8;43(Suppl 2):ii10-ii16. doi: 10.1093/pubmed/fdab131.
BACKGROUND
The contribution of mental illness to the total burden of disease in India nearly doubled from 1990 to 2017, increasing from 2.5% of the total disability-adjusted life years in 1990 to 4.7% in 2017. Despite efforts by the Indian government, a treatment gap of 75-85%, with heterogeneity across multiple dimensions, exists across India. We conducted a qualitative study in Tamil Nadu, India, to better understand the contextual factors affecting the care-seeking behaviour for mental illness.
METHODS
Qualitative methods, including semi-structured interviews and focus groups (FGs), were conducted with stakeholders involved in the mental health care pathway in Tamil Nadu. Ten semi-structured interviews and five FGs were conducted and analysed using an inductive approach to identify codes, using Dedoose v7, related to the emerging themes and categories.
RESULTS
Our analyses identified three key areas that influence care-seeking: views on what causes and/or constitutes mental illness, stigma and discrimination associated with mental illness and broader factors influencing decision-making.
CONCLUSIONS
The specific contextual factors identified by our study can be used to design and implement approaches that can help to address some of the issues that influence the care-seeking behaviour and manifest in the treatment gaps seen in Tamil Nadu and in India, more generally.
背景
从 1990 年到 2017 年，精神疾病对印度总疾病负担的贡献几乎翻了一番，从 1990 年占总伤残调整生命年的 2.5%增加到 2017 年的 4.7%。尽管印度政府做出了努力，但印度各地仍存在 75-85%的治疗缺口，存在多个维度的异质性。我们在印度泰米尔纳德邦进行了一项定性研究，以更好地了解影响精神疾病求医行为的背景因素。
方法
采用定性方法，包括与泰米尔纳德邦精神卫生保健途径相关的利益攸关方进行半结构式访谈和焦点小组（FG）。进行了十次半结构式访谈和五次 FG，并使用 Dedoose v7 采用归纳法进行分析，以确定与新兴主题和类别相关的代码。
结果
我们的分析确定了影响求医行为的三个关键领域：对导致和/或构成精神疾病的因素的看法、与精神疾病相关的耻辱和歧视以及影响决策的更广泛因素。
结论
我们的研究确定的特定背景因素可用于设计和实施方法，以帮助解决一些影响求医行为并在泰米尔纳德邦和印度更普遍存在治疗缺口的问题。
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