Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
National Institute of Health Research and Development, Ministry of Health, Jakarta, Republic of Indonesia.
PLoS One. 2022 Feb 4;17(2):e0263232. doi: 10.1371/journal.pone.0263232. eCollection 2022.
Mental illness is a leading cause of disease burden amongst children and young people (CYP). This is exacerbated in low- and middle-income (LMIC) countries which often have embryonic care structures. Understanding and targeting illness beliefs is a potentially efficacious way of optimising the development of health prevention interventions. These beliefs remain relatively underexplored in CYP in LMIC contexts. Aim: To develop an in-depth understanding of CYPs beliefs about mental health and illness in Indonesia.
Semi-structured interviews (n = 43) combined with photo elicitation methodology were undertaken with CYP aged 11-15 from Java, Indonesia. Our sample comprised those living with (n = 19) and without (n = 24) high prevalence mental health conditions, specifically anxiety or depression. Data were analysed using framework analysis, informed by the Common Sense Model of Self-Regulation of Health and Illness. Positive mental health and illness were dichotomised in accounts with mental health typically characterised as an absence of mental disturbance. This contributed to attributions of abnormality and the marginalisation of those with mental illness. Mental illness was conceptualised as a single entity, commonly arising from individual failings. This prompted feelings of self-stigma in those with lived experience of mental illness. Analysis identified marked differences in the perceived time dimensions of positive mental health and illness with mental illness conceived as less transient than episodes of positive mental health. Illness beliefs appeared relatively consistent across the two groups of CYP although some nuanced differences were identified. CYP with anxiety and depression were less likely to believe that mental illness could be diagnosed visually, more likely to uphold multiple causal factors and endorse the potential efficacy of professional input.
Public health interventions to increase understanding may be necessary to develop healthcare systems to reduce treatment barriers, optimise return on investment and enhance population health effect.
精神疾病是儿童和青少年（CYP）疾病负担的主要原因。在中低收入国家（LMIC），这种情况更为严重，因为这些国家的医疗保健结构往往还处于萌芽阶段。了解和针对疾病观念是优化健康预防干预措施发展的一种潜在有效方法。这些观念在 LMIC 背景下的 CYP 中仍然相对没有得到充分探索。目的：深入了解印度尼西亚 CYP 对心理健康和精神疾病的观念。
采用半结构式访谈（n = 43）和照片启发法，对来自印度尼西亚爪哇岛的 11-15 岁 CYP 进行了研究。我们的样本包括患有（n = 19）和不患有（n = 24）高患病率精神健康状况（特别是焦虑或抑郁）的 CYP。数据采用框架分析进行分析，该分析受健康和疾病自我调节的常识模型的指导。积极的心理健康和疾病在账户中被分为两类，心理健康通常被描述为没有精神障碍。这导致了对异常的归因和对精神疾病患者的边缘化。精神疾病被概念化为一个单一的实体，通常源于个人的失败。这在有精神疾病经历的人中引起了自我污名化的感觉。分析确定了积极心理健康和疾病的感知时间维度之间存在明显差异，精神疾病被认为比积极心理健康的发作更持久。尽管发现了一些细微的差异，但两组 CYP 的疾病观念似乎相对一致。患有焦虑和抑郁的 CYP 不太可能相信可以通过肉眼诊断精神疾病，更有可能坚持多种因果因素，并认可专业投入的潜在效果。
可能需要开展公共卫生干预措施来提高认识，以建立医疗保健系统，减少治疗障碍，优化投资回报，并增强人口健康效果。
