Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany.
Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany.
J Hepatol. 2022 Aug;77(2):516-524. doi: 10.1016/j.jhep.2022.04.026. Epub 2022 May 5.
People with alcohol-related liver disease (ALD) experience stigma and discrimination. This review summarises the evidence on stigma in healthcare and its implications for people with ALD, drawing from the literature on the stigma associated with mental illness and, specifically, alcohol use disorder (AUD). Public stigma, self-stigma and structural stigma all contribute to failure to seek help or delays in seeking help, inferior healthcare, and negative health outcomes, which increase the overall burden of ALD. Stigma can be experienced, but also anticipated and avoided, with both scenarios negatively impacting on ALD healthcare. Blaming people with ALD for their condition is central to the stigma of ALD. Stigma affects ALD healthcare at all stages, from prevention, early detection and intervention, to allocation of scarce resources in liver transplantation. People with lived experience need to be empowered to lead action against the stigmatisation of patients with ALD. Promulgating a dynamic model of individual and social responsibility for AUD, a continuum model of harmful alcohol use, and establishing training on ALD-related stigma for healthcare professionals are strategies to address stigma. Integrating addiction and ALD services, providing stigma-free prevention, and overcoming the frequent separation of addiction services from general healthcare are necessary. Beyond healthcare, addressing social inequality, the social dimensions of ALD risk and outcomes, and ensuring equal access to services is necessary to improve outcomes for all people with ALD. More research is needed on the stigma of ALD in low- and middle-income countries and in countries with restrictive drinking norms. Interventions to reduce the stigma of ALD and facilitate early help-seeking need to be developed and evaluated.
患有酒精相关肝病（ALD）的人会经历耻辱和歧视。本综述总结了医疗保健领域耻辱感的证据及其对ALD 患者的影响，借鉴了与精神疾病相关的耻辱感以及特定的酒精使用障碍（AUD）的相关文献。公众耻辱感、自我耻辱感和结构性耻辱感都导致了寻求帮助的失败或延迟、医疗服务质量下降以及负面的健康结果，从而增加了 ALD 的总体负担。耻辱感既可以被体验到，也可以被预期和避免，这两种情况都会对ALD 医疗保健产生负面影响。将ALD 归咎于患者是ALD 耻辱感的核心。耻辱感影响着 ALD 医疗保健的各个阶段，从预防、早期发现和干预，到肝移植中稀缺资源的分配。需要赋予有实际经验的人权力，以对抗ALD 患者的污名化。宣传 AUD 的个人和社会责任的动态模型、有害饮酒的连续体模型，并为医疗保健专业人员提供有关ALD 相关耻辱感的培训，这些都是解决耻辱感的策略。整合成瘾和 ALD 服务，提供无耻辱感的预防措施，并克服成瘾服务与一般医疗保健经常分离的情况，是必要的。除了医疗保健，还需要解决社会不平等、ALD 风险和结果的社会维度，以及确保所有人都能平等获得服务，以改善所有ALD 患者的预后。需要在中低收入国家和饮酒规范受限的国家开展和评估有关ALD 耻辱感的更多研究。需要制定和评估减少ALD 耻辱感和促进早期寻求帮助的干预措施。
