加拿大安大略省青年寻求心理健康服务时，污名是早期干预的障碍：一项定性研究。
Stigma as a barrier to early intervention among youth seeking mental health services in Ontario, Canada: a qualitative study.
机构信息
Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada.
出版信息
BMC Health Serv Res. 2023 Jan 26;23(1):86. doi: 10.1186/s12913-023-09075-6.
BACKGROUND
Stigma associated with mental health challenges is a major barrier to service seeking among youth. Understanding how stigma impacts service-seeking decisions from the perspectives of youth remains underexplored. Such research is necessary to inform effective stigma reduction.
OBJECTIVE
This study aims to understand how stigma influences service seeking among youth with mental health challenges.
METHODS
Qualitative inquiry was taken using youth engagement, underpinned by pragmatism. Data were collected via 4 virtual focus groups with 22 purposively selected youth participants with lived experience of mental health challenges in Ontario, Canada. Focus group guides were developed collaboratively among research team members, including youth co-researchers. Data were analyzed inductively using reflexive thematic analysis.
RESULTS
Three main themes were constructed from the data: point of entry into the system, being biomedicalized or trivialized, and paving the way for non-stigmatizing services. Initial contact with the mental healthcare system was seen to be affected by stigma, causing participants to delay contact or be refused services if they do not fit with an expected profile. Participants described a constant negotiation between feeling 'sick enough' and 'not sick enough' to receive services. Once participants accessed services, they perceived the biomedicalization or trivialization of their challenges to be driven by stigma. Lastly, participants reflected on changes needed to reduce stigma's effects on seeking and obtaining services.
CONCLUSION
A constant negotiation between being 'sick enough' or 'not sick enough' is a key component of stigma from the perspectives of youth. This tension influences youth decisions about whether to seek services, but also service provider decisions about whether to offer services. Building awareness around the invisibility of mental health challenges and the continuum of wellness to illness may help to break down stigma's impact as a barrier to service seeking. Early intervention models of care that propose services across the spectrum of challenges may prevent the sense of stigma that deters youth from accessing and continuing to access services.
背景
与心理健康挑战相关的污名是阻碍青年寻求服务的主要障碍。从青年的角度了解污名如何影响服务寻求决策仍然未得到充分探索。此类研究对于告知有效的污名减少措施是必要的。
目的
本研究旨在了解污名如何影响有心理健康挑战的青年寻求服务。
方法
采用青年参与为基础的定性研究方法，以实用主义为基础。数据通过在加拿大安大略省与有心理健康挑战的生活经历的 22 名青年参与者进行的 4 个虚拟焦点小组收集。焦点小组指南由研究团队成员（包括青年共同研究者）共同制定。使用反思性主题分析对数据进行归纳分析。
结果
从数据中构建了三个主要主题：进入系统的切入点、被生物医学化或被轻视、为非污名化服务铺平道路。与心理健康保健系统的初始接触受到污名的影响，导致参与者如果不符合预期的模式，就会延迟接触或被拒绝服务。参与者描述了一种在“足够生病”和“不够生病”之间不断进行的协商，以获得服务。一旦参与者获得服务，他们认为对他们的挑战进行生物医学化或轻视是由污名驱动的。最后，参与者反思了减少污名对寻求和获得服务的影响所需的改变。
结论
从青年的角度来看，“足够生病”或“不够生病”之间的不断协商是污名的一个关键组成部分。这种紧张关系影响了青年是否寻求服务的决定，但也影响了服务提供者是否提供服务的决定。围绕心理健康挑战的无形性和从健康到疾病的连续体提高认识可能有助于打破污名作为寻求服务障碍的影响。提出服务涵盖挑战范围的早期干预护理模式可能会防止阻止青年获得和继续获得服务的污名感。
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