Fond Guillaume, Vidal Martin, Joseph Morgane, Etchecopar-Etchart Damien, Solmi Marco, Yon Dong Keon, Correll Christoph U, Boyer Laurent
AP-HM, Aix-Marseille Univ., CEReSS-Health Service Research and Quality of Life Center, Marseille, France.
FondaMental Foundation, Creteil, France.
Mol Psychiatry. 2023 May;28(5):1920-1931. doi: 10.1038/s41380-023-02003-4. Epub 2023 Mar 8.
In schizophrenia, it is currently thought that stigma experience is increased by psychotic and depressive symptomatology, exposure to stigma at the workplace, and that self-stigma levels vary across countries without knowing the factors explaining these variations. The aim of the present meta-analysis was to synthetize the data of observational studies comprehensively exploring multiple self-stigma dimensions and associated factors. A systematic literature search without language or time restrictions was conducted in Medline, Google Scholar, and Web of Science for studies, last 09/2021. Eligible studies that included ≥80% of patients diagnosed with schizophrenia-spectrum disorders and used a validated scale measuring self-stigma dimensions were meta-analysed using random-effects models, followed by subgroup and meta-regression analyses. Study registration: PROSPERO CRD42020185030. Overall, 37 studies (n = 7717) from 25 countries (5 continents) published between 2007 and 2020 were included, with 20 studies conducted in high-income countries. These studies used two scales with total scores ranging 1-4. The mean estimate of perceived stigma was 2.76 [95% confidence interval (CI) = 2.60-2.94], experienced stigma 2.29 [95% CI = 2.18, 2.41], alienation 2.40 [95% CI = 2.29, 2.52], stereotype endorsement 2.14 [95% CI = 2.03, 2.27], social withdrawal 2.28 [95% CI = 2.17, 2.39] and stigma resistance 2.53 [95% CI = 2.43, 2.63]). Self-stigma levels did not reduce over time. Living outside urban areas, low-income, singleness, unemployment, high antipsychotic dose and low functioning were associated with different stigma dimensions. Some stigma dimensions were lower in studies carried out in Europe compared to other regions. Most studies published since 2007 report that self-stigma is a particular concern for a specific subgroup of patients. This subgroup is characterized by unemployment, high antipsychotic dose and low functioning. We identified important other missing factors that should be explored to improve the effectiveness of public policies and personalized interventions to reduce self-stigma. Importantly, classical illness severity indices (psychotic severity, age at illness onset, illness duration) and sociodemographic variables (age, sex and education) were not associated with self-stigma, moderating previous findings.
目前认为，在精神分裂症中，精神病性和抑郁症状、在工作场所遭受污名化会加剧污名化体验，而且在不了解造成这些差异的因素的情况下，不同国家的自我污名化水平也有所不同。本荟萃分析的目的是综合观察性研究的数据，全面探讨多个自我污名化维度及相关因素。于2021年9月对Medline、谷歌学术和科学网进行了无语言或时间限制的系统文献检索，以查找相关研究。对符合条件的研究进行荟萃分析，这些研究纳入了≥80%被诊断为精神分裂症谱系障碍的患者，并使用经过验证的量表测量自我污名化维度，采用随机效应模型，随后进行亚组分析和元回归分析。研究注册号：PROSPERO CRD42020185030。总体而言，纳入了2007年至2020年间来自25个国家（5个大洲）的37项研究（n = 7717），其中20项研究在高收入国家进行。这些研究使用了两种总分范围为1 - 4的量表。感知污名的平均估计值为2.76 [95%置信区间（CI）= 2.60 - 2.94]，经历污名2.29 [95% CI = 2.18, 2.41]，疏离感2.40 [95% CI = 2.29, 2.52]，刻板印象认同2.14 [95% CI = 2.03, 2.27]，社交退缩2.28 [95% CI = 2.17, 2.39]，污名抵抗2.53 [95% CI = 2.43, 2.63]。自我污名化水平并未随时间降低。居住在城市地区以外、低收入、单身、失业、高剂量抗精神病药物治疗以及功能低下与不同的污名化维度相关。与其他地区相比，在欧洲进行的研究中，某些污名化维度较低。2007年以来发表的大多数研究报告称，自我污名化是特定患者亚组特别关注的问题。该亚组的特征是失业、高剂量抗精神病药物治疗和功能低下。我们确定了其他一些重要的缺失因素，应加以探索以提高公共政策和个性化干预措施减少自我污名化的有效性。重要的是，经典的疾病严重程度指标（精神病性严重程度、发病年龄、病程）和社会人口统计学变量（年龄、性别和教育程度）与自我污名化无关，这修正了先前的研究结果。
