Leurent Martin, Ducasse Déborah
Service de psychiatrie adulte, centre de thérapies des troubles de l'humeur et émotionnels/Borderline, La Colombière, CHU de Montpellier, 34000 Montpellier, France.
Service de psychiatrie adulte, centre de thérapies des troubles de l'humeur et émotionnels/Borderline, La Colombière, CHU de Montpellier, 34000 Montpellier, France; Département d'urgences et post-urgences psychiatriques, CHRU de Montpellier, Montpellier, France; IGF, université de Montpellier, CNRS-Inserm, 34000, Montpellier, France.
Encephale. 2023 Dec;49(6):632-639. doi: 10.1016/j.encep.2023.04.011. Epub 2023 Jun 23.
This study aimed to update the scientific knowledge concerning the relationship between discrimination, stigma and self-concept.
A review was conducted and allowed to include 15 peer-reviewed articles for qualitative analysis, consisting of 13 unique samples (n=2830; Mage=37.6). The search was conducted on Pubmed and PsychInfo following this research protocol: "de stigmatization" ([Title/Abstract] or "destigmatization" [Title/Abstract] or "self-stigma" [Title/Abstract] or "Perceived stigma" [Title/Abstract] or "anticipated discrimination" [Title/Abstract] or "experienced discrimination" [Title/Abstract]) and (identi*[Title] or "self-concept" [Title]). The search resulted in 43 articles, plus three articles identified from other sources. Thirty-one articles were excluded because they did not align with the aim of the review.
Among the 15 articles included, there were 11 quantitative studies, two qualitative studies, one literature review and one theoretical article. The stigma was related to a mental disorder (n=8), a physiological or ethnic difference (n=5) or sexual orientation and gender identity (n=2). Among the 11 quantitative studies based on unique samples, all included both males and females (n=2616; Mage=36.7; 61.1% of women). Four studies established a significant impact of perceived stigma on social identity. This impact was negative when there was at least one other parallel social identity perceived favorably by the individual, and positive otherwise. In two studies, this impact was moderated by the importance of the stigmatized social identity in the self-concept. In one study, social identity was correlated to psychological distress. The sign, positive or negative, of this correlation depended on self-stigma. When self-stigma was high (i.e., self-concept is strongly perceived through the prism of negative stereotypes associated with the social identity), then social identity was positively associated with psychological distress. Otherwise, the sign of this association was negative. In one study, four distinct variables were predictors of suicidal ideation: experienced discrimination, perceived stigma, anticipated discrimination and self-stigma. Experienced discrimination predicted suicidal ideation through anticipatory discrimination and self-stigma; and perceived stigma predicted suicidal ideation through anticipated discrimination. Self-stigma and anticipatory discrimination predicted suicidal ideation at the same level.
The results suggest that a key variable to address in order to reduce the negative consequences of discrimination and stigmatization is self-stigma, i.e., the fact of conceiving the self-concept through the filter of the negative stereotypes associated with the characteristic perceived as discriminated. The altered self-concept should therefore be a main transnosographic diagnostic and therapeutic target. An easy-to-use proxy to detect the altered self-concept is the propensity to feel the emotion of shame, which is correlated to self-stigma.
本研究旨在更新关于歧视、污名与自我概念之间关系的科学知识。
进行了一项综述,纳入15篇经同行评审的文章进行定性分析,这些文章包含13个独立样本(n = 2830;平均年龄 = 37.6岁)。按照以下研究方案在PubMed和PsychInfo上进行检索:“去污名化”([标题/摘要]或“destigmatization”[标题/摘要]或“自我污名”[标题/摘要]或“感知到的污名”[标题/摘要]或“预期歧视”[标题/摘要]或“经历过的歧视”[标题/摘要])以及(identi*[标题]或“自我概念”[标题])。检索结果有43篇文章,另外从其他来源确定了3篇文章。31篇文章因不符合综述目的而被排除。
在纳入的15篇文章中,有11篇定量研究、2篇定性研究、1篇文献综述和1篇理论文章。污名与精神障碍(n = 8)、生理或种族差异(n = 5)或性取向及性别认同(n = 2)相关。在基于独立样本的11篇定量研究中,均包含男性和女性(n = 2616;平均年龄 = 36.7岁;女性占61.1%)。四项研究确定了感知到的污名对社会认同有显著影响。当个体至少有一个其他被积极看待的平行社会认同时,这种影响是负面的,否则是正面的。在两项研究中,这种影响受到被污名化的社会认同在自我概念中的重要性的调节。在一项研究中,社会认同与心理困扰相关。这种关联的正负取决于自我污名。当自我污名较高时(即通过与社会认同相关的负面刻板印象强烈地感知自我概念),那么社会认同与心理困扰呈正相关。否则,这种关联的迹象是负面的。在一项研究中,四个不同变量是自杀意念的预测因素:经历过的歧视、感知到的污名、预期歧视和自我污名。经历过的歧视通过预期歧视和自我污名预测自杀意念;感知到的污名通过预期歧视预测自杀意念。自我污名和预期歧视在相同程度上预测自杀意念。
结果表明,为了减少歧视和污名化的负面后果而需要解决的一个关键变量是自我污名,即通过与被视为受歧视特征相关的负面刻板印象来构想自我概念这一事实。因此,改变的自我概念应是一个主要的跨诊断诊断和治疗目标。检测改变的自我概念的一个易于使用的替代指标是感到羞耻情绪的倾向,它与自我污名相关。