Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Epidemiol Psychiatr Sci. 2023 Nov 21;32:e66. doi: 10.1017/S2045796023000781.
Mental health related stigma and discrimination is a universal phenomenon and a contributor to the adversity experienced by people with schizophrenia. Research has produced inconsistent findings on how discrimination differs across settings and the contextual factors that underpin these differences. This study investigates the association between country-level Human Development Index (HDI) and experienced and anticipated discrimination reported by people with schizophrenia.
This study is a secondary data analysis of a global cross-sectional survey completed by people living with schizophrenia across 29 countries, between 2005 and 2008. Experienced and anticipated discrimination were assessed using the Discrimination and Stigma Scale (DISC-10). Countries were classified according to their 2006 HDI. Negative binomial and Poisson regression analyses with a robust standard errors approach were conducted to investigate associations between country-level HDI and discrimination.
In the regression analyses, no evidence was found for a linear association between HDI and experienced or anticipated discrimination. Further exploratory analyses showed a significant non-linear association between HDI ratings and experienced discrimination. Participants in "high" and "very high" HDI countries reported more experienced discrimination compared to those in "medium" HDI countries.
HDI does, to some extent, appear to be associated with how far discrimination is experienced across different contexts. More high-quality cross-national research, including research focused on "medium" and "low" countries, is needed to substantiate these findings and identify underlying factors that may explain the pattern observed for experienced discrimination, including generating new datasets that would enable for these analyses to be repeated and contrasted with more recent data. An in-depth understanding of these factors will further aid the adaptation of cross-cultural and context specific anti-stigma interventions in future.
心理健康相关的污名和歧视是一种普遍现象，也是导致精神分裂症患者遭遇困境的一个因素。研究结果显示，不同环境下的歧视程度存在差异，而导致这种差异的背景因素也不尽相同，这些结果并不一致。本研究旨在调查国家人类发展指数（HDI）与精神分裂症患者所经历和预期的歧视之间的关系。
本研究是对 2005 年至 2008 年间在 29 个国家生活的精神分裂症患者进行的全球横断面调查的二次数据分析。使用歧视和污名量表（DISC-10）评估所经历和预期的歧视。根据其 2006 年人类发展指数将国家进行分类。采用负二项和泊松回归分析，并采用稳健标准误差方法来研究国家层面人类发展指数与歧视之间的关系。
在回归分析中，没有证据表明人类发展指数与经历或预期的歧视之间存在线性关系。进一步的探索性分析显示，人类发展指数评分与经历的歧视之间存在显著的非线性关系。“高”和“非常高”人类发展指数国家的参与者报告经历的歧视比“中”人类发展指数国家的参与者更多。
在一定程度上，人类发展指数似乎与不同背景下经历歧视的程度有关。需要进行更多高质量的跨国研究，包括对“中”和“低”人类发展指数国家的研究，以证实这些发现，并确定可能解释经历歧视模式的潜在因素，包括生成新的数据集，使这些分析能够重复并与更近期的数据进行对比。深入了解这些因素将有助于未来在跨文化和特定背景下调整抗污名干预措施。
