Gonzales Lauren, Kois Lauren E, Mandracchia Francis, Dhillon Ashley, Purcell Alexandra
Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons.
Institute of Law, Psychiatry, and Public Policy, University of Virginia School of Medicine.
Psychiatr Rehabil J. 2024 Jun;47(2):150-156. doi: 10.1037/prj0000598. Epub 2024 Feb 15.
"Serious mental illness" (SMI) is a priority population within mental health treatment and policy. However, there is no standard operational definition across research, clinical, and policy contexts. The use of the label has also not been evaluated regarding its association with stigma among the general public. This mixed-method study compared community members' stigma toward "SMI" with other psychiatric labels and examined community understanding and perceptions of the SMI label.
Two hundred forty-six participants recruited via Prolific read randomly manipulated vignettes describing an individual diagnosed with depression, schizophrenia, or "SMI" and completed measures of stigma and qualitative questions regarding familiarity, understanding, and perceived utility of SMI. Quantitative analyses evaluated stigma across vignettes, and qualitative analyses identified common themes across responses.
Stigma was relatively high across vignettes, with more negative views reported toward SMI and schizophrenia compared with depression. Quantitative differences in stigma by vignette were not significant after controlling for participants' age and gender. Qualitative responses were split regarding the perceived utility of the SMI term, with noted concerns including its broadness and potential for stigma. Most participants described functional impairment or disability as characteristic of "SMI," and approximately 70% associated schizophrenia and psychotic disorders with "SMI" compared with 45% for depression.
Person-level factors were more strongly associated with stigma than psychiatric labels. However, our sample described concerns that the SMI term is vague and may exacerbate stigma. Community education and antistigma efforts should move beyond diagnostic labels in characterizing mental illness to facilitate change in attitudes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
“严重精神疾病”（SMI）是心理健康治疗和政策中的重点人群。然而，在研究、临床和政策背景下，尚无标准的操作定义。该标签的使用与公众污名化之间的关联也未得到评估。这项混合方法研究比较了社区成员对“SMI”与其他精神科标签的污名化情况，并考察了社区对SMI标签的理解和认知。
通过Prolific招募的246名参与者随机阅读描述被诊断为抑郁症、精神分裂症或“SMI”的个体的短文，并完成污名化测量以及关于对SMI的熟悉程度、理解和感知效用的定性问题。定量分析评估各短文中的污名化情况，定性分析确定各回答中的共同主题。
各短文中的污名化程度相对较高，与抑郁症相比，对SMI和精神分裂症的负面看法更多。在控制参与者的年龄和性别后，各短文在污名化方面的定量差异不显著。关于SMI一词的感知效用，定性回答存在分歧，指出的问题包括其宽泛性和污名化可能性。大多数参与者将功能损害或残疾描述为“SMI”的特征，约70%的人将精神分裂症和精神障碍与“SMI”联系起来，而将抑郁症与“SMI”联系起来的比例为45%。
个人层面的因素比精神科标签与污名化的关联更强。然而，我们的样本表明担心SMI一词模糊不清，可能会加剧污名化。社区教育和反污名化努力在描述精神疾病时应超越诊断标签，以促进态度转变。（PsycInfo数据库记录（c）2024美国心理学会，保留所有权利）
