Lee Yang Jae, Christ Ryan, Mbabazi Rita, Dabagia Jackson, Prendergast Alison, Wykoff Jason, Dasari Samhitha, Safai Dylan, Nakaweesi Shakira, Aturinde Swaib Rashid, Galvin Michael, Akena Dickens, Ashaba Scholastic, Waiswa Peter, Rosenheck Robert, Tsai Alexander C
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America.
Empower Through Health, St. Louis, Missouri, United States of America.
PLOS Ment Health. 2024;1(1). doi: 10.1371/journal.pmen.0000069. Epub 2024 Jun 21.
Understanding and eliminating mental illness stigma is crucial for improving population mental health. In many settings, this stigma is gendered, from the perspectives of both the stigmatized and the stigmatizers. We aimed to find the differences in the level of stigma across different mental disorders while considering the gender of the study participants as well as the gender of the people depicted in the vignettes. This was a population-based, experimental vignette study conducted in Buyende District of Eastern Uganda in 2023. We created 8 vignettes describing both men and women with alcohol use disorder, major depressive disorder, generalized anxiety disorder, and schizophrenia consistent with DSM-5 criteria. Participants from 20 villages in rural Buyende District of Uganda (N=379) were first read a randomly selected vignette and administered a survey eliciting their attitudes (Personal Acceptance Scale [PAS] and Broad Acceptance Scale [BAS]) towards the person depicted in the vignette. We used analysis of variance (ANOVA) with Bonferroni-adjusted, empirical p-values to compare levels of acceptance across disorders and genders. Attitudes towards people with mental illness, as measured by the PAS, varied across different mental disorders (p=0.002). In pairwise mean comparisons, the greater acceptance of anxiety disorder vs. schizophrenia was statistically significant (Mean [SD] PAS: 2.91 [3.15] vs 1.62 [1.95], p=0.008). Secondary analyses examining differences in acceptance across gender combinations within mental disorders showed that PAS varied across gender combinations for depression (p=0.017), suggesting that acceptance is higher for women with depression than men with depression. In this population-based vignette study from rural Uganda, we found that people with schizophrenia were less accepted compared to people with anxiety disorders. We also found that there was greater acceptance of women with depression than men with depression. Anti-stigma initiatives may need to be targeted to specific disorders and genders.
理解并消除精神疾病污名对于改善人群心理健康至关重要。在许多情况下，无论是被污名化者还是污名施加者的角度，这种污名都存在性别差异。我们旨在找出不同精神障碍之间污名程度的差异，同时考虑研究参与者的性别以及案例中所描述人物的性别。这是一项基于人群的实验性案例研究，于2023年在乌干达东部的布延德区进行。我们创建了8个案例，描述了符合《精神疾病诊断与统计手册》第5版（DSM - 5）标准的患有酒精使用障碍、重度抑郁症、广泛性焦虑症和精神分裂症的男性和女性。来自乌干达布延德区农村20个村庄的参与者（N = 379）首先阅读一个随机选择的案例，并接受一项调查，以了解他们对案例中所描述人物的态度（个人接受量表[PAS]和广泛接受量表[BAS]）。我们使用方差分析（ANOVA）以及经邦费罗尼校正的实证p值来比较不同障碍和性别的接受程度。通过PAS测量，对患有精神疾病者的态度在不同精神障碍之间存在差异（p = 0.002）。在两两均值比较中，对焦虑症患者的接受程度高于精神分裂症患者具有统计学意义（均值[标准差]PAS：2.91[3.15]对1.62[1.95]，p = 0.008）。对精神障碍内不同性别组合的接受程度差异进行的二次分析表明，抑郁症患者的PAS在不同性别组合中存在差异（p = 0.017），这表明抑郁症女性患者比男性患者更易被接受。在这项来自乌干达农村的基于人群的案例研究中，我们发现精神分裂症患者比焦虑症患者更不被接受。我们还发现抑郁症女性患者比男性患者更易被接受。反污名化举措可能需要针对特定的障碍和性别。
