Heylen Elsa, Srinivasan Krishnamachari, Johnson-Pradeep Ruben, Ekstrand Maria L
Division of Prevention Sciences, University of San Francisco, San Francisco, California, USA.
Division of Mental Health and Neurosciences, St. John's Research Institute.
Indian J Soc Psychiatry. 2024 Jul-Sep;40(3):220-227. doi: 10.4103/ijsp.ijsp_205_22. Epub 2023 Nov 10.
Mental illness (MI) remains stigmatized globally, including in India, where suicide and suicidality have been rising. Internalization of society's negative stereotypes by people with MI is known as internalized MI stigma.
The present paper examined the prevalence of internalized MI stigma in a large sample of rural Indian participants with comorbid chronic medical conditions and previously undiagnosed, mostly mild-to-moderate depression/anxiety. It further examined correlates of internalized MI stigma and its association with suicidality.
Face-to-face interviews were conducted at four-time points with adults with depression/anxiety and chronic physical illness in primary health centers in Ramanagaram, Karnataka. Topics included demographics, social support, depression (9-item Patient Health Questionnaire scale), anxiety (7-item General Anxiety Disorder scale), suicidality (Mini-International Neuropsychiatric Interview), and internalized MI stigma (Internalized Stigma of Mental Illness [ISMI] scale). Data analysis included linear and hierarchical logistic regression.
At baseline, 29.1% of participants showed a high level of internalized stigma, and 10.4% exhibited at least moderate suicidality. Hierarchical logistic regression showed that every 1-point increase on the ISMI scale more than tripled the odds of moderate to high suicidality (adjusted odds ratio [AOR] 3.24). Those being at least moderately depressed/anxious were 2.4 times more likely to be at least moderately suicidal than participants with no-mild depression/anxiety. Social support lowered the odds of suicidality (AOR 0.44).
Internalized MI stigma and suicidality were substantial among these rural adults with mostly mild-to-moderate anxiety/depression. Higher stigma was associated with increased suicidality, independently of depression/anxiety. Therefore, efforts to reduce internalized MI stigma should be included in mental health treatment.
精神疾病在全球范围内仍受到污名化，在印度也是如此，该国的自杀率和自杀倾向一直在上升。精神疾病患者将社会的负面刻板印象内化，这被称为内化的精神疾病污名。
本文调查了印度农村地区大量患有慢性合并症且此前未被诊断出、大多为轻度至中度抑郁/焦虑的参与者中内化的精神疾病污名的患病率。它进一步研究了内化的精神疾病污名的相关因素及其与自杀倾向的关联。
在卡纳塔克邦拉马纳加姆的初级卫生中心，对患有抑郁/焦虑和慢性身体疾病的成年人进行了四个时间点的面对面访谈。主题包括人口统计学、社会支持、抑郁（9项患者健康问卷量表）、焦虑（7项广泛性焦虑障碍量表）、自杀倾向（迷你国际神经精神病学访谈）以及内化的精神疾病污名（精神疾病内化污名[ISMI]量表）。数据分析包括线性和分层逻辑回归。
在基线时，29.1%的参与者表现出高度的内化污名，10.4%表现出至少中度的自杀倾向。分层逻辑回归显示，ISMI量表每增加1分，中度至高度自杀倾向的几率就会增加两倍多（调整后的优势比[AOR]为3.24）。与没有轻度抑郁/焦虑的参与者相比，至少中度抑郁/焦虑的参与者至少中度自杀的可能性高出2.4倍。社会支持降低了自杀倾向的几率（AOR为0.44）。
在这些大多患有轻度至中度焦虑/抑郁的农村成年人中，内化的精神疾病污名和自杀倾向相当严重。较高的污名与自杀倾向增加相关，独立于抑郁/焦虑因素。因此，减少内化的精神疾病污名的努力应纳入心理健康治疗中。
