Ren Yila, Wang Sheng, Fu Xiangqi, Shi Xiuxiu
School of Nursing, Hangzhou Normal University, Zhejiang, People's Republic of China.
Psychol Res Behav Manag. 2025 Apr 7;18:851-875. doi: 10.2147/PRBM.S503942. eCollection 2025.
Implicit association tests have been extensively applied to reveal socially unacceptable and concealed stigma. Studies have explored the implicit stigma toward mental illness in specific groups, with limited comparisons across different groups. To investigate the implicit stigma toward mental illness among different groups, along with the interaction between implicit and explicit measurements.
Based on PRISMA guidelines, Web of Science, Embase, PubMed/MEDLINE, Cochrane Library, and PsycINFO were searched from 1998 to April 18, 2024. Searches were updated through February 12, 2025. The Medical Education Research Quality Instrument (MERSQI) served as the quality evaluation framework, and Stata 12.0 facilitated the conduct of a meta-analysis.
The analysis included fifty studies in the systematic review and thirty in the meta-analysis. Most studies used "mental illness" or related physical illness terms as concept words, paired with emotionally contrasting attribute words. Twenty-eight studies calculated the implicit effect using an improved algorithm, while thirty-eight examined the correlations between implicit and explicit measures. The pooled standardized mean differences (SMDs) revealed that the lowest scores were observed in the general population (SMD = 0.79, < 0.001), followed by healthcare providers (SMD = 1.09, = 0.054), students (SMD = 1.17, < 0.001) and people with mental illness (SMD = 1.20, < 0.001).
The findings indicated that the selection of concept and attribute words, as well as the processing of data measuring implicit stigma, was not standardized. No reliable correlation was found between implicit and explicit measures. Despite the heterogeneity of included studies, the general public demonstrated the most positive attitudes, while individuals with mental illness exhibited negative attitudes. Further research is required to develop personalized anti-stigma interventions for different groups and regions based on these results, particularly from the perspective of implicit stigma.
内隐联想测验已被广泛应用于揭示社会不可接受和隐藏的耻辱感。已有研究探讨了特定群体对精神疾病的内隐耻辱感，但不同群体间的比较有限。本研究旨在调查不同群体对精神疾病的内隐耻辱感，以及内隐测量与外显测量之间的相互作用。
根据PRISMA指南，检索了1998年至2024年4月18日期间的Web of Science、Embase、PubMed/MEDLINE、Cochrane图书馆和PsycINFO。检索更新至2025年2月12日。医学教育研究质量工具（MERSQI）作为质量评估框架，Stata 12.0软件用于进行荟萃分析。
系统评价纳入50项研究，荟萃分析纳入30项研究。大多数研究使用“精神疾病”或相关躯体疾病术语作为概念词，并与情感上形成对比的属性词配对。28项研究使用改进算法计算内隐效应，38项研究考察了内隐测量与外显测量之间的相关性。合并后的标准化平均差（SMD）显示，普通人群得分最低（SMD = 0.79，P < 0.001），其次是医疗保健提供者（SMD = 1.09，P = 0.054）、学生（SMD = 1.17，P < 0.001）和精神疾病患者（SMD = 1.20，P < 0.001）。
研究结果表明，概念词和属性词的选择以及内隐耻辱感测量数据的处理并不规范。内隐测量与外显测量之间未发现可靠的相关性。尽管纳入研究存在异质性，但普通公众表现出最积极的态度，而精神疾病患者表现出消极态度。基于这些结果，需要进一步开展研究，为不同群体和地区制定个性化的反耻辱干预措施，特别是从内隐耻辱感的角度。
