健康与遗传心理学研究室知识库

 我国心理治疗行业尚属于起步阶段，人们对心理疾病不甚了解，加之传统观念的影响，心理疾病患者容易为避免自己和家人受到歧视而回避求助行为，导致病情严重，而妨碍人们寻求治疗的一个重要因素就是污名。近年来，美国、法国等西方国家及中国台湾和大陆相关的研究都证实，心理疾病患者普遍受到污名。污名可分为公众污名和自我污名，其中，自我污名会导致心理疾病患者自尊降低、低生活质量、长期抑郁、社会关系受损、治疗的延长或提前终止，严重妨碍患者的治疗康复。心理疾病自我污名是心理康复的一个高危因子，但在我国，心理疾病患者自我污名方面的研究还很少。本研究以修订过的心理疾病自我污名量表为基础，对我国心理疾病患者自我污名的特点及其与自尊水平和社会支持的关系进行初步探讨，希望能对我国的心理疾病患者去污名干预及效果研究提供初步依据。 本研究采用量表测查的方法，对济南、天津、哈尔滨3所医院共109名心理疾病患者施测《心理疾病自我污名量表》（ISMI），《自尊量表》（SES），《领悟社会支持量表》（PSSS），对数据进行了t检验、卡方检验、相关分析和回归分析。 研究得到以下结果： 1、心理疾病患者自我污名总体水平为2.12。 2、心理疾病患者自我污名在性别、婚姻、月收入上差异显著（P<0.05）。 3、以总体自我污名为自变量对自尊水平做一元线性回归，判定系数R 2=0.360,可建立方程：y=4.585-0.722x (F=59.508,P<0.001)。以自我污名的五个维度为自变量，以自尊水平为因变量做多元回归，发现自我疏离因子的显著性意义最强(P<0.001)，其次是社交回避和无能感知(P<0.05)。判定系数R 2=0.433，可建立多元回归方程为：y=4.470-0.388x1-0.192x2-0.198x3（F= 15.609，p<0.001）（x1代表自我疏离，x2代表社交回避，x3代表无能感知）。 4、以总体自我污名为自变量对领悟社会支持做回归，判定系数R2=0.195，可建立方程y=3.710-0.354x (F=19.116,P<0.01)。以自我污名五个维度为自变量，以领悟社会支持为因变量做多元回归，发现自我疏离、社交回避和无能感知对社会支持的影响显著（P<0.01）。判定系数R2=0.218，可建立多元回归方程为：y=3.474-0.391x1-0.301x2+0.301x3（F=5.695，P<0.001）（x1代表自我疏离，x2代表社交回避，x3代表无能感知）。 5、以自我污名五个维度为自变量，以是否自愿到医院就诊为因变量做逻辑回归，发现-2倍的对数似然值超过临界值，达到显著水平（-2LL=213.147. Model Х2=16.858，P<0.01）。其中，社交回避和歧视体验因子对心理疾病患者自愿到医院就诊的态度有负面影响（回归系数β=-0.673，P<0.05；回归系数β=-0.732，P<0.05），无能感知对心理疾病患者自愿到医院就诊的态度有正面影响（回归系数β=-0.859，P<0.01）。 本研究的结论为： 1、我国北方心理疾病患者存在一定程度的自我污名。 2、男性心理疾病患者比女性更易体验到社会身份受到损害；已婚患者比单身患者更易体验到社会身份受到损害；中低收入患者比低收入和高收入者更容易认同外界的负面刻板印象。 3、心理疾病患者自我污名程度越高，其自尊越低，其中自我疏离、社交回避和无能感知因子能有效预测患者的自尊水平。 4、心理疾病患者自我污名程度越高，其社会支持水平越低，其中自我疏离、社交回避、无能感知因子能有效预测患者的领悟社会支持水平。 5、心理疾病患者自我污名程度与主动求医行为关系显著，社交回避和歧视体验因子得分越高的患者，越不会主动寻求治疗，而无能感知越强的患者主动求医行为概率越大。

 
Abstract Psychological treatment is still belonged to the start stage in our country.There is something that is not understood about mental illness.Together with the influence of traditional ideas, mental illness always avoid help-seeking to reduce discrimination on themselves and there families,Which can condition deteriorated.And an important factor of hindering people to seek treatment is stigma. In recent years, the related studies carried out by psychologists from the United States and France,Taiwan and the other counteries have confirmed that stigma was common to mental illness. Stigma can be divided into public stigma and self stigma.The self-stigma can result in low self-esteem, low quality of life and long-term depression, damaged social relations,suspension or termination of the therapy,which may impede the treating and rehabilitating process of mental illness. Self- stigma of mental illness is a high risk factor of rehabilitation, But the research on the self- stigma of mental illness has not developed in our country. This study is based on the revised mental illness self stigma scale,to explore how the self-stigma of mental illness influence self-esteem and social support, we hoped this article could prove evidence for researches of reducing stigma and its effect in our country. Methods:One sample(109 mental illness from Jinan,Tianjinand Harbin )were selected and assessed with the Internalized Stigma of Mental Illness(ISMI),The self-esteem scale(SES),Perceived social support scale(PSSS). T test,chi-square test and regression analysis were implemented. Results: 1.The overall average score of the self- stigma of mental illness was 2.12. 2. Significant differences were found in different gender, merital states and income level（P<0.05）. 3. Taking the overall self- stigma of mental illness as independent variables and self-esteem as the independent variable to establish a simple linear regression equation : y=4.585-0.722x(F=59.508,P<0.001), R 2=0.360.Taking the five attributes of self-stigma as the independent variables to do multiple regression , found that the strongest significant factor was self-alienation(P<0.001), the next were the social avoidance and perceived powerless(p<0.05). R 2=0.433，And the multiple regression equation could be established as: y=4.470-0.388 x1-0.192x2-0.198x3（F= 15.609，p<0.001）(x1=self alienation, x2= social avoidance, x3= incompetent sensation ). 4. Taking the overall self- stigma of mental illness as independent variables and perceived social support as the independent variable to establish a simple linear regression equation : y=3.710-0.354x (F=19.116,P<0.01), R 2=0.195.Taking the five attributes of self-stigma as the independent variables to do multiple regression , found that the significant factor was self-alienation,social avoidance and perceived powerless(P<0.01).R 2=0.433，And the multiple regression equation could be established as: y=3.474-0.391x1-0.301x2 +0.301x3（F=5.695，P<0.001）(x1=self alienation, x2= social avoidance, x3= perceived powerless ). 5. Taking the five attributes of self-stigma as the independent variables and health care seeking behavior as independent variablesto do logical regression,found that (-2LL=213.147. Model Х2=16.858，P<0.01）, social avoidance and discrimination experience had a negative impact on seeking help behavior（β=-0.673，P<0.05；β=-0.732，P<0.05）,while, perceived powerless had a positive influence（β=-0.859，P<0.01）. Conclusions: 1.The patients were self stigmatized to some extent. 2. Male patients with mental illness were more likely to experience social identity than women; Married patients were more likely to experience social identity than in single patients; Low income patients were more likely to agree with the outside negative stereotypes than lower income and high income earners. 3. Mental illness with more serious self stigma,the lower the self-esteem will they have. The self alienation, social avoidance and incompetent perception factor could effectively predict the patient's self esteem. 4. Mental illness with more serious self stigma,the lower the social support will they have.The self alienation, social avoidance and incompetent perception factor could effectively predict the patient's social support. 5. Self stigma with mental illness had a negative impact on the health care seeking behavior.The patients with high score of social avoidance and discrimination experience will less desire to seek treatment, and the patients with high score of incompetent sensation will more desire to seek treatment.