Reducing mental health-related stigma in primary health care settings in low- and middle-income countries: a systematic review.
Reducing mental health-related stigma in primary health care settings in low- and middle-income countries: a systematic review.
复制标题
减少低收入和中等收入国家初级卫生保健环境中与心理健康相关的污名：系统评价。
DOI：
10.1017/s2045796018000458
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发表时间：
2018-09-04
影响因子：
8.1
通讯作者：
Thornicroft G
中科院分区：
文献类型：
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作者：
Heim E;Kohrt BA;Koschorke M;Milenova M;Thornicroft G
本系统综述汇编了在低收入和中等收入国家（LMICs）减少初级卫生保健（PHC）中精神卫生相关污名的干预措施的证据。包括针对初级保健人员（包括非专业人员）的研究。主要结果是污名化态度和歧视行为。数据收集包括两种策略。首先，检索以前的系统综述，寻找符合本综述纳入标准的研究。其次，进行新的检索，涵盖自上次评审以来的时间，即2013年1月至2017年5月。为了获取相关文献，我们将五个搜索概念结合起来：耻辱、心理健康、干预、初级保健人员和中低收入国家。用MAXQDA软件对所有纳入的全文进行定性分析。全文分析了干预措施的内容、教学方法、精神障碍、文化适应、结果测量类型和主要结果。此外，还进行了偏倚风险评估。共纳入18项研究。在大多数纳入的研究中，偏倚风险被评为高。只有六项研究在对照条件下测试了他们的干预措施，其中两项使用了随机分配。最常用的干预措施是提供理论信息的讲座。许多研究还使用互动方法（N = 9），讨论案例研究（N = 8）或使用角色扮演（N = 5）。三项研究报告说，他们已经使用了临床实践和监督。这些研究的结果好坏参半。短期训练干预（例如1小时至1天）没有或只有很小的影响。更长的训练干预和更复杂的教学方法在有效的病耻感问卷中产生了统计上显著的变化。由于存在偏倚风险，必须谨慎解释这些结果。干预措施的文化适应方法很少有文献记载。中低收入国家需要进行更严格的试验，以测试针对与患者关系中的歧视行为的干预措施。在此类试验中，应更明确地处理耻辱干预措施的文化适应和结构/制度因素。
This systematic review compiled evidence on interventions to reduce mental health-related stigma in primary health care (PHC) in low- and middle-income countries (LMICs). Studies targeting PHC staff (including non-professionals) were included. Primary outcomes were stigmatising attitudes and discriminatory behaviours. Data collection included two strategies. First, previous systematic reviews were searched for studies that met the inclusion criteria of the current review. Second, a new search was done, covering the time since the previous reviews, i.e. January 2013 to May 2017. Five search concepts were combined in order to capture relevant literature: stigma, mental health, intervention, PHC staff and LMICs. A qualitative analysis of all included full-texts was done with software MAXQDA. Full-texts were analysed with regards to the content of interventions, didactic methods, mental disorders, cultural adaptation, type of outcome measure and primary outcomes. Furthermore, a risk of bias assessment was undertaken. A total of 18 studies were included. Risk of bias was rated as high in most included studies. Only six studies had tested their intervention against a control condition, two of which had used random allocation. Most frequently used interventions were lectures providing theoretical information. Many studies also used interactive methods (N = 9), discussed case studies (N = 8) or used role plays (N = 5). Three studies reported that they had used clinical practice and supervision. Results of these studies were mixed. No or little effects were found for brief training interventions (e.g. 1 h to 1 day). Longer training interventions with more sophisticated didactic methods produced statistically significant changes in validated stigma questionnaires. These results have to be interpreted with caution due to risk of bias. Methods for cultural adaptation of interventions were rarely documented. More rigorous trials are needed in LMICs to test interventions that target discriminatory behaviours in relationship with patients. Cultural adaptation of stigma interventions and structural/institutional factors should be more explicitly addressed in such trials.