Perceived Stigma in Health Care Settings and the Physical and Mental Health of People of Color in the United States
Perceived Stigma in Health Care Settings and the Physical and Mental Health of People of Color in the United States
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DOI：
10.1089/heq.2018.0079
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发表时间：
2019-01-01
期刊：
影响因子：
2.7
通讯作者：
De, Prabal
中科院分区：
文献类型：
--
作者：
Budhwani, Henna;De, Prabal
用途：在临床环境中解决感知和制定的耻辱对于确保提供高质量的以患者为中心的护理，减少健康差距和改善人口健康结果至关重要。研究方法：分析了行为风险因素监测系统（2012-2014）对种族模块的反应的数据，以检验医疗保健环境中感知的耻辱与较差的身心健康相关的假设。健康状况不佳的衡量标准是：（1）过去一个月内受访者身体或精神疾病的天数;（2）抑郁症诊断。采用多元线性和logistic回归模型。结果：污名对学生的身心健康有显著影响。感知到的耻辱感与额外的2.79天身体健康不良（beta =2.79，置信区间[CI]=1.84-3.75）和2.92天心理健康不良（beta =2.92，CI=1.97-3.86）相关。此外，在卫生保健环境中感知的耻辱与报告抑郁症的几率高出61%相关（校正比值比=1.61，CI=1.29-2.00）。在其他研究结果中，已婚、年轻、收入较高、拥有大学学位、有工作的人报告的身体和精神健康状况不佳的天数明显减少，自我报告的抑郁症的几率也较低。结论：减少对有色人种在卫生保健环境（环境应该是亲病人）的耻辱必须是人口健康学者和临床医生的首要任务。减少临床环境中的耻辱感可能会使少数群体患者的身心健康状况得到改善，从而减少健康差距。此外，由于健康状况不佳而损失的天数减少，可以通过减少利用率来对医疗保健系统产生积极影响，并可以通过增加健康天数来提高经济生产力。
Purpose: Addressing perceived and enacted stigma in clinical settings is critical to ensuring delivery of high-quality patient-centered care, reducing health disparities, and improving population health outcomes. Methods: Data from the Behavioral Risk Factor Surveillance System's (2012-2014) Reaction to Race module were analyzed to test the hypothesis that perceived stigma in health care settings would be associated with poorer physical and mental health. Poor health was measured by (1) the number of days the respondent was physically or mentally ill over the past month and (2) depressive disorder diagnosis. Multivariate linear and logistic regression models were employed. Results: Effects of stigma on physical and mental health were significant. Perceived stigma was associated with additional 2.79 poor physical health days (beta =2.79, confidence interval [CI]=1.84-3.75) and 2.92 more days of poor mental health (beta =2.92, CI=1.97-3.86). Moreover, perceived stigma in health care settings was associated with 61% higher odds of reporting a depressive disorder (adjusted odds ratio=1.61, CI=1.29-2.00). Among other findings, individuals who were married, younger, had higher income, had college degrees, and were employed reported significantly fewer poor physical and mental health days and had lower odds of self-reported depressive disorder. Conclusions: Reducing stigma against people of color in health care settings (environments that should be pro-patient) must be a top priority for population health scholars and clinicians. Reducing perceived stigma in clinical settings may produce better mental and physical health outcomes in minority patients thereby reducing health disparities. In addition, fewer days lost to poor health could positively influence the health care system by decreasing utilization and may improve economic productivity through increasing days of good health.