Stigma and depression among primary care patients
Stigma and depression among primary care patients
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DOI：
10.1016/s0163-8343(03)00066-5
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发表时间：
2003-09-01
影响因子：
7
通讯作者：
Wells, KB
中科院分区：
文献类型：
--
作者：
Roeloffs, C;Sherbourne, C;Wells, KB
我们评估了来自 46 个美国初级保健诊所的 1,187 名抑郁症患者的耻辱感对就业、健康保险和友谊的影响。我们比较了与抑郁症、艾滋病毒、糖尿病和高血压相关的耻辱感。最后，我们在 6 个月的随访期间研究了与抑郁症相关的耻辱感与医疗服务使用和未满足的心理保健需求之间的关系。我们发现，67% 的抑郁症初级保健患者预计抑郁症相关的耻辱会对就业产生负面影响，59% 的患者预计会对健康保险产生负面影响，24% 的患者预计会对友谊产生负面影响。与抑郁症相关的耻辱感比高血压或糖尿病更大，但与艾滋病毒无关。年轻男性报告称，影响就业的耻辱较少。妇女受到更多与就业相关的耻辱感，但社会支持在一定程度上减轻了这种耻辱感。与耻辱相关的其他因素包括种族（与健康保险耻辱相关）和慢性疾病的数量（与健康保险和友谊相关耻辱相关）。耻辱与服务使用无关，但有与友谊相关的耻辱担忧的个人报告称，未得到满足的心理保健需求更大。总之，耻辱感在抑郁症初级保健患者中很常见，并且与年龄、性别、种族、社会支持和慢性病有关。耻辱与服务使用之间的关系值得在不同环境和人群中进一步研究。 (C) 2003 Elsevier Inc. 保留所有权利。
We assessed stigma affecting employment, health insurance, and friendships in 1,187 depressed patients from 46 U.S. primary care clinics. We compared stigma associated with depression, HIV, diabetes, and hypertension. Finally, we examined the association of depression-related stigma with health services use and unmet need for mental health care during a 6-month follow-up. We found that 67% of depressed primary care patients expected depression related stigma to have a negative effect on employment, 59% on health insurance, and 24% on friendships. Stigma associated with depression was greater than for hypertension or diabetes but not HIV. Younger men reported less stigma affecting employment. Women had more employment-related stigma but this was somewhat mitigated by social support. Other factors associated with stigma included ethnicity (associated with health insurance stigma) and number of chronic medical conditions (associated with health insurance and friendship related stigma). Stigma was not associated with service use, but individuals with stigma concerns related to friendships reported greater unmet mental health care needs. In summary, stigma was common in depressed primary care patients and related to age, gender, ethnicity, social support and chronic medical conditions. The relationship between stigma and service use deserves further study in diverse settings and populations. (C) 2003 Elsevier Inc. All rights reserved.