Rural vs urban residence and experience of discrimination among people with severe mental illnesses in Ethiopia
Rural vs urban residence and experience of discrimination among people with severe mental illnesses in Ethiopia
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DOI：
10.1186/s12888-019-2345-7
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发表时间：
2019-11-05
期刊：
影响因子：
4.4
通讯作者：
Hanlon, Charlotte
中科院分区：
文献类型：
--
作者：
Forthal, Sarah;Fekadu, Abebaw;Hanlon, Charlotte
背景：很少有研究涉及低收入国家与精神疾病相关的歧视，这些国家的精神健康治疗差距最大。我们的目的是评估埃塞俄比亚这个低收入、快速城市化的非洲国家中严重精神疾病 (SMI) 患者遭受歧视的经历，并假设生活在农村的人遭受歧视的程度高于城市。方法：这项研究是对社区确定的 SMI 患者样本进行横断面调查，这些人接受了确认性诊断访谈。使用歧视和耻辱量表 (DISC-12) 来衡量所经历的歧视。使用零膨胀负二项回归来估计居住地（农村与城市）对歧视的影响，并针对潜在的混杂因素进行调整。结果：在 300 名研究参与者中，63.3% 的人在前一年经历过歧视，最常见的是因精神疾病而被回避或回避 (38.5%)。城市居民更有可能遭受朋友（chi(2)(1)=4.80；p=0.028）、警察（chi(2)(1)=11.97；p=0.001）、保住工作（chi(2)(1)=5.43；p=0.020）和安全方面（chi(2)(1)=5.00；p=0.025）的不公平待遇，并且DISC-12 得分显着高于农村地区的人（调整后的风险比：1.66；95% CI：1.18，2.33）。 结论：生活在城市环境中的 SMI 患者比农村地区的人遭受更多的歧视，这可能反映了城市环境中更广泛的社会机会的缺点。扩大获得精神卫生保健机会的举措应考虑如何在不同环境下克服社会排斥。
Background: Few studies have addressed mental illness-related discrimination in low-income countries, where the mental health treatment gap is highest. We aimed to evaluate the experience of discrimination among persons with severe mental illnesses (SMI) in Ethiopia, a low-income, rapidly urbanizing African country, and hypothesised that experienced discrimination would be higher among those living in a rural compared to an urban setting.Methods: The study was a cross-sectional survey of a community-ascertained sample of people with SMI who underwent confirmatory diagnostic interview. Experienced discrimination was measured using the Discrimination and Stigma Scale (DISC-12). Zero-inflated negative binomial regression was used to estimate the effect of place of residence (rural vs. urban) on discrimination, adjusted for potential confounders.Results: Of the 300 study participants, 63.3% had experienced discrimination in the previous year, most commonly being avoided or shunned because of mental illness (38.5%). Urban residents were significantly more likely to have experienced unfair treatment from friends (chi(2)(1)=4.80; p=0.028), the police (chi(2)(1) =11.97; p=0.001), in keeping a job (chi(2)(1)=5.43; p=0.020), and in safety (chi(2)(1)=5.00; p=0.025), and had a significantly higher DISC-12 score than those living in rural areas (adjusted risk ratio: 1.66; 95% CI: 1.18, 2.33).Conclusions: Persons with SMI living in urban settings report more experience of discrimination than their rural counterparts, which may reflect a downside of wider social opportunities in urban settings. Initiatives to expand access to mental health care should consider how social exclusion can be overcome in different settings.