Mental illness stigma and suicidality: the role of public and individual stigma
Mental illness stigma and suicidality: the role of public and individual stigma
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DOI：
10.1017/s2045796016000949
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发表时间：
2018-04-01
影响因子：
8.1
通讯作者：
Ruesch, N.
中科院分区：
文献类型：
--
作者：
Oexle, N.;Waldmann, T.;Ruesch, N.
目标。失业者的自杀率在增加，精神疾病的耻辱可能会导致失业和自杀。精神病患者在公众中感觉到消极的态度，并在他们的日常生活中经历歧视(=公共污名成分)，可能导致自我污名和预期的歧视(=个人污名成分)。以前的研究发现了精神疾病耻辱和自杀之间存在关联的证据，但尚未阐明解释不同耻辱成分如何相互作用并促成自杀想法的潜在途径。对227名患有精神疾病的失业人员进行了公共和个人污名成分及其与自杀意念的关系的研究。在Mplus中使用结构方程模型检验了由个体污名成分(预期歧视、自我污名)中介的公共污名成分(经历过的歧视、感知到的污名)与自杀意念之间的路径模型。我们的样本在性别上平均为43岁，约一半的人报告在过去30天内没有自杀念头。在双变量分析中，所有耻辱成分都与自杀意念显着相关。在路径模型和症状控制中，经历的歧视和自杀意念之间的关联完全通过预期的歧视和自我污名来调节。被知觉到的耻辱对自杀意念的影响完全是通过预期歧视来实现的，而不是通过自我羞辱。总体而言，解决多种耻辱因素的方案似乎在改善自杀预防方面最有效。除了针对一般公众的消极态度和歧视行为的干预措施外，支持精神病患者应对被认为和经历过的耻辱的方案可以改善自杀预防。今后的研究应测试这种干预措施对自杀的短期和长期影响，并进一步调查耻辱应对(例如保密)和情感后果(例如绝望和孤独)对耻辱成分与自杀之间的关联的作用。
Aims. Suicide rates are increased among unemployed individuals and mental illness stigma can contribute to both unemployment and suicidality. Persons with mental illness perceive negative attitudes among the general public and experience discrimination in their everyday life (=public stigma components) potentially leading to self-stigma and anticipated discrimination (=individual stigma components). Previous research found evidence for an association between aspects of mental illness stigma and suicidality, but has not yet clarified the underlying pathways explaining how different stigma components interact and contribute to suicidal ideation.Method. Public and individual stigma components and their association with suicidal ideation were examined among 227 unemployed persons with mental illness. A path model linking public stigma components (experienced discrimination, perceived stigma) with suicidal ideation, mediated by individual stigma components (anticipated discrimination, self-stigma), was examined using structural equation modelling within Mplus.Results. Our sample was equally split in terms of gender, on average 43 years old and about half reported no suicidal ideation during the past 30 days. In bivariate analyses all stigma components were significantly associated with suicidal ideation. In the path model and controlling for symptoms, the association between experienced discrimination and suicidal ideation was fully mediated by anticipated discrimination and self-stigma. Perceived stigma's contribution to suicidal ideation was fully mediated by anticipated discrimination, but not by self-stigma.Conclusions. In general, programmes addressing multiple stigma components seem to be most effective in improving suicide prevention. Besides interventions targeting negative attitudes and discriminating behaviours of the general public, programmes to support persons with mental illness in coping with perceived and experienced stigma could improve suicide prevention. Future studies should test the short- and long-term effects of such interventions on suicidality and further investigate the role of stigma coping (e.g. secrecy) and emotional consequences (e.g. hopelessness and loneliness) for the association between stigma components and suicidality.