Stigma against mental health disorders in Nepal conceptualised with a 'what matters most' framework: a scoping review.
Stigma against mental health disorders in Nepal conceptualised with a 'what matters most' framework: a scoping review.
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DOI：
10.1017/s2045796021000809
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发表时间：
2022-01-28
影响因子：
8.1
通讯作者：
Kohrt B
中科院分区：
文献类型：
--
作者：
Gurung D;Poudyal A;Wang YL;Neupane M;Bhattarai K;Wahid SS;Aryal S;Heim E;Gronholm P;Thornicroft G;Kohrt B
与精神障碍有关的耻辱是高质量精神保健的障碍。本综述旨在综合尼泊尔与精神障碍相关的病耻感文献，以了解病耻感过程。理解文化和耻辱的“最重要的”这一人类学概念被用来构建关于解释模型、表现形式、后果、结构性促进因素和缓解因素以及干预措施的文献。我们进行了一项范围评价，并在系统评价首选报告项目和范围评价扩展元分析（PRISMA-ScR）的指导下进行筛选。使用三个国际数据库（PsycINFO、Medline和Web of Science）、一个尼泊尔数据库（NepJol）和交叉引用2000年1月1日至2020年6月24日的出版物进行了结构化搜索。重复搜索，包括结构性耻辱相关的术语。定量研究的质量采用观察研究质量系统评估（SAQOR）工具进行评估。该综述通过开放科学框架（OSF）注册（OSF .io/u8jhn）。在20年的时间里，搜索产生了57项研究：19项定量研究，19项定性研究，9项混合方法研究，5篇综述文章，2篇民族志研究和3项其他类型的研究。该综述确定了尼泊尔使用的9项耻辱感措施，1项耻辱感干预措施，没有关注青少年和儿童心理健康耻辱感的研究。研究结果表明，尼泊尔文化中对服务使用者、护理人员、社区成员和卫生工作者“最重要的”包括声望、生产力、隐私、接受度、婚姻和资源。与“什么最重要”相关的文化价值观反映在结构性障碍和促进因素上，包括缺乏政策、方案规划和资源。大多数使用定量工具评估病耻感的研究没有描述文化适应或验证过程，18项定量研究中有15项在SAQOR质量评级中属于“低质量”。审查显示，尼泊尔在污名化干预措施的实施和评估方面存在明显差距，仅报告了一项干预措施，而且大多数污名化措施在文化上不适合使用。由于病耻感过程是复杂的，它们对“最重要的事情”以及结构性障碍和促进因素的影响是相互关联的，因此需要更多的研究来了解这种复杂性，并建立针对多个领域的有效干预措施。我们建议病耻感研究者应该澄清概念模型，为研究设计和解释提供信息。有必要制定程序，系统地适应污名化评估工具的文化。应开展研究，以了解结构性耻辱感的形式和驱动因素，并扩大干预研究，以评估减少耻辱感的策略。
Stigma related to mental disorders is a barrier to quality mental healthcare. This scoping review aimed to synthesise literature on stigma related to mental disorders in Nepal to understand stigma processes. The anthropological concept of ‘what matters most’ to understand culture and stigma was used to frame the literature on explanatory models, manifestations, consequences, structural facilitators and mitigators, and interventions. We conducted a scoping review with screening guided by the Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR). A structured search was done using three international databases (PsycINFO, Medline and Web of Science), one Nepali database (NepJol) and cross-referencing for publications from 1 January 2000 through 24 June 2020. The search was repeated to include structural stigma-related terms. Quality of quantitative studies was assessed using the Systematic Assessment of Quality in Observational Research (SAQOR) tool. The review was registered through the Open Science Framework (OSF) (osf.io/u8jhn). The searches yielded 57 studies over a 20-year period: 19 quantitative, 19 qualitative, nine mixed methods, five review articles, two ethnographies and three other types of studies. The review identified nine stigma measures used in Nepal, one stigma intervention, and no studies focused on adolescent and child mental health stigma. The findings suggest that ‘what matters most’ in Nepali culture for service users, caregivers, community members and health workers include prestige, productivity, privacy, acceptance, marriage and resources. Cultural values related to ‘what matters most’ are reflected in structural barriers and facilitators including lack of policies, programme planning and resources. Most studies using quantitative tools to assess stigma did not describe cultural adaptation or validation processes, and 15 out of the 18 quantitative studies were ‘low-quality’ on the SAQOR quality rating. The review revealed clear gaps in implementation and evaluation of stigma interventions in Nepal with only one intervention reported, and most stigma measures not culturally adapted for use. As stigma processes are complex and interlinked in their influence on ‘what matters most’ and structural barriers and facilitators, more studies are required to understand this complexity and establish effective interventions targeting multiple domains. We suggest that stigma researchers should clarify conceptual models to inform study design and interpretations. There is a need to develop procedures for the systematic cultural adaptation of stigma assessment tools. Research should be conducted to understand the forms and drivers of structural stigma and to expand intervention research to evaluate strategies for stigma reduction.