Mental health stigma at primary health care centres in Lebanon: qualitative study.
Mental health stigma at primary health care centres in Lebanon: qualitative study.
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DOI：
10.1186/s13033-022-00533-y
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发表时间：
2022-05-07
影响因子：
3.6
通讯作者：
El-Chammay, Rabih
中科院分区：
文献类型：
--
作者：
Hana, Racha Abi;Arnous, Maguy;Heim, Eva;Aeschlimann, Anais;Koschorke, Mirja;Hamadeh, Randa S.;Thornicroft, Graham;Kohrt, Brandon A.;Sijbrandij, Marit;Cuijpers, Pim;El-Chammay, Rabih
与心理健康有关的污名化是一个全球公共卫生问题，也是寻求治疗的主要障碍。在这项研究中，我们探讨了污名化的作用，作为一个障碍，以扩大精神卫生服务的初级卫生保健（PHC）中心在黎巴嫩。我们专注于医疗保健提供者（HCP）为精神健康状况（MHCs）患者提供服务的经验，政策制定者的观点，以及MHCs患者对耻辱或歧视的看法。这项研究是作为INDIGO-PRIMARY的一部分进行的，INDIGO-PRIMARY是一个更大的多国减少耻辱计划。在2018年8月至2019年9月期间，对政策制定者（n = 3），PHC管理层（n = 4），PHC工作人员（n = 24）和服务用户（SU）（n = 14）进行了半结构化定性访谈（n = 45）。这些访谈探讨了心理健康知识，态度和工作人员的行为，提供治疗的挑战，以及病人的结果。所有访谈都使用NVivo和主题编码框架进行编码。本研究的结果分为三个主题：（1）初级保健水平上的耻辱，（2）初级保健中心外的耻辱，（3）结构性耻辱。SU没有证明来自HCP的歧视，但确实描述了来自家人的污名化行为。有趣的是，在初级保健一级，污名报告不同的工作人员根据权力梯度。护士和社会工作者没有明确报告污名化事件，但将MHCs患者描述为不合作，强调了他们对心理健康的内在负面看法。全科医生和主任比护士更直言不讳地谈到精神健康患者面临的挑战。精神卫生专业人员透露，HCP仍然对MHCs患者持有隐性负面看法，但他们的态度最近有所改善。我们的分析强调了影响SU的五个耻辱层。这项定性研究表明，污名仍然是影响MHC患者的一个关键问题。SU报告说，在社区中经历了公开的污名化行为，但在初级保健环境中不太明显的歧视。我们的研究结果强调了以下几点的重要性：（1）通过法律的改革来打击结构性污名化;（2）解决人际污名化;（3）承诺PHC管理层提供高质量的心理健康综合服务;（4）通过建立公众同情心来减少人际污名化。
Mental health-related stigma is a global public health concern and a major barrier to seeking care. In this study, we explored the role of stigma as a barrier to scaling up mental health services in primary health care (PHC) centres in Lebanon. We focused on the experiences of Healthcare Providers (HCPs) providing services to patients with mental health conditions (MHCs), the views of policy makers, and the perceptions of stigma or discrimination among individuals with MHCs. This study was conducted as part of INDIGO-PRIMARY, a larger multinational stigma reduction programme. Semi-structured qualitative interviews (n = 45) were carried out with policy makers (n = 3), PHC management (n = 4), PHC staff (n = 24), and service users (SUs) (n = 14) between August 2018 and September 2019. These interviews explored mental health knowledge, attitudes and behaviour of staff, challenges of providing treatment, and patient outcomes. All interviews were coded using NVivo and a thematic coding framework. The results of this study are presented under three themes: (1) stigma at PHC level, (2) stigma outside PHC centres, and (3) structural stigma. SUs did not testify to discrimination from HCPs but did describe stigmatising behaviour from their families. Interestingly, at the PHC level, stigma reporting differed among staff according to a power gradient. Nurses and social workers did not explicitly report incidents of stigma but described patients with MHCs as uncooperative, underscoring their internalized negative views on mental health. General practitioners and directors were more outspoken than nurses regarding the challenges faced with mental health patients. Mental health professionals revealed that HCPs still hold implicitly negative views towards patients with MHCs however their attitude has improved recently. Our analysis highlights five layers of stigma affecting SUs. This qualitative study reveals that stigma was still a key concern that affects patients with MHC. SUs reported experiencing overt stigmatising behaviour in the community but less explicit discrimination in a PHC setting. Our findings emphasise the importance of (1) combatting structural stigma through legal reform, (2) addressing interpersonal stigma, (3) committing PHC management to deliver high quality mental health integrated services, and (4) reducing intrapersonal stigma by building public empathy.
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影响因子：
7.5
作者：
Gearing, Robin E.;Schwalbe, Craig S.;Al-Krenawi, Alean
通讯作者：
Al-Krenawi, Alean
影响因子：
2.7
作者：
Dardas, L. A.;Simmons, L. A.
通讯作者：
Simmons, L. A.
影响因子：
6.6
作者：
Holmes, EP;Corrigan, PW;Kubiak, MA
通讯作者：
Kubiak, MA
影响因子：
8.1
作者：
Gurung D;Poudyal A;Wang YL;Neupane M;Bhattarai K;Wahid SS;Aryal S;Heim E;Gronholm P;Thornicroft G;Kohrt B
通讯作者：
Kohrt B
减少低收入和中等收入国家初级卫生保健环境中与心理健康相关的污名：系统评价。
影响因子：
8.1
作者：
Heim E;Kohrt BA;Koschorke M;Milenova M;Thornicroft G
通讯作者：
Thornicroft G