Indigo (International study of discrimination and stigma outcomes)

靛蓝伙伴关系的总体目标是提高对精神疾病患者污名化的理解，然后开发和测试新的方法来减少经济发展中国家的这种污名化。这很重要的原因是，在世界各地，污名化和歧视都有负面影响，将精神疾病患者排除在社会主流之外。例如，在大多数国家，精神病患者的就业率远低于一般人群，婚姻前景可能受到严重损害。参与该伙伴关系的中心位于4个中低收入国家，他们将与来自4个高收入国家的工作人员密切合作：中国（北京大学医学部和广州医科大学）;埃塞俄比亚（阿迪斯大学）;德国（乌尔姆大学）;印度（乔治研究所，新德里和NIMHANS，班加罗尔），瑞士（世卫组织，日内瓦）;突尼斯（拉齐医院，突尼斯）;联合王国（科隆大学）;美国（乔治华盛顿大学）。这些活动将侧重于：（一）无意识的偏见（例如医护人员在无意中对病人不太好）;（ii）市民如何科普污名化而不致造成负面影响;（iii）如何改善精神病患者与非精神病患者之间的“人际接触”，以减少污名化;以及（iv）如何根据中低收入国家的当地情况和文化调整减少耻辱感的干预措施。这些研究是基于高收入国家的研究结果，即这种人际接触是减少耻辱感的最有效方法。我们还将从文化上改编7个衡量耻辱感不同方面的量表，并将其翻译成阿姆哈拉语、阿拉伯语、英语、印地语、卡纳达语、普通话和泰卢固语，我们会继续推行三个试验计划，测试减少精神健康相关污名的具体方法，包括：（i）地方社区利用公众认识和社会营销方案，增加精神病患者接受地方保健服务的转诊;（ii）初级保健工作人员;以及（iii）与专业精神卫生保健人员合作。这些干预措施的说明将根据这些研究进行调整，并作为“干预手册”公开提供。如果这些项目在减少污名方面取得了积极的成果，我们将在未来申请研究基金，在国际多地点干预试验中更彻底地测试其有效性。在这项工作中，整个伙伴关系的工作人员将支持中国、埃塞俄比亚、印度和突尼斯的工作人员发展他们的研究技能和职业生涯，以便它们今后能够在这些国家中每一个国家建立耻辱问题研究杰出人员中心。我们的长期目标是找到有效的方法，减少中低收入国家对精神病患者的羞辱和歧视，并为更多患有这种疾病的人在未来获得有效的精神卫生保健做出贡献（即减少所谓的“治疗差距”），并取得更好的结果，实现更大的社会包容性。

Summary for lay readersThe overall aim of the Indigo Partnership is to improve understanding of stigmatisation against people with mental illness, and then to develop and test new methods to reduce such stigma in economically developing countries.The reason why this is important is that all over the world stigma and discrimination have negative effects, which exclude people with mental illness from the mainstream of society. For example, employment rates for people with mental illness are much lower than for the general population in most countries, and the prospects of marriage can be severely harmed.The participating centres in this Partnership are in 4 low and middle countries, who will work in close collaboration with staff from 4 high income countries: China (Peking University Health Science Centre, and Guangzhou Medical University); Ethiopia (Addis Ababa University); Germany (University of Ulm); India (George Institute, New Delhi and NIMHANS, Bengaluru), Switzerland (WHO, Geneva); Tunisia (Hôpital Razi, Tunis); UK (KCL); and USA (George Washington University).The plan is to conduct 4 research activities to understand better how stigma has a negative impact. These will be focussed upon: (i) unconscious bias (for example health care staff who treat people less well without intending to do so); (ii) how people can manage to cope with stigma without it having a negative impact; (iii) how to improve the effect of 'inter-personal contact' between people with and without experience of mental illness to reduce stigma; and (iv) how to adapt stigma reduction interventions to the local context and culture in low and middle income countries. These studies are based upon the findings of research in high income countries that such inter-personal contact is the most effective way to reduce stigma.We shall also culturally adapt 7 scales which measure different aspects of stigma and translate them into Amharic, Arabic, English, Hindi, Kannada, and Mandarin and Telugu, and make these openly available as an 'evaluation toolkit'.We shall go on to carry out 3 pilot projects to test specific methods intended to reduce mental health related stigma in: (i) local communities using a public awareness and social marketing programme to increase referrals for people with mental illness to attend local health care services; (ii) in primary health care staff; and (iii) with specialist mental health care staff.The instructions for these interventions will be adapted, learning from these studies, and made openly available as 'intervention manuals'. If the results of these projects are positive in achieving stigma reduction, we shall apply for research funds in future to test their effectiveness more thoroughly within international, multi-site intervention trials.In the course of this work the, staff in the whole partnership will support staff in China, Ethiopia, India, and Tunisia to develop their research skills and their careers, so that they can establish centres of excellent in stigma research in each of these countries in future. Our longer term objectives are to identify effective way to reduce stigma and discrimination against people with mental illness in low- and middle-income countries, and to make a contribution towards more people with such conditions gaining access to effective mental health care in future (namely to decreases the so-called 'treatment gap'), and better outcomes, and achieving greater social inclusion.