Stigma and Psychosis: A Prospective Study

描述(由申请人提供)：卫生局局长关于精神健康的报告肯定了许多精神健康服务消费者的观点，将克服耻辱置于国家促进精神健康努力的前列。尽管我们知道污名如何对心理健康产生负面影响，并剥夺人们获得机会的机会，但我们需要更多地了解精神疾病标签最初是如何对接触这些疾病的人产生意义和后果的。我们需要捕捉这些信息，因为它随着时间的推移在患有严重精神疾病的人的职业生涯中展开。作为实现了解和干预这一最终目标的一个步骤，这项发展提案寻求资金，以制定和评估新的措施，以实现对污名的多方法评估。具体地说，我们将：a)使用与患者在首次住院之前、期间和之后发生的事件的半结构化访谈得出的叙述对耻辱成分进行评级；b)通过编码关于过程和事件的开放式报告的录音带和文字稿来评估羞耻、尴尬、羞辱、愤怒和其他与耻辱有关的感觉；c)进行直接观察和关键信息人访谈，以评估与耻辱相关的背景因素，并构建与患者叙述平行的叙述，但源于医院记录和对精神卫生工作人员和亲属的采访。这份R21将产生访谈和观察方案，编码手册，以及关于评估污名的多方法方法的可靠性和有效性的证据。这些信息将对其他研究耻辱的研究人员有用，并将成为一项更大的前瞻性研究的基础，该研究将评估耻辱对重要结果的影响，并为减少耻辱对精神疾病患者生活的影响的干预措施提供信息。

DESCRIPTION (provided by applicant): Affirming the view of many consumers of mental health services, the Surgeon General's Report on Mental Health places overcoming stigma at the forefront of the nation's efforts to promote mental health. Although we know a great deal about how stigma adversely impacts psychological well-being and denies people access to opportunities, we need to know more about how mental illness labels initially come to have meaning and consequences for individuals who are exposed to them. We need to capture this information as it unfolds over time in the careers of people who develop serious mental illnesses. As a step towards reaching this ultimate goal of understanding and intervention, this developmental proposal seeks funds to develop and evaluate new measures in order to achieve a multi-method assessment of stigma. Specifically we will: a) develop ratings of stigma components using narratives derived from semi-structured interviews with patients concerning events in the period before, during and after their first hospitalization, b) develop ratings that assess shame, embarrassment, humiliation, anger and other stigma-related feelings by coding audiotapes and transcripts of open-ended reports about processes and events and, c) conduct direct observations and key- informant interviews to assess stigma-relevant contextual factors and to construct a narrative parallel to the patients narrative but derived from hospital records and interviews with mental health staff and relatives. This R21 will yield interview and observation protocols, coding manuals, and evidence concerning the reliability and validity of a multi-method approach to assessing stigma. This information will be useful to other researchers studying stigma and will form the basis of a larger prospective study that will assess the impact of stigma on important outcomes and inform interventions to reduce the influence of stigma in the lives of people with mental illness.