Reducing the Adverse Impact of Mental Illness Stigma Among Family Caregivers

描述(申请人提供)：研究表明，照顾患有严重精神疾病的亲属的家庭成员以及消费者都会受到精神疾病的污名和歧视，导致自责、无能、退出社会支持、增加照顾者负担和/或抑郁。这项拟议的研究旨在通过评估NAMI-康涅狄格州(P.I.项目主任Trade Zavatsky)开发的一项计划的可行性、可接受性和初步疗效，来减少耻辱对精神分裂症患者家庭照顾者的不利影响。和西奈山的研究人员(Deborah Perlick，Ph.D.，P.I.)，在我们自己的Voice-Family Companion(IOOV-FC)中命名。IOOV-FC是以我们自己的声音(IOOV)为蓝本，由全国精神疾病联盟(NAMI)开发，以减少对消费者的污名。在第一年，每个家庭成员、消费者和临床医生将评估IOOV-FC预试版本的可接受性和结构效度，每个利益相关者的两个焦点小组将召开会议，确定家庭成员与耻辱相关的需求，以开发新版本的IOOV-FC。IOOV-FC旨在通过与其他家庭的接触和社会比较，在同行主导的关于精神疾病从症状出现到康复的过程中遇到的耻辱的讨论中，改善耻辱的应对。12名家庭成员将接受培训，以交付IOOV-FC。精神分裂症患者的家庭将随机接受IOOV-FC(N=70)或由专家提供的家庭教育课程(N=70)，并将在干预前、立即以及干预后3个月和6个月就自我羞辱和社交退缩的措施进行评估。主要分析将采用混合效应模型，其中时间、治疗组及其交互作用(时间×治疗组)为固定效应，受试者为随机效应；似然比检验将在每个随访点评估组差异。由于精神疾病污名是精神卫生服务使用的障碍，而家庭影响消费者对服务的使用，让家庭更好地应对精神疾病污名将有助于消费者及其家庭成员获得精神卫生保健。这项拟议的研究代表了一种改善污名应对的新方法，该方法基于健全的社会心理学原则，并效仿了一项广泛传播的针对消费者的反污名计划。

DESCRIPTION (provided by applicant): Studies have shown that family members who care for relatives with severe mental illness experience mental illness stigmatization and discrimination, as well as consumers, leading to feelings of self-blame, incompetence, withdrawal from social supports and increased caregiver burden and/or depression. The proposed research aims to reduce the adverse effects of stigma directed towards family caregivers of people with schizophrenia by assessing the feasibility, acceptability and initial efficacy of a program developed by NAMI-Connecticut (Trade Zavatsky, Program Director, P.I.) and researchers at Mount Sinai (Deborah Perlick, Ph.D., P.I.), termed In Our Own Voice-Family Companion (IOOV-FC). IOOV-FC is modeled after In Our Own Voice (IOOV), developed by the National Alliance on Mental Illness (NAMI) to reduce stigma directed towards consumers. During Year 1, 10 each of family members, consumers and clinicians will evaluate the acceptability and construct validity of the prepilot version of IOOV-FC and 2 focus groups of each stakeholder will convene to identify the stigma-related needs of family members to develop a new version of IOOV-FC. IOOV-FC aims to improve stigma coping through contact and social comparison with other families in a peer-led discussion of mental illness stigma encountered from the onset of symptoms to recovery. Twelve family members will be trained to deliver IOOV-FC. Families of consumers with schizophrenia will be randomized to receive either IOOV-FC (N = 70) or a family education course delivered by an expert (N = 70) and will be evaluated pre- intervention, immediately and 3 and 6 months post-intervention on measures of self-stigma and social withdrawal. The major analysis will be a mixed effects model in which time, treatment group, and their interactions (time x treatment group) are fixed effects, and subjects are random effects; likelihood ratio tests will evaluate group differences at each follow-up point. Because mental illness stigma is a barrier to mental health service use, and families influence consumers' use of services, equipping families to better cope with mental illness stigma will facilitate access to mental health care for both consumers and their family members. The proposed research represents a novel approach to improving stigma coping based on sound social psychological principles and modeled after a widely-disseminated anti-stigma program for consumers.