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的耻辱的理解，然后开发和测试新的方法来减少经济发展中国家的这种耻辱。这一点很重要的原因是，在世界各地，耻辱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，精神疾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。该伙伴关系的参与中心位于4个低收入和中等收入国家，它们将与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（亚的斯亚贝巴大学）；德国（乌尔姆大学）；印度（新德里乔治研究所和班加罗尔NIMHANS），瑞士（世卫组织，日内瓦）；突尼斯（Hôpital Razi，突尼斯）；英国(氯化钾);美国（乔治华盛顿大学）。该计划是开展研究活动，以更好地了解耻辱如何产生负面影响。这些问题将集中在：(i)无意识的偏见（例如，卫生保健工作人员对人不那么好，而不是有意这样做）；（ii）人们如何在不产生负面影响的情况下应对耻辱；（iii）如何改善有和没有精神疾病经历的人之间“人际接触”的效果，以减少污名；（四）如何使减少耻辱感的干预措施适应中低收入国家的当地背景和文化。这些研究基于高收入国家的研究结果，即这种人际接触是减少耻辱的最有效方式。我们还将在文化上调整衡量耻辱不同方面的7种量表，并将其翻译成阿姆哈拉语、阿拉伯语、英语、印地语、卡纳达语、普通话和泰卢古语，并将其作为“评估工具包”公开提供。我们将继续开展3个试点项目，以测试旨在减少与精神健康有关的耻辱的具体方法：(i)地方社区利用公众意识和社会营销方案，增加精神疾病患者到当地保健服务机构的转诊；㈡初级保健工作人员；（三）与专业精神保健人员合作。这些干预措施的指导将根据这些研究进行调整，并作为“干预手册”公开提供。如果这些项目的结果在减少耻辱感方面是积极的，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它们的有效性。在这项工作的过程中，整个合作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，以便他们将来能够在这些国家建立优秀的耻辱研究中心。我们的长期目标是确定有效的方法，减少对低收入和中等收入国家精神疾病患者的耻辱和歧视，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（即减少所谓的“治疗差距”）做出贡献，取得更好的结果，并实现更大的社会包容。

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.