Stigma and Mental Illness in Cross-National Perspective

描述(由申请人提供)：精神疾病(MI)是全球疾病负担中最严重的健康问题之一，据报道，与其相关的耻辱既是个人问题(例如，服务使用率低，阻碍了康复进展)，也是系统问题(例如，研究和治疗基础设施资金不足)的核心。事实上，世界卫生组织的精神分裂症国际研究(ISOS)等研究表明，有记录的最严重形式的MI患者的不同结果，部分是由于不同社会对MI患者的不同文化规范、态度和行为。然而，对于公众对MI的反应是否以及如何在不同国家之间存在差异，我们知之甚少。这项申请提出了第一次基于理论和方法协调的尝试，以了解各国对MI的理解和污名程度。使用多学科和多层次的理论框架和国际社会调查计划(ISSP)成员国的子集，这项申请提出了一项15个国家的比较研究，对严重抑郁症、精神分裂症和双相情感障碍的耻辱水平和相关性进行比较研究。我们提出了三个具体目标。首先，我们得出了一个关于心肌梗死污名的病因学的综合理论模型，该模型是由对心肌梗塞患者污名化反应的原因和相关性的现有研究的跨学科综合而得到的。其次，我们与一组国际心理健康和调查研究专家合作，开发并预试了基于这一框架的工具。收集的数据将来自对每个国家具有全国代表性的成年人样本(N=1,000-1,500人)的面对面采访。这将提供国内和国际的描述性概况，说明公众对心肌梗死和心肌梗死患者的知识、熟悉、信念和污名化反应。第三，我们对理论模型下提出的假设进行了实证检验，包括全国范围和跨国家范围。通过了解公众对不同类型严重精神疾病(SMI)的反应，临床医生和研究人员将更好地解释观察到的国内和跨国SMI患者结局的异质性。这一知识可以为公共卫生和治疗系统干预提供科学基础，以减轻耻辱对SMI患者生活的破坏性负面影响。

DESCRIPTION (provided by applicant): Mental illness (MI) ranks among the most critical health problems in the global burden of disease, and the stigma associated with it is reported to be at the center of both individual (e.g., low service use, hindered progress toward recovery) and system problems (e.g., inadequate funding of research and treatment infrastructures). In fact, studies such as the World Health Organization's International Study of Schizophrenia (ISoS) have suggested that documented differential outcomes for persons with one of the most serious forms of MI is due, in part, to the differing cultural norms, attitudes and behaviors toward persons with MI across societies. Yet, we know relatively little about whether and how the public's reaction to MI varies across countries. This application proposes the first theoretically based and methodologically coordinated attempt to understand the extent to which MI is understood and stigmatized across countries. Using a multidisciplinary and multi-level theoretical framework and a subset of International Social Survey Program (ISSP) member countries, this application proposes a 15-country, comparative study of the levels and correlates of the stigma of major depression, schizophrenia and bi-polar disorder. We propose three specific aims. First, we derive a comprehensive theoretical model of the etiology of the stigma of MI that is informed by an interdisciplinary synthesis of existing research on the causes and correlates of stigmatizing responses to persons with MI. Second, we develop and pre-test an instrument based on this framework in collaboration with an international set of mental health and survey research experts. Collected data will be from face-to-face interviews with a nationally representative sample (N=1,000-1,500) of adults in each country. This will provide national and international descriptive profiles of the public's knowledge of, familiarity with, beliefs about, and stigmatizing responses toward MI and persons with MI. Third, we empirically examine hypotheses proposed under the theoretical model, both nationally and cross-nationally. By understanding the public's reaction to different types of serious mental illness (SMI), both clinicians and researchers will be in a better position to account for the observed heterogeneity in outcomes of persons with SMI within and across countries. This knowledge can provide the scientific base for public health and treatment system interventions to mitigate the devastating negative effects of stigma on the lives of persons with SMI.