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，与之相关的耻辱感是个人（例如，服务使用率低，阻碍康复进展）和系统问题（例如，研究和治疗基础设施资金不足）的核心。事实上，诸如世界卫生组织国际精神分裂症研究（ISoS）等研究表明，记录的最严重形式的心肌梗死患者的不同结果部分是由于不同社会对心肌梗死患者的不同文化规范、态度和行为。然而，我们对各国公众对心肌梗死的反应是否不同以及如何不同所知相对较少。这一应用提出了第一个基于理论和方法协调的尝试，以了解MI在多大程度上被各国理解和污名化。使用多学科和多层次的理论框架和国际社会调查计划（ISSP）成员国的一个子集，本应用程序提出了一个15个国家的比较研究，对重度抑郁症，精神分裂症和双相情感障碍的耻辱水平和相关关系进行比较研究。我们提出三个具体目标。首先，我们通过跨学科综合对MI患者污名化反应的原因和相关因素的现有研究，得出了MI污名化病因学的综合理论模型。其次，我们与一组国际心理健康和调查研究专家合作，基于该框架开发并预测试了一种工具。收集的数据将来自对每个国家具有全国代表性的样本（N=1,000-1,500）的成年人进行面对面访谈。这将提供国内和国际公众对MI和MI患者的知识、熟悉程度、信念和污名化反应的描述性概况。第三，我们在国内和跨国上实证检验了理论模型下提出的假设。通过了解公众对不同类型的严重精神疾病（SMI）的反应，临床医生和研究人员将能够更好地解释在国家内部和国家之间观察到的重度精神疾病患者结果的异质性。这些知识可以为公共卫生和治疗系统干预措施提供科学基础，以减轻耻辱对重度精神分裂症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.