Reducing the Adverse Impact of Mental Illness Stigma Among Family Caregivers

描述（由申请人提供）：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化和歧视，导致自责，无能，退出社会支持，增加照顾者负担和/或抑郁。拟议的研究旨在通过评估NAMI-Connecticut （Trade Zavatsky，项目主任，P.I.）和Mount Sinai的研究人员（Deborah Perlick，博士，P.I.）开发的一个项目的可行性、可接受性和初步效果，减少对精神分裂症患者家庭照顾者的耻辱的不利影响，该项目被称为“我们自己的声音-家庭伴侣”（IOOV-FC）。IOOV- fc以“我们自己的声音”（In Our Own Voice， IOOV）为原型，由国家精神疾病联盟（NAMI）开发，旨在减少对消费者的羞辱。在第一年，每个家庭成员、消费者和临床医生将评估预试版IOOV-FC的可接受性和构建效度，每个利益相关者将召集2个焦点小组，确定家庭成员的耻感相关需求，以开发新的IOOV-FC版本。IOOV-FC旨在通过与其他家庭的接触和社会比较来改善从症状开始到康复所遇到的精神疾病耻辱。12名家庭成员将接受培训，以提供IOOV-FC。患有精神分裂症的消费者家庭将被随机分配接受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、干预后立即以及干预后3个月和6个月对自我耻辱和社会退缩的测量进行评估。主要分析将是混合效应模型，其中时间、治疗组及其相互作用（时间x治疗组）为固定效应，受试者为随机效应；似然比检验将评估每个随访点的组差异。由于精神疾病耻辱感是使用精神卫生服务的障碍，而且家庭影响消费者对服务的使用，因此，让家庭更好地应对精神疾病耻辱感，将有助于消费者及其家庭成员获得精神卫生保健。本研究以健全的社会心理学原则为基础，以广泛传播的消费者反污名计划为模型，提出了一种改善污名应对的新方法。

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.