上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (11): 1527-.doi: 10.3969/j.issn.1674-8115.2011.11.005

• 专题报道（双相障碍） • 上一篇    下一篇

心境障碍患者自我病耻感及相关因素研究

吴志国, 苑成梅, 王 振, 黄 佳, 李则挚, 王 勇, 张 晨, 方贻儒   

  1. 上海交通大学 医学院附属精神卫生中心心境障碍科, 上海 200030
  • 出版日期:2011-11-28 发布日期:2011-11-29
  • 通讯作者: 方贻儒, 电子信箱: yirufang@yahoo.com.cn。
  • 作者简介:吴志国（1978—）, 男, 主治医师, 硕士；电子信箱: wu_zhiguo@yahoo.com.cn。
  • 基金资助:

    国家自然科学基金（30971047）；国家高技术研究发展计划（“八六三”计划）(2006AA02Z430)；上海交通大学医学院“重点学科建设”基金（沪交医科[2008]-6）；上海市卫生局公共卫生优秀青年人才项目（08GWQ075）；上海市卫生局青年科研项目（2007Y14）

Self-stigma in patients with mood disorders and its related factors

WU Zhi-guo, YUAN Cheng-mei, WANG Zhen, HUANG Jia, LI Ze-zhi, WANG Yong, ZHANG Chen, FANG Yi-ru   

  1. Department of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
  • Online:2011-11-28 Published:2011-11-29
  • Supported by:

    National Natural Science Foundation of China, 30971047；National High Technology Research and Development Program of China, “863” Program, 2006AA02Z430；Shanghai Jiaotong University School of Medicine Foundation, 2008-6；Shanghai Municipal Health Bureau Foundation, 08GWQ075, 2007Y14

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摘要：

目的 探讨心境障碍患者自我病耻感程度及相关因素。方法 采用精神疾病内在病耻感量表（ISMI）对446例心境障碍患者自我病耻感进行评估，比较具有不同人口学或临床特征患者的自我病耻感水平；对384例抑郁发作患者病耻感与部分临床变量进行Spearman相关分析。结果 72.9%的患者存在自我病耻感，中、重度占24.2%；有病耻抵抗的患者比例（79.6%）最高；有歧视体验的患者比例（41.0%）最低。男性患者刻板印象认同、歧视体验和社交退缩分量表分高于女性患者（P<0.05）；在职患者歧视体验分量表分低于非在职患者（P<0.05）；受高等教育患者ISMI总分及价值否定、刻板印象认同、歧视体验、社交退缩分量表分低于未受高等教育者（P<0.05）；抑郁症与双相障碍患者ISMI总分比较差异无统计学意义（P>0.05）；发作期患者ISMI总分、价值否定、刻板印象认同、社交退缩和病耻抵抗分量表分高于缓解期患者（P<0.05）。年龄和疾病严重程度（17项汉密尔顿抑郁量表总分）与抑郁发作患者ISMI总分呈显著正相关（r=0.168, P<0.01和r=0.300, P<0.01）；受教育年限与ISMI总分呈显著负相关（r=－0.178, P<0.01）。结论 心境障碍患者普遍存在自我病耻感，且病耻抵抗能力较差；临床上应重视具有特定社会人口学和临床特征患者的病耻感程度，从多个维度上系统评估其自我病耻感，重点帮助患者提高应对病耻感的能力。

关键词: 心境障碍, 自我病耻感, 病耻抵抗

Abstract:

Objective To investigate the level of self-stigma in patients with mood disorders and its related factors. Methods Self-stigma in 446 patients with mood disorders was evaluated using Internalized Stigma of Mental Illness scale (ISMI), and levels of self-stigma were compared among patients with different sociodemographic or clinical features. Spearman correlation analysis was conducted between self-stigma and clinical variables in 384 patients with depressive episode. Results Self-stigma existed in 72.9% of patients, and moderate to severe self-stigma accounted for 24.2%. The percent of patients with stigma resistance was the highest (79.6%), and the percent of patients with discrimination experience was the lowest (41.0%). Male patients had higher scores of stereotype endorsement, discrimination experience and social withdrawal subscale than female patients (P<0.05). Employed patients had lower score of discrimination experience subscale than the unemployed (P<0.05). Patients with higher education had lower ISMI total score, as well as lower alienation, stereotype endorsement, discrimination experience and social withdrawal subscale scores than those with lower education (P<0.05). There was no significant difference in ISMI total score between patients with major depressive disorder and those with bipolar disorders (P>0.05). ISMI total score and alienation, stereotype endorsement, social withdrawal and stigma resistance subscale scores of unrecovered patients were significantly higher than those of the recovered (P<0.05). Age and depression severity (total score of 17-item Hamilton Rating Scale for Depression) were positively associated with ISMI total score (r=0.168, P<0.01; r=0.300, P<0.01), and education experience was negatively associated with ISMI total score (r=－0.178, P＜0.01) in patients with depressive episode. Conclusion Self-stigma and high stigma resistance are common in patients with mood disorders. Self-stigma of patients with certain sociodemographic and clinical features should be attached great importance and assessed cautiously and comprehensively. Efforts on helping patients to enhance their ability to resist stigma should be strengthened.

Key words: mood disorders, self-stigma, stigma resistance