网络干预对社区精神分裂症患者病耻感的影响及其机制

目的 探讨网络干预对社区精神分裂症患者病耻感的影响极其机制.方法 随机抽取的社区精神分裂症患者105例分为网络干预组(n=53)和对照组(n=52),对干预组进行5个月的网络干预,采用问卷调查法,比较两组患者社会支持、临床症状、自我效能感以及病耻感,并分析影响患者病耻感的因素.结果 经5个月的网络干预后,干预组患者主观支持、客观支持、支持的利用度、一般自我效能感量表分高于对照组患者,简明精神病评定量表的缺乏活力因子、思维障碍因子、焦虑抑郁因子得分和病耻感量表分均低于对照组患者,差异均有统计学意义(P＜0.05),患者的自我效能感、主观支持和焦虑抑郁因子分与患者的病耻感相关.结论 网络干预可以提高患者社会支持并增强自我效能感,减轻临床症状和病耻感,自我效能感、主观支持和焦虑抑郁因子分是网络干预影响患者病耻感的重要因素.     

‘It’s good being part of the community and doing the right thing’: (Re)problematising ‘community’ in new recovery-oriented policy and consumer accounts

The renewed focus on ‘recovery’ in alcohol and other drug policy over the last decade has been subject to sustained international attention and academic critique. However, little scholarly work has addressed how new recovery discourse has harnessed the ideals of community participation and cohesion and how people who use drugs, the targets of such proposals, experience these injunctions. Analysing the two most recent Australian National Drug Strategies – in which new recovery has featured – and interviews with people who inject drugs, I draw on Bacchi’s problematisation approach to make visible the politics of community in new recovery. My analysis demonstrates that there has been a shift in the way new recovery is framed from recovery through community reintegration and reconnection to recovery through ‘evidence-based’ treatment. However, community endures as an important dividing practice that targets people who regularly use drugs as dependent, unproductive and marginal to social life, while also claiming to be the solution to the disorder attributed to alcohol and other drug use. In the second half of this article, I draw on people’s accounts of regular drug use and recovery to explore the ‘lived effects’ of these problematisations and to pursue a critical practice of thinking otherwise. I argue that these accounts disrupt and contest the problematisations and promises underpinning recovery through community reintegration by: 1) drawing attention to the way in which the boundaries of community exclude inclusion for people who use drugs, and emphasising people’s already existing social relationships; 2) making present hitherto silenced and unproblematised barriers to social connection; and 3) critiquing the normative fantasies of healthy society and citizenship that underpin recovery. In concluding I consider the politics of appeals to community in new recovery-oriented policy, and suggest the need to foreground consumer accounts in problematisation-oriented analyses in order to better contest authoritative enactments of drug ‘problems’ that bear little resemblance to the challenges people face.     

Stigma as a barrier to health care utilization among female sex workers and men who have sex with men in Burkina Faso

Purpose

The aim of this study is to examine the prevalence and correlates of perceived health care stigma among female sex workers (FSWs) and men who have sex with men (MSM), including other stigma types, suicidal ideation, and participation in social activities.

减重代谢术前患者肥胖相关病耻感的质性研究

目的深入了解减重代谢手术患者术前肥胖相关的病耻感体验,以期为提高患者手术信心和术后自我管理质量提供参考。 方法选择北京市某三级甲等医院9名拟行减重代谢手术的患者为研究对象,采用半结构式访谈法,运用主题分析法对访谈资料进行分析、归纳及提炼主题。 结果减重代谢手术患者的术前病耻感体验归结为4个类属。类属一：病耻感体验,即自卑感、孤独、自责和被歧视的经历;类属二：病耻感来源,一方面来自自身,另一方面来自他人,如亲友和同事、医护人员、公众;类属三：病耻感的应对,包括盲目采取各种方法,减少社会活动、逃避、持有积极减重的态度;类属四：对手术改善肥胖的态度,包括经他人推荐相信减重效果,或对手术了解较少抱着尝试心态。 结论减重代谢手术的患者术前存在病耻感体验,医护人员应为其提供相应的心理支持,指导其采取正确的应对方式;同时应做好社会健康教育,加强公众对肥胖与代谢疾病的认识,正确认识减重代谢手术在治疗肥胖与代谢疾病中的效果。     

HIV-Related Stigma among People with HIV and their Families: A Qualitative Analysis

We examined the interconnectedness of stigma experiences in families living with HIV, from the perspective of multiple family members. Semi-structured interviews were conducted with 33 families (33 parents with HIV, 27 children under age 18, 19 adult children, and 15 caregivers). Parents were drawn from the HIV Cost and Services Utilization Study, a representative sample of people in care for HIV in US. All of the families recounted experiences with stigma, including 100% of mothers, 88% of fathers, 52% of children, 79% of adult children, and 60% of caregivers. About 97% of families described discrimination fears, 79% of families experienced actual discrimination, and 10% of uninfected family members experienced stigma from association with the parent with HIV. Interpersonal discrimination seemed to stem from fears of contagion. Findings indicate a need for interventions to reduce HIV stigma in the general public and to help families cope with stigma.     

Stigma and drug use settings as correlates of self-reported,non-fatal overdose among people who use drugs in Baltimore,Maryland

BackgroundFatalities from opioid overdose quadrupled during the last 15 years as illicit opioid use increased. This study assesses how stigma and drug use settings are associated with non-fatal overdose to identify targets for overdose risk reduction interventions and inform overdose education and naloxone distribution programs.MethodsWe surveyed 444 people who used drugs in Baltimore, Maryland, USA, from 2009 to 2013 as part of a randomized clinical trial of a harm reduction intervention. Participants reported demographic characteristics, drug use, overdose history, use of a local syringe services program, involvement in the local drug economy, and whether they experienced discrimination from others (i.e., enacted stigma) or stigmatized themselves (i.e., internalized stigma) related to their drug use. We used multinomial logistic regression models to identify correlates of experiencing a non-fatal overdose within the past year or >1 year ago relative to participants who never experienced an overdose.ResultsStigma was positively associated with experiencing a non-fatal overdose in the past year (adjusted Odds Ratio [aOR]: 1.7, 95% Confidence Interval [CI]: 1.1–2.7) and >1 year ago (aOR [95% CI]: 1.5 [1.1–2.0]) after adjustment for demographic and substance use characteristics. The association of stigma with overdose was stronger for enacted versus internalized stigma. The number of public settings (shooting gallery, crack house, abandoned building, public bathroom, outside) where participants used drugs was also positively associated with experiencing an overdose.ConclusionsStigma related to drug use and using drugs in more settings may increase overdose risk. The effectiveness of overdose prevention and naloxone training may be improved by reducing discrimination against people who use drugs in community and medical settings and diversifying the settings in which overdose prevention trainings are delivered. These efforts may be enhanced by use of peer outreach approaches in which people who use drugs diffuse prevention messages through their social networks and within settings of drug consumption outside the medical setting.     

Background factors in people living with HIV in Japan who switch to cabotegravir plus rilpivirine: A pilot study

Long-acting therapy of cabotegravir and rilpivirine is expected to free people from the negative emotions of living with HIV associated with taking drugs, but problems such as increased number of hospital visits, lack of anti-HBV activity, and limited convenience in people with concomitant drugs have been noted. In this single-center, prospective, cross-sectional study, we investigated background factors of people living with HIV in Japan who chose cabotegravir plus rilpivirine. Forty-seven percent (36 of 76) of individuals chose this regimen, but many people living with HIV who visited the hospital once every 3 months or needed concomitant medications due to complications chose this regimen and there were no significant differences in background factors that could affect convenience between the groups of those who switched and those who did not.     

The effect of drama-based group therapy on aspects of mental illness stigma

This study examined the effect of drama-based group therapy on the self-esteem and self-stigma of five participants with mental illness and on the public stigma of seven university students without mental illness who participated in the same group. ABA single-case experimental design was utilized to systematically assess change across 14 time points. We used visual analysis to inspect change as well as hierarchical linear modeling that allows the aggregation of single-case results to the population level. To study the effect of the treatment, contrasts were examined, comparing scores at baseline, treatment, and follow-up. The findings for all measures indicated a significant difference between scores in the baseline phase compared with scores in both the intervention and the follow-up phases. Significant differences were not detected between scores in the intervention phase and the follow-up phase. Interpretations of findings are provided, followed by a discussion of possible change processes, limitations, and future directions.     

Prävention psychischer Erkrankungen – Ziele für ein Nationales Aktionsprogramm

Mental disorders represent an immense psychological, social and economic burden. Therefore, a national action plan for promoting mental health is suggested strengthening multimodal and interdisciplinary prevention measures in Germany. By offering low-threshold treatments at the same time relieve of healthcare systems and reduction of waiting time for guideline-based therapies are expected.