2型糖尿病患者病耻感调查及其影响因素分析

目的探讨2型糖尿病患者病耻感现状,并分析病耻感的影响因素。方法2018年8月—2020年3月期间,采用便利抽样法,对该院就诊的135例2型糖尿病患者进行问卷调查。调查工具为一般情况调查表、2型糖尿病病耻感评估表。对病耻感的影响因素进行单因素分析和多因素分析。结果所有患者平均病耻感得分为(54.22±10.65)分。不同年龄、文化水平、是否接受胰岛素治疗、是否合并并发症等4个因素的单因素亚组分析显示,组间病耻感得分差异有统计学意义(P<0.05);采用逐步多元线性回归分析显示,只有年龄、是否合并并发症、文化水平是影响病耻感的独立因素。结论该次调查显示2型糖尿病患者普遍存在病耻感,年龄低、具有糖尿病并发症和文化水平较高的患者具有更明显的病耻感,应引起医务人员的重视,并及时给予治疗干预。     

中学生专业心理帮助有效性、归因方式与心理污名关系

目的:了解中学生的心理健康素养状况,并研究心理健康素养各构成间的关系。方法:采用分层抽样抽取382名初高中生,采用一般资料调查表、知识测量、污名化量表、心理疾病病因观问卷和专业心理健康服务有效性问卷为工具。结果:1对短文主人公主要问题的识别在人口学上差异没有统计学意义;2污名化与归因(r=0.353,P0.01)和有效性(r=-0.140,P0.01)上也存在显著相关;3回归分析显示内因(U=0.051,P0.01)、外因(U=0.048,P0.01)和有效性(U=0.050,P0.01)对污名化有预测作用。结论:中学生的心理健康素养水平有待提高;各构成之间不是孤立的存在,尤其是污名化会导致中学生对专业心理帮助的有效性产生怀疑。     

‘You need to know in order to help’: how HIV-related stigma obstructs pastoral care in Kenyan primary schools

ABSTRACT

In low-resource and high HIV prevalence settings, schools are increasingly called upon as sites of care and support for vulnerable children. It is therefore crucial to understand the processes through which teachers take on pastoral care roles in response to the needs of vulnerable learners. As pastoral care is often contingent on teacher’s being aware of learner’s vulnerabilities and needs, we examine information-sharing between learners, their parents, and teachers. We draw on eight individual interviews conducted with teachers from three rural primary schools located in high HIV prevalence settings of the Siaya district of Western Kenya. The interviews were recorded, transcribed, and analysed using thematic network analysis. Our analysis revealed that HIV-related stigma made it difficult for vulnerable learners to disclose their vulnerabilities to teachers, fearing the repercussions of what might happen if other members of the school community would become aware of their association with HIV. When teachers sought out parents for more information, they were often met with denial of their vulnerabilities. This paper provides valuable insights into some of the difficulties primary school teachers face in ascertaining the pastoral care needs of vulnerable learners. It highlights that HIV-related stigma is a critical barrier for teachers to adopt a pastoral care role in high HIV prevalence communities of western Kenya.     

The association between experiencing discrimination and physical and mental health among people who inject drugs

BackgroundDiscrimination can be a daily issue in the lives of people who inject drugs (PWID). However, the extent to which discrimination is related to the health of PWID remains unclear.MethodsData focusing on discrimination against PWID and potential health correlates were collected as part of the 2013 Illicit Drug Reporting System, a national survey with 887 PWID recruited in all Australian states and territories. Experience of discrimination, its setting, perceived reason and outcome, were self-reported by participants. The Kessler-10 scale and the mental component score of the Short Form 12-Item Health Survey were used to measure mental health. Physical health was assessed using the physical component score of the Short Form 12-Item Health Survey, specifically questions assessing injecting related problems and risk behaviour. Poisson and multinomial regression analyses were performed. Models were adjusted for socio-demographic and drug-related covariates.FindingsPWID reported experiencing discrimination in pharmacies, hospitals, government services and doctors/prescribers. The most commonly reported instances of discrimination were being refused service and experiencing abuse and/or violence. Experience of discrimination was associated with mental and physical health indicators. PWID who experienced discrimination were more likely to report high or very high mental distress (ARRR = 2.4, CI₉₅ = 1.5–3.6) and mental health problems (ARRR = 1.4, CI₉₅ = 1.2–1.7). The mental functioning (ARRR = 1.3, CI₉₅ = 1.1–1.4) and physical functioning (ARRR = 1.1, CI₉₅ = 1.1–1.4) of PWID, who experienced discrimination, were also more likely to be below Australian population mean scores.ConclusionSelf-reported experience of discrimination was associated with poor mental and physical health amongst PWID.     

Effects of weight stigma in news media on physical activity,dietary and weight loss intentions and behaviour

ObjectivesTo investigate the effect of weight stigma in news media on (a) intentions to increase physical activity (PA), improve diet quality and lose weight, and (b) changes in PA, diet quality and body mass index (BMI) over one month, in (i) women of all weight categories and (ii) a subsample of women living with obesity.MethodsUK-based women (N = 172; subgroup with obesity N = 81) were assigned to read an experimental (weight stigma; N = 75) or control (smoking stigma; N = 97) news article. Questionnaires were administered immediately after, and one month subsequently to collect information on BMI, PA, diet quality, intentions, past stigma, and diet and PA self-efficacy. Logistic and linear regression analyses were used to assess the effect of weight stigma on all outcome variables.ResultsIn the whole sample, there was no significant effect of weight stigma on any primary or secondary outcome. In women with obesity, there was no significant effect of weight stigma on diet quality (0.26 units, 95% CI: ?0.36 to 0.87) or PA (?1.83 units, 95% CI: ?11.11 to 7.44) at follow up, but exposure to weight stigma was associated with a significant increase in BMI at 1-month follow-up (1.15 kg/m², 95% CI: 0.38 to 1.92) compared with the control group.ConclusionsIn people with obesity, exposure to weight-stigmatising media may contribute to increased BMI over time. Larger trials with longer follow-up are needed to confirm these findings.     

Culture,causal attributions to visual impairments,and stigma: A mediation model

BackgroundCausal attributions are central to the understanding of public reactions to disability (that is, disability-related stigma). Research shows that culture and ethnicity were found to play a significant role in both causal attributions of disability and disability-related stigma.Disability-related stigma was found to influence physical and mental health. Nevertheless, to the best of our knowledge, the relationships linking culture, causal attributions of disability and disability-related stigma, have not been previously examined.ObjectiveThe study examined whether causal attributions (natural, mystic, punitive and emotional) to a specific disability-visual impairments - mediate the relationship between culture and stigma towards individuals with visual impairments.MethodsA quota sample comprised of 305 university and college students was drawn. Data were collected via a self-reported questionnaire.ResultsThe main findings indicated that emotional and punitive causal attribution to visual impairments mediated the relationship between culture and visual impairments-stigma; Israeli Arab-Palestinians had a higher tendency to attribute higher levels of punitive and emotional causes to visual impairments compared to Israeli Jews. Higher levels of punitive and emotional attributed causes for visual impairments were correlated with higher levels of visual impairments-stigma. Israeli Arab-Palestinians have a higher tendency to attribute visual impairments to mystic causes compared to Israeli Jews. However, this type of perceived causation was unrelated to visual impairments-stigma.ConclusionsInterventions to reduce visual impairments-stigma should focus on misconceptions concerning causation. It is especially important to design culturally sensitive interventions for visual impairments stigma reduction among Israeli Arab-Palestinians, which will focus on de-psychologizing visual impairments.     

“I think that everybody should be involved”: What informs experiences of shared decision-making in supporting people living with schizophrenia spectrum disorders?

ObjectiveTo identify facilitators and barriers associated with shared decision-making (SDM) in Australians affected by schizophrenia spectrum disorders.MethodsWe surveyed 78 participants with lived experience and held 12 in-depth interviews, including seven carers.ResultsA multiple linear regression model identified two independent variables significantly associated with degree of SDM: Personal Wellbeing Index scores (ß = .32, t = 3.3, p = .001) and treatment satisfaction rating (ß =.46, t = 4.7, p < .001), indicating that higher personal wellbeing and higher treatment satisfaction were significantly related to higher degree of SDM. Two key themes were identified through interview data: a complex pathway to SDM and impacts on wellbeing. Sub-themes included: self and carer characteristics, holistic care, education and knowledge, and power balance. Generally, participants reported a desire for SDM, noting that healthcare professionals inconsistently involve them in treatment decisions.ConclusionSDM is associated with treatment satisfaction and personal wellbeing among people living with schizophrenia spectrum disorders, but can be difficult to implement due to a range of challenges.Practice implicationsThere is a need to improve SDM in this population by decreasing stigma and discrimination, balancing power in consultations, increasing access to holistic treatment, and improving education and knowledge.     

A national study of the mental health literacy of community pharmacists

BackgroundCommunity pharmacists are in a prime position to communicate with and assist those with mental health needs. However, mental health literacy, which includes beliefs and knowledge of mental health conditions, can impact the provision of pharmacy services. The mental health literacy of community pharmacists in New Zealand is currently unknown.ObjectivesTo assess the mental health literacy of community pharmacists in New Zealand.MethodsWe employed a national cross-sectional online survey, evaluating attitudes towards mental illness, ability to recognise depression using a vignette and followed by questions related to the helpfulness of various interventions, and willingness to provide pharmacy services for people with mental illness in comparison to cardiovascular diseases. Additionally, opportunities for mental health training were explored. Participants were community pharmacists working in New Zealand contacted via mailing lists of professional bodies.ResultsWe received responses from 346 participants. The majority of participants showed positive attitudes towards mental illness and correctly identified depression in the vignette (87%). Participants rated counsellors (84%) and physical activity (92%) as the most helpful professionals and intervention respectively while only 43% considered antidepressants as helpful for depression. When compared to other people in the community, long-term functioning of the individual described in the vignette was rated poorly, especially in terms of increased likelihood to attempt suicide (85%) and reduced likelihood to be a productive worker (64%). Approximately 30% of participants reported reduced confidence/comfort while approximately half of participants reported greater interest in providing mental health-related care compared to cardiovascular disease. The participants also highlighted several areas for future mental health training they wished to undertake.ConclusionsWe have identified positive attitudes towards mental illness in our study. Participants correctly identified and supported evidence-based interventions for mild to moderate depression. However, we highlighted the need for ongoing mental health training to address knowledge gaps and enhance the confidence in providing mental health-related care.