心理疾病自我污名:心理康复的一个高危因子

心理疾病自我污名是心理疾病患者内化公众的消极刻板印象、偏见和歧视,形成自我偏见和歧视的现象.心理疾病自我污名会给患者带来一系列的负面影响,是心理康复过程中的一个高危因子.自我污名可能是通过引发患者的消极认知、负面情感和自我歧视行为来危及心理康复过程的.对自我污名的干预应针对患者和社会公众分别加以实施.未来可以从理论构建、测量工具和干预措施的改进,以及去污名与心理康复的融合等方面展开自我污名本土化的研究.     

污名现象及其心理效应

污名本质上是一种消极的刻板印象,是社会对某些个体或群体贬低性的、侮辱性的标签,对被污名者有着深刻的影响。文章从三个方面对污名的相关研究做了简要的回顾。首先介绍了几种污名的相关定义;然后介绍了污名的心理效应,包括污名他人的功能,污名对群体和个体的影响,以及社会公众对污名的态度和应对过程;第三介绍了两个污名研究的主要领域：一个是污名群体知觉、应对歧视规律的污名歧视研究,另一个是可隐匿污名的相关研究,如隐匿污名的心理过程,隐匿的情绪反应以及揭示污名的心理意义等。最后,提出了未来研究的几点展望,可隐匿污名的相关研究,内隐社会认知研究和消除污名消极影响的干预研究     

体重污名:对肥胖的歧视与偏见

体重污名指个体因超重或肥胖受到的社会污名,主要表现为公众对这一群体的歧视、偏见、消极态度,其测量主要从公众和被污名群体自身展开。它会对被污名个体的心理、行为、身体产生消极影响,且这些影响之间存在递进关系。现有体重污名干预研究主要聚焦于减少公众污名、降低体重以及缓解体重污名消极心理影响三个方向。未来研究可以在体重污名影响机制、测量工具和行之有效的干预策略方面进一步扩展。     

国外心理疾病烙印影响研究概述

心理疾病污名足加诸在心理疾病患者身上的耻辱标记,世界卫生组织2001年指出"心理和行为障碍患者康复的最大阻碍就是社会对他们的污名和与之相连的歧视".作者对国外污名领域的研究进行了回顾,论述了心理疾病污名的概念、有关其影响机制的理论和实证研究.从公众污名和自我污名两方面论述了污名对心理疾病患者的影响以及消除污名的方法.     

群体认同、自尊和心理疾病污名的关系

通过对620位在校大学生进行问卷施测,探讨大学生群体认同、自尊和心理疾病污名之间的内在关系,并使用LISREL 8.70建构了彼此之间的关系模型,进行了中介效应分析.结果发现:(1)群体认同显著地负向预测自我污名,且通过自尊和公众污名这两个中介变量影响自我污名;(2)自尊显著负向预测自我污名,公众污名显著正向预测自我污名.结论:三个变量之间相关非常显著;所建构的模型具有较高的拟合度.     

艾滋病污名的形成机制、负面影响与干预

艾滋病污名主要包括实际污名、感知污名和自我污名, 这些不同形式的污名给艾滋病患者带来了精神上的痛苦、社会资源的剥夺等一系列的负面影响。归因理论、社会文化理论和道德理论分别从社会心理学、社会不平等和文化道德的角度阐述了艾滋病污名的形成机制。从这些机制出发, 减少艾滋病污名可以结合接触假设、知识传播以及认知行为疗法, 并注意改变艾滋病患者的自身观念。未来的艾滋病污名研究应更多地从社会文化以及道德的角度进行跨文化的量化研究。     

心理疾病内隐污名述评

心理疾病内隐污名是个体无法内省或精确识别的与心理疾病有关的痕迹, 它潜在地调节着个体对心理疾病患者的观念和行为。心理疾病内隐污名的主要测量方法包括内隐联想测验、简式内隐联想测验、启动任务和生理心理测量。当前该研究领域集中在内隐污名的成分、公众内隐污名、自我内隐污名、去污名化评估等方面。未来研究可从心理疾病内隐污名的构成与结构、认知神经基础、测量整合和本土化等角度做进一步探讨。     

接触干预在减少精神障碍公众污名中的应用

接触干预是减少精神障碍公众污名的重要方式之一。不同接触形式已被广泛应用在减少公众污名的干预研究中, 且被证实在态度、情感、行为倾向等方面均能有效减少污名。接触干预的效果受到干预实施过程和干预对象特点两方面影响。从干预实施过程来看, 有效接触干预包含精神障碍患者、信息和互动三个关键成分, 这些成分需要具备一定特点才能产生效果; 同时, 多形式接触、连续接触、接触质量等成分的存在能够进一步扩大接触干预效果。从干预对象来看, 接触干预效果会随着干预对象的个体差异而有所不同。未来的研究需要进一步完善接触干预的研究设计, 丰富接触干预的理论机理研究, 推动接触干预的循证实践发展。同时, 应用接触干预减少特定群体公众污名, 以及干预特定精神障碍类型公众污名是进一步研究方向, 并在我国文化背景下进一步检验接触干预效果。     

大学生内隐艾滋病污名的刻板解释偏差研究

该研究随机抽取120名大学生,采用刻板解释偏差（SEB）对艾滋病内隐污名进行了探讨。结果发现：大学生对艾滋病有关的主语在积极行为情境下的归因数量显著少于在消极行为情境下的归因数量。对艾滋病有关的主语在与积极行为情景下的外归因数量显著少于消极行为情境下的外归因数量。这一结果表明大学生被试不存在内隐艾滋病污名。由于SEB方法的一些特点,内隐艾滋病污名还需进一步的验证,SEB作为测查高社会赞许性的内隐心理现象的有效性还需进一步讨论。     

污名应对策略的研究现状与展望

应激与应对的理论发展构建了污名应对研究的基本框架。污名应对策略是指被污名者在具体污名情境中为减少压力的消极影响而有目的地采用的情绪、认知和行为反应。目前, 关于被污名者应对污名策略的研究, 特别是艾滋病污名应对策略的研究日趋增多。根据不同的划分标准, 可以区分出问题聚焦性与情绪聚焦性策略、卷入与摆脱策略以及前摄性与反应性策略; 对于可隐藏污名而言, 还涉及到表露/隐藏策略。在研究方法上, 质性研究范式日益发挥重要作用。未来应该注重污名应对策略的情境性, 加强不同污名领域的专题研究, 关注对应对策略的评价并构建污名应对策略的层次模型。     

Stigma and Psychological Distress in People With HIV/AIDS

Using a community sample of 197 people living with HIV/AIDS, we examined how awareness of societal stigma (felt stigma) and negative feelings toward oneself as a member of a stigmatized group (self-stigma) are related to psychological well-being. Both felt stigma and self-stigma were significantly correlated with symptoms of depression and anxiety, but controlling for felt stigma reduced self-stigma's association with depressive symptoms to nonsignificance. Global self-esteem and social avoidance fully mediated the associations between self-stigma and distress but only partially mediated the associations between felt stigma and distress. Felt stigma mediated the relationship between distress and HIV-related changes in physical appearance.     

Community norms about suppression of AIDS-related prejudice and perceptions of stigma by people with HIV or AIDS

We investigated the relationship between community motivations to control AIDS-related prejudice and the experience of stigma by community members with HIV or AIDS, using self-reports from 203 New England residents with HIV or AIDS and 2,444 randomly selected residents of the same New England communities. Multilevel regression analyses revealed that the disclosure concerns of participants with HIV or AIDS were lower in communities where residents were motivated by personal values to control AIDS-related prejudice, and were higher in communities where residents were motivated by social pressure to control AIDS-related prejudice. Reported experiences with discrimination and exclusion were unrelated to community motivations. The results of our study suggest that external and internal pressures to control prejudice shape the experience of stigmatization.     

对体胖者的社会性偏向：本土化视角的探索

通过三个研究从本土化视角探索人们对体胖者的社会性偏向特征。研究1采用访谈法和问卷法获得了被试对体胖者的刻板印象内容；研究2使用情感温度计和AMP范式对体胖者的外显与内隐偏见进行了测量；研究3通过情境测量对比人们在不同生活情境中对体胖者的行为反应。结果表明，中国被试对体胖者的刻板印象内容提名以高热情特质为主，刻板印象评价呈现低能力为主的特征；人们对体胖者没有外显偏见，但存在一定内隐偏见；社会生活情境中体胖者可能遭遇歧视，对女性体胖者的歧视程度更高。总体上，人们对体胖者的社会性偏向表现出复合性的本土化特征。     

Personal Meaning,Social Support,and Perceived Stigma in Individuals Receiving HIV Mental Health Services

Human immunodeficiency virus (HIV) stigma represents a significant source of stress among individuals living with HIV disease, prompting interest in research to identify factors that may help to ameliorate the stress burden associated with HIV stigma. Consistent with this research line, the current study was conducted as a cross-sectional investigation examining associations between positive global personal meaning, social support, and perceived HIV stigma. Global personal meaning refers to beliefs and aspirations through which one ascribes value and purpose in living. The study sample was comprised of individuals living with HIV disease who presented for an initial visit in a specialty HIV mental health services program. In bivariate analyses, social support was negatively correlated with multidimensional aspects of HIV stigma that included distancing, blaming, and discrimination stigma, whereas personal meaning was negatively associated only with blaming stigma. In further analyses using structural equation modeling, social support significantly mediated the association between personal meaning and both distancing and blaming stigma. Interactions between positive personal meaning and social support may be useful to consider in future research on psychological resource factors and HIV stigma. Understanding these interactions may also inform clinical efforts to address HIV stigma concerns.     

Reducing AIDS-related stigma in developing countries: the importance of theory- and evidence-based interventions

In many developing countries persons living with HIV and AIDS experience strong stigma and discrimination, and AIDS-related stigma has an enormous negative impact on their social relationships, access to resources, and psychological well being. Moreover, AIDS-related stigma hampers HIV-related health promotion, including voluntary HIV counselling and testing. In this article, we will argue that programs to reduce AIDS-related stigma are most likely to be effective if these programs are based upon thorough needs assessments, theory- and evidence-based intervention strategies and collaborative planning. A protocol for health promotion programs design is outlined. Furthermore, psychosocial correlates of AIDS-related stigma in developing countries, social-psychological theories that might be useful in designing intervention strategies to reduce stigmatisation and successful elements of previous interventions aimed at stigma reduction are discussed. It is concluded that psychological theory does provide guidelines for the development of stigma-reducing intervention programs, but that such programs can only be effective when based upon context-specific needs assessment and collaborative planning.     

艾滋病羞辱和歧视的概念及研究工具发展状况

艾滋病相关羞辱和歧视量表的研制是对其进行评价和采取有效干预措施的先决条件。阐述了艾滋病相关羞辱和歧视的定义和分类,重点介绍和分析了目前应用较广泛的艾滋病羞辱和歧视量表,并指出这些量表主要由发达国家研制,缺少适合中国文化背景的量表;对艾滋病高危人群所经历的双重羞辱和歧视,全世界还没有相应的测量工具。研制和修订适合中国文化背景的艾滋病羞辱和歧视量表是该研究领域亟待解决的难题     

Individual attitudes and perceived social norms: Reports on HIV/AIDS‐related stigma among service providers in China

This study examined HIV/AIDS‐related stigma among Chinese service providers by comparing their personal attitudes toward people living with HIV/AIDS with their perception of social norms related to people living with HIV/AIDS. We randomly selected three provincial hospitals, four city/prefecture hospitals, 10 county hospitals, 18 township health clinics, and 54 village clinics from Yunnan, China. Doctors and nurses were randomly sampled proportionally to the doctor–nurse ratio of each hospital or clinic. Lab technicians were over‐sampled in order to include an adequate representation in the analysis. A total of 1,101 service providers participated in a voluntary, anonymous survey where demographic characteristics, individual attitude and perceived social norms toward people living with HIV/AIDS, discrimination intent at work, general prejudicial attitude and knowledge on HIV/AIDS were measured. A majority of the sample demonstrated a similarity between their personal views and what they thought most people in society believe. Multiple logistic regressions revealed that participants who were younger or reported personal contact with people living with HIV/AIDS were significantly more likely to report personal attitudes toward the population that were more liberal than their perceived social norms. Holding a more liberal personal attitude toward people living with HIV/AIDS than perceived social norms was significantly and negatively related to the level of discrimination intent at work, perceived discrimination at interpersonal level and the level of general prejudicial attitude toward people living with HIV/AIDS. Results underscored the importance of understanding social norms and personal attitudes in studying HIV‐related stigma and called for the incorporation of existing human capital into future HIV stigma reduction programs.     

An Investigation of the Determinants of Stigmatization and Prejudice Toward People Living With HIV/AIDS

The components and determinants of HIV/AIDS stigma and prejudice were investigated in an online‐questionnaire study. The results show that the components of the attitude toward people with HIV/AIDS consist of social distance, demands for political measures, negative stereotypes, and attribution of responsibility to people living with HIV/AIDS. Besides antigay attitudes and false beliefs about ways of infection, the HIV/AIDS attitude is connected to and depends on social dominance orientation (SDO) and right‐wing authoritarianism (RWA). Structural equation modeling indicated that antigay attitudes and false beliefs function as mediator variables for SDO and RWA. Implications of the results are discussed.