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中国公众的心理疾病观:内容、结构及测量

The Conception of Mental Illness in Chinese Public: Content, Structure and Measure

【作者】 李凤兰

【导师】 江光荣

【作者基本信息】 华中师范大学, 应用心理学, 2015, 博士

【摘要】 世界范围内心理疾病的高流行率是一个重要的全球性公共卫生问题。公众关于心理疾病知识的缺乏,观念的误区以及污名态度,不仅极大地阻碍了心理疾病患者的专业求助,也直接影响了心理疾病患者的生存环境和疾病康复,甚至阻碍了国家和社会心理健康服务事业的发展。因此,加强公众心理疾病观研究,寻找减少公众对心理疾病及其患者污名的有效途径,成为心理健康服务领域重要的研究主题。目前心理疾病观的许多研究都来自西方文化背景。首先,研究问题过于零散,未能深入地分析公众对心理疾病和心理疾病患者的观念二者的结构关系。其次,公众的观念必然受社会文化的影响,这导致西方以个人主义文化为特征的社会背景下的心理疾病观,可能不适宜于以集体主义文化为特征的中国社会。基于以上两点,本研究提出了心理疾病观的层级结构系统假设:心理疾病观包含知识性内容、评价性内容和对患者态度三个部分,三个部分是一个存在层级结构的系统。在此基础上,本研究的主要研究目的是描述中国公众心理疾病观的内容以及内部各成分之间的关系,探寻并验证影响中国公众对心理疾病患者态度的核心维度。研究一采用访谈和开放式问卷的质性研究方法,探索公众心理疾病观在知识性内容、评价性内容和对患者态度三个部分上的具体内容。共有183名超过18周岁来自不同地域、不同职业、不同年龄的被试参与了调查。主要研究发现如下,在公众眼里心理疾病与身体疾病不同,其症状可以自愈;“心理”问题与“精神”问题是存在本质差异的不同类别;对心理疾病的表征以传统的“精神病”为原型;心理疾病比身体疾病更可怕,因为心理疾病被视为难以掌控的极端异常,会导致患者不可恢复的彻底损伤和被社会抛弃的悲惨命运;对心理疾病患者的态度表现出包含不同程度的消极的社会拒绝和积极的社会接纳的多种成分并存的状况。研究二采用自编的《中国公众心理疾病观问卷》探索并验证心理疾病观知识性内容、评价性内容和患者态度三部分各自的维度结构。共有来自全国27个省市、不同年龄、职业和社会阶层的1375名被试参与了问卷调查。结果发现:(1)知识性内容中,对心理疾病患者表现的认识包含社会破坏行为、言语表现异常、人际关系异常、外表神情异常、思想观念异常、情绪异常、思维特点异常,共七个维度;关于心理疾病的原因认识包含社会风气及环境、挫折打击及生活压力、情绪因素、家庭环境、人际交往、大脑及身体缺陷,共六个维度;关于心理疾病后果的认识包括家庭负担及影响、社会隔离、自我伤害、事业及生活受挫、情绪痛苦、失去生命安全及意义、危害社会,共七个维度;关于心理疾病处理方法的认识包括亲友帮助、医学治疗、心理治疗、社会帮助、自身活动调节、自身心理调节、自身情绪调节、社会管制,共八个维度。(2)中国公众对心理疾病的评价包含整体糟糕、社会危害严重、行为怪异难预测、原因难理解、难治疗、个体影响严重、原因复杂和原因个人可控,共八个维度。(3)公众对心理疾病患者的情绪感受包含尴尬无奈、压抑恼火、同情惋惜、紧张害怕,共四个维度;对心理疾病患者的行为倾向包含拒绝回避、歧视嘲笑和理解帮助,共三个维度。研究三采用回归分析检验心理疾病观知识性内容、评价性内容和患者态度三个成分之间的关系。研究工具为自编的《中国公众心理疾病观问卷》,研究对象为18周岁以上成年人,共有来自23个省、4个直辖市的695人参与了问卷调查。研究发现,三成分各维度之间存在不同程度的相关。其中知识性内容中关于心理疾病原因的认识对评价性内容的影响较少,而关于疾病后果和处理方法的认识对评价性内容的影响更大。心理疾病的整体糟糕性评价主要针对的是疾病对患者自身的影响;而社会危害性评价主要针对的是症状表现异常程度高的严重的“精神病”。认为心理疾病症状表现异常程度高、社会危害严重、需要社会管制和医学治疗的观念可以正向预测对患者的消极态度;认为心理疾病异常程度低、以情绪因素为主要原因、需要心理治疗、自身调节和社会帮助的观念可以正向预测对患者的积极情绪。研究四采用多维尺度分析法探索影响公众对心理疾病评价的核心维度。根据疾病诊断标准编写20种常见心理疾病的案例情景描述材料,将心理疾病评价的9个指标设计为9个评估问题,被试对每个案例的9个问题进行评估。总共有156个被试,平均年龄35.14岁(SD=12.78)分析结果发现,心理疾病评价的核心维度是心理疾病的严重性和原因个人可控性,其中严重性包含患者行为不可预测性、患者对社会危害的严重性、疾病对个体影响的严重性和疾病难处理的程度及整体糟糕性。研究五采用内隐联想测验和行为学实验检验心理疾病评价核心维度对心理疾病内隐态度和对患者帮助行为的作用。195名被试参与了实验研究,平均年龄28.92岁(SD=11.67)。结果显示,疾病的整体糟糕性评价越高对患者的内隐评价越消极;对心理疾病原因个人可控性评价越高,对患者的内隐态度越积极;对心理疾病个体影响严重性评价越高,对患者的内隐态度越消极。对心理疾病的整体糟糕性评价会提升公众对心理疾病患者面对面帮助的意愿,但是会降低公众对心理疾病患者面对面帮助的时间长度。对心理疾病患者行为难预测的评价会降低公众对心理疾病患者面对面帮助的意愿。在前期五个研究基础上,研究六编制了简化的中国公众心理疾病观调查问卷,以来自全国不同地区共2222名成年人为样本进行大规模问卷调查,分析中国公众对心理疾病的整体评价和态度,并以常见的六种心理疾病类型为例,分析中国公众心理疾病观的知识性内容。结果发现,中国公众对心理疾病的评价是患者表现怪异、行为难预测、整体糟糕、原因复杂、个体影响严重、处理困难、社会危害严重。对心理疾病患者的情绪感受中同情惋惜的成分最为突出,同时也包括歧视、理解帮助和回避拒绝等态度和行为倾向。公众认为心理疾病的原因是多方面,最突出的后果是个人情绪痛苦、家庭负担及影响、伤害自我及造成个体事业及生活的失败。心理治疗被认为是最有效的治疗方法,医学治疗和社会管制的用处不大。研究结论:(1)中国公众心理疾病观的内容包含知识性内容、评价性内容和患者态度三个部分。知识性内容包含患者表现、疾病原因、后果和处理方法方面的认知,中国公众对这些方面的认知表征以严重的“精神病”为原型,但存在“心理”问题与“精神”问题的区分;中国公众从整体糟糕、社会危害严重、个体影响严重、患者行为怪异难预测、难治疗、原因复杂、原因难理解和原因个人可控八个方面对心理疾病进行评价,存在对心理疾病的消极评价;中国公众对心理疾病患者的情绪感受包含尴尬无奈、压抑恼火、同情惋惜和紧张害怕四个主要成分,同情惋惜最为突出,对患者的行为倾向包含歧视嘲笑、理解帮助和拒绝回避。(2)心理疾病观内部各成分之间关系密切,疾病后果的认知是心理疾病评价的主要依据,也是影响患者态度最主要的因素。(3)心理疾病观的核心维度是心理疾病的严重性和原因个人可控性评价两个方面,其中严重性评价以疾病对患者及社会利益的损害程度为主要依据。这两个方面与公众对心理疾病的内隐态度相关,可以在一定程度上预测公众对心理疾病患者的帮助行为。

【Abstract】 The high prevalence of mental illness within the scope of the world appears to be an important global public health problem. Lack knowledge of mental illness, misunderstanding and stigma to mental illness of the public, greatly hampered the patients seeking professional help, damaged to their living atmosphere and rehabilitation, even hindered the development of mental health services in the nation and social. Therefore, it has become an important research topic in the field of mental health services to do more research on public conceptions of mental illness and to reduce the stigma to mental illness and patients of the public.At present many researches on the public conception of mental illness are rooted in western cultural background. Firstly, research topics are scattered, not involving the structural relationship between the conception of mental illness and attitude toward patients. Secondly, views of public are inevitably influenced by social culture, which leads to the findings under the western culture characterized by individualism are possibly not fitted in Chinese culture characterized by collectivism. Based on the above two points, this study puts forward the assumption that public conception of mental illness is a hierarchy system composed of three components:knowledge, evaluation of mental illness, and the attitudes towards patients. Based on this assumption, six researches in this study were used to describe the contents of and the relationship among the three components, explore and validate the core dimensions of the conception of mental illness in Chinese public.In study 1, we used qualitative method to explore contents of the three components by research interview and open-ended questionnaire. A total of 183 participants above 18 years from different areas, professions and ages participated. Results showed, in the eyes of public:problems of psychological was different from physical illness which existed organic damage, and it could be self-healed; problems of mental and psychiatric are essentially different; the representation of mental illness were based on originally prototypes of psychosis; sometimes, mental illness was more terrible than physical illness due to the uncontrollable extremely abnormality; public attitudes towards patients coexisted negative social refuse and positive social accept.In study 2, we used questionnaire survey to explore dimensions of the three components by EFA and CFA. A total of 1375 participants from 27 provinces, with different professions, social status and ages, joined the research. The results indicated:(1)About the knowledge content, opinions of patients manifestations including seven dimensions:social vandalism, abnormal verbal expression, abnormal interpersonal relationship, abnormal appearance and expression, abnormal thoughts, abnormal feelings, and abnormal thinking characteristics; The causes of mental illness containing six dimensions:social climate and environment, frustration and life pressure, emotional factors, family environment, interpersonal relationship, brain and body defect; The consequences of mental illness containing seven dimensions:burden and affect to family, social isolation, self-injury, career and life setbacks, emotional pain, loss of life safety and meaning, harm the social security; The handle methods of mental illness including eight dimensions:help from friends and family, medical treatment, psychotherapy, social support, self-adjustment by activity, adjustment thought by self, adjustment emotion by self and social control. (2)The evaluation of mental illness included eight dimensions:bad on the overall, serious harm to social,behaviors’ unpredictable reasons hard to understand, difficult to treat, serious impact on individual, complex reasons and individually controllable reasons; (3)The public feeling to patients with mental illness included four dimensions:embarrassing and helpless, depressed and annoyed, sympathy and pity, tension and fear; behavior disposition towards patients included three dimensions:avoidance, discrimination, understanding and helping.In study 3, we examined relationship of the three components by regression analysis. Self-made Chinese public view of Mental Illness Questionnaire was used in a sample of 695 above 18 years from 27 provinces from the country. The mean age was 37.44 (SD= 13.86). We found that there were correlations in different degree among those dimensions of three components. Among contents of knowledge component, opinions on consequences and handle methods of mental illness affected evaluation component more than opinions on causes of mental illness. Bad on the overall evaluation to mental illness focused on impact on patients themselves, and social harmful evaluation focused to some extremely abnormal psychosis. Public opinions of negative effect of mental illness could predict negative attitude to patients, and understanding could predict positive attitude to patients.Based on the nine indexes of evaluation component obtained from study 2, in study 4, we used multidimensional scaling analysis method to explore the core dimensions of evaluation on mental illness. We showed 20 vignettes of different mental illness patients, participants should evaluate vignettes by the nine indexes according to understanding by themselves.156 participants from 18 provinces completed the investigation. The mean age was 35.14 (SD=12.78). The results showed that the core dimensions were consequences severity and causes-controllable by themselves, with severity including patient behaviors’unpredictable, serious harm to social, serious impact on individual, difficult to treat and bad on the whole.In study 5, we used the implicit association test and behavioral experiment to investigate the impact of core dimensions of evaluation on implicit attitude to mental illness and helping behavior to patients. A total of 195 adults participated the research, with mean age of 28.92(SD=11.67). Results showed that the worse evaluation on the disease, the more negative public implicit attitude to patients; the more controllable to illness causes, the more positive public attitude to patients; the more severity of impact on individual, the more negative attitude to patients. The overall bad evaluation to mental illness would improve the willingness of giving help to patients face-to-face, but reduce the time length of giving help. Public opinions of patients’ behaviors hard to predict would reduce their willingness of giving help to patients face-to-face.Based on the above five studies, the sixth study developed a simplified version of Chinese Public conception of Mental Illness Questionnaire in a sample of 2222 from all over the country to investigate Chinese public view of mental illness, and explore the knowledge contents component. Results showed that in the eye of Chinese public, the mental illness is weird,patient behaviors’ unpredictable, bad on the whole, causes complex, impact on individual severely, difficult to handle and harmful to social. The most prominent feeling to patients is sympathy and pity. There were also other feelings such as discrimination, understanding, and refusal. In the eye of public, mental illness was caused by several reasons, and the main consequences were pain to patient individual, burden to family, and fail in career and life. Psychological treatment was considered to be the most effective method, and medical treatment and social control as useless.Research conclusion:(1)The conceptions of mental illness in Chinese public composes three components:knowledge, evaluation of mental illness, and the attitudes towards patients. The knowledge content involve opinions of patients manifestations, the causes, consequences and handle methods of mental illness. The representations of mental illness were based on originally prototypes of psychosis, and the problems of psychological were distinguished from physical illness by public. The Chines public evaluate mental illness by eight indicate with bad on the overall, serious harm to social, serious impact on individual, behaviors’ unpredictable, reasons hard to understand, difficult to treat, complex reasons and individually controllable reasons. The evaluation of mental illness was negative. (2) There were correlations in different degree among those dimensions of three components. Opinions on consequences were the main basis for evaluation of mental disorder and attitudes toward the patient. (3)The core dimensions of conception of mental illness in Chinese public were consequences severity and causes-controllable by themselves, and the consequences severity was basis on evaluation of benefit damage on the patient and the society. There were correlations between the core dimension of conception and implicit attitude about mental illness, the help behavior toward patients affected by the core dimension of conception of mental illness.

  • 【分类号】B844
  • 【被引频次】7
  • 【下载频次】814
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