健康醫療照護領域專業人員與學生之精神疾病去污名介入成效：系統性回顧與網絡統合分析

Abstract

背景 醫療照護人員對於精神疾病的污名態度可能對精神疾病患者的醫療服務品質產生負面影響。目前已針對醫療照護人員發展出不同精神疾病去污名的介入方式，然而對於此特定族群的各項介入方式之成效仍尚未有明確的定論。本研究旨在進行網絡統合分析，估算並釐清針對醫療照護人員所設計的不同類型去污名介入方式之間的相對成效。 研究方法 本研究已註冊於PROSPERO（International prospective register of systematic reviews）數據庫（編號：CRD42018112865）。透過PubMed，MEDLINE，ERIC，PsycARTICLES，PsycINFO，CINAHL和Cochrane Liberty等電子資料庫進行文獻搜尋。搜尋年限至2018年止。搜尋關鍵字分為精神疾病、污名、介入方式以及醫療照護人員（專業人員和學生）等四大類。本研究僅限於具對照組之實驗設計之研究。研究分析使用隨機效應模型進行，效果量則使用標準化平均差異（standard mean difference, SMD）呈現。 結果 系統性文獻回顧結果共納入來自九個國家18項研究（20項數據）進行分析。網絡統合分析中，相對成效排名之前三名介入方式分別為：課堂教育融合影片觀賞的間接接觸（SUCRA = 81.5％），問題導向學習模式工作坊融合面對面的直接接觸（SUCRA = 77.4％）以及影片觀賞的間接接觸（SUCRA = 72.2％）。單獨社會接觸的介入方式以及融合社會接觸的教育介入方式其降低精神疾病污名的成效均比單獨教育介入方式更佳。本研究延伸過去的研究結果發現，融合社會接觸的去污名介入方式，不僅對於公眾，對於醫療照護人員亦為最有效降低精神疾病污名的短期介入方式。 結論 透過適當的介入可有效降低醫療照護人員對於精神疾病的污名態度。教育融合社會接觸的精神疾病去污名介入方式成效最佳，將可廣泛運用於醫療照護場域，改善精神疾病患者的醫療服務品質。未來研究需進一步探討影響去污名介入成效的組成要素，以提升介入成效。Background Stigma existing among healthcare providers (HCPs) may lead to a poor quality of healthcare services for people with mental illness. Given a plenty of research on changing the stigma of mental illness, little is known regarding evidence on interventions for reducing mental illness stigma in HCPs. This study aimed to conduct a network meta-analysis to estimate the relative efficacy among different types of anti-stigma interventions among HCPs. Materials and Methods This study has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42018112865). A systematic review was carried out in PubMed, MEDLINE, ERIC, PsycARTICLES, PsycINFO, CINAHL and Cochrane Library till 2018. Search terms fell into four categories: stigma, mental illness, anti-stigma intervention, and HCPs (professionals and students). Studies were limited to randomized and non-randomized controlled trials. Data was analyzed using a random-effect model with the effect size based on standardized mean difference (SMD). Results A total of 18 studies (20 trails) from nine countries were included in the analysis. In the network meta-analysis, rank probabilities showed that intervention of indirect contact plus lecture (SUCRA=81.5%), direct contact plus problem-based learning workshop (SUCRA=77.4%), and indirect contact (SUCRA=72.2%) had the highest probability of being ranked first, second, and third. Intervention with contact alone and with education combining social contact had a better ranking than those with education alone on reducing stigma. This might extend previous research that social contact is the most effective type of short-term intervention to improve stigma-related attitudes not only among the public but also among HCPs. Conclusion This study indicates that HCPs’ negative attitude toward mental illness can be changed in a positive way throughout an appropriate intervention. Our findings suggest that education combining social contact is the most effective type of anti-stigma interventions, which can be implemented in clinical practices to help reduce the negative effects of stigma among HCPs and improve the healthcare services for people living with mental illness. Further research is required to investigate the active ingredients of interventions in order to maximize the efficacy.