探討精神疾病熟悉程度對公眾污名的影響：結合統合分析與結構方程模型的研究

Abstract

研究目的：全球有近十億人患有精神疾病，其中近七成精神疾病患者未能尋求心理健康專業協助，公衆對於精神疾病的污名和歧視可能會進一步惡化這種情況。公眾對精神疾病的熟悉程度可有效減少精神疾病污名程度。公眾污名存有多面向性，各面向的關連性仍有待釐清。截至目前為止，已有許多探討熟悉程度與公衆污名相關性的研究，本研究旨在使用統合分析結合結構方程模型，檢驗熟悉程度與社會距離之間關連性，以及感知危險和恐懼在其中所扮演的角色。研究方法：本研究以PubMed、MEDLINE、ERIC、Psychology and Behavioral Sciences Collection和Airiti Library資料庫為範疇，針對2022年7月之前發表的相關論文進行了系統檢索。本研究採用六個綜合分析結果，建構熟悉程度、感知危險、恐懼和社會距離之間的雙變數相關矩陣。進而在結構方程模型中檢驗熟悉程度到社會距離的「態度-情緒-行為」模型的影響路徑，感知危險和恐懼為此影響路徑的序列中介變項。研究結果：系統性文獻回顧結果共納入115個橫斷式研究中的117個獨立樣本，將207筆相關性數據納入分析，涵蓋了114,572位研究參與者。統合分析結果顯示，對精神疾病具有較高熟悉程度者具有較低公眾污名態度，而感知危險、恐懼和社會距離此三個變項彼此間具有正相關。關於熟悉程度與社會距離的影響路徑，簡單中介模式檢驗結果並不支持感知危險或恐懼為單一中介因子，然而，序列中介模式檢驗結果則顯示感知危險和恐懼為序列中介因子 (B=-0.015, p=0.034)。結論：本研究為第一個探討熟悉程度到社會距離的態度-情緒-行為模型的統合分析結合結構方程模型研究，有助於瞭解熟悉程度、感知危險、恐懼和社會距離之間的雙變量關係，並驗證熟悉程度影響公衆污名的可能影響路徑，本研究結果可提供發展精神疾病去污名介入方案或政策的實證研究基礎。未來研究可針對本研究所驗證的序列中介模型進行長期追蹤研究，探討熟悉程度對公眾污名的動態及長期的影響歷程。Background and aims: Mental illness affects almost one billion people worldwide, with nearly 70% of individuals with mental illness not seeking professional psychological assistance. Public stigma and discrimination towards mental illness can worsen this situation. Public stigma towards mental illness encompasses multiple dimensions, and the interrelationships between these dimensions require further clarification. While several studies have examined the association between familiarity and public stigma towards mental illness, there is a need to conduct a meta-analytic structural equation modeling study to investigate the relationship between familiarity and social distance, as well as the role of perceived dangerousness and fear in this relationship.Method: This study conducted a systematic search of relevant articles published before July 2022 in the PubMed, MEDLINE, ERIC, Psychology and Behavioral Sciences Collection, and Airiti Library databases. A bivariate correlation matrix was constructed among familiarity, perceived dangerousness, fear, and social distance using six meta-analysis results. Additionally, a structural equation modeling was employed to examine the paths of the Attitude-Emotion-Behavior model, exploring the relationship from familiarity to social distance. Perceived dangerousness and fear were included as serial mediating variables in our study.Results: The meta analysis obtain and code 207 correlations, based on 115 articles of 117 samples, encompassing a total sample of 114,572 participants. The meta-analysis revealed a significant association between higher levels of familiarity with mental illness and lower levels of public stigma. Furthermore, a positive correlation was observed among the three variables of perceived dangerousness, fear, and social distance. In terms of the influence path between familiarity and social distance, the results of the simple mediation model did not support perceived dangerousness or fear as individual mediators. However, the results of the serial mediation model demonstrated that perceived dangerousness and fear acted as serial mediators (B = -0.015, p = 0.034).Conclusion: This study represents the first investigation utilizing meta-analytic structural equation modeling to explore the attitude-emotion-behavior model between familiarity and social distance. The findings significantly contribute to our understanding of the bivariate relationships among familiarity, perceived dangerousness, fear, and social distance. Moreover, these findings validate the influential pathway of familiarity on public stigma. Importantly, the results of this study offer empirical evidence that can serve as a foundation for developing interventions or policies aimed at reducing the stigma associated with mental illness. For future research, it is recommended to conduct long-term follow-up studies to explore the dynamic and long-lasting impact process of familiarity on public stigma, building upon the serial mediation model validated in this study.