中国公众的心理疾病观：内容、结构及测量

发布时间：2018-07-03 09:21

  本文选题：中国公众 + 心理疾病观　； 参考：《华中师范大学》2015年博士论文

【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 psychosocial diseases worldwide is an important global public health problem. The lack of knowledge of psychological diseases, misconceptions and stigma attitudes of the public not only greatly impede the professional help for psychological disease patients, but also directly affect the living environment and disease recovery of patients with psychological diseases, and even impede the disease. The development of mental health service in the state and society, therefore, to strengthen the study of the public psychological disease concept, to find an effective way to reduce the public's mental illness and the stigma of their patients, has become an important research topic in the field of mental health service. The structural relationship between the two ideas of the public to mental illness and mental illness is not thoroughly analyzed. Secondly, the public concept is bound to be influenced by the social culture, which leads to the psychological view of the society under the social background characterized by individualist culture, which may not be suitable for the Chinese society characterized by collectivism. Based on the above two points, this study proposed the hierarchical structure system of psychological disease concept: psychological disease concept includes knowledge content, evaluative content and patient attitude three parts, and the three part is a hierarchical structure system. On this basis, the main purpose of this study is to describe Chinese public psychological disease. The content of the view and the relationship between the internal components, explore and verify the core dimensions that affect the attitude of the Chinese public to mental illness. First, the qualitative research method of interview and open questionnaire is used to explore the three parts of the public psychological disease concept in the knowledge content, the evaluation content and the patient's attitude. 183 people over 18 years of age from different regions, different professions and different ages have participated in the investigation. The main findings are as follows. The main findings are as follows: the symptoms can be recovered from the psychological and physical diseases in the public, and the "psychological" and "mental" problems are different types of differences in nature, and the representation of psychological diseases is transmitted. The archetype of the "psychosis" of the unification; psychological diseases are more fearful than physical diseases, because psychological diseases are regarded as extreme exceptions that are uncontrolled, which can lead to unrecoverable and unrecoverable damage and the tragic fate of discarded by the society; the attitudes of patients with psychological diseases include negative social refuses and positive Societies. The status of the coexistence of various components. Two the study was conducted to explore and verify the knowledge content of psychological disease concept, evaluation content and three parts of the attitude of patient's attitude. There were 1375 subjects from 27 provinces and cities in China, and 1375 subjects of different ages, professions and social classes participated in the study. The results are as follows: (1) in the knowledge content, the knowledge of psychological diseases includes social destructive behavior, abnormal speech expression, abnormal interpersonal relationship, abnormal appearance, abnormal ideas, abnormal emotions, abnormal thinking characteristics and seven dimensions, and the understanding of psychological diseases includes social atmosphere and environment. A total of six dimensions, such as folding strike and life stress, emotional factors, family environment, interpersonal communication, brain and body defects, including family burden and influence, social isolation, self injury, frustrations of career and life, emotional pain, loss of life safety and significance, endangering society, seven dimensions; about psychology The understanding of the methods of disease treatment includes the help of relatives and friends, medical treatment, psychological treatment, social help, self adjustment, self adjustment, self emotion regulation, social control, and eight dimensions. (2) the public assessment of psychological diseases in China includes the whole bad, the social harm is serious, the behavior is difficult to predict, the cause is difficult to understand, difficult to treat, and difficult to treat. The influence of the body is serious, the cause is complicated and the cause is controlled by individual. There are eight dimensions. (3) the public's emotional feelings of psychological disease patients include embarrassment, repression, pity, tension and fear, and there are four dimensions. The behavior tendency of patients with psychological diseases includes three dimensions. A regression analysis was used to test the knowledge content of mental illness, the relationship between the evaluative content and the three components of the patient's attitude. The research tool was made up of a self compiled questionnaire for public mental illness in China. The subjects were adults over 18 years of age, from 23 provinces, and 695 of the 4 municipalities. The research found that three components were different. There are different degrees of correlation between the dimensions. Among the knowledge content, the understanding of the causes of psychological disease has less influence on the evaluative content, and the understanding of the consequences of the disease and the understanding of the treatment methods have greater impact on the evaluative content. The overall bad evaluation of mental diseases mainly focuses on the effect of the disease on the patient itself; The social harmfulness evaluation is mainly aimed at the serious "psychosis" with high abnormal symptoms. It thinks that the symptoms of psychological diseases are highly abnormal and the social harm is serious. The concept of social control and medical treatment can predict the negative attitude towards the patients. For the main reason, psychosocial treatment, self-regulation and social help can predict positive emotions to patients. Study four multidimensional scale analysis is used to explore the core dimensions of public assessment of psychological diseases. According to the standard of disease diagnosis, 20 kinds of case description materials for common mental diseases are written, and psychological diseases will be used. The 9 indicators of the disease evaluation were designed to be 9 assessment problems. The subjects were evaluated for 9 problems in each case. A total of 156 subjects, with a mean age of 35.14 years (SD=12.78), found that the core dimension of psychological disease evaluation was the severity of mental illness and the personal controllability of the cause, of which the severity of the disease included the unpredictability of the patient's behavior. The severity of the damage to the society, the severity of the disease, the degree of the difficulty of the disease and the overall bad nature of the disease. Study five the implicit association test and the behavior test were used to test the core dimension of psychological disease evaluation on the implicit attitude of mental illness and the role of.195 in the patient's help. All 28.92 years old (SD=11.67). The results showed that the higher the overall evaluation of the disease was more negative to the implicit evaluation of the patients; the higher the personal controllability of the causes of mental illness, the more active the implicit attitude of the patients; the higher the assessment of the individual impact on the individual psychological disease, the more negative the implicit attitude to the patients. Overall poor assessment will enhance the public's willingness to face face-to-face assistance to mental illness, but reduce the length of the public's face-to-face assistance to patients with mental illness. The assessment of the difficult behavior of patients with mental illness will reduce the public's willingness to help patients with mental illness face-to-face. On the basis of the previous five studies, Six a simplified Chinese public psychological disease survey questionnaire was compiled. A large scale questionnaire survey was conducted with 2222 adults from different regions of the country to analyze the overall evaluation and attitude of the Chinese public on psychological diseases. The knowledge content of the public mental disease concept in China was analyzed with the six common types of psychological diseases. The results showed that the evaluation of mental illness in the Chinese public is that the patient's behavior is weird, the behavior is difficult to predict, the whole is bad, the cause is complex, the individual influence is serious, the treatment is difficult, and the social harm is serious. The public believes that the cause of mental illness is multifaceted. The most prominent consequences are personal emotional pain, family burden and impact, injury to self and the failure of individual career and life. Psychotherapy is considered to be the most effective treatment, medical treatment and social management are not useful. Conclusions: (1) Chinese public heart The content of the concept of physical disease includes three parts: knowledge content, evaluative content and patient attitude. The knowledge contains the cognition of patient performance, disease causes, consequences and treatment methods. The Chinese public's cognitive representation of these aspects is the original type of serious "psychosis", but there is "psychological" and "mental" problems. The Chinese public from the overall bad, the serious social harm, the serious individual influence, the abnormal behavior of the patient, the difficult to treat, the cause complex, the reason difficult to understand and the individual controllable eight aspects to evaluate the psychological disease, the negative evaluation of the psychological disease; the Chinese public's emotional feelings about the psychological disease patients include The four main components of embarrassment, embarrassment, oppression, pity and tension are the most prominent, the sympathy of the patient is most prominent, the behavior tendency of the patient includes discrimination mockery, understanding of help and refusal to avoid. (2) the relationship between the internal components of the psychological disease concept is closely related, and the recognition of the consequences of the disease is the main basis for the evaluation of mental illness and the influence of the patient's state. The main factors of degree. (3) the core dimension of psychological disease concept is the two aspects of the severity of mental illness and the personal controllability evaluation of the cause, among which the severity evaluation is based on the damage degree of the disease to the patients and the social interests. These two aspects are related to the implicit attitude of the public to the psychological disease, and can be pretreated to a certain extent. Measure the public's help to patients with mental illness.
【学位授予单位】：华中师范大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：B844
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本文编号：2093167