#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

“That’s all Fake”: Health professionals stigma and physical healthcare of people living with Serious Mental Illness


Autoři: Eliut Rivera-Segarra aff001;  Nelson Varas-Díaz aff002;  Axel Santos-Figueroa aff003
Působiště autorů: School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico aff001;  Department of Global and Sociocultural Studies, Florida International University, Miami, United States of America aff002;  Department of Psychology, University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226401

Souhrn

Background

People living with a Serious Mental Illness (SMI) die earlier than the general population due to preventable medical conditions. Latinos living with SMI are a particularly vulnerable population with higher prevalence of chronic medical conditions. Stigma has been identified as a factor that fosters health inequities for Latinos/as with SMI, particularly Puerto Ricans. Although personal and social consequences of stigmatization have been well documented, research regarding the role of cultural factors on healthcare interactions is scarce. Furthermore, little research has focused on addressing stigma from the perspective of healthcare professionals.

Methods

We investigated this process through a qualitative design using semi-structured individual interviews with 11 healthcare professionals (8 physicians and 3 nurses) in Puerto Rico. We conducted a thematic analysis to analyze the data.

Results

Following a thematic analysis, we found three main themes and nine sub-themes related to the stigmatization process. Some participants reported perceptions of dangerousness and uneasiness, social distance and inadequate care. Participants also emphasized a lack of medical training regarding SMI within the Puerto Rican context.

Conclusions

These findings support the need to develop culturally appropriate public health interventions targeting healthcare professionals in order to address stigma and eliminate health disparities among Latinos/as with SMI.

Klíčová slova:

Allied health care professionals – Culture – Emotions – Health care policy – Mental health and psychiatry – Physicians – Puerto Rico – Religion


Zdroje

1. National Institutes of Mental Health. [Internet]. 2009. Available from: https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

2. De Hert M, Dekker J, Wood D, Kahl K, Holt R, Möller H. Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). European Psychiatry. 2009;24(6):412–424. doi: 10.1016/j.eurpsy.2009.01.005 19682863

3. Lawrence D, Kisely S. Review: Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology. 2010;24(4_suppl):61–68.

4. Walker E, McGee R, Druss B. Mortality in Mental Disorders and Global Disease Burden Implications. JAMA Psychiatry. 2015;72(4):334. doi: 10.1001/jamapsychiatry.2014.2502 25671328

5. Druss B, Zhao L, Von Esenwein S, Morrato E, Marcus S. Understanding Excess Mortality in Persons With Mental Illness. Medical Care. 2011;49(6):599–604.

6. Thornicroft G. Physical health disparities and mental illness: the scandal of premature mortality. British Journal of Psychiatry. 2011;199(06):441–442.

7. Kisely S, Crowe E, Lawrence D. Cancer-Related Mortality in People with Mental Illness. 2013; 70 (2): 209–217. doi: 10.1001/jamapsychiatry.2013.278 23247556

8. Carliner H, Collins P, Cabassa L, McNallen A, Joestl S, Lewis-Fernández R. Prevalence of cardiovascular risk factors among racial and ethnic minorities with schizophrenia spectrum and bipolar disorders: a critical literature review. Comprehensive Psychiatry. 2014;55(2):233–247. doi: 10.1016/j.comppsych.2013.09.009 24269193

9. Hellerstein D, Almeida G, Devlin M, Mendelsohn N, Helfand S, Dragatsi D et al. Assessing Obesity and Other Related Health Problems of Mentally Ill Hispanic Patients in an Urban Outpatient Setting. Psychiatric Quarterly. 2007;78(3):171–181. doi: 10.1007/s11126-007-9038-y 17417734

10. Ortega A, Feldman J, Canino G, Steinman K, Alegría M. Co-occurrence of mental and physical illness in US Latinos. Social Psychiatry and Psychiatric Epidemiology. 2006;41(12):927–934. doi: 10.1007/s00127-006-0121-8 17013767

11. Cordero D. Preocupa retrato de salud mental en Puerto Rico [Internet]. Metro. 2017 [cited 10 August 2018]. Available from: https://www.metro.pr/pr/noticias/2017/05/03/preocupa-retrato-salud-mental-puerto-rico.html

12. Salud Mental en Puerto Rico. In: Departamento de Salud. http://www.salud.gov.pr/Documents/AcreditacióndelDepartamentodeSalud/PRDoHCHSA(DraftArt)SaludMental.pdf

13. Alegría M, Canino G, Shrout P, Woo M, Duan N, Vila D et al. Prevalence of Mental Illness in Immigrant and Non-Immigrant U.S. Latino Groups. American Journal of Psychiatry. 2008;165(3):359–369. doi: 10.1176/appi.ajp.2007.07040704 18245178

14. Alegría M, Mulvaney-Day N, Torres M, Polo A, Cao Z, Canino G. Prevalence of Psychiatric Disorders Across Latino Subgroups in the United States. American Journal of Public Health. 2007;97(1):68–75. doi: 10.2105/AJPH.2006.087205 17138910

15. Daviglus ML, Talavera GA, Avilés-Santa ML, Allison M, Cai J, Criqui MH, et al. Prevalence of Major Cardiovascular Risk Factors and Cardiovascular Diseases Among Hispanic/Latino Individuals of Diverse Backgrounds in the United States. JAMA. 2013;308(17):1775–84.

16. Daviglus ML, Pirzada A, Durazo-Arvizu R, Chen J, Allison M, Avilés-Santa L, et al. Prevalence of Low Cardiovascular Risk Profile Among Diverse Hispanic/Latino Adults in the United States by Age, Sex, and Level of Acculturation: The Hispanic Community Health Study/Study of Latinos. Journal of the American Heart Association. 2016;5(8).

17. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association. Circulation. 2013;127(1).

18. Cabassa LJ, Gomes AP, Meyreles Q, Capitelli L, Younge R, Dragatsi D, et al. Primary Health Care Experiences of Hispanics with Serious Mental Illness: A Mixed-Methods Study. Administration and Policy in Mental Health and Mental Health Services Research. 2013;41(6):724–36

19. Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a Fundamental Cause of Population Health Inequalities. American Journal of Public Health. 2013;103(5):813–21. doi: 10.2105/AJPH.2012.301069 23488505

20. Link B, Hatzenbuehler ML. Stigma as an Unrecognized Determinant of Population Health: Research and Policy Implications. Journal of Health Politics, Policy and Law. 2016;41(4):653–73. doi: 10.1215/03616878-3620869 27127258

21. Dijker AJM, Koomen W. Stigmatization, tolerance and repair: an integrative psychological analysis of responses to deviance. Cambridge: Cambridge University Press; 2009.

22. Link BG, Phelan JC. Conceptualizing Stigma. Annual Review of Sociology. 2001; 27: 363–385.

23. Phelan JC, Link BG, Dovidio JF. Stigma and prejudice: One animal or two? Social Science & Medicine. 2008;67(3):358–67.

24. Cook JE, Purdie-Vaughns V, Meyer IH, Busch JT. Intervening within and across levels: A multilevel approach to stigma and public health. Social Science & Medicine. 2014;103:101–9.

25. Stangl A, Earnshaw V, Logie C, Brakel W, Simbayi L, Barré I, Dovidio J. The Health Stigma Discrimination Framework: A Global, Crosscutting Framework to Inform Research, Intervention Development and Policy on Health Related Stigmas. BMC Medicine. 2019; 17; 31. doi: 10.1186/s12916-019-1271-3 30764826

26. Brakel W, Cataldo J, Grover S, Kohrt B, Nyblade L, Stockton M, Wouters E, Yang L. Out of the Silos: Identifying Crosscutting Features of Health-Related Stigma to Advance Measurement and Intervention. BMC Medicine. 2019: 17; 13. doi: 10.1186/s12916-018-1245-x 30764817

27. Koschorke M, Evans-Lacko S, Sartorius N, Thornicroft G. Stigma in Different Cultures. In Gaebel W, Rössler W, Sartorius N. (Eds). The Stigma of Mental Illness–End of the Story? Springer; 2017; 65–82.

28. Link BG, Yang LH, Phelan JC, Collins PY. Measuring Mental Illness Stigma. Schizophrenia Bulletin. 2004;30(3):511–41.

29. Yang LH, Kleinman A, Link BG, Phelan JC, Lee S, Good B. Culture and stigma: Adding moral experience to stigma theory. Social Science & Medicine. 2007;64(7):1524–35.

30. Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. Public conceptions of mental illness: labels, causes, dangerousness, and social distance. American Journal of Public Health. 1999;89(9):1328–33. doi: 10.2105/ajph.89.9.1328 10474548

31. Smith V, Reddy J, Foster K, Asbury ET, Brooks J. Public perceptions, knowledge and stigma towards people with schizophrenia. Journal of Public Mental Health. 2011;10(1):45–56.

32. Wood L, Birtel M, Alsawy S, Pyle M, Morrison A. Public perceptions of stigma towards people with schizophrenia, depression, and anxiety. Psychiatry Research. 2014;220(1–2):604–8. doi: 10.1016/j.psychres.2014.07.012 25064387

33. Mashiach-Eizenberg M, Hasson-Ohayon I, Yanos PT, Lysaker PH, Roe D. Internalized stigma and quality of life among persons with severe mental illness: The mediating roles of self-esteem and hope. Psychiatry Research. 2013;208(1):15–20. doi: 10.1016/j.psychres.2013.03.013 23570969

34. Vogel DL, Bitman RL, Hammer JH, Wade NG. Is stigma internalized? The longitudinal impact of public stigma on self-stigma. Journal of Counseling Psychology. 2013;60(2):311–6. doi: 10.1037/a0031889 23421775

35. West ML, Yanos PT, Smith SM, Roe D, Lysaker PH. Prevalence of Internalized Stigma among Persons with Severe Mental Illness. Stigma Research and Action. 2011;1(1).

36. Corrigan PW, Larson JE, Rüsch N. Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry. 2009;8(2):75–81. doi: 10.1002/j.2051-5545.2009.tb00218.x 19516923

37. Whitley R. Social Defeat or Social Resistance? Reaction to Fear of Crime and Violence Among People with Severe Mental Illness Living in Urban ‘Recovery Communities.’ Culture, Medicine, and Psychiatry. 2011;35(4):519–35.

38. Peluso ÉDTP Blay SL. Community perception of mental disorders. Social Psychiatry and Psychiatric Epidemiology. 2004;39(12):955–61. doi: 10.1007/s00127-004-0820-y 15583902

39. Mascayano F, Tapia T, Schilling S, Alvarado R, Tapia E, Lips W, et al. Stigma toward mental illness in Latin America and the Caribbean: a systematic review. Revista Brasileira de Psiquiatria. 2016;38(1):73–85. doi: 10.1590/1516-4446-2015-1652 27111703

40. Corrigan PW, Torres A, Lara JL, Sheehan L, Larson JE. The Healthcare Needs of Latinos with Serious Mental Illness and the Potential of Peer Navigators. Administration and Policy in Mental Health and Mental Health Services Research. 2016;44(4):547–57.

41. Rivera-Segarra E, Rivera G, López-Soto R, Crespo-Ramos G, Marqués-Reyes D. Stigmatization Experiences among People Living with Borderline Personality Disorder in Puerto Rico. The Qualitative Report. 2014;19(30):1–18.

42. Caqueo-Urízar A, Boyer L, Urzúa A, Williams D. Self-Stigma in Patients with Schizophrenia: A Multicentric Study from Three Latin-American Countries. Social Psychiatry and Psychiatric Epidemiology. 2019; https://doi.org/10.1007/s00127-019-01671-4

43. Sabogal F, Marín G, Otero-Sabogal R, Marín BV, Perez-Stable EJ. Hispanic Familism and Acculturation: What Changes and What Doesnt? Hispanic Journal of Behavioral Sciences. 1987;9(4):397–412.

44. Villatoro AP, Morales ES, Mays VM. Family culture in mental health help-seeking and utilization in a nationally representative sample of Latinos in the United States: The NLAAS. American Journal of Orthopsychiatry. 2014;84(4):353–63. doi: 10.1037/h0099844 24999521

45. Andrés-Hyman RC, Ortiz J, Añez LM, Paris M, Davidson L. Culture and clinical practice: Recommendations for working with Puerto Ricans and other Latinas(os) in the United States. Professional Psychology: Research and Practice. 2006;37(6):694–701.

46. Torres JB, Solberg VSH, Carlstrom AH. The myth of sameness among Latino men and their machismo. American Journal of Orthopsychiatry. 2002;72(2):163–81. doi: 10.1037/0002-9432.72.2.163 15792057

47. Lawrence RE, Brent D, Mann JJ, Burke AK, Grunebaum MF, Galfalvy HC, et al. Religion as a Risk Factor for Suicide Attempt and Suicide Ideation Among Depressed Patients. The Journal of Nervous and Mental Disease. 2016;204(11):845–50. doi: 10.1097/NMD.0000000000000484 26894320

48. Yang LH, Chen F-P, Sia KJ, Lam J, Lam K, Ngo H, et al. “What matters most:” A cultural mechanism moderating structural vulnerability and moral experience of mental illness stigma. Social Science & Medicine. 2014;103:84–93.

49. Pescosolido BA, Boyer CA. The American Health Care System Beginning the Twenty-First Century with High Risk, Major Challenges, and Great Opportunities. In: Cockerham W, editor. The New Blackwell Companion to Medical Sociology. Oxford, U.K.: Wiley-Blackwell; 2010. p. 391–411.

50. Schulze B. Stigma and mental health professionals: A review of the evidence on an intricate relationship. International Review of Psychiatry. 2007;19(2):137–55. doi: 10.1080/09540260701278929 17464792

51. Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rüsch N, Brown J, Thornicroft G. What is the Impact of Mental Health-Related Stigma on Help-Seeking? A Systematic Review of Quantitative and Qualitative Studies. Psychological Medicine. 2015; 45; 11–27. doi: 10.1017/S0033291714000129 24569086

52. Henderson C, Noblett J, Parke H, Clement S, Caffrey A, Gale-Grant O, Schulze B, Druss B, Thornicroft G. Mental Health-Related Stigma in Health Care and Mental Health-Care Settings. Lancet Psychiatry. 2014; 1; 467–482 doi: 10.1016/S2215-0366(14)00023-6 26361202

53. Kopera M, Suszek H, Bonar E, Myszka M, Gmaj B, Ilgen M, et al. Evaluating Explicit and Implicit Stigma of Mental Illness in Mental Health Professionals and Medical Students. Community Mental Health Journal. 2014;51(5):628–34. doi: 10.1007/s10597-014-9796-6 25535045

54. Stone E, Nawei L, Daumit G, Linden S, McGinty E. General Medical Clinicians’ Attitudes Towards People with Serious Mental Illness: A Scoping Review. Journal of Behavioral Health Services & Research. 2019: 1–23.

55. Rao H, Mahadevappa H, Pillay P, Sessay M, Abraham A, Luty J. A study of stigmatized attitudes towards people with mental health problems among health professionals. Journal of Psychiatric and Mental Health Nursing. 2009;16(3):279–84. doi: 10.1111/j.1365-2850.2008.01369.x 19291157

56. Nordt C, Rössler W, Lauber C. Attitudes of Mental Health Professionals Toward People With Schizophrenia and Major Depression. Schizophrenia Bulletin. 2006; 32 (4); 709–714. doi: 10.1093/schbul/sbj065 16510695

57. Pascal Hengartner M, Adrade Loch A, Lorea Lawson F, Bevilacquia F, Wang YP, Rössler W, Farid Gattaz W. Attitudes of Mental Health Professionals Towards Persons With Schizophrenia: A Transcultural Comparison Between Switzerland and Brazil. Rev Psiq Clin. 2012; 39 (4); 115–121.

58. Andrade Loch A, Pascal Hengartner M, Bevilacqua Guarniero F, Lorea Lawson F, Wang YP, Farid Gattaz W, Rössler W. The more information, the more negative stigma towards schizophrenia: Brazilian general population and psychiatrists compared. Psychiatry Research. 2013; 205 (3); 185–191. doi: 10.1016/j.psychres.2012.11.023 23266022

59. Oliveira S, Esteves F, Carvalho H. Clinical Profiles of Stigma Experiences, Self-Esteem and Social Relationships Among People with Schizophrenia, Depressive, and Bipolar Disorders. Psychiatry Research. 2015; 229; 167–173. doi: 10.1016/j.psychres.2015.07.047 26208983

60. Ellison N, Mason O, Scior K. Bipolar Disorder and Stigma: A Systematic Review of the Literature. Journal of Affective Disorders. 2013; 151; 805–820. doi: 10.1016/j.jad.2013.08.014 24135506

61. Knaak S, Mantler E, Szeto A. Mental Illness-Related Stigma in Healthcare: Barriers to Access and Care and Evidence-Based Solutions. Healthcare Management Forum. 2017; 30 (2); 111–116. doi: 10.1177/0840470416679413 28929889

62. Rivera-SegarraE, Rosario-Hernández E, Carminelli-Corretjer P, Tollinchi-Natali N, Polanco-Frontera N. Suicide Stigma Among Medical Students in Puerto Rico. Int J Environ Res Public Health. 2018; 15; 1366.

63. Murphy A, O’Reilly C, Ataya R, Doucette S, Martin-Misener R, Rosen A, Gardner D. A Survey of Canadian and Australian Pharmacists’ Stigma of Suicide. SAGE Open Medicine. 2019; 7; 1–9.

64. Nutt R, Gilchrist G, Marsa Sambola F, Baldacchino A. Staff Regard Toward Working with Patients with Co-morbid Depression and Substance Misuse: An Exploratory Study. Heroin Addict Relat Clin Probl. 2017.

65. Gilchrist G, Moskalewicz J, Slezakova S, Okruhlica L, Torrens M, Vajd R, Baldacchino A. Staff Regards Towards Working with Substance Users: A European Multi-Centre Study. Addiction. 2011; 106 (6): 1114–1125. doi: 10.1111/j.1360-0443.2011.03407.x 21320230

66. van Boekel LC, Browers EP, van Weeghel J, Garretsen HF. Healthcare Professionals’ Regards Towards Working with Patients with Substance Use Disorders: Comparision of Primary Care, General Psychiatry and Specialist Addiction Services. Drug and Alcohol Dependence. 2014. 134; 92–98. doi: 10.1016/j.drugalcdep.2013.09.012 24099970

67. Varas-Díaz N, Santiago Negrón S, Neilands T, Cintrón Bou F, Malavé Rivera S. Stigmatization of Ilicit Drug Use Among Puerto Rican Health Professionals in Training. PR Health Sciences Journal. 2010; 29 (2); 109–116.

68. Nyblade L, Stockton M, Giger K, Bond V, Eckstrand M, McLean R, Mitchell E, Nelson L, Sapag J, Siraprapasiri T, Turan J, Wouters E. Stigma in Health Facilities: Why it Matters and how can we Change it. BMC Medicine. 2019; 17; 25. doi: 10.1186/s12916-019-1256-2 30764806

69. Sickel A, Seacat J, Nabors N. Mental Health Stigma: Impact on Mental Health Treatment Attitudes and Physical Health. Journal of Health Psychology. 2016; 24 (5); 586–599. doi: 10.1177/1359105316681430 27909162

70. Polanco-Frontera N, Cajigas-Vargas I, Rivera-Segarra E, Varas-Díaz N, Santos-Figueroa A, Rosario-Hernández E. Estigma hacia problemas de salud mental entre profesionales de la salud en adiestramiento en Puerto Rico. Salud & Sociedad. 2013;4(3):250–63.

71. Williams G, Elliot E. Exploring Social Inequalities in Health: The Importance of Thinking Qualitatively. In: Bourgeault I, Dingwall R, de Vires R, editors. The Sage Handbook of Qualitative Methods in Health Research. Thousand Oaks: SAGE Publications Ltd.; 2013. p. 106–22.

72. Denzin N, Lincoln YS. The Discipline And Practice Of Qualitative Research. In: Denzin N, Lincoln YS, editors, The Sage Handbook of Qualitative Research. Thousand Oaks: SAGE Publications Ltd.; 2011. p. 1–20.

73. Ross CA, Goldner EM. Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: a review of the literature. Journal of Psychiatric and Mental Health Nursing. 2009;16(6):558–67. doi: 10.1111/j.1365-2850.2009.01399.x 19594679

74. Rapley T. The (extra)ordinary practices of qualitative interviewing. In: Gubrium J, Holstein A, Marvasti A, McKinney K, editors. The SAGE Handbook of Interview Research: The Complexity of the Craft. 2nd ed. Thousand Oaks: SAGE Publications.; 2012. p. 541–55.

75. Kaisar K. Protecting Confidentiality. In: Gubrium J, Holstein A, Marvasti A, McKinney K, editors. The SAGE Handbook of Interview Research: The Complexity of the Craft. 2nd ed. Thousand Oaks: SAGE Publications.; 2012. p. 457–464.

76. Cook K. Stigma and the Interview Encounter. In: Gubrium J, Holstein A, Marvasti A, McKinney K, editors. The SAGE Handbook of Interview Research: The Complexity of the Craft. 2nd ed. Thousand Oaks: SAGE Publications.; 2012. p. 333–344.

77. Morse JM. Critical Analysis of Strategies for Determining Rigor in Qualitative Inquiry. Qualitative Health Research. 2015;25(9):1212–22. doi: 10.1177/1049732315588501 26184336

78. Guest G, Bunce A, Johnson L. How Many Interviews Are Enough? An Experiment with Data Saturation and Variability. Field Methods. 2006;18(1):59–82.

79. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77–101.

80. Fereday J, Muir-Cochrane E. Demostrating Rigor Using Thematic Analysis: A hybrid Approach of Inductive and Deductive Coding and Theme Development. International Journal of Qualitative Methods. 2006; 5 (1); 80–92.

81. Decuir-Gunby JT, Marshall PL, Mcculloch AW. Developing and Using a Codebook for the Analysis of Interview Data: An Example from a Professional Development Research Project. Field Methods. 2010;23(2):136–55.

82. Phelan JC, Lucas JW, Ridgeway CL, Taylor CJ. Stigma, status, and population health. Social Science & Medicine. 2014;103:15–23.

83. Corrigan PW, Mittal D, Reaves CM, Haynes TF, Han X, Morris S, et al. Mental health stigma and primary health care decisions. Psychiatry Research. 2014;218(1–2):35–8. doi: 10.1016/j.psychres.2014.04.028 24774076

84. de Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, et al. Physical illness in patients with severe mental disorders: Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10(1):52–77. doi: 10.1002/j.2051-5545.2011.tb00014.x 21379357

85. McCloughen A, Foster K, Huws-Thomas M, Delgado C. Physical health and wellbeing of emerging and young adults with mental illness: An integrative review of international literature. International Journal of Mental Health Nursing. 2012;21(3):274–88. doi: 10.1111/j.1447-0349.2011.00796.x 22533335

86. Gray R. Physical health and mental illness: A silent scandal. International Journal of Mental Health Nursing. 2012;21(3):191–2. doi: 10.1111/j.1447-0349.2012.00832.x 22533325

87. Reis AF. Antipsychotic drugs and metabolic syndrome: can we prevent it? Revista Brasileira de Psiquiatria. 2007;29(1):9–10. doi: 10.1590/s1516-44462007000100005 17435920

88. Jones S, Howard L, Thornicroft G. ‘Diagnostic overshadowing’: worse physical health care for people with mental illness. Acta Psychiatrica Scandinavica. 2008;118(3):169–71. doi: 10.1111/j.1600-0447.2008.01211.x 18699951

89. Shefer G, Henderson C, Howard L, Murray J, Thornicroft G. Diagnostic Overshadowing and Other Challenges Involved in the Diagnostic Process of Patients with Mental Illness Who Present in Emergency Departments with Physical Symptoms–A Qualitative Study. PLOS One. 2014; 9 (11): e111682. doi: 10.1371/journal.pone.0111682 25369130

90. Carpenter-Song E, Chu E, Drake R, Ritsema M, Smith B, Alverson H. Ethno-Cultural Variations in the Experience and Meaning of Mental Illness and Treatment: Implications for Access and Utilization. Transcultural Psychiatry. 2010;47(2):224–51. doi: 10.1177/1363461510368906 20603387

91. Magana SM, Ramirez-Garcia J, Hernandez MG, Cortez R. Psychological Distress Among Latino Family Caregivers of Adults With Schizophrenia: The Roles of Burden and Stigma. Psychiatric Services. 2007;58(3):378–84. doi: 10.1176/appi.ps.58.3.378 17325112

92. Rivera-Segarra E, Fernández A, Camacho-Acevedo Z, Ortiz N, López-Robledo Y. ‘Ahí Batallando’: the psychosocial impact of psychosis among Puerto Rican family caregivers. Journal of Family Studies. 2015;22(3):240–55.

93. Instituto de Estadísticas de Puerto Rico. Informe sobre los sistemas de Salud Mental en Puerto Rico. 2016. http://www.who.int/mental_health/evidence/puerto_rico_whoaims_report.pdf

94. Farrelly S, Jeffery D, Rüsch N, Williams P, Thornicroft G, Clement S. The link between mental health-related discrimination and suicidality: service user perspectives. Psychological Medicine. 2015;45(10):2013–22. doi: 10.1017/S0033291714003158 25678059


Článek vyšel v časopise

PLOS One


2019 Číslo 12
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

KOST
Koncepce osteologické péče pro gynekology a praktické lékaře
nový kurz
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Svět praktické medicíny 5/2023 (znalostní test z časopisu)

Imunopatologie? … a co my s tím???
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#