Development of an intervention to reduce self-stigma in outpatient mental health service users in Chile

Sara Shilling, Juan Antonio Bustamante, Andres Salas, Claudio Acevedo, Patricia Cid, Thamara Tapia, Eric Tapia, Ruben Alvarado, Jaime C Sapag, Lawrence Hsin Yang, Ellen Lukens, Franco Mascayano

Resumen


Background:
Latin America is characterized by a high prevalence of public stigma toward those with mental illness, and significant selfstigma among labeled individuals, leading to social exclusion, low treatment adherence, and diminished quality of life. However, there is no published evidence of an intervention designed to address stigma in the region. In light of this, a psychosocial intervention to reduce self-stigma among users with severe mental illness was developed and tested through an RCT in two regions of Chile. Objectives: To describe the development of the psychosocial intervention, assess its feasibility and acceptability, and evaluate its preliminary impact. Methods: An intervention was designed and is being tested, with 80 users with severe mental illness attending two community mental health outpatient centers. To prepare the intervention, pertinent literature was reviewed, and experts and mental health services users were consulted. Feasibility and acceptability were assessed, and impact was analyzed, based on follow-up qualitative reports by the participants. Results: The recovery-oriented, ten-session group intervention incorporates the Tree of Life narrative approach, along with other narrative practices, to promote a positive identity change in users, and constructivist psychoeducation, based on case studies and group discussions, to gather tools to confront self-stigma. The intervention was feasible to implement and well evaluated by participants, family members, and center professionals. Participants reported increased self-confidence, and the active use of anti-stigma strategies developed during the workshop. Conclusions: This group intervention promises an effective means to reduce stigma of mental illness within Chile and other Latin American countries and feasibility to scale up within mental health services.

Resumen: Antecedentes: Latinoamérica se ha caracterizado por ser una región que presenta una alta prevalencia de estigma público hacia la enfermedad mental, y niveles significativos de auto-estigma entre las personas con diagnóstico psiquiátrico, conduciendo a un alto nivel de exclusión social, baja adherencia al tratamiento y una disminución de la calidad de vida. Sin
embargo, no se dispone de evidencia científica sobre alguna intervención diseñada para abordar el estigma a nivel local o regional. Considerando lo anterior, se ha desarrollado y evaluado a través de una ensayo clínico aleatorizado una intervención psicosocial para reducir el auto-estigma entre usuarios de servicios de salud mental en dos regiones de Chile.Objetivos:
Describir el desarrollo de una intervención psicosocial anti-estigma y evaluar su confiabilidad, aceptabilidad e impacto inicial entre un grupo de suarios.Métodos: La intervención fue diseñada y evaluada en 80 usuarios con diagnóstico de trastorno mental severo que estuvieron asistiendo a dos centros ambulatorios de salud mental comunitaria. Para elaborar la intervención, se revisó literatura científica pertinente y se conformaron paneles de discusión con expertos y usuarios de servicios de salud mental. La factibilidad y la aceptabilidad fueron evaluadas y se analizó su impacto inicial entre los participantes, en base
a una serie de evaluaciones cualitativas.Resultados: Se generó una intervención orientada a la recuperación, que considera 10 sesiones grupales e incorpora el abordaje del ‘Árbol de la Vida’, además de otras prácticas narrativas, para promover un cambio positivo en la identidad de los usuarios; adicionalmente, se incluyen elementos de psicología constructivista, basada en estudio de casos y grupos de discusión, para que los usuarios adquieran herramientas para afrontar el estigma. La intervención fue implementada apropiadamente y bien evaluada por participantes, familiares y profesionales de los centros de salud mental. Los participantes reportaron un incremento de la autoconfianza y un activo uso de las estrategias anti-estigma desarrolladas durante las sesiones de trabajo. Conclusiones: La presente intervención grupal demostró un promisorio efecto en la reducción del estigma hacia la enfermedad mental en Chile, y cuenta con el potencial para ser implementado en otros servicios de salud mental de Latinoamérica.


Palabras clave


servicios de salud mental; estigma social; salud mental; America Latina;Ensayo Clínico Controlado Aleatorio

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