Zusammenfassung
Hintergrund
Die soziokulturellen Zusammenhänge um stigmatisierende Einstellungen und psychiatrische Unterversorgung sind komplex und unzureichend verstanden.
Fragestellung
Ist das soziale Milieu ein potenziell nützliches Instrument der psychiatrischen Einstellungs- und Versorgungsforschung?
Methode
Der Beitrag beschreibt individuelle Behandlungsbarrieren um Wissen und Einstellungen mit Kontextualisierung des sozialen Milieubegriffes und gibt eine narrative Literaturübersicht (PubMed, PsycINFO, Google Scholar) zu Assoziationen unterschiedlicher Dimensionen des Milieubegriffes (Soziodemografie, Werte, Wohnort, Ethnie) mit stigmatisierenden Einstellungen und der Inanspruchnahme psychiatrischer Versorgungsangebote.
Ergebnisse
Soziodemografisch sind ein geringer Bildungsgrad und ein männliches Geschlecht häufig mit psychiatrischer Unterversorgung und stigmatisierenden Einstellungen zu psychischer Krankheit und ihrer Behandlung assoziiert. Einfache soziodemografische Parameter allein scheinen unzureichend, um Stigma und Unterversorgung vorherzusagen. Das Wissen über psychische Erkrankungen und stigmatisierende Einstellungen stellen wichtige individuelle Behandlungsbarrieren dar. Diese soziodemografischen und individuellen Aspekte können in einzelnen sozialen Milieus kulminieren. So könnten sich besondere Zielgruppen und Kommunikationsanforderungen für Interventionen identifizieren lassen.
Schlussfolgerung
Das Konzept des sozialen Milieus ist eine potenziell wichtige und bislang kaum genutzte Schnittstelle von Soziologie und Medizin. Vor dem Hintergrund zunehmender Polarisierung und sozialer Ungleichheit könnte es helfen, das Stigma psychischer Erkrankungen besser zu verstehen und es scheint in mehrfacher Hinsicht für sekundär- und tertiärpräventive Überlegungen rund um psychiatrische Unterversorgung relevant.
Abstract
Background
The sociocultural interconnections surrounding stigmatizing attitudes and the treatment gap in mental healthcare are complex and insufficiently understood.
Objective
Is the social milieu including personal values a potentially useful instrument for psychiatric research into attitudes and healthcare provision?
Method
This article describes individual barriers to treatment which pertain to literacy and attitudes, with contextualization of the social milieu concept. It gives a narrative review of the literature (PubMed, PsycINFO, Google Scholar) relating to the associations of different social milieu dimensions (e.g. sociodemographics, values, place of residence, ethnicity) with stigmatizing attitudes and utilization of psychiatric treatment options.
Results
Sociodemographically, lower educational attainment and male gender are often associated with psychiatric undertreatment and prevailing stigmatizing attitudes towards mental illness and its treatment. Simple sociodemographic parameters alone appear to be insufficient for predicting stigma and undertreatment. Stigmatizing attitudes and mental health literacy constitute important individual barriers to treatment. These sociodemographic and individual aspects can culminate in certain social milieus. This could allow the identification of specific target groups and communication requirements for interventions.
Conclusion
The concept of the social milieu constitutes a potentially important and so far barely used intersection between sociology and medicine. Against the backdrop of rising public polarization and social inequality, the concept could contribute to achieving a better understanding of the stigma of mental illness. It appears to be of relevance in a number of ways for secondary and tertiary preventive considerations regarding the treatment gap in mental healthcare.
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S. Speerforck und G. Schomerus geben an, dass keine Interessenkonflikte bestehen. S. Speerforck ist Oberarzt an der Universitätsklinik für Psychiatrie und Psychotherapie in Leipzig und erhält eine themenbezogene Drittmittelförderung durch die Deutsche Forschungsgemeinschaft (DFG SP 1810/1-1). G. Schomerus ist Direktor der Universitätsklinik für Psychiatrie und Psychotherapie in Leipzig und erhält eine themenbezogene Drittmittelförderung durch die Fritz-Thyssen-Stiftung (10.18.2.009SO).
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Speerforck, S., Schomerus, G. Soziale Milieus: Ein relevantes Konzept für ein besseres Verständnis von Stigma und psychiatrischer Unterversorgung?. Nervenarzt 91, 785–791 (2020). https://doi.org/10.1007/s00115-020-00927-8
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DOI: https://doi.org/10.1007/s00115-020-00927-8