中国人心理健康素养干预效果的元分析

doi:10.3724/SP.J.1041.2020.00497

摘要/Abstract

摘要：

本研究遵循PRISMA-Protocol, 运用元分析的技术, 以心理健康素养的知识、污名态度和求助为结果变量, 考察干预效果及影响因素, 以期为更高效地提升心理健康素养提供参考。元分析共纳入38项研究。结果发现：干预对知识、污名态度和求助的即时效果量达到显著的中到大的效果(知识：g = 0.70, 污名态度：g = -0.52, 求助：g = 1.18)。亚组分析结果表明：心理健康素养的干预效果受地域、被干预者类型、干预中的互动与接触以及试验类型等多个变量的影响。后续研究应进一步探索心理健康素养的调节变量, 并结合中国文化, 制定针对不同干预对象的个性化干预方案, 以提升干预效益。

关键词: 心理健康素养, 干预效果, 互动, 接触

Abstract:

Following the PRISMA-Protocol and using meta-analytic techniques, this study examines the effects of interventions for mental health literacy among Chinese people, with knowledge of mental health stigma and help-seeking as outcome variables. The study also explores the influences of five moderator variables (types of intervention, types of contact, types of intervention staff, types of region, and types of experiment) on the intervention effects in order to identify the active ingredients of the intervention. Another purpose of this study is to clarify the relationships among knowledge, stigma, and help-seeking in intervention, in order to provide some theoretical references for more effective improvement of mental health literacy.

Studies were identified by searching six foreign databases (PubMed, PsycARTICLES, PsycINFO, Elsevier Web of Science and Cochrane Controlled Trials Register) and three Chinese databases (CNKI, Wanfang, VIP). The search terms consisted of subject headings such as mental illness, mental health, mental disorder; outcome measures such as attitude, knowledge, help-seeking; intervention methods such as health education, health promotion, curriculum; regions such as Mainland China, Hongkong, Taiwan, Macao; and these groups of search terms were paired and combined. Selection criteria included: (1) Participants: Chinese people living in Mainland China, Hongkong, Taiwan and Macao; (2) Study design: the study provided a control group, including randomized and non-randomized trials, examining the mental health literacy at pre and post intervention; (3) Outcome measure: using knowledge, stigma, or help-seeking to measure mental health literacy; (4) Intervention: education and contact to improve mental health literacy; (5) The included studies are peer-reviewed papers and include master's and doctoral thesis. Excluding criteria were (1) participants with psychological disorders; (2) non-Chinese and non-English literature.

A total of 38 studies were included in the meta-analysis. Results: (1) The immediate effect of the intervention on knowledge, stigma and help-seeking was significant and medium-to-large (knowledge: g = 0.70, stigma: g = -0.52, help-seeking: g = 1.18). At a 6-month follow-up, only the effect of intervention on knowledge was significant (g = 0.67); at longer follow-ups (> 6 month), the effect of intervention on knowledge was still significant (g = 0.74), and the effect of intervention on stigma was significant (g = -0.34). (2) Results of the subgroup analysis: In terms of knowledge, the subgroup analysis indicated the types of region, the types of participants, the types of interaction and contact in intervention, and the types of experiment were significant. With respect to the help-seeking, only the types of region and the types of interaction and contact in intervention were significant. (3) Results of regression analysis: In terms of knowledge, the moderating effect of regions was significant after controlling other variables. In terms of stigma, the moderating effect of the types of experiment was not significant. Studies have shown that mental health literacy interventions have obvious cultural differences. Intervention effects on knowledge are stable in time, while the intervention effects on stigma are unstable. The intervention of interaction on knowledge is effective, but not conducive to stigma. The role of contact in intervention on knowledge and stigma is unclear.

Implications for future studies: (1) Improve the conceptual framework of mental health literacy. (2) Further explore the moderating variables of mental health literacy and develop individualized intervention programs. (3) Cultural factors should be considered when developing an intervention plan. (4) Explore new methods to improve mental health literacy.

Key words: mental health literacy, intervention effect, interaction, contact

中图分类号:

R395

任志洪, 赵春晓, 田凡, 闫玉朋, 李丹阳, 赵子仪, 谭梦鸰, 江光荣. (2020). 中国人心理健康素养干预效果的元分析. 心理学报, 52(4), 497-512.

REN Zhihong, ZHAO Chunxiao, TIAN Fan, YAN Yupeng, LI Danyang, ZHAO Ziyi, TAN Mengling, JIANG Guangrong. (2020). Meta-analysis of the effect of mental health literacy intervention in Chinese people. Acta Psychologica Sinica, 52(4), 497-512.

图/表 9

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结果变量	k	N	g (95% CI)	敏感性检验	异质性检验			发表偏倚检验
结果变量	k	N	g (95% CI)	g (95% CI)	Q_w	df	I²	N_fs	Egger’s intercept	SE	95% CI	p
知识
后测	22	9159	0.70^***(0.51, 0.90)	0.74^*** (0.54, 0.95)	337.26^***	21	93.78	3416	0.67	1.53	[-2.52, 3.86]	0.67
6个月内	7	3222	0.67^***(0.61, 0.74)	无异常值	1.71	6	0	531	0.21	0.41	[-0.84, 1.26]	0.62
6个月后	4	209	0.74^**(0.06, 1.41)	1.001^***(0.35, 1.66)	22.91^***	3	86.90	29	23.96	7.02	[-6.23, 54.15]	0.08
污名态度
后测	26	8435	-0.52^**(-0.90, -0.16)	-0.64^*** (-1.09, -0.19)	1429.56^***	25	98.25	1803	-4.71	3.23	[-11.36, 1.95]	0.16
6个月内	7	4331	-0.17 (-0.45, 0.12)	-0.121 (-0.59, 0.25)	84.26^***	6	92.88	0	-6.12	1.20	[-9.20, -3.04]	0.004
6个月后	2	246	-0.34^**(-0.59, -0.09)	-0.32^**(-0.62, -0.02)	0.07	1	0	/	/	/	/	/
求助
后测	9	2087	1.18^***(0.55, 1.80)	3.65 (-0.52, 7.82)	493.41^***	8	98.38	162	6.08	3.62	[-2.49, 14.64]	0.14
6个月内	2	2304	-0.04 (-0.11, 0.04)	/	0.87	1	0	/	/	/	/	/
6个月后	0	/	/	/	/	/	/	/	/	/	/	/

结果变量	k	N	g (95% CI)	敏感性检验	异质性检验			发表偏倚检验
结果变量	k	N	g (95% CI)	g (95% CI)	Q_w	df	I²	N_fs	Egger’s intercept	SE	95% CI	p
知识
后测	22	9159	0.70^***(0.51, 0.90)	0.74^*** (0.54, 0.95)	337.26^***	21	93.78	3416	0.67	1.53	[-2.52, 3.86]	0.67
6个月内	7	3222	0.67^***(0.61, 0.74)	无异常值	1.71	6	0	531	0.21	0.41	[-0.84, 1.26]	0.62
6个月后	4	209	0.74^**(0.06, 1.41)	1.001^***(0.35, 1.66)	22.91^***	3	86.90	29	23.96	7.02	[-6.23, 54.15]	0.08
污名态度
后测	26	8435	-0.52^**(-0.90, -0.16)	-0.64^*** (-1.09, -0.19)	1429.56^***	25	98.25	1803	-4.71	3.23	[-11.36, 1.95]	0.16
6个月内	7	4331	-0.17 (-0.45, 0.12)	-0.121 (-0.59, 0.25)	84.26^***	6	92.88	0	-6.12	1.20	[-9.20, -3.04]	0.004
6个月后	2	246	-0.34^**(-0.59, -0.09)	-0.32^**(-0.62, -0.02)	0.07	1	0	/	/	/	/	/
求助
后测	9	2087	1.18^***(0.55, 1.80)	3.65 (-0.52, 7.82)	493.41^***	8	98.38	162	6.08	3.62	[-2.49, 14.64]	0.14
6个月内	2	2304	-0.04 (-0.11, 0.04)	/	0.87	1	0	/	/	/	/	/
6个月后	0	/	/	/	/	/	/	/	/	/	/	/

调节变量	模型1		模型2		模型3
调节变量	b (95% CI)	SE	b (95% CI)	SE	b (95% CI)	SE
年龄	-0.004 (-0.03, 0.02)	0.012	0.001 (-0.02, 0.02)	0.01	0.002 (-0.03, 0.02)	0.01
地域
内地	0.18 (-0.27, 0.71)	0.275	0.57^** (0.16, 0.98)	0.21	0.47 (-0.04, 0.98)	0.26
港澳台[参照变量]	—	—	—	—	—	—
干预周期	—	—	-0.04 (-0.10, 0.02)	0.03	-0.03 (-0.10, 0.05)	0.04
干预时间	—	—	0.02 (-0.01, 0.04)	0.02	0.01 (-0.02, 0.04)	0.01
日常是否接触患者
是			-0.21 (-0.76, 0.34)	0.28	-0.33 (-0.96, 0.31)	0.33
否[参照变量]	—	—	—	—	—	—
干预中是否接触患者
是			-0.86 (-1.88, 0.15)	0.52	0.66 (-1.86, 0.53)	0.61
否[参照变量]	—	—	—	—	—	—
干预者与被干预者互动
高互动			1.23^*(0.27, 2.18)	0.49	1.03 (-0.11, 2.17)	0.58
低互动[参照变量]	—	—	—	—	—	—
被干预者间互动
有			-0.47 (-1.44, 0.49)	0.49	-0.11 (-1.48, 1.27)	-0.11
无[参照变量]	—	—	—	—	—	—
试验类型
RCT	—	—			0.31 (-0.44, 1.06)	0.38
非RCT [参照变量]	—	—	—	—	—	—
R²	0.01		0.74		0.70
Q (df)	0.55 (2)		16.35^* (8)		15.81^*(9)

调节变量	模型1		模型2		模型3
调节变量	b (95% CI)	SE	b (95% CI)	SE	b (95% CI)	SE
年龄	-0.004 (-0.03, 0.02)	0.012	0.001 (-0.02, 0.02)	0.01	0.002 (-0.03, 0.02)	0.01
地域
内地	0.18 (-0.27, 0.71)	0.275	0.57^** (0.16, 0.98)	0.21	0.47 (-0.04, 0.98)	0.26
港澳台[参照变量]	—	—	—	—	—	—
干预周期	—	—	-0.04 (-0.10, 0.02)	0.03	-0.03 (-0.10, 0.05)	0.04
干预时间	—	—	0.02 (-0.01, 0.04)	0.02	0.01 (-0.02, 0.04)	0.01
日常是否接触患者
是			-0.21 (-0.76, 0.34)	0.28	-0.33 (-0.96, 0.31)	0.33
否[参照变量]	—	—	—	—	—	—
干预中是否接触患者
是			-0.86 (-1.88, 0.15)	0.52	0.66 (-1.86, 0.53)	0.61
否[参照变量]	—	—	—	—	—	—
干预者与被干预者互动
高互动			1.23^*(0.27, 2.18)	0.49	1.03 (-0.11, 2.17)	0.58
低互动[参照变量]	—	—	—	—	—	—
被干预者间互动
有			-0.47 (-1.44, 0.49)	0.49	-0.11 (-1.48, 1.27)	-0.11
无[参照变量]	—	—	—	—	—	—
试验类型
RCT	—	—			0.31 (-0.44, 1.06)	0.38
非RCT [参照变量]	—	—	—	—	—	—
R²	0.01		0.74		0.70
Q (df)	0.55 (2)		16.35^* (8)		15.81^*(9)

调节变量	模型1		模型2		模型3
调节变量	b (95% CI)	SE	b (95% CI)	SE	b (95% CI)	SE
年龄	-0.03 (-0.07, 0.01)	0.023	-0.04 (-0.10, 0.01)	0.03	-0.81 (-0.14, -0.02)	0.03
被干预者类型
专业人员	-0.88 (-2.26, 0.50)	0.702	-1.69 (-3.39, 0.55)	1.14	0.12 (-2.55, 2.79)	1.36
非专业人员[参照变量]	—	—	—	—
地域
内地	-0.28 (-1.51, 0.95)	0.626	-0.64 (-2.22, 0.94)	0.82	-1.25 (-2.79, 0.28)	0.78
港澳台[参照变量]	—	—	—	—
干预周期			0.04 (-0.21, 0.28)	1.23	0.21 (-0.07, 0.49)	0.14
干预时间			0.23 (-0.03, 0.07)	0.03	0.01 (-0.04, 0.05)	0.02
干预中是否接触患者
是			-0.16 (-1.81, 1.49)	0.84	-0.74 (-2.31, 0.84)	0.80
否[参照变量]	—	—	—	—
干预者与被干预者互动
高互动			-059 (-2.73, 1.55)	-0.59	-0.48 (-2.39, 1.43)	0.97
低互动[参照变量]	—	—	—	—
被干预者间的互动
有			0.04 (-1.95, 2.04)	1.02	0.63 (-1.23, 2.49)	0.95
无[参照变量]	—	—	—	—
试验类型
RCT					2.33* (0.03, 4.65)	1.18
非RCT (参照变量)	—	—	—	—
R²	0.23		0.30		0.45
Q (df)	4.20 (3)		6.14 (8)		11.71 (9)