Factors Related To The Attitude Of Lay Health Workers Towards Patients With Severe Mental Disorders

BackgroundRecruiting and training lay health workers to fill the huge treatment gap in the mental health field is an excellent strategy for community mental health service,which are gradually being implemented in Lower-Middle income countries（LMICs）.The duties of lay health workers include identifying people with mental disorders in the community,referring patients at the onset stage of mental disorders,carrying out corresponding community follow-up work,providing social support for people with mental disorders and even necessary psychological intervention.It was proved that lay health workers have played a positive role in the psychosocial rehabilitation and prognosis of patients with mental disorders.They are also playing an increasingly important role in delivering community mental health services.However,their perceptions of mental disorders and patients greatly affect the deliver quality of mental health services.Little research has been done in China from this aspect in the field of community mental health.ObjectivesThis article is aiming at exploring negative attitudes and related discriminatory behaviors of lay health workers towards patients with severe mental disorders,in order to provide a scientific basis for delivering effective,sustainable,as well as low-cost medical and health services to patients with severe mental disorders in the community.MethodsA total of 312 participants were recruited from 4 districts in Guangzhou by cluster random sampling.Participants were investigated with the demographic questionnaire,PDD,MICA,MAKS and some additional items.Data were analyzed with the IBM SPSS Statistics（version 23.0）.Descriptive statistics,ANOVA analysis and multivariable linear regression analysis were performed.All statistically significant results were reported at P<0.05.Result1.Demographic data:A total of 312 LHW data were collected.The average age was39.93（±8.97）years old.More than half of the participants were male（59.9%）,college degree or above（79.8%）,willing to supervise patients with severe mental disorders（68.6%）.Police officers（20.2%）and community cadres（63.8%）are the main components of group.2.1 Multiple factor analysis showed that the MICA score was significantly correlated with age（F=8.466,P<0.001）,care groups（F=7.716,P<0.001）,care willingness（F=11.564,P<0.001）,and two additional items reflecting LHW attitudes（additional item1:F=6.295,P=0.002;additional item 2:F=43.450,P<0.001）.2.2 Multiple factor analysis showed that the PDD score was significantly correlated with care groups（F=3.984,P=0.008）and additional item2（F=9.369,P<0.001）.2.3 Multiple factor analysis showed that the MAKS score wasn’t significantly correlated with age（F=1.450,P=0.228）,care willingness（F=0.441,P=0.644）and two additional items reflecting LHW attitudes（additional item1:F=1.902,P=0.151;additional item 2:F=0.086,P=0.917）.3.Correlation analysis of MICA score:MICA total score was significantly positively correlated with PDD total score（r=0.339,P<0.001）,MICA total score wasn’t significantly correlated with MAKS total score（r=-0.047,P=0.411）.4.Using multivariate linear regression analysis to determine factors that influencing MICA total score.Adjusted R²is 0.441,The result showed that age(b_ad=0.115,P=0.006),care willingness(b_ad=1.892,P<0.001),two additional items reflecting LHW attitudes(additional item1:b_ad=-0.716,P=0.023;additional item2:b_ad=-2.349,P<0.001)and PDD total score(b_ad=0.279,P<0.001)are the influencing factors of MICA total score.In terms of care willingness,participants with prejudice attitude and discriminatory behaviors about mental disorder shows higher score on MICA.Conclusion1.Negative attitude holds by LHW towards people with severe mental disorders is related to their age,subordinate occupation,care willingness,whether they have prejudice attitude and discriminatory behaviors.2.Most of LHW in the city of Guangzhou holds the stereotype of“long-term hospitalization”towards patients with severe mental disorders.3.From now on,community mental health work should be targeted at carrying out training work that reduce stigma and discrimination behavior in LHW groups and promote quality mental health services.