The purpose of this systematic review was to evaluate stigma and Functional Neurological Disorder (FND) regarding: 1) prevalence and associated factors, 2) the nature and context of stigma in FND, and 3) stigma-reduction interventions. We searched four relevant databases from inception to December 2023, using search terms relevant to FND and stigma themes. We employed the method of synthesis by “aggregation and configuration” to synthesise and analyse the data into emergent themes. We found 127 studies, spanning 148 countries, involving 18,886 participants. Of these, 4889 were patients, 13,123 were healthcare professionals, and 526 were caregivers. Quantitatively, stigma has been mainly studied in patients with functional seizures, and was higher than patients with epilepsy in three studies. Stigma experienced by patients is associated with poorer quality of life and caregiver burden. We found 10 themes and 29 subthemes revealing stigma as a systemic process, with intrapersonal, interpersonal and structural aspects. Few studies examined the perspective of caregivers, the public or online community. We identified six anti-stigma interventions. Stigma in FND is a layered process, and affects patient quality of life and provision of care. Stigma needs to be addressed from the top structures, at governmental level, so that appropriate care pathways can be created, giving patients with FND parity of esteem with other medical conditions.

中文翻译：

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功能性神经障碍 (FND) 中的耻辱——系统评价


本系统评价的目的是评估耻辱感和功能性神经障碍 (FND)：1) 患病率和相关因素，2) FND 中耻辱感的性质和背景，以及 3) 减少耻辱感的干预措施。我们使用与 FND 和耻辱主题相关的搜索词搜索了从成立到 2023 年 12 月的四个相关数据库。我们采用“聚合与配置”的综合方法，将数据综合分析成涌现的主题。我们发现了 127 项研究，涵盖 148 个国家，涉及 18,886 名参与者。其中，4889 名患者、13,123 名医疗保健专业人员和 526 名护理人员。从数量上看，耻辱感主要在功能性癫痫患者中进行研究，在三项研究中，耻辱感高于癫痫患者。患者经历的耻辱与较差的生活质量和护理人员的负担有关。我们发现 10 个主题和 29 个子主题揭示了耻辱作为一个系统性过程，涉及个人内部、人际和结构方面。很少有研究考察护理人员、公众或在线社区的观点。我们确定了六种反耻辱干预措施。 FND 中的耻辱是一个分层过程，影响患者的生活质量和护理服务。需要从政府层面的高层机构解决耻辱问题，以便建立适当的护理途径，让 FND 患者得到与其他疾病患者同等的尊重。