分析在线药瘾者社区中自我污名的三类表现，发现行为表达常先于内心感受。
The cognitive, affective, and behavioral expression of self-stigma among people who use drugs in online substance use communities
- 构建涵盖认知、情感、行为的十项自污名编码体系，通过双人核对确保可靠性。
- 5.3%的帖子含自污名，其中自我标签与绝望感最常见，且行为表现多伴随内在认同。
- 行为性表达往往早于情感内化，挑战了传统渐进式心理模型的适用性。
目的：开发涵盖认知、情感和行为维度的自我污名编码手册，并估算其在Reddit药瘾用户帖子中的流行率、共现情况及时间模式。方法：通过共识驱动的归纳编码建立包含十项指标的编码体系，涵盖认知（自我标签、悲观/自我挫败、应得感/无价值感）、情感（羞耻、内疚/自责、绝望/无望）和行为（隐藏、预期排斥、戒断意愿、矛盾态度）；两名编码员达成良好一致性（Cohen's k = 0.72）。随后采用经专家标注验证的大语言模型进行规模化分类（k = 0.73, F1 = 0.80），分析1,660名英语用户在2006–2025年间发布的72,115条发帖。结果：共3,838篇帖子（5.3%）来自1,228名用户（74.0%）存在自污名；全部十项指标均能有效区分自污名帖子（相对风险比3.6至86.2），以自我标签（56.0%）和绝望/无望（48.5%）最为突出。自污名具整合性：核心指标与行为指标在用户层面强相关（OR = 4.65，95% CI 3.12–6.94，p < 0.001），87.0%含行为指标的帖子也包含核心指标。与进步模型相反，行为指标出现时间早于核心指标（戒断意愿中位位置0.08，羞耻感为0.38）。除悲观情绪外，其余九项指标在发布轨迹中保持稳定；仅悲观情绪随时间上升（OR = 1.62，95% CI 1.25–2.10）。结论：在线药瘾者中，自污名是整合现象，行为表达通常不单独出现且常早于内在体验。多数表现长期稳定，但对改变的悲观倾向加深，提示早期数字干预时机，且表明渐进式心理模型无法直接映射文本披露过程。
原文摘要 · Abstract (English)
Objectives: To develop a codebook for self-stigma across cognitive, affective, and behavioral domains, and to estimate the prevalence, co-occurrence, and temporal patterns of these indicators in Reddit posts by people who use drugs. Methods: We developed a ten-indicator codebook through consensus-based abductive coding spanning cognitive (self-labeling, pessimism/self-defeatism, deservingness/worthlessness), affective (shame, guilt/self-blame, despair/hopelessness), and behavioral (concealment, anticipated rejection, desire to quit, ambivalence) domains; two coders reached substantial agreement (Cohen's k = 0.72). We then scaled classification with a large language model validated against expert coding (k = 0.73, F1 = 0.80), analyzing 72,115 thread-initiating posts from 1,660 English-language users (2006-2025). Results: 3,838 posts (5.3%) from 1,228 users (74.0%) contained self-stigma; all ten indicators discriminated self-stigma posts (RR 3.6 to 86.2), led by self-labeling (56.0%) and despair/hopelessness (48.5%). Self-stigma was integrated: core and behavioral indicators were strongly associated at the user level (OR = 4.65, 95% CI 3.12-6.94, p < 0.001), and 87.0% of posts with behavioral indicators also contained a core indicator. Contrary to progressive models, behavioral indicators emerged earlier than core ones (desire to quit at median position 0.08 vs. shame at 0.38). Nine of ten indicators were stable across posting trajectories; only pessimism increased (OR = 1.62, 95% CI 1.25-2.10). Conclusion: Among people who use drugs online, self-stigma is an integrated phenomenon in which behavioral indicators rarely appear without internalized ones and often precede them. Most expressions remain stable over time, but pessimism about change deepens, marking a target for early digital intervention and showing that progressive stage models do not map directly onto textual disclosure.
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