臺灣博碩士論文加值系統

摘要

自我污名和男性心理健康。精神疾病很常見而且與身體疾病一樣有害。 雖然已有各種治療方法，但預防和早期診斷比後期治療更為重要。不幸的是，許多人在需要時無法獲得專業幫助。他們害怕談論自己的疾病，因為消極的刻板印象以及污名化的思想；比如精神病患者是危險的、懶惰的、軟弱的、無望的。也就是說，減少自我羞辱主要取決於個人的努力。他們還需要一種推動、適當的支持、信息和動力。恥辱可以影響任何人，但有很多不同的方式，例如，社會地位、民族、宗教、性別、教育、自尊等許多內外因素都在影響著。依靠男性化的刻板印象，普通公眾甚至精神衛生專業人士都看不到“男人”在社會弱勢群體中的需求。男性和女性都患有精神疾病和恥辱感，但對男性的影響更嚴重。在統計中，女性比男性更容易患上精神疾病和自殺未遂，但男性死於自殺的可能性幾乎是女性的四倍。自殺只是許多未經治療的精神疾病的惡果之一。

自我污名和有毒男性氣質結合，從內心破壞了男人的精神健康和幸福。當痛苦變得無法忍受時，男人把自己置於社會孤立中，直到最後都不向任何人敞開心扉。有一些人試圖用最被認為是“男性化”的方式進行自我治療：酗酒、打架和性行為。導致他們陷入貧困、離婚、犯罪和身心殘疾。幸運的是，一旦男人決定與精神疾病作鬥爭，他們確實很堅持的。因此，主要問題是如何激勵他們邁出第一步。[1] [2]

心理健康應用程式與男性觀眾。一旦有人隱藏情緒，避免人際交往，接受幫助的可能性就很有限。在這種情況下，數字媒體是信息的主要來源。57%的數字媒體使用來自移動應用程式。全球27億智能手機用戶，90%的使用手機時間都花在了應用程式上。它有巨大的潛力，但也有一些地方需要考慮。市場上有220萬個IOS，260萬個安卓應用程式 (11月, 2019)[3]。其中只有3%是與健康和健身相關的應用程式，29%的應用程式專註於心理健康診斷、治療或支持。[4]它不多也不小。研究表明，大多數應用程式充其量是無用的，最壞的是有害的。來源可靠的應用程式很可能被認為是無聊和難以使用的。如果仔細看看這幾個成功的心理健康應用程式，它的效率是值得懷疑的。因為每天和每月的活躍使用比下載次數更重要。在心理健康應用程式中，還沒有找到足夠的基於不同性別的用戶研究。一些研究包括男性和女性用戶，但通常70%以上的研究對象是女性。為了瞭解理健康應用程式的男性用戶，將需要進行基於性別的研究和檢查。如果我們看有最多男性用戶的手機應用（2016年3月），男性則喜歡競爭性（甚至是戰鬥性）的視頻游戲和運動，如戰略、格鬥和運動主題游戲、新聞評分和現場游戲。玩電子游戲是緩解男性壓力的首要方法之一。除此之外，一項研究顯示97%的電子游戲描繪了心理健康問題，以消極的方式表現出來。

研究目的。嚴肅游戲（用於嚴肅目的的電腦游戲）和游戲化（游戲之外使用的游戲元素）市場正在增長。它的定義多種多樣，並被許多類別所劃分。本文研究正對結果導向的嚴肅移動游戲對某不理解自我污名以及毒性男子氣概的男性用戶群體。將縮小研究範圍，本研究旨在探索和設計一項移動應用程式，其作用正對減少蒙古25-40歲失業男性自我污名。

動機。蒙古國現狀最常見的精神障礙是抑鬱、酗酒和焦慮。根據世衛組織2017年公佈的最新數據，蒙古自殺死亡人數達到836人，占總死亡人數的4.47%。世界排名第三。其中84%是男性，47%是失業者，大多數人受教育程度較低。25-29歲年齡組自殺率最高。這絕對是發生變化的年齡段。然而，蒙古是一個非常獨特的國家，具有獨特的文化。蒙古人自豪地崇拜自己的傳統和遺產。這種民族自豪感帶來了幸福和很多機會，也帶來了正面和負面的成見。總的來說，蒙古語的應用程式很少，也沒有關於心理健康的應用（2019）。這是一個挑戰，也是本研究的一個動機。

研究方法。本研究的目的即是瞭解一般情況和用戶行為，因此需要定性和定量的混合研究方法（多方法論）。三種主要方法將被用於進一步的研究。定量在線調查：開放式和封閉式的綜合問題將有助於瞭解蒙古國人普遍存在的恥辱感和刻板印象。（1）一對一在線訪談。遠程採訪方法是首選，因為本研究的目標用戶更容易避免刻板的標簽，無意透露自己。小組討論或面對面訪談不符合他們。（2）嚴肅手機游戲原型版本的用戶測試：該原型版本將根據在線定量調查結果和文獻成果設計。它將有三個主要功能：玩、監視和獎勵。採用用戶觀察法，有助於確定用戶行為，瞭解未充分就業和失業男性用戶行為的差異。專家訪談作為二次研究：在研究過程中，會進行多次專家訪談。為深入收集技術資料和臨床觀點。

潛在研究結果與限制。第一部分的研究結果將包括定性和定量的分析，列出了常見的毒性男子氣概、公眾和自我污辱的信仰，以及基於性別的、基於就業狀況的比較表。第二部分是基於原型設計和被採訪者回答的心理健康相關應用和嚴肅游戲的用戶行為、動機和態度。然而，這項研究受到國籍（蒙古語）、年齡（25-40歲）、性別（心理男性）和壓力因素（就業狀況）的限制。在未來，為了減少男性的自我污名和有毒男子氣概，需要在國際層面上對各種壓力因素（內部和外部）進行更詳細的研究。

關鍵詞: 心理健康，減少， 自我污名，毒性男子氣概，嚴肅的手機游戲， 蒙古男性

Abstract

Stigma and men’s mental health
Mental illnesses are common, and they are as harmful as physical illnesses. Treatments are available, but prevention and early diagnosis are more important than dealing with major problems. Unfortunately, a lot of people can not get professional help when needed. They are afraid to talk about their illnesses because of negative stereotypes, stigmatized thoughts; such as mentally ill people are dangerous, lazy, weak, and hopeless. Stigma has three main types, public, structural, and self-stigmatization. Reducing public and structural stigma requires complete actions from people, organizations, and the government. Therefore, it is better to start fighting with self-stigmatization. Which means reduction of self-stigmas is mainly dependent on the individuals’ effort. They also need a push, proper support, information, and motivation. Stigma can affect anyone but in many different ways. For example, social status, nationality, religion, gender, education, and many more internal, external factors are influencing. Relying on stereotypes of masculinity, the general public and even professionals in the mental care system do not see “men” among vulnerable groups in society. Men and women both suffer from mental illnesses and stigma, but it impacts harder on men. In statistics, women are more likely to get diagnosis and attempt suicide than men, but mens suicide attempts are more likely to end fatally. It is just one of the many pernicious outcomes of untreated mental illnesses.

Self-stigmatization combined with toxic masculinity is destroying men’s mental well-being and happiness from the inside. When the suffering becomes intolerable, men put themselves in social isolation and do not open up about their feelings to anyone until the very end. Some try to do self-treatment in the most perceived “masculine” way; alcohol, fight, and sex. It leads them into poverty, divorce, crime, and mental and physical disability. Fortunately, once men decide to fight against mental illness, they are powerful and do not give up ( Winnie Wing-Sze MAK, Ph.D, CUHK ). “Hence, the main problem is how to motivate them to take their first step.” ( Men and Depression - NIMH - NIH., “APA Guidelines for Psychological Practice with Boys and Men”)

Mental health apps and male audience
Once someone is hiding emotions and avoiding human interaction, the possibility of receiving help is limited. In this case, digital media is the primary source of information. 57% of all digital media usage comes from mobile apps. It has a huge potential but there are points that need to be considered. (Statista. 2019)
2.2 million IOS, 2,6 million Android applications on the market (Business of Apps. November 2019). Only 3% of it is health and fitness-related apps, 29% of those are focused on mental health diagnosis, treatment, or support (Chandrashekar P. 2018). It is not a lot, nor a small. Studies show that most apps are not beneficial and sometimes it can be even harmful. Apps with trustful sources are likely to be said to be boring and hard to use. If you look closer at those few successful mental health apps, their delivery efficiency is questionable. Because daily and monthly active users are more important than the number of downloads. Not enough gender-based user research has been done on mental health applications. Some studies include a percentage of male and female users but often above 70 percent of respondents were female. To understand male users of mental health apps, gender-based research and examination are required in the future. If you look at mobile apps that have the largest men audiences (March, 2016), men enjoy competitive (or even combative) video games and sports, such as strategy, fighting and sport themed games, news, scores and live games. Playing video games is one of the top stress-relieving approaches among men. A study shows that 97% of video games portray mental health problems, representing them negatively.

Objectives
On the other hand, the market is increasing in serious games and gamification. It has been defined variously and divided into many categories. This research will examine outcome-oriented, motivational types of serious mobile game approaches for male users who do not actively seek help and might not understand stigma and toxic masculinity. By narrowing down the focus, this research aims to explore and experiment with a mobile application design to reduce self-stigma among Mongolian, 16 to 60 years old.

Motivation
Depression, alcoholism and anxiety are the most common mental illnesses in Mongolia. According to the latest WHO (World Health Organization) data published in 2017 Suicide Deaths in Mongolia reached 836 or 4.47% of total deaths. Ranks #3 in the world. 84% of them are male, and 47% are unemployed, and most of them have low levels of education. The 25-29 age group holds the highest percentage of suicide. It is a sign of time to change. However, Mongolia is a unique country, unique culture. Mongolians proudly worshipped their own traditions and heritage. That ethnic pride brings happiness and many opportunities, positive and negative stereotypes too. Overall, there are few apps available in Mongolian, none of these related to mental health (2019). It is a challenge, also a motivation for this research.

Methodology
Since this research aims to understand the general situations and user behavior, qualitative and quantitative mixed research methods (multi methodology) are required. Three main methods will be used in further research. Quantitative online survey: Open-ended and closed-ended combined questions will help to understand common stigma and stereotypes among Mongolian people in general. Qualitative User Research: First of all, the participant selection process is important. (1) One-to-One online interview. Remote interview methods are preferred because target users of this research are more likely to avoid stereotyped labels, with no intention to reveal themselves. Group discussions or face-to-face interviews will not fit their condition. (2) User testing of a serious mobile game prototype: The prototype will be made based on the quantitative online survey result and previous research. It will have two main functions; play, monitor, reward. BUsing the user observation method will help determine user behavior and understand the difference between under and unemployed male users’ behavior. Expert Interviews as secondary research: Several expert interviews will take place to collect in-depth and technical information and clinical points of view during the research process.

Potential outcome and limitation
The first part of the research result will include quantitative and qualitative analysis with lists of common toxic masculinity, public and self-stigmatized beliefs in Mongolian people, and gender-based, employment status-based comparison tables. The second part will include user behavior, motivation, and attitude towards mental health-related apps and serious games based on prototype design and interviewees’ answers. However, this research is limited by nationality (Mongolian), age (25-40), gender (psychologically male), and stress factor (employment status). In the future, reducing self-stigmatization and toxic masculinity among men requires more diverse research with various stress factors(internal and external) at the international level.

Keywords: Mental health, Reduction, Self-stigmatization, Toxic masculinity, Serious Mobile Games, Mongolian Men

Abstract II
摘要 VI
Table Of Contents IX
List of Abbreviations XI
List of Charts XIV
List of Figures XVI
List of Tables XVIII

Chapter One: Introduction 1
1.1 Research Background 1
1.2 Research Motivation 3
1.3 Research Objectives 3
1.4 Research Questions 3

Chapter Two: Literature Review 4
2.1 Stigma and Men’s Mental Health 4
2.2 Mental Health Apps and Male Audience 10
2.3 Summary 18

Chapter Three: Methods 19
3.1 Theoretical Frameworks 19
3.2 Conceptual Frameworks 21
3.3 Research Design 23
3.4 Data Collection Methods 24
3.5 Data Analysis Strategy 25
3.6 Research Procedure 27

Chapter Four: Results 46
4.1 Survey Results 46
4.2 Game Prototype Feedbacks 59

Chapter Five: Discussion 61
5.1 Conclusion 65
5.2 Future Recommendations 67
5.3 Limitations of the Research 67

References 69

Appendix A. Survey Q&A in English 75

Appendix B. Survey Q&A in Mongolian 83

Appendix C. Sketches and draft materials that not used in the final prototype 91

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