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Halliday S, Rao D, Augusto O, Poongothai S, Sosale A, Sridhar GR, Tandon N, Sagar R, Patel SA, Narayan KMV, Johnson LCM, Wagenaar BH, Huh D, Flaherty BP, Chwastiak LA, Ali MK, Mohan V. A mediation analysis evaluating change in self-stigma on diabetes outcomes among people with depression in urban India: A secondary analysis from the INDEPENDENT trial of the collaborative care model. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003624. [PMID: 39231130 DOI: 10.1371/journal.pgph.0003624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/30/2024] [Indexed: 09/06/2024]
Abstract
Self-stigma-the internalization of negative community attitudes and beliefs about a disease or condition-represents an important barrier to improving patient care outcomes for people living with common mental disorders and diabetes. Integrated behavioral healthcare interventions are recognized as evidence-based approaches to improve access to behavioral healthcare and for improving patient outcomes, including for those with comorbid diabetes, yet their impact on addressing self-stigma remains unclear. Using secondary data from the Integrating Depression and Diabetes Treatment (INDEPENDENT) study-a trial that aimed to improve diabetes outcomes for people with undertreated and comorbid depression in four urban Indian cities via the Collaborative Care Model-we longitudinally analyzed self-stigma scores and evaluated whether change in total self-stigma scores on diabetes outcomes is mediated by depressive symptom severity. Self-stigma scores did not differ longitudinally comparing Collaborative Care Model participants to enhanced standard-of-care participants (mean monthly rate of change in Self-Stigma Scale for Chronic Illness-4 Item scores; B = 0.0087; 95% CI: -0.0018, 0.019, P = .10). Decreases in total self-stigma scores over 12 months predicted diabetes outcomes at 12 months (HbA1c, total effect; B = 0.070 95%CI: 0.0032, 0.14; P < .05), however depressive symptoms did not mediate this relationship (average direct effect; B = 0.064; 95% CI: -0.0043, 0.13, P = .069). Considering the local and plural notions of stigma in India, further research is needed on culturally grounded approaches to measure and address stigma in India, and on the role of integrated care delivery models alongside multi-level stigma reduction interventions. Trial registration : ClinicalTrials.gov, NCT02022111. https://clinicaltrials.gov/study/NCT02022111.
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Affiliation(s)
- Scott Halliday
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
- Manhiça Health Research Centre (CISM), Maputo, Mozambique
| | - Subramani Poongothai
- Madras Diabetes Research Foundation, Chennai, India
- Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Aravind Sosale
- Diabetes Care and Research Center, Diacon Hospital, Bangalore, India
| | | | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Shivani A Patel
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, United States of America
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, United States of America
| | - Leslie C M Johnson
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, United States of America
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - David Huh
- School of Social Work, University of Washington, Seattle, Washington, United States of America
| | - Brian P Flaherty
- Department of Psychology, University of Washington, Seattle, Washington, United States of America
| | - Lydia A Chwastiak
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Mohammed K Ali
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia, United States of America
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Chennai, India
- Dr. Mohan's Diabetes Specialities Centre, Chennai, India
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Cheng M, Zhu C, Meng J, Pu C, Chen G, Liu H. Association between stigma and quality of life among chronic refractory wounds patients and informal caregivers: an actor-partner interdependence model analysis. Qual Life Res 2024:10.1007/s11136-024-03759-0. [PMID: 39162970 DOI: 10.1007/s11136-024-03759-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE The co-occurrence of health impairments in patients and their informal caregivers may be particularly common in intimate care settings in China. Patients with Chronic Refractory Wounds (CRWs) and their informal caregivers constitute a dyad and exhibit dyadic effects during the caring process. Unfortunately, no study has yet explored the dyadic effects of stigma on the QoL of patients with CRWs and their caregivers. METHODS We used a convenience sampling method and recruited CRWs patient-caregiver dyads (N = 207) in China between April 2022 and October 2023. RESULTS We found that: (i) dyadic members experience varying degrees of stigma; (ii) the actor-partner effect of CRWs patients' stigma on their own and their informal caregivers' QoL was significant (Path A1: β = - 1.27, Path A2: β = - 0.37, Path P1: β = - 0.08, Path P2: β = - 0.18); (iii) informal caregivers' stigma adversely affects both their own and their patients' psychological QoL((Path A4: β = - 0.65, Path P4: β = - 0.52)). Informal caregivers' stigma can negatively impact patients' physical QoL (Path P3: β = - 0.17), whereas it does not significantly affect their own physical QoL. CONCLUSION There is a notable actor-partner effect of the CRWs patients' stigma on their own and their informal caregivers' QoL. CRWs patients' stigma should become a priority for the government to improve CRWs patients' and informal caregivers' QoL. Besides, health professionals should be addressing several assessments and interventions to decrease informal caregivers' affiliate stigma symptoms and improve CRWs patients' and informal caregivers' QoL.
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Affiliation(s)
- Ming Cheng
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 95 Qingchun Street, Hangzhou, Zhejiang Province, 310003, China.
| | - Chenya Zhu
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan Province, 250021, China
| | - Jiamin Meng
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 95 Qingchun Street, Hangzhou, Zhejiang Province, 310003, China
| | - Chenxi Pu
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 95 Qingchun Street, Hangzhou, Zhejiang Province, 310003, China
| | - Guoying Chen
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 95 Qingchun Street, Hangzhou, Zhejiang Province, 310003, China
| | - Huan Liu
- Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 95 Qingchun Street, Hangzhou, Zhejiang Province, 310003, China
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Gowling H, O'Keeffe F, Eccles FJR. Stigma, coping strategies, distress and wellbeing in individuals with cervical dystonia: a cross-sectional study. PSYCHOL HEALTH MED 2024; 29:1313-1330. [PMID: 38254270 DOI: 10.1080/13548506.2024.2305172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
Cervical dystonia (CD) is a movement disorder which causes sustained muscle contractions in the neck leading to abnormal postures and repetitive movements. As it is a highly visible condition, people with CD can experience stigma, which may lead to unhelpful coping strategies and increased psychological distress. This study investigated whether adaptive and maladaptive coping strategies mediate the relationship between stigma and psychological outcomes in people with CD. A total of 114 adults with CD completed measures of stigma, coping, health-related quality of life (HRQOL), psychological distress (depression, anxiety, stress), and psychological wellbeing at one time point. Participants' levels of distress were high, compared to the general population. Correlational analyses showed increased stigma and maladaptive coping (e.g. substance use, behavioural disengagement) were both significantly related to increased distress, lower wellbeing and lower HRQOL, whereas higher adaptive coping (e.g. acceptance, humour) was only related to higher wellbeing. In a parallel mediation model, maladaptive coping strategies mediated the relationship between stigma and distress, HRQOL and wellbeing, but adaptive coping strategies did not. These findings suggest that maladaptive coping may play an important role in explaining the relationship between stigma and some aspects of distress and wellbeing in CD. Interventions which focus on reducing different aspects of maladaptive coping may be helpful to improve wellbeing as well as reducing stigma.
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Affiliation(s)
- Helen Gowling
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Fiadhnait O'Keeffe
- Department of Psychology, St Vincent's University Hospital, Dublin, Ireland
| | - Fiona J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
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McGhie-Fraser B, McLoughlin C, Lucassen P, Ballering A, van Dulmen S, Brouwers E, Stone J, Olde Hartman T. Measuring persistent somatic symptom related stigmatisation: Development of the Persistent Somatic Symptom Stigma scale for Healthcare Professionals (PSSS-HCP). J Psychosom Res 2024; 181:111689. [PMID: 38704347 DOI: 10.1016/j.jpsychores.2024.111689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/19/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Persistent somatic symptoms (PSS) describe recurrent or continuously occurring symptoms such as fatigue, dizziness, or pain that have persisted for at least several months. These include single symptoms such as chronic pain, combinations of symptoms, or functional disorders such as fibromyalgia or irritable bowel syndrome. While stigmatisation by healthcare professionals is regularly reported, there are limited measurement instruments demonstrating content validity. This study develops a new instrument to measure stigmatisation by healthcare professionals, the Persistent Somatic Symptom Stigma scale for Healthcare Professionals (PSSS-HCP). METHODS Development was an iterative process consisting of research team review, item generation and cognitive interviewing. We generated a longlist of 60 items from previous reviews and qualitative research. We conducted 18 cognitive interviews with healthcare professionals in the United Kingdom (UK). We analysed the relevance, comprehensibility and comprehensiveness of items, including the potential for social desirability bias. RESULTS After research team consensus and initial feedback, we retained 40 items for cognitive interviewing. After our first round of interviews (n = 11), we removed 20 items, added three items and amended five items. After our second round of interviews (n = 7), we removed four items and amended three items. No major problems with relevance, comprehensibility, comprehensiveness or social desirability were found in remaining items. CONCLUSIONS The provisional version of the PSSS-HCP contains 19 items across three domains (stereotypes, prejudice, discrimination), demonstrating sufficient content validity. Our next step will be to perform a validation study to finalise item selection and explore the structure of the PSSS-HCP.
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Affiliation(s)
- Brodie McGhie-Fraser
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Caoimhe McLoughlin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Peter Lucassen
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Aranka Ballering
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Sandra van Dulmen
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands; Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Evelien Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands.
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Tim Olde Hartman
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands.
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Dew CW, Gabel RM. How perceived communication skills needed for careers influences vocational stereotyping of people who stutter. JOURNAL OF FLUENCY DISORDERS 2024; 80:106039. [PMID: 38359501 DOI: 10.1016/j.jfludis.2024.106039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/15/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Prior research has revealed people who stutter experience role entrapment in which they are discouraged from pursuing certain careers over others. The Vocational Advice Scale (VAS; Gabel et al., 2004) is a reliable survey previously used to investigate this phenomenon. This study used the VAS to determine if communication skills required for careers influences reports of role entrapment. METHOD An online survey which included the VAS and perceptions of communication skills needed for each career listed on the VAS was distributed. Correlations between items on the two surveys were completed to investigate how communication skills influences the presence of role entrapment. In addition, a one-way analysis of variance was completed to explore differences between individuals who regularly provide career advice with those who do not. RESULTS Analysis found a significant correlation between perceived communication skills required for a career and the advice provided. As the perceived communication skills needed for a career increases, the likelihood of someone advising a person who stutters to pursue that career decreases. A one-way analysis of variance further revealed participants who regularly provide career advice did not differ from those participants who do not. CONCLUSION Perceived communication abilities needed for a career is a significant indicator of role entrapment towards people who stutter. Results agree with previous studies which found differences in advisability of certain careers over others for people who stutter, especially those which require communication within challenging situations (e.g., judge, attorney).
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Affiliation(s)
- Cody W Dew
- Binghamton University, Binghamton, NY, USA.
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Ji Q, Zhang L, Xu J, Ji P, Song M, Chen Y, Guo L. The relationship between stigma and quality of life in hospitalized middle-aged and elderly patients with chronic diseases: the mediating role of depression and the moderating role of psychological resilience. Front Psychiatry 2024; 15:1346881. [PMID: 38840950 PMCID: PMC11151782 DOI: 10.3389/fpsyt.2024.1346881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/01/2024] [Indexed: 06/07/2024] Open
Abstract
Objective Patients with chronic diseases may have some psychological problems due to their own or surrounding environmental factors, which can adversely affect the patient's illness and life. Given that the number of chronically ill patients in China is currently increasing every year, more research is needed to determine the best ways to manage changes in psychological status and psychological stress responses in chronically ill patients. The researchers constructed a mediated moderation model to explore the impact of stigma on the quality of life of chronically ill patients, as well as the mediating role of depression and the moderating role of psychological resilience. Methods A stratified sampling method was used to select 363 middle-aged and old-aged patients with chronic diseases aged 45 years and older from the Affiliated Hospital of Zhejiang University for the study. Data were collected from patients with chronic diseases such as cardiac, respiratory, renal, and other chronic diseases using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), the Stigma Scale for Patients with Chronic Diseases (SSCI), the Patient Health Questionaire-9 (PHQ-9), the Quality of Life Inventory (SF-12), and the Conner-Davidson Resilience Scale (CD-RISC) were collected from patients with cardiac, respiratory, renal, and other chronic diseases. A descriptive analysis was used to describe the sample. Linear regression was used to evaluate the relationship between the variables. Mediation and moderation analyses were used to explore the mediating role of depression and the moderating role of psychological resilience. Results There was a moderate negative correlation between stigma and quality of life (r = -0.378, P < 0.01). There was a moderate negative correlation between depression and quality of life (r = -0.497, P < 0.01). There was a moderately positive correlation between psychological resilience and quality of life (r = 0.382, P < 0.01). There was a moderate negative correlation between psychological resilience and depression (r = -0.348, P < 0.01). There was a weak negative correlation between psychological resilience and stigma (r = -0.166, P < 0.01). There was a strong positive correlation between stigma and depression (r = 0.607, P < 0.01) The mediation study showed that stigma was a significant predictor of quality of life and that stigma and quality of life were mediated to some extent by depression, with the mediating effect accounting for 67.55% of the total effect. The direct path from stigma to depression is moderated by psychological resilience (β = -0.0018, P < 0.01). Conclusions Depression mediates the relationship between stigma and quality of life, while psychological elasticity plays a moderating role between stigma and depression, and when the level of psychological elasticity increases, the more significant the role of stigma on depression. As a physiologically and psychologically vulnerable group, patients with chronic diseases' overall quality of life and mental health should be taken more seriously, and clinical workers should pay timely attention to the psychological and mental conditions of patients with chronic diseases and provide timely and appropriate interventions and therapeutic measures. The relevant results of this study also provide a new perspective for clinical work on psychological intervention for patients with chronic diseases.
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Affiliation(s)
- Qiqi Ji
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Jiashuang Xu
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Pengjuan Ji
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Miaojing Song
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Yian Chen
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Leilei Guo
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
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Ownsworth T, Mols H, O'Loghlen J, Xie Y, Kendall M, Nielsen M, Mitchell J, Jones R, Geraghty T. Stigma following acquired brain injury and spinal cord injury: relationship to psychological distress and community integration in the first-year post-discharge. Disabil Rehabil 2024; 46:1796-1806. [PMID: 37128900 DOI: 10.1080/09638288.2023.2205173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE This study aimed to compare stigma levels after acquired brain injury (ABI) and spinal cord injury (SCI) during the first 12-months post-discharge and investigate relationships between stigma, psychological distress and community integration. METHODS 110 adults with ABI (55%) or SCI (45%) were recruited from brain and spinal cord injury inpatient rehabilitation units of a tertiary healthcare facility. They were administered Neuro-QOL Stigma subscale and Depression Anxiety and Stress Scales (DASS-21) at discharge, 3-months and 12-months post-discharge, and Community Integration Measure at 12-months post-discharge. RESULTS Stigma levels did not significantly differ between individuals with ABI and SCI. However, stigma significantly decreased between discharge and 12-months post-discharge for the total sample. Stigma was positively associated with psychological distress at discharge and 3-months post-discharge, but not at 12-months post-discharge. Lower functional status and power wheelchair use were associated with higher stigma at 12-months post-discharge. Stigma at 3-months post-discharge predicted community integration at 12-months post-discharge, controlling for psychological distress and functional status. CONCLUSION Experience of stigma in the first few months post-discharge may negatively impact individuals' community reintegration. The early post-discharge period may be a pivotal time for supporting individuals to explore disability and injury-related appraisals and enhance connection to their community.
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Affiliation(s)
- Tamara Ownsworth
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Helen Mols
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jessica O'Loghlen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Yanfei Xie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Melissa Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Mandy Nielsen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Jessie Mitchell
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Rachel Jones
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
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Winston-Khan SI, Healy BC, Kehoe SB, Zurawski JD, Singhal T, Glanz BI. Stigma in Multiple Sclerosis: A Narrative Review of Current Concepts, Measures, and Findings. Int J MS Care 2024; 26:125-133. [PMID: 38765301 PMCID: PMC11096853 DOI: 10.7224/1537-2073.2023-047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Stigma is an undesired differentness associated with a particular characteristic or condition that distinguishes a person as being outside the norm and cueing stereotypes. Stigma is common in people with multiple sclerosis (MS) and is associated with several disease variables including disease duration, age, age of onset, and disease course. Stigma is also associated with psychological and psychosocial variables such as depression, anxiety, and quality of life. This article reviews our current understanding of stigma in people with MS with a focus on the various stigma types including anticipated, experienced, and internalized stigma, and the lack of consistent definitions across studies. It also describes the 7 instruments that are most commonly used to measure stigma in people with MS, and the limitations of each measure. We conclude that a better understanding of stigma that includes standard definitions of stigma types could lead to more direct intervention strategies aimed at reducing particular stigma concepts and resulting in improved health-related quality of life in people with MS.
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Affiliation(s)
| | - Brian C. Healy
- From the Brigham MS Center, Brigham and Women's Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Sydney B. Kehoe
- From the Brigham MS Center, Brigham and Women's Hospital, Boston, MA
| | - Jonathan D. Zurawski
- From the Brigham MS Center, Brigham and Women's Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
| | - Tarun Singhal
- From the Brigham MS Center, Brigham and Women's Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
| | - Bonnie I. Glanz
- From the Brigham MS Center, Brigham and Women's Hospital, Boston, MA
- Department of Neurology, Harvard Medical School, Boston, MA
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Kaplan RI, McDowell CP, Wall J, Kinger SB, Salazar RD, Neargarder S, Cronin‐Golomb A. Discordance between Reports of Internalized Symptoms in Persons with Parkinson's Disease and Informants: Results from an Online Survey. Mov Disord Clin Pract 2024; 11:391-397. [PMID: 38269854 PMCID: PMC10982598 DOI: 10.1002/mdc3.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/19/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Self-report of motor and non-motor symptoms is integral to understanding daily challenges of persons with Parkinson's disease (PwPD). Care partners are often asked to serve as informants regarding symptom severity, raising the question of concordance with PwPD self-reports, especially regarding internalized (not outwardly visible) symptoms. OBJECTIVES Concordance between PwPD and informant ratings of motor and non-motor symptoms was evaluated across multiple domains. METHODS In 60 PwPD-informant pairs, we compared ratings on 11 online self-report measures comprising 33 total scores, 2/3 of which represented purely internalized symptoms. For discordant scores, multiple regression analyses were used to examine demographic/clinical predictors. RESULTS Though concordant on 85% of measures, PwPD endorsed more non-motor symptoms, bodily discomfort, stigma, and motor symptoms than informants. For PwPD, younger age, greater disease severity, and female gender predicted discordance. CONCLUSIONS Discordance between PwPD and informants on measures assessing symptoms that cannot be outwardly observed may require targeted education.
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Affiliation(s)
- Rini I. Kaplan
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
| | | | - Juliana Wall
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
| | - Shraddha B. Kinger
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
| | - Robert D. Salazar
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
| | - Sandy Neargarder
- Department of Psychological and Brain SciencesBoston UniversityBostonMAUSA
- Department of PsychologyBridgewater State UniversityBridgewaterMAUSA
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Uçan Tokuç FE, Göksu EÖ, Katı ŞD. Internal stigmatization in patients with chronic migraine and medication overuse headache. BMC Neurol 2024; 24:100. [PMID: 38500111 PMCID: PMC10949642 DOI: 10.1186/s12883-024-03586-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/26/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES Internalized stigma can have profound effects on how individuals with migraines and other primary headache disorders see themselves and their quality of life. We aimed to investigate internalized stigma in patients with chronic migraines and medication overuse headaches. METHODS A total of 57 patients (52 women, 5 men) were included in the study, 26 of these patients were affected by chronic migraine, 31 of them were affected by medication overuse headache and chronic migraine. The Internalized Stigma Scale in Mental Illness (Ristsher's stigmatization scale) and General Health Questionnaire were applied to all patients. RESULTS In Ristsher's stigmatization scale, which measures internalization of stigma, internalized stigmatization was more significant in patients with medication overuse headache than in patients with chronic migraine compared to groups (p:0.05). The subtitle of alienation was statistically significant when the groups were compared to all subscales in the form of alienation, confirmation of stereotypes, perceived discrimination, social withdrawal and resistance to stigma (p:0.05). DISCUSSION Although internal stigmatize has been observed in chronic migraine patients, medication overuse headache is also a type of headache with intense stigma. In addition, this internal stigma perhaps plays an active role in the transformation of chronic migraine patients to medication overuse headaches patient.
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Affiliation(s)
- Firdevs Ezgi Uçan Tokuç
- Republic of Turkey Ministry of Health Antalya Provincial Health Directorate, Neurology department, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey.
| | - Eylem Özaydın Göksu
- Republic of Turkey Ministry of Health Antalya Provincial Health Directorate, Neurology department, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Şennur Delibaş Katı
- Republic of Turkey Ministry of Health Antalya Provincial Health Directorate, Neurology department, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
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Logan BA, Neargarder S, Kinger SB, Larum AK, Salazar RD, Cronin-Golomb A. Self-perceived stigma in Parkinson's Disease in an online sample: Comparison with in-person sample, role of anxiety, and relative utility of four measures of stigma perception. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-10. [PMID: 38442327 DOI: 10.1080/23279095.2024.2321578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVE Persons with Parkinson's disease (PwPD) experience motor and non-motor symptoms that may elicit stigmatization. We investigated whether online assessment would replicate in-person findings of younger age and depression as predictors of stigma perception. We further assessed the predictive value of anxiety, and compared predictors across four stigma measures. METHODS The online study (n = 347), like the earlier in-person study (n = 362), used the Parkinson's Disease Questionnaire stigma subscale (PDQ-39stigma). It also assessed anxiety and added the Stigma Scale for Chronic Illness (SSCI), Stigmatization Scale, and Mental Health Consumers' Experience of Stigma Scale. We correlated stigma perception scores with demographic/clinical characteristics and conducted hierarchical regression and mediation analyses. RESULTS Online and in-person predictors of stigma perception with the PDQ-39stigma included younger age (men) and depression (men, women). Depression mediated the relation between stigma perception and motor experiences of daily living (EDLs). In the online sample, when anxiety was added, it predicted stigma perception (PDQ-39stigma, SSCI) and mediated the relation between stigma and both motor and non-motor EDLs (PDQ-39stigma). For all four stigma-perception scales, younger age predicted scores. Multiple additional predictors of PDQ-39stigma and SSCI scores suggest their utility relative to the other two scales. Conclusions: Younger age and depression predicted self-perceived stigma in online and in-person samples, indicating the cross-modal utility of the measure, PDQ-39stigma. In the online sample, anxiety also predicted stigma perception per the PDQ-39stigma and SSCI. We recommend both measures and note that treating depression and anxiety may be important especially in younger PwPD to reduce self-perceived stigma.
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Affiliation(s)
- Bridget A Logan
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Sandy Neargarder
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- Department of Psychology, Bridgewater State University, Bridgewater, MA, USA
| | - Shraddha B Kinger
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Amie K Larum
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Robert D Salazar
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Kitamura S, Miyamoto R, Watanabe S, Yoshida T, Ishii Y. Development of the Japanese version of the stroke stigma scale: a validity and reliability assessment. Top Stroke Rehabil 2024:1-10. [PMID: 38373013 DOI: 10.1080/10749357.2024.2318097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/04/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The stigma perceived by many post-stroke persons hinders their social lives. A scale to measure stigma is needed to identify social problems related to stigma, and to evaluate effectiveness of interventions. OBJECTIVES This study aimed to develop a Japanese version of the Stroke Stigma Scale (SSS-J), and confirm its utility by examining reliability and validity. METHODS Eighty community-dwelling post-stroke individuals were enrolled at six sites. After translating the scale into Japanese using back translation methods, psychometric properties of the rating scale, internal scale validity, and reliability were examined to fit the Rasch model. Criterion-related validity, construct validity, and test-retest reliability were examined using total scores transformed to logit. For test-retest reliability, 30 participants completed the SSS-J twice, one week apart. RESULTS Rasch analysis showed that the SSS-J had the best fit with 15 items on a 3-category rating scale. Item difficulty logits were -2.01 to 2.21, person ability logits were -4.69 to 0.62 (mean, -1.41), person reliability coefficient was 0.71 (separation index, 1.58), and item reliability coefficient was 0.96 (separation index, 5.04). For criterion validity, Spearman's rank correlation coefficient with the Center for Epidemiologic Studies Depression Scale was 0.51 (p < 0.001). For construct validity, Spearman's rank correlation coefficients with each subscale of the Stroke Impact Scale ranged from -0.36 to -0.16 (p = 0.002-0.126). For test-retest reliability, the intra-class correlation coefficient was 0.64 (p < 0.001). CONCLUSIONS The SSS-J adapted to the Rasch model was reliable and valid. This scale can be used to quantitatively measure stigma among community-dwelling post-stroke persons in Japan.
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Affiliation(s)
- Shin Kitamura
- Department of Occupational Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Reiko Miyamoto
- Department of Occupational Therapy, School of Health Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Shota Watanabe
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Taiki Yoshida
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Yoshikazu Ishii
- Department of Occupational Therapy, Faculty of Rehabilitation, Gunma Paz University, Gunma, Japan
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13
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Katusiime B, Cassidy R, Krska J, Corlett SA. Medicine burden experiences of people living with HIV and association with stigma. AIDS Care 2024; 36:227-237. [PMID: 37848005 DOI: 10.1080/09540121.2023.2264557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
The medicine burden of people living with HIV (PLWH) is unknown. Between 2018 and 2020, participants completed a survey comprising outcome measures for medicine burden (LMQ-3) and stigma experiences (SSCI-8). Participants were HIV+ adults (≥18 years), using antiretrovirals (ARV) with or without non-ARV medicines, recruited via two outpatient clinics in southeast England and online via HIV charities across the UK. Spearman's correlations between medicine burden levels and stigma scores were calculated. Participants were mostly males (72%, 101/141) of mean (SD) age 48.6 (±12.31) years. Total number of medicines ranged from 1-20. High medicine burden was self-reported by 21.3% (30) and was associated with polypharmacy (≥ 5 medicines) (101.52 Vs 85.08, p = 0.006); multiple doses versus once daily regimes (109.31 Vs 85.65, p = 0.001); unemployment (98.23 Vs 84.46, p = 0.004); and ethnicity (97 Vs 86.85, p = 0.041 for non-White versus White participants). A correlation between medicine burden and stigma was observed (r = 0.576, p < 0.001). The LMQ-3 demonstrated adequate construct validity and reliability (domain loadings ranging 0.617-0.933 and Cronbach's α of 0.714-0.932). Assessment of medicine burden and psychosocial stigma in PLWH could enable identification of those needing additional support in future research and practice.
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Affiliation(s)
- B Katusiime
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, UK
| | - R Cassidy
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - J Krska
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, UK
| | - S A Corlett
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, UK
- Clinical Trials, Research and Innovation, Medway NHS Foundation Trust, Windmill Road, Gillingham, UK
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14
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Ghajarzadeh M, Fitzgerald KC, Mowry EM, Nourbakhsh B. Association between demographics, socioeconomics, and disease-related factors and the perception of stigma in people with MS. Mult Scler 2024; 30:238-246. [PMID: 38179970 DOI: 10.1177/13524585231223057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Stigma is prevalent among individuals with chronic diseases, such as multiple sclerosis (MS) and those with comorbid mental health disorders, but its associated factors are poorly understood. OBJECTIVE To investigate the prevalence and correlates of stigma in people living with MS. METHODS We analyzed data from the MS Partners Advancing Technology and Health Solutions (MS PATHS) network, which collected patient information and outcomes during routine clinic visits. We used a multinomial logistic regression model to examine the cross-sectional association between stigma and demographic, socioeconomics, and MS-related factors. RESULTS We included 11,634 participants. The mean Neuro-QoL stigma T-score was 47.2 ± 8.6, and 17.7% of participants were classified as having moderate to severe stigma using established cutoffs. Multinomial logistic regression models suggest that higher disability levels, progressive form of the disease, shorter duration of the disease, and unemployment were associated with higher stigma while being male, married, undergoing treatment with high-efficacy disease-modifying therapies (DMTs), and being from European MS centers were associated with lower stigma perception. Disability levels, measured by Patient-Determined Disease Steps (PDDS), had the strongest independent association with stigma. CONCLUSION Stigma remains a relevant issue for people living with MS. Factors, such as physical and cognitive disability, DMT, and employment status may influence the severity of perceived stigma.
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Affiliation(s)
- Mahsa Ghajarzadeh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Douglas M, Yielder R, Kleinstäuber M, Borgmann A, Karu LT, Dalbeth N, Petrie KJ. The Big Picture: Patient Drawings of Gout and Their Relationship to Illness Perceptions and Stigma. J Rheumatol 2024; 51:203-205. [PMID: 37839819 DOI: 10.3899/jrheum.2023-0617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Affiliation(s)
- Meihana Douglas
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rachael Yielder
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Anna Borgmann
- Department of Psychology, Medical School Hamburg, Hamburg, Germany
| | - Leanne Te Karu
- Department of General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
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Habibi MA, Yazdan Panah M, Vaheb S, Olfatifar M, Shaygannejad A, Mokary Y, Ghasemi M, Thapa S, Shaygannejad V, Mirmosayyeb O. Validity and reliability of the Persian version of Recce stigma scale in people with multiple sclerosis and its impact on quality of life. BMC Neurol 2024; 24:36. [PMID: 38254066 PMCID: PMC10802045 DOI: 10.1186/s12883-024-03544-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND There is often a fear of social stigma experienced by people with multiple sclerosis (pwMS), which negatively impacts the quality of their lives (QoL). Currently, no Persian-validated questionnaire is available to assess this issue in pwMS. This study aimed to assess the validaty and reliability of the Persian version of Reece Stigma Scale Multiple Sclerosis (RSS-MS) questionnaire for pwMS. METHOD This cross-sectional was conducted between January and February 2023 in Isfahan, Iran. The demographic and clinical information and the RSS-MS and Multiple Sclerosis Impact Scale-29 (MSIS-29) questionnaires were recorded from pwMS. The content validity index (CVI) and content validity ratio (CVR) have been used to evaluate validity. To identify the factors supporting the MS-related stigma, an exploratory factor analysis (EFA) was conducted. RESULTS The present study recruited 194 pwMS. Based on factor analysis, only two factors had eigenvalues ≥ 1.0 and exhibited high internal consistency. The Cronbach's α coefficient for internal consistency of the RSS-MS scale was 0.822. More evidence for the construct validity suggested that having higher levels of stigma is significantly correlated with psychological (r = 0.468, p-value < 0.001) and physical dimensions (r = 0.585, p-value < 0.001) of MSIS-29. Expanded Disability Status Scale, disease duration, and treatment duration did not show a significant correlation with stigma (p-value > 0.05). CONCLUSION This study indicated that the modified version of the RSS-MS scale in the Persian language showed acceptable validity and reliability for evaluating the stigma among Persian pwMS. Furthermore, this study emphasizes the cruciality of monitoring and addressing stigma among pwMS, as it can potentially enhance medical, psychological, physical, and QoL outcomes.
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Affiliation(s)
- Mohammad Amin Habibi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Yazdan Panah
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Meysam Olfatifar
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Aysa Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yousef Mokary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Ghasemi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sangharsha Thapa
- Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Xu G, Liu T, Jiang Y, Xu Y, Zheng T, Li X. Heterogeneity in Psychological Adaptation Patterns and Its Predictive Factors Among Patients with Inflammatory Bowel Disease: A Latent Profile Analysis. Psychol Res Behav Manag 2024; 17:219-235. [PMID: 38269258 PMCID: PMC10807268 DOI: 10.2147/prbm.s438973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
Purpose To identify the distinct profiles of psychosocial adaptation of Chinese inflammatory bowel disease (IBD) patients and the predictive factors. Patients and Methods A cross-sectional survey method was used to recruit 263 IBD patients who were treated in a tertiary hospital in Shandong Province from July 2022 to April 2023. The general information questionnaire, Inflammatory Bowel Disease Psychosocial Adaptation Questionnaire, Resilience Scale for Inflammatory Bowel Disease, Chinese Benefit Finding Scale, and Stigma Scale for Chronic Illnesses, Medical Coping Modes Questionnaire and Inflammatory Bowel Disease-Disk were used as the instruments for investigation. Latent profile analysis was conducted with the six dimensions of the IBD Psychosocial Adaptation Questionnaire as the explicit indicators. The predictors of profile membership were analyzed by multinomial logistic regressions. Results Four profiles of psychosocial adaptation in IBD patients were identified: Low level psychosocial adaptation (14.1%), Medium level psychosocial adaptation - High body image distress (25.5%), Medium level psychosocial adaptation - Low body image distress (30.0%) and High level psychosocial adaptation (30.4%). Compared with Low level psychosocial adaptation group, High level psychosocial adaptation group had a higher level of positive cognition (OR=2.930, 95%IC 0.017-0.305, p< 0.001) and overall psychological resilience (OR=1.832, 95%IC 0.000-0.016, p < 0.001), more health behaviors (OR= 2.520, 95%IC 0.191-1.358, p=0.001), a lower level of internal stigma (OR=0.135, 95%IC 0.043-0.420, p < 0.001) and overall stigma (OR=0.010, 95%IC 0.003-0.118, p=0.001), less acceptance-resignation coping style (OR=0.055, 95%IC 0.209-3.200, p < 0.001) and lower disease burden (OR=0.407, 95%IC 0.298-0.698, p=0.006). Conclusion About a half of IBD patients had a medium level of psychosocial adaptation. Psychological resilience, benefit finding, stigma, medical coping styles and disease burden predicted psychosocial adaptation profiles. Healthcare providers need to focus on the heterogeneity of psychosocial adaptation of IBD patients and formulate personalized intervention programs for patients with different profiles to improve their psychosocial adaptation.
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Affiliation(s)
- Guangyi Xu
- Author affiliations School of Nursing, Qingdao University, Shandong, People’s Republic of China
| | - Ting Liu
- Author affiliations School of Nursing, Qingdao University, Shandong, People’s Republic of China
| | - Yunxia Jiang
- Author affiliations School of Nursing, Qingdao University, Shandong, People’s Republic of China
| | - Yanhong Xu
- Author affiliations Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Shandong, People’s Republic of China
| | - Taohua Zheng
- Author affiliations Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Shandong, People’s Republic of China
| | - Xiaona Li
- Author Affiliations Endoscopic Diagnosis and Treatment Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Qingdao, People’s Republic of China
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Grady KL, Kallen MA, Beiser DG, Lindenfeld J, Teuteberg J, Allen LA, McIlvennan CK, Rich J, Yancy C, Lee CS, Denfeld QE, Kiernan M, Walsh MN, Adler E, Ruo B, Stehlik J, Kirklin JK, Bedjeti K, Cella D, Hahn EA. Novel measures to assess ventricular assist device patient-reported outcomes: Findings from the MCS A-QOL study. J Heart Lung Transplant 2024; 43:36-50. [PMID: 37591454 PMCID: PMC10867283 DOI: 10.1016/j.healun.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/24/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Generic and heart failure-specific measures do not capture unique aspects of living with a ventricular assist device (VAD). Using state-of-the-science psychometric measurement methods, we developed a measurement system to assess post-ventricular assist device adjustment and health-related quality of life (HRQOL). METHODS Patients were recruited from 10/26/16-2/29/20 from 12 U.S. VAD programs. We created a dataset of participants (n = 620) enrolled before left (L)VAD implantation, with data at 3- or 6- months post-implantation (group1 [n = 154]), and participants enrolled after LVAD implantation, with data at one timepoint (group 2 [n = 466]). We constructed 5 item banks: 3 modified from existing measures and 2 new measures. Analyses included item response theory (IRT) modeling, differential item functioning tests for systematic measurement bias, and indicators of reliability and validity. RESULTS Of 620 participants, 56% (n = 345) were implanted as destination therapy, 51% (n = 316) were <12 months post-implantation, mean age = 57.3 years, 78% (n = 485) male, 70% (n = 433) White, 58% (n = 353) married/partnered, and 58% (n = 357) with >high school education. We developed 5 new VAD item banks/measures: 6-item VAD Team Communication; 12-item Self-efficacy Regarding VAD Self-care; 11-item Being Bothered by VAD Self-care and Limitations; 7-item Satisfaction with Treatment; and 11-item Stigma. Cronbach's alpha reliability ranged from good (≥0.80) to excellent (≥0.90) for item banks/measures. All measures, except VAD Team Communication, demonstrated at least moderate correlations (≥0.30) with construct validity indicators. CONCLUSIONS These measures meet IRT modeling assumptions and requirements; scores demonstrate reliability and validity. Use of these measures may assist VAD clinicians to inform patients about VADs as a treatment option and guide post-VAD interventions.
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Affiliation(s)
- Kathleen L Grady
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David G Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois
| | - JoAnn Lindenfeld
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | | | - Larry A Allen
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Colleen K McIlvennan
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jonathan Rich
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Clyde Yancy
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | - Quin E Denfeld
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Michael Kiernan
- Department of Medicine, Tufts University, Boston, Massachusetts
| | | | - Eric Adler
- Department of Medicine, University of California-San Diego, La Jolla, California
| | - Bernice Ruo
- Department of Medicine, University of California-San Diego, La Jolla, California
| | - Josef Stehlik
- Department of Medicine, University of Utah, Salt Lake City, Utah
| | | | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Dave Cella
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Nawfal ES, Gray A, Sheehan DM, Ibañez GE, Trepka MJ. A Systematic Review of the Impact of HIV-Related Stigma and Serostatus Disclosure on Retention in Care and Antiretroviral Therapy Adherence Among Women with HIV in the United States/Canada. AIDS Patient Care STDS 2024; 38:23-49. [PMID: 38150524 PMCID: PMC10794841 DOI: 10.1089/apc.2023.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
This systematic review explores the roles of HIV stigma and disclosure of HIV serostatus in antiretroviral therapy (ART) adherence and retention in care (RIC) among women with HIV (WHIV) in the United States and Canada. We conducted a systematic search of electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Google scholar) to identify peer-reviewed articles published between January 1996 and December 2022. The search yielded 1120 articles after duplicates were removed. Of these, 27 articles met the inclusion criteria. The majority (89%) of the studies were conducted in the United States. The studies included WHIV from diverse racial/ethnic groups, residing in both urban and rural areas. Most of the studies suggested that internalized stigma, perceived community stigma, and fear of disclosure were important barriers to ART adherence and RIC among WHIV. HIV-related stigma experienced within the health care setting was also reported as a factor impacting health care utilization. A few studies identified mental health distress as a potential mechanism accounting for the association and suggested that social support and resilience may buffer the negative effects of stigma and disclosure on ART adherence and RIC among WHIV. Our review indicates that stigma and concerns about disclosure continue to significantly affect HIV health outcomes for WHIV in high-income countries. It underscores the importance of integrated HIV care services and interventions targeting mental health, resilience building, and improved patient-provider relationships for WHIV to enhance ART adherence and RIC. Longitudinal studies and investigations into additional mechanisms are needed to advance understanding and inform women-centered interventions.
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Affiliation(s)
- Ekpereka Sandra Nawfal
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Aaliyah Gray
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
| | - Gladys E. Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
- Research Center for Minority Institutions, Florida International University, Miami, Florida, USA
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Mei Y, Yang X, Gui J, Li Y, Zhang X, Wang Y, Chen W, Chen M, Liu C, Zhang L. The relationship between psychological resilience and quality of life among the Chinese diabetes patients: the mediating role of stigma and the moderating role of empowerment. BMC Public Health 2023; 23:2043. [PMID: 37858079 PMCID: PMC10585926 DOI: 10.1186/s12889-023-16927-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Although some factors, such as stigma and empowerment, influence the complex relationship between psychological resilience and quality of life, few studies have explored similar psychological mechanisms among patients with diabetes. Therefore, this study explored the mediating role of stigma and the moderating role of empowerment in the psychological mechanisms by which psychological resilience affects quality of life. METHODS From June to September 2022, data were collected by multi-stage stratified sampling and random number table method. Firstly, six tertiary hospitals in Wuhu were numbered and then selected using the random number table method, resulting in the First Affiliated Hospital of Wannan Medical College being selected. Secondly, two departments were randomly selected from this hospital: endocrinology and geriatrics. Thirdly, survey points were set up in each department, and T2DM patients were randomly selected for questionnaire surveys. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure the psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma. Empowerment was measured by the Diabetes Empowerment Scale (DES). Quality of Life was assessed by the Diabetes Quality of Life Scale (DQoL). We used SPSS (version 21) and PROCESS (version 4.1) for data analysis. RESULTS (1) Psychological resilience was negatively correlated with stigma and quality of life, and positively correlated with empowerment. Stigma was positively associated with empowerment and quality of life. Empowerment was negatively correlated with quality of life. (2) The mediation analysis showed that psychological resilience had a direct predictive effect on the quality of life, and stigma partially mediated the relationship; Empowerment moderates the first half of "PR → stigma → quality of life"; Empowerment moderates the latter part of "PR → stigma → quality of life." CONCLUSIONS Under the mediating effect of stigma, psychological resilience can improve quality of life. Empowerment has a moderating effect on the relationship between psychological resilience and stigma, and it also has a moderating effect on the relationship between stigma and quality of life. These results facilitate the understanding of the relationship mechanisms between psychological resilience and quality of life.
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Affiliation(s)
- Yujin Mei
- School of Nursing, Anhui Province, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, People's Republic of China
| | - Xue Yang
- School of Nursing, Anhui Province, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, People's Republic of China
| | - Jiaofeng Gui
- School of Nursing, Anhui Province, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, People's Republic of China
| | - Yuqing Li
- School of Nursing, Anhui Province, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, People's Republic of China
| | - Xiaoyun Zhang
- School of Nursing, Anhui Province, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, People's Republic of China
| | - Ying Wang
- School of Nursing, Anhui Province, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, People's Republic of China
| | - Wenyue Chen
- School of Nursing, Anhui Province, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, People's Republic of China
| | - Mingjia Chen
- School of Nursing, Anhui Province, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, People's Republic of China
| | - Changjun Liu
- School of Marxism, Liaoning Province, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, People's Republic of China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, People's Republic of China.
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Almeida A, Ogbonnaya IN, Wanyenze RK, Crockett KS, Ediau M, Naigino R, Lin CD, Kiene SM. A Psychometric Evaluation and a Framework Test of the HIV Stigma Mechanisms Scale Among a Population-Based Sample of Men and Women Living with HIV in Central Uganda. AIDS Behav 2023; 27:3038-3052. [PMID: 36917424 PMCID: PMC10440247 DOI: 10.1007/s10461-023-04026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/15/2023]
Abstract
HIV stigma is a critical barrier to HIV prevention and care. This study evaluates the psychometric properties of the HIV Stigma Mechanisms Scale (HIV-SMS) among people living with HIV (PLHIV) in central Uganda and tests the underlying framework. Using data from the PATH/Ekkubo study, (n = 804 PLHIV), we assessed the HIV-SMS' reliability and validity (face, content, construct, and convergent). We used multiple regression analyses to test the HIV-SMS' association with health and well-being outcomes. Findings revealed a more specific (5-factor) stigma structure than the original model, splitting anticipated and enacted stigmas into two subconstructs: family and healthcare workers (HW). The 5-factor model had high reliability (α = 0.92-0.98) and supported the convergent validity (r = 0.12-0.42, p < 0.01). The expected relationship between HIV stigma mechanisms and health outcomes was particularly strong for internalized stigma. Anticipated-family and enacted-family stigma mechanisms showed partial agreement with the hypothesized health outcomes. Anticipated-HW and enacted-HW mechanisms showed no significant association with health outcomes. The 5-factor HIV-SMS yielded a proper and nuanced measurement of HIV stigma in central Uganda, reflecting the importance of family-related stigma mechanisms and showing associations with health outcomes similar to and beyond the seminal study.
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Affiliation(s)
- Alexandra Almeida
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- School of Social Work, College of Health and Human Services, San Diego State University, San Diego, CA, USA
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Ijeoma Nwabuzor Ogbonnaya
- School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, USA
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Katherine Schmarje Crockett
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Michael Ediau
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Rose Naigino
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Chii-Dean Lin
- Department of Mathematics & Statistics, San Diego State University, La Jolla, CA, USA
| | - Susan M Kiene
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
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Kocas HD, Rubin LR, Lobel M. Stigma and mental health in endometriosis. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100228. [PMID: 37654520 PMCID: PMC10465859 DOI: 10.1016/j.eurox.2023.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023] Open
Abstract
This review provides an overview of patient experiences of endometriosis, endometriosis-related types and sources of stigma pertaining to menstruation, chronic pain, and infertility, and their impact on patients' mental health with particular implications for patient care. Because endometriosis is a complex disease with multifactorial etiology, complicated pathophysiology, and a spectrum of clinical features, diagnosis of endometriosis is typically a lengthy process, and many patients experience initial misdiagnosis. A hallmark symptom is severe menstrual pain with other symptoms including chronic pelvic pain, dysmenorrhea, and infertility. Prior research documents that the diagnostic odyssey, complex management, disabling and unpredictable nature of the disease, and painful symptom profile affect multiple life domains of patients, resulting in poor physical, social, and psychological functioning and clinically-significant rates of anxiety and depression for many. More recently, stigma has been recognized as a potent contributor to poor mental health in endometriosis patients, but existing research is limited and largely atheoretical. We identify major sources of stigma related to endometriosis, including menstrual stigma, chronic pain stigma, and infertility stigma, and their likely impact on patients and health care provision. An integrative theoretical approach is described to facilitate research on the prevalence and effects of endometriosis stigma and their explanatory mechanisms, highlighting specific well-validated psychological instruments to assess stigma. Implications for patient care are emphasized. Better understanding of stigma and mental health in people with endometriosis will enhance the standard of care for this patient population.
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Affiliation(s)
- H. Deniz Kocas
- Department of Clinical Psychology, The New School for Social Research, New York, NY, USA
| | - Lisa R. Rubin
- Department of Clinical Psychology, The New School for Social Research, New York, NY, USA
| | - Marci Lobel
- Department of Psychology and Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
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Mei Y, Yang X, Liu C, Li Y, Gui J, Zhang L. The impact of psychological resilience on chronic patients' depression during the dynamic Zero-COVID policy: the mediating role of stigma and the moderating role of sleep quality. BMC Psychol 2023; 11:213. [PMID: 37480116 PMCID: PMC10362636 DOI: 10.1186/s40359-023-01248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 07/12/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE Chronic patients are experiencing depression caused by themselves or the surrounding environment, how to cope with the change of mentality and adjust the psychological stress response, especially under the background of the current dynamic Zero-COVID policy in China, is a problem worth further discussion. The researchers constructed a mediating regulation model to test the influence of psychological resilience on depression of chronic patients during dynamic Zero-COVID, as well as the mediating role of stigma and the moderating role of sleep. METHOD From October 2021 to February 2022, this study used a multi-stage sampling method and random number table method to collect data in the Shang Cheng District of Hangzhou City, Zhejiang Province. Firstly, the Second Affiliated Hospital of the Zhejiang University School of Medicine, a third-class hospital was randomly selected from the Shang Cheng District. Secondly, three departments were strategically selected from this hospital: endocrinology, dermatology, and traditional Chinese medicine. Thirdly, survey points were set up in each department, and chronic patients were strategically selected for questionnaire surveys. Finally, a face-to-face survey was conducted on 398 chronic patients who met the criteria for inclusion. In addition, chronic medical illness burden was assessed using the Cumulative Illness Rating Scale-Geriatrics (CIRS-G), psychological resilience was measured by the Conner-Davidson Resilience Scale (CD-RISC), stigma was measured by the Stigma Scale for Chronic Illness (SSCI), sleep was measured by the Pittsburgh Sleep Quality Index(PSQI) and depression was estimated by the Patient Health Questionaire-9(PHQ-9). SPSS (version 25.0) and PROCESS (version 4.0) were used for correlation analysis, mediation analysis, and mediated moderation analysis. RESULTS Psychological resilience was negatively correlated with depression, stigma, and sleep. Depression was positively correlated with stigma and sleep. Stigma and sleep were positively correlated; Stigma played a mediating role in the relationship between psychological resilience and depression; Sleep moderated the first half of the pathway "psychological resilience [Formula: see text] stigma [Formula: see text] depression". CONCLUSION Psychological resilience affected depression directly and indirectly through stigma. At the same time, sleep played a moderating role between psychological resilience and depression. The correlation between psychological resilience and stigma was stronger when levels of sleep levels were higher.
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Affiliation(s)
- Yujin Mei
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, P.R. China
| | - Xue Yang
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, P.R. China
| | - Changjun Liu
- School of Marxism, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, P.R. China
| | - Yuqing Li
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, P.R. China
| | - Jiaofeng Gui
- School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, P.R. China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, P.R. China.
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24
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Fekih-Romdhane F, Obeid S, Chidiac G, Dabbous M, Malaeb D, Hallit R, Hallit S. Measuring public attitudes towards people living with chronic diseases in Arabic-speaking populations: adaptation and development of the Social Stigma Scale of Chronic Diseases (SSS-CD). BMC Public Health 2023; 23:1375. [PMID: 37464332 DOI: 10.1186/s12889-023-16315-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/14/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND A large proportion of the population in Arab countries suffer from chronic diseases. According to the statistics by the Global Health Estimates, chronic illnesses contribute by 71% to total deaths in the Arab region. While chronic illnesses have been demonstrated to carry high levels of social stigma, it is only recently that little research attention has been given to this topic in the Arab world. It is well-established that the social stigma construct is culturally-dependent. Therefore, the lack of an Arabic measure highlighted the urgent need for developing a culturally adapted and valid instrument to assess social stigma toward people living with chronic diseases. In this study, we aimed to examine the psychometric properties of the Arabic translation, adaptation and development of "the Social Stigma Scale of Chronic Diseases" (SSS-CD). METHOD Fifteen items derived from the literature and assessing social stigma towards chronic diseases have been administered to 570 Arabic-speaking adults from the Lebanese general population (aged 24.59 ± 6.75years; 68.6% women). Items were translated into Arabic using a forward-backward translation method. Exploratory factor analysis (EFA) using a principal-axis EFA on the first split-half subsample, followed by a confirmatory factor analysis (CFA) tested on the model extracted from the EFA on the second split-half subsample, were conducted to examine the construct validity of the SSS-CD. Fit indices were deemed adequate if the normed model chi-square (χ²/df) ≤ 3, the Steiger-Lind root mean square error of approximation (RMSEA) ≤ 0.08, the Tucker-Lewis Index (TLI) and the comparative fit index (CFI) ≥ 0.90. RESULTS Findings revealed that the 10-item SSS-CD has a unidimensional factor structure, with the following fit indices: χ2/df = 92.95/34 = 2.73, RMSEA = 0.077 (90% CI 0.059, 0.096), SRMR = 0.062, CFI = 0.939, TLI = 0.919. A good internal consistency was demonstrated by a McDonald's omega value of 0.73 for the total score. Findings also supported invariance across gender, with men exhibiting higher levels of social stigma attached to chronic diseases than women. All three dimensions of stigmatization (social, psychological and evolutionary stigmatization) were positively correlated with SSS-CD scores (Social self-interest [r = .40; p < .001], Evolutionary self-interest [r = .37; p < .001], Psychological self-interest [r = .42; p < .001]), demonstrating relatively strong convergent validity. CONCLUSION Our findings suggest that the SSS-CD has robust psychometric qualities. We thus preliminarily suggest that the scale is valid, reliable and suitable for use among Arabic-speaking people from the general population to measure public attitudes towards people living with chronic diseases. Providing this psychometrically sound measure will hopefully enable to foster research in this area in order to draw a clear overview of the prevalence and characteristics of social stigma attached to chronic diseases in Arabic-speaking communities. However, given that this was the first study to examine the psychometric properties of the SSS-CD, the present findings and conclusions should be considered tentative pending future cross-national validation studies.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, Manouba, 2010, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Georgio Chidiac
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Dermatology, University Claude Bernard Lyon 1, Lyon, France
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon
- Department of Infectious Disease, Notre Dame des Secours University Hospital Center, Street 93, Byblos, Postal Code 3, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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25
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Mesinkovska N, Craiglow B, Ball SG, Morrow P, Smith SG, Pierce E, Shapiro J. The Invisible Impact of a Visible Disease: Psychosocial Impact of Alopecia Areata. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00941-z. [PMID: 37289409 DOI: 10.1007/s13555-023-00941-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION The physical impact of alopecia areata (AA) is visible, but the psychological and social consequences and emotional burden are often underrecognized. METHODS In this cross-sectional study, 547 participants recruited via the National Alopecia Areata Foundation completed a survey encompassing demographics; AA illness characteristics; and five patient-reported outcome measures on anxiety and depression, perceived stress, psychological illness impact, stigma, and quality of life (QoL). Differences in disease severity subgroups were assessed via analysis of variance (ANOVA) and t tests. RESULTS Mean age was 44.6 years, and 76.6% were female. Participants with more severe hair loss tended to report longer duration of experiencing AA symptoms (P < 0.001). Overall, participants reported negative psychological impact, emotional burden, and poor QoL due to AA. Participants with 21-49% or 50-94% scalp hair loss reported greater psychological impact and poorer QoL than those with 95-100% scalp hair loss (most parameters P < 0.05). Similar results were observed for eyebrow/eyelash involvement subgroups. CONCLUSIONS These results suggest that participants with AA experience emotional burden, negative self-perception, and stigma, but the impact of AA is not dependent solely on the amount of hair loss. Lower impact among participants with 95-100% scalp hair loss may indicate that they have adapted to living with AA.
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Affiliation(s)
- Natasha Mesinkovska
- Department of Dermatology, School of Medicine, University of California, Irvine, CA, USA
| | - Brittany Craiglow
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Susan G Ball
- Eli Lilly and Company, 639 S Delaware St, Indianapolis, IN, 46225, USA.
| | - Paula Morrow
- Eli Lilly and Company, 639 S Delaware St, Indianapolis, IN, 46225, USA
| | - Sarah G Smith
- Eli Lilly and Company, 639 S Delaware St, Indianapolis, IN, 46225, USA
| | - Evangeline Pierce
- Eli Lilly and Company, 639 S Delaware St, Indianapolis, IN, 46225, USA
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University, NY, USA
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26
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Tan H. The mediating role of anxiety in feelings of stigma and quality of life of post-epidemic hemiplegic patients with cerebral hemorrhage. J Clin Neurosci 2023; 112:12-19. [PMID: 37028216 DOI: 10.1016/j.jocn.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To analyze factors influencing the sense of shame, anxiety and quality of life of hemiplegic patients after cerebral hemorrhage and to verify the intermediary role of anxiety in the post-epidemic period. METHODS 240 hemiplegic patients with cerebral hemorrhage were enrolled from a third class a hospital in Hubei Province and interrogated by questionnaire and convenience sampling method. RESULTS Some ICH patients demonstrated problems related to sense of shame, anxiety, and poor quality of life. Sense of shame was positively related to anxiety and shame and anxiety were negatively related to the quality of life. Multivariate regression analysis indicated that age, educational level, occupational status, per capita monthly income, medical payment method, disease duration, sense of shame and anxiety influenced quality of life and together explained 55.8% of the variability. Anxiety mediated prediction of illness and shame on quality of life and the mediating effect accounted for 55.6% of the total effect. CONCLUSION The current study examined correlations between anxiety, stigma and quality of life while testing the hypothesis that anxiety mediated the quality of life. Anxiety was related to quality of life. As such, treatment of anxiety may present an opportunity to improve quality of life after ICH.
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Affiliation(s)
- Hui Tan
- Yanbian University, School of Nursing, YanJi 133000, China.
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27
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Pan S, Wang L, Zheng L, Luo J, Mao J, Qiao W, Zhu B, Wang W. Effects of stigma, anxiety and depression, and uncertainty in illness on quality of life in patients with prostate cancer: a cross-sectional analysis. BMC Psychol 2023; 11:129. [PMID: 37098648 PMCID: PMC10131473 DOI: 10.1186/s40359-023-01159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/04/2023] [Indexed: 04/27/2023] Open
Abstract
PURPOSE Although much work has been carried out on stigma, anxiety and depression, and quality of life(QoL) in cancer patients, far less work has been done to examine their associations. This study explores the effects of stigma, anxiety and depression, and uncertainty in illness on QoL in prostate cancer patients. METHODS A cross-sectional study surveyed levels of stigma, anxiety and depression, QoL, and uncertainty in illness in 263 people diagnosed with prostate cancer from the First Affiliated Hospital, Zhejiang University School of Medicine. The main study variables were analyzed by structural equation modeling. RESULTS Anxiety and depression were significantly negatively related to QoL, with a standardized regression coefficient (β=-0.312, S.E. =0.478, p < 0.05), which means that participants reporting higher levels of anxiety reported decreased levels of QoL. Stigma was positively related to anxiety and depression (β = 0.135, S.E. =0.203, p < 0.001) and uncertainty in illness (β = 0.126, S.E. =2.194, p < 0.05). Stigma has direct effects on QoL (β=-0.209, S.E. =1.655, p < 0.001), but in the presence of a third variable (anxiety and depression overall), direct effects are reduced, as indirect effects emerge through the variable anxiety and depression overall, with an indirect effect size of - 0.054. CONCLUSIONS Stigma impacts mental health, such as anxiety and depression, uncertainty in illness, and QoL. Health care professionals may help patients alleviate feelings of anxiety, depression, and uncertainty in illness to improve QoL outcomes.
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Affiliation(s)
- Shucheng Pan
- Department of Nursing, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lijuan Wang
- Department of Nursing, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Li Zheng
- Department of Nursing, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Luo
- Department of Urology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinjiao Mao
- Department of Nursing, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenbo Qiao
- Department of Nursing, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Binbin Zhu
- Department of Nursing, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Wang
- Department of Nursing, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Zhou K. The Relationship Between Acceptance, Biopsychosocial Factors, and Quality of Life: A Structural Equation Model. REHABILITATION COUNSELING BULLETIN 2023. [DOI: 10.1177/00343552231155216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Disability acceptance is one of the most significant constructs in the psychosocial adaptation process. Although prior research has examined the relationship among different biopsychosocial factors, disability acceptance, and quality of life (QoL), limited study focused on entering a series of biopsychosocial factors simultaneously into analysis to reflect live experience of individuals with disabilities. This study aimed to examine the role of acceptance regarding the relationship between a series of biopsychosocial factors (i.e., general health, physical functioning, pain, anxiety, depression, stress, loneliness, stigma, sense of community, and neighborhood problems) and QoL based on Livneh’s psychosocial adaptation model to inform psychosocial interventions. A total of 430 participants with disabilities completed an online survey consisting of instruments measuring target variables. Exploratory and confirmatory factor analyses indicated a three-factor structure for selected biopsychosocial factors (i.e., psychological difficulties, physical status, and community issues). Structural equation modeling results showed that the proposed model indicated a fair model fit after respecification. Effect analyses showed that disability acceptance directly affected QoL and partially mediated the relationship between physical status and QoL and psychological difficulties and QoL. In addition, loneliness has been found to significantly and directly predict QoL in the respecified model. The model demonstrated that disability acceptance and loneliness have a significant impact on QoL.
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Sedney C, Cowher A, Turiano NA, Cox S, Dekeseredy P, Haggerty T. Understanding the Intersectional Relationship of Pain Stigma, Weight Bias Internalization, and Clinical Indicators in a Rural Population with Back Pain: A Survey-Based Study. World Neurosurg 2023; 171:e846-e851. [PMID: 36603648 DOI: 10.1016/j.wneu.2022.12.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Stigma is understood to be intersectional, meaning multiple characteristics can be stigmatizing, and they may be both overlapping and coconstitutive. Chronic pain and overweight are common complaints in the spinal surgery clinic. Since being overweight may relate to back pain in a complex fashion, we sought to understand if there is a moderating effect between weight bias and pain stigma. METHODS This study involves a survey-based, quantitative, cross-sectional, observational design using previously validated measures and demographic and clinical information. There were 192 participants. Statistical calculations were done with statistical package for the social sciences. RESULTS Pain stigma was not significantly correlated with BMI (body mass index), and weight bias was not significantly correlated with back pain. There was a strong positive correlation between weight bias and pain stigma. There was a strong positive correlation between weight bias and BMI when pain stigma was also high. CONCLUSIONS Given the relationship between weight stigma and pain, the intersection of weight and pain stigma is important because it indicates the vulnerability of patients with higher BMI to other forms of stigma, such as stigma for their pain complaints. Clinicians should be mindful of expressing pain stigma more significantly amongst patients with higher BMI.
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Affiliation(s)
- Cara Sedney
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
| | - Abigail Cowher
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Nicholas A Turiano
- Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
| | - Stephanie Cox
- Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, West Virginia, USA
| | - Patricia Dekeseredy
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Treah Haggerty
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
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30
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Wang W, Gasperetti A, Sears SF, Tichnell C, Murray B, Tandri H, James CA, Calkins H. Subcutaneous and Transvenous Defibrillators in Arrhythmogenic Right Ventricular Cardiomyopathy: A Comparison of Clinical and Quality-of-Life Outcomes. JACC Clin Electrophysiol 2023; 9:394-402. [PMID: 36328892 DOI: 10.1016/j.jacep.2022.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is limited evidence guiding the selection between subcutaneous and transvenous implantable cardioverter-defibrillators (ICDs) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) at risk for sudden death. OBJECTIVES This study aimed to compare clinical and quality-of-life outcomes between transvenous and subcutaneous ICDs among patients with ARVC. METHODS Patients with a subcutaneous ICD (n = 57) were matched to patients with a transvenous ICD (n = 88) based on sex, proband status, primary prevention or secondary prevention, monomorphic ventricular tachycardia before implantation, and year of implantation. Appropriate therapy for ventricular arrhythmia, inappropriate shocks, and complications were compared. Quality-of-life surveys were conducted annually. RESULTS The matched cohort (median age of 35 years, 43% men, 78% proband, and 37% secondary prevention device) were prospectively followed for 5.1 ± 2.5 years. No significant difference was observed in the rate of appropriate ICD shocks. The subcutaneous group had more inappropriate shocks (23% vs 10%) and fewer procedure-related complications (4% vs 14%) than the transvenous group (P < 0.05). The association between ICD type and the composite of inappropriate shock and complication was not statistically significant (subcutaneous vs transvenous adjusted HR: 1.43; 95% CI: 0.72-2.84). A subcutaneous ICD was associated with more body image concerns and range of motion than a transvenous ICD (P < 0.05). CONCLUSIONS In patients with ARVC receiving an ICD, the risk of inappropriate shocks from a subcutaneous ICD should be balanced against the significant vascular complication risk from a transvenous ICD. Patients with a subcutaneous ICD had more concerns for body image and range of motion.
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Affiliation(s)
- Weijia Wang
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Mavragani A, Goud BR, Kalidindi B, Ruben JP, Devadass D, Waghmare A, Collins PY, Raj T, Srinivasan K. Mobile Mental Health in Women's Community-Based Organizations: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e42919. [PMID: 36753310 PMCID: PMC9947759 DOI: 10.2196/42919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Of every 10 women in rural India, 1 suffers from a common mental disorder such as depression, and untreated depression is associated with significant morbidity and mortality. Several factors lead to a large treatment gap, specifically for women in rural India, including stigma, lack of provider mental health workforce, and travel times. There is an urgent need to improve the rates of detection and treatment of depression among women in rural India without overburdening the scarce mental health resources. OBJECTIVE We propose to develop, test, and deploy a mental health app, MITHRA (Multiuser Interactive Health Response Application), for depression screening and brief intervention, designed for use in women's self-help groups (SHGs) in rural India. METHODS We will use focus groups with SHG members and community health workers to guide the initial development of the app, followed by iterative modification based on input from a participatory design group consisting of proposed end users of the app (SHG members). The final version of the app will then be deployed for testing in a pilot cluster randomized trial, with 3 SHGs randomized to receive the app and 3 to receive enhanced care as usual. RESULTS This study was funded in June 2021. As of September 2022, we have completed both focus groups, 1 participatory design group, and app development. CONCLUSIONS Delivering app-based depression screening and treatment in community settings such as SHGs can address stigma and transportation-related barriers to access to depression care and overcome cultural and contextual barriers to mobile health use. It can also address the mental health workforce shortage. If we find that the MITHRA approach is feasible, we will test the implementation and effectiveness of MITHRA in multiple SHGs across India in a larger randomized controlled trial. This approach of leveraging community-based organizations to improve the reach of depression screening and treatment is applicable in rural and underserved areas across the globe. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42919.
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Affiliation(s)
| | | | | | - Johnson Pradeep Ruben
- St John's Medical College, Bengaluru, India.,St John's Research Institute, Bengaluru, India
| | | | | | - Pamela Y Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Tony Raj
- St John's Research Institute, Bengaluru, India
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Eccles FJR, Sowter N, Spokes T, Zarotti N, Simpson J. Stigma, self-compassion, and psychological distress among people with Parkinson's. Disabil Rehabil 2023; 45:425-433. [PMID: 35171069 DOI: 10.1080/09638288.2022.2037743] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE People with Parkinson's disease (hereafter Parkinson's) can experience stigma through the attitudes and actions of others (enacted stigma) and through anticipation of enacted stigma and internalisation of negative stereotypes (felt stigma). Self-compassion may protect against the impact of stigma. This study aimed to investigate the relationships between self-compassion, stigma, and psychological distress among people with Parkinson's. METHODS A total of 130 people with Parkinson's completed questionnaires measuring self-compassion, enacted and felt stigma, and depression, anxiety, and stress. Correlation, mediation, and moderation models were used to investigate relationships between variables. RESULTS All variables correlated significantly in the expected directions. Felt stigma mediated the relationship between self-compassion and the three outcome variables - depression, anxiety, and stress. Self-compassion did not moderate the relationship between enacted stigma and distress and suggested enacted stigma was associated with distress, regardless of levels of self-compassion. CONCLUSIONS Self-compassion and both enacted and felt stigma are important predictors of distress for people with Parkinson's. Part of the relationship between lower self-compassion and psychological distress appears to occur via the internalisation of stigma. These findings may be relevant to the development of individualised and societal interventions with the aim of improving the psychological wellbeing of people with Parkinson's.Implications for rehabilitationSelf-compassion was associated with lower levels of psychological distress (i.e., depression, anxiety, and stress) and self-stigma partially mediated this relationship.Self-compassion did not moderate the relationship between enacted stigma and psychological distress, suggesting enacted stigma increases distress, regardless of self-compassion.The development and assessment of the effectiveness of compassion-focused interventions tailored for people with Parkinson's may be important as well as systemic stigma focused interventions.
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Affiliation(s)
- Fiona J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Natalie Sowter
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Terry Spokes
- Bali Beginnings Addiction Treatment Centre, Sanur, Indonesia
| | - Nicolò Zarotti
- Department of Clinical Psychology, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, UK
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Sattler DN, Bishkhorloo B, Lawley KA, Hackler R, Byambajav C, Munkhbat M, Smith-Galeno B. Stigma, Post-traumatic Stress, and COVID-19 Vaccination Intent in Mongolia, India, and the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2084. [PMID: 36767449 PMCID: PMC9915119 DOI: 10.3390/ijerph20032084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Background: Stigma and discrimination during the coronavirus (COVID-19) pandemic have increased precipitously worldwide. This multinational study examines how stigma, blaming groups for virus spread, concern regarding contracting the virus, resource loss, life satisfaction, and protective behaviors that help control the spread of COVID-19 are associated with post-traumatic stress and vaccine intent in Mongolia, India, and the United States. Method: 1429 people in Mongolia, India, and the United States completed measures assessing stigma during the COVID-19 pandemic, post-traumatic stress, blame, protective behaviors, and vaccine intent. Results: Mean post-traumatic stress scores in all three countries exceeded the cut-off that is commonly used to determine probable post-traumatic stress. Post-traumatic stress was associated with COVID-19 stigma experience, personal behavior change due to COVID-19 stigma, blaming groups for the spread of COVID-19, fear of COVID-19, and resource loss. In India and the United States, personal behavior change due to COVID-19 stigma, anger at individuals spreading COVID-19, and perceived susceptibility to illness were positively associated with vaccine intent. Conclusions: Stigma is a collateral stressor during the pandemic. The findings underscore the importance of prompt action to address stigma as a deleterious consequence of the pandemic. The findings illuminate potential barriers to receiving the vaccine and provide direction for future research to address barriers.
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Affiliation(s)
- David N. Sattler
- Department of Psychology, Western Washington University, Bellingham, WA 98225-9172, USA
| | - Boldsuren Bishkhorloo
- Department of Education and Psychology, National University of Mongolia, Ulaanbaatar 14200, Mongolia
| | - Kendall A. Lawley
- Global Center for Integrated Health of Women, Adolescents, and Children, University of Washington, Seattle, WA 98195, USA
| | - Ruth Hackler
- Department of Psychology, Western Washington University, Bellingham, WA 98225-9172, USA
| | - Chuluunbileg Byambajav
- Department of Education and Psychology, National University of Mongolia, Ulaanbaatar 14200, Mongolia
| | - Michidmaa Munkhbat
- Department of Education and Psychology, National University of Mongolia, Ulaanbaatar 14200, Mongolia
| | - Brooklyn Smith-Galeno
- Department of Psychology, Western Washington University, Bellingham, WA 98225-9172, USA
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Sommers-Spijkerman M, Kavanaugh MS, Kruitwagen-Van Reenen E, Zwarts-Engelbert A, Visser-Meily JMA, Beelen A. Stigma experienced by ALS/PMA patients and their caregivers: a mixed-methods study. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:327-338. [PMID: 36593637 DOI: 10.1080/21678421.2022.2161911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: Previous work suggests that stigma negatively impacts quality of life in people living with amyotrophic lateral sclerosis (ALS) and progressive muscular atrophy (PMA). This study aimed to explore experiences of enacted stigma (experienced discrimination) and felt stigma (shame, fear of exclusion) among Dutch ALS/PMA patients and their caregivers. A secondary aim was to assess associated factors of enacted/felt stigma among patients. Methods: A two-phase mixed-methods study was conducted, comprising cross-sectional surveys among 193 ALS/PMA patients and 87 caregivers, and semi-structured interviews with 8 ALS/PMA patients and 11 family caregivers. Descriptive and multivariable regression analyses along with qualitative content analysis were used to analyze survey and interview data. Results: Survey findings indicate that patients and caregivers experience enacted and felt stigma. Interviews with both patients and caregivers revealed two manifestations of enacted stigma, including social exclusion (e.g. relationship distancing) and stigmatizing attitudes/behaviors displayed by others (e.g. staring), and three manifestations of felt stigma, including alienation (e.g. shame/embarrassment), perceived discrimination (e.g. feeling judged) and anticipated stigma (e.g. fear of exclusion). Patients and caregivers engaged in concealing and resisting responses to stigma. More bulbar symptoms, King's clinical stage, younger age and living without a partner were significantly associated with enacted/felt stigma among patients. Conclusions: Our findings reveal a range of perceptions and experiences underlying enacted/felt stigma among ALS/PMA patients and their caregivers that may serve as conversation topics in clinical practice. Future research may shed more light on the determinants as well as the consequences of stigmatizing experiences among patients and caregivers.
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Affiliation(s)
- Marion Sommers-Spijkerman
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, and
| | - Melinda S Kavanaugh
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Esther Kruitwagen-Van Reenen
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, and
| | - Aimée Zwarts-Engelbert
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, and
| | - Anita Beelen
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands, and
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Stopic V, Jost ST, Baldermann JC, Petry-Schmelzer JN, Fink GR, Dembek TA, Dafsari HS, Kessler J, Barbe MT, Sauerbier A. Parkinson's Disease Stigma Questionnaire (PDStigmaQuest): Development and Pilot Study of a Questionnaire for Stigma in Patients with Idiopathic Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:829-839. [PMID: 37334621 PMCID: PMC10473132 DOI: 10.3233/jpd-230071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Stigma is significant in Parkinson's disease (PD). However, no specific tool is available to assess stigma in PD comprehensively. OBJECTIVE This pilot study aimed to develop and test a stigma questionnaire specific to PD patients (PDStigmaQuest). METHODS Based on a literature review, clinical experience, expert consensus, and patients' feedback, we developed the preliminary, patient-completed PDStigmaQuest in German language. It included 28 items covering five stigma domains: uncomfortableness, anticipated stigma, hiding, experienced stigma, and internalized stigma. In this pilot study, 81 participants (PD patients, healthy controls, caregivers, and health professionals) were included to investigate the acceptability, feasibility, comprehensibility, and psychometric properties of the PDStigmaQuest. RESULTS The PDStigmaQuest showed 0.3% missing data points for PD patients and 0.4% for controls, suggesting high data quality. Moderate floor effects, but no ceiling effects were found. In the item analysis, most items met the standard criteria of item difficulty, item variance, and item-total correlation. Cronbach's alpha was > 0.7 for four of five domains. PD patients' domain scores were significantly higher than healthy controls' for uncomfortableness, anticipated stigma, and internalized stigma. Feedback to the questionnaire was predominantly positive. CONCLUSION Our results indicate that the PDStigmaQuest is a feasible, comprehensive, and relevant tool to assess stigma in PD and helps to understand the construct of stigma in PD further. Based on our results, the preliminary version of the PDStigmaQuest was modified and is currently validated in a larger population of PD patients for use in clinical and research settings.
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Affiliation(s)
- Vasilija Stopic
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Stefanie T. Jost
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Juan Carlos Baldermann
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jan Niklas Petry-Schmelzer
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Gereon R. Fink
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscienceand Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Till A. Dembek
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Haidar S. Dafsari
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Josef Kessler
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael T. Barbe
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna Sauerbier
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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The Mediating Role of Stigma, Internalized Shame, and Autonomous Motivation in the Relationship Between Depression, Anxiety, and Psychological Help-Seeking Attitudes in Multiple Sclerosis. Int J Behav Med 2023; 30:133-145. [PMID: 35325406 PMCID: PMC9879833 DOI: 10.1007/s12529-022-10078-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Depression and anxiety are commonly experienced in individuals with multiple sclerosis (MS) yet little is known about factors associated with psychological help-seeking attitudes in those with MS. METHOD The current study investigated whether increased stigma related to chronic illness, internalized shame, and autonomous motivation mediated the relationship between depressive and anxiety symptoms and psychological help-seeking attitudes in individuals with MS. Two hundred fifty-four participants with MS completed an online questionnaire assessing depressive and anxiety symptoms, stigma related to chronic illness, internalized shame, autonomous motivation, and psychological help-seeking attitudes. RESULTS Stigma related to chronic illness, internalized shame, and autonomous motivation mediated the relationships between increased depressive symptoms and anxiety symptoms and psychological help-seeking attitudes. The study also found that higher levels of chronic illness-related stigma and internalized shame were associated with more negative psychological help-seeking attitudes and higher autonomous motivation was associated with more positive psychological help-seeking attitudes. There were no direct effects of depressive or anxiety symptoms on psychological help-seeking attitudes. CONCLUSION The significant mediating roles of stigma-related chronic illness, internalized shame, and autonomous motivation indicate that these factors may be useful to include in future depression and anxiety intervention studies targeting MS populations.
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Alford K, Banerjee S, Daley S, Hamlyn E, Trotman D, Vera JH. Health-Related Quality of Life in People Living With HIV With Cognitive Symptoms: Assessing Relevant Domains and Associations. J Int Assoc Provid AIDS Care 2023; 22:23259582231164241. [PMID: 36945871 PMCID: PMC10034276 DOI: 10.1177/23259582231164241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
This study aimed to validate and assess a comprehensive set of illness-specific health-related quality of life (HRQL) domains in people living with HIV (PLWH) with cognitive symptoms. One hundred and three HIV patients with cognitive symptoms (n = 93 male, 90.3%) were identified from two UK HIV clinics and complete a series of validated scales measuring seven HRQL domains identified as important to HRQL by PLWH with cognitive impairment. These included: physical functioning, cognition, social connectedness, self-concept, HIV stigma, acceptance of and perceived control over cognitive health, and physical and mental health and wellbeing. Exploratory factor analysis confirmed that domain total scores loaded onto one main factor, representing HRQL. Scale cut-off scores revealed a significant proportion of patients scored outside the normal range on single domains (between 26.2% and 79.6%), and many patients on multiple domains (40.8% on 4 or more domains). We found evidence of poor HRQL across domains in the majority of PLWH with cognitive symptoms and identified domains driving these experiences. This provides targets for intervention development and clinical action to maintain or improve HRQL in PLWH with cognitive symptoms or impairment.
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Affiliation(s)
- Kate Alford
- Department of Global Health and Infection, 12190Brighton and Sussex Medical School, Brighton, UK
| | - Sube Banerjee
- Faculty of Health, 6633University of Plymouth, Plymouth, UK
| | - Stephanie Daley
- Centre for Dementia Studies, 12190Brighton and Sussex Medical School, Brighton, UK
| | - Elizabeth Hamlyn
- 111990HIV and Sexual Health Service, King's College Hospital NHS Foundation Trust, London, UK
| | - Daniel Trotman
- 111990HIV and Sexual Health Service, King's College Hospital NHS Foundation Trust, London, UK
| | - Jaime H Vera
- Department of Global Health and Infection, 12190Brighton and Sussex Medical School, Brighton, UK
- 8721HIV and Sexual Health Service, University Hospitals Sussex NHS Trust, Brighton, UK
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The impact of migraine and probable migraine on productivity loss in Korea: A cross-sectional online survey. PLoS One 2022; 17:e0277905. [PMID: 36441801 PMCID: PMC9704660 DOI: 10.1371/journal.pone.0277905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
Migraine is an enormous burden on society, but relevant studies are limited. The population of interest of this study was migraine or probable migraine (PM) in Korea. In this population, we aimed to assess the productivity loss through the level of severity defined by monthly migraine days (MMD) and analgesic frequency and to estimate costs and associated factors of productivity loss. We conducted an online survey of adults with migraine symptoms. We defined migraine and PM using the modified International Classification of Headache Disorders, second edition. Severity level was defined by subgroups of MMD (0-3, 4-14, and ≥15 days) and analgesic frequency (0, 1, 2, 3, and ≥4 per week). Productivity loss was assessed using the Work Productivity and Activity Impairment questionnaire and consisted of absenteeism, presenteeism, overall work productivity loss, and activity impairment. The costs of productivity loss due to absenteeism and presenteeism were calculated in 2020 USD. We used negative binomial regression to identify the factors associated with the costs of productivity loss. We identified 362 respondents with migraine or PM. Mean age was 41.7 years, 75.7% were female (N = 274), and 73.2% (N = 265) were employed. On average, productivity losses due to absenteeism and presenteeism were 8.1% and 39.7%, respectively. As MMD increased, there was a trend toward increased activity impairment, presenteeism, and overall work productivity loss. The mean overall productivity loss cost was USD 44.61 per person per day. Duration of migraine attacks was significantly associated with higher absenteeism costs. The results of this study indicate that the higher the MMD, the greater the productivity loss in patients with migraine or PM in Korea. We also found that patients with low-frequency migraine and PM experienced substantial productivity loss. This study provides comprehensive evidence of the burden of migraine in Korea using a representative sample.
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Development of ETStig, a measure for stigma in essential tremor. Parkinsonism Relat Disord 2022; 104:38-43. [PMID: 36215750 DOI: 10.1016/j.parkreldis.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION People with essential tremor commonly experience psychological difficulties that are not addressed. The effect of stigma, i.e., negative judgement by others because of a perceived difference in this case shaky movement, is a heretofore unstudied element. This project was undertaken to develop and field test a new measure for stigma associated with essential tremor. METHODS Under guidance from a patient panel and an expert panel of neurologists and psychologists, the essential tremor stigma construct was delineated, and survey items were written to quantify three dimensions of interest: cumulative experience of stigma; related psychological distress; and resulting behavioral dysfunction. After pilot testing and revision, the essential tremor stigma measure underwent field testing by 198 essential tremor patients at two academic neurology clinics. RESULTS The experience, distress and dysfunction scales were shown to have good internal consistency and test-retest reliability. Retained items demonstrated acceptable correlations and response properties. The validity of the distress scale was supported by concurrence with an existing stigma scale for neurologic disease, while a patient's openness to psychologic referral was predicted by higher scores on the dysfunction scale. CONCLUSION This new measure is introduced to study the phenomenon of stigma associated with essential tremor. It may prove useful in assessing potential treatments for the psychological distress and maladaptive behavior that result from this stigma.
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Kim J. Disability acceptance as a moderator of the impacts of disability stigma on job satisfaction of people with disabilities in the workplace. JOURNAL OF VOCATIONAL REHABILITATION 2022. [DOI: 10.3233/jvr-221213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Disability stigma is a significant risk factor that reduces job satisfaction. Based on the previous studies, the role of disability acceptance as a buffer to prevent the negative impact of stigma in the workplace is hypothesized. OBJECTIVE: This study examined the moderating effect of disability acceptance on the negative effects of disability stigma on job satisfaction of people with disabilities. METHODS: 164 participants working at the time of the survey completed questionnaires measuring disability stigma, disability acceptance, and job satisfaction. The associations among the three variables were examined using simple linear regression analyses. Hierarchical linear regression analysis was conducted to identify the moderating effect of disability acceptance after controlling disability type. RESULTS: Disability stigma (β=–0.17, p < 0.05) and disability acceptance (β=0.18, p < 0.05) were significantly associated with job satisfaction respectively. In the final model, disability acceptance moderated the relationship between disability stigma and job satisfaction (β=–0.16, p < 0.05). Specifically, the impacts of disability stigma on job satisfaction for participants with higher disability acceptance differed from those with lower acceptance. CONCLUSION: The current research suggests that disability acceptance plays a critical role for people with disabilities to cope with the negative impact of disability stigma. This result implies that disability acceptance should be an important focus of intervention to increase job satisfaction.
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Affiliation(s)
- Jaeyoung Kim
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, Madison, WI, USA
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Larsen AM, Osborn L, Ronen K, Richardson BA, Jiang W, Chohan B, Matemo D, Unger JA, Drake AL, Kinuthia J, John-Stewart G. Trajectories of Depression Symptoms From Pregnancy Through 24 months Postpartum Among Kenyan Women Living With HIV. J Acquir Immune Defic Syndr 2022; 90:473-481. [PMID: 35394987 PMCID: PMC9283247 DOI: 10.1097/qai.0000000000002998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examined longitudinal patterns and cofactors of depressive symptoms among pregnant and postpartum women living with HIV (WLWH). METHODS This study used data from a randomized trial of a text messaging intervention. WLWH were serially assessed for depressive symptoms from pregnancy through 24 months postpartum at 6 time points (pregnancy, 6 weeks, and 6, 12, 18, and 24 months postpartum). Depressive symptoms were assessed using Patient Health Questionnaire-9 and longitudinal patterns using group-based trajectory modeling. Moderate-to-severe depressive symptoms (MSD) correlates were assessed using generalized estimating equations. RESULTS Among 824 enrolled women, 14.6% ever had MSD during pregnancy or postpartum; 8.6% of WLWH had MSD in pregnancy and 9.0% any postpartum MSD. MSD was associated with abuse [RR: 3.8, 95% confidence interval (CI): 2.6 to 5.4], stigma (RR: 4.4, 95% CI: 3.1 to 6.3), and food insecurity (RR: 2.7, 95% CI: 1.9 to 3.8). Unintended pregnancy (RR: 1.6, 95% CI: 1.1 to 2.3) and recent HIV diagnosis (RR: 1.8, 95% CI: 1.2 to 2.6) were associated with higher MSD risk, whereas HIV status disclosure to partner (RR: 0.3, 95% CI: 0.2 to 0.6) and social support (RR: 0.97, 95% CI: 0.96 to 0.98) were associated with lower risk. Trajectory modeling identified 4 phenotypes of peripartum depressive symptoms: persistent no/low symptoms (38.5%), mild symptoms resolving postpartum (12.6%), low symptoms increasing slightly in postpartum (47.9%), and persistent moderate-severe symptoms throughout (1.1%). CONCLUSIONS WLWH attending PMTCT services had varied patterns of depressive symptoms, which were associated with stressors (recent diagnosis and food insecurity) and factors reflecting low social power (abuse, stigma, and unintended pregnancy). Women experiencing concurrent abuse, stigma, and food insecurity should be prioritized for interventions to prevent persistent depression.
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Affiliation(s)
| | - Lusi Osborn
- Kenyatta National Hospital Research and Programs, Nairobi, Kenya; and
| | | | | | | | - Bhavna Chohan
- University of Washington, Seattle, WA
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Daniel Matemo
- Kenyatta National Hospital Research and Programs, Nairobi, Kenya; and
| | | | | | - John Kinuthia
- Kenyatta National Hospital Research and Programs, Nairobi, Kenya; and
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Stinson J, Wolfe R, Spaulding W. Social Connectedness in Schizotypy: The Role of Cognitive and Affective Empathy. Behav Sci (Basel) 2022; 12:bs12080253. [PMID: 35892353 PMCID: PMC9394355 DOI: 10.3390/bs12080253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/27/2022] [Accepted: 07/19/2022] [Indexed: 12/30/2022] Open
Abstract
Social connectedness is increasingly understood to be a resilience factor that moderates vulnerability to poor physical and mental health. This study examines cognitive and affective processes that support normal socialization and social connectedness, and the impact of schizotypy, in well-functioning college students. In this study, a total of 824 college students completed a series of self-report questionnaires, and structural equation modeling was then employed to identify relationships between cognitive and affective empathy, alexithymia, distress tolerance, social connectedness, and schizotypy. Schizotypy is a trait-like condition, presumed to be genetic in origin, associated with the risk for schizophrenia. Like schizophrenia, schizotypy is thought to have three distinct dimensions or categories, termed positive, negative, and disorganized. Results indicate that the respective dimensions of schizotypy have different pathways to social connectedness, through both direct and indirect effects. Positive schizotypy exerts a counterintuitive positive influence on social connectedness, mediated by positive effects on cognitive empathy, but this is obscured by the high correlations between the schizotypal dimensions and the strong negative influences on empathy and social connectedness of the negative and disorganized dimensions, unless all those intercorrelations are taken into account. Overall, the pathways identified by structural equation modeling strongly support the role of empathy in mediating the impact of schizotypy on social connectedness. Implications for the etiology of social impairments in schizotypy, and for interventions to enhance social connectedness to improve quality of life and reduce health disparities in people at risk for severe mental illness, are discussed.
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Affiliation(s)
- Jessica Stinson
- Department of Psychology, College of Arts and Sciences, University of Nebraska–Lincoln, Lincoln, NE 68588, USA; (R.W.); (W.S.)
- South Texas Veterans Healthcare System, San Antonio, TX 78229, USA
- Correspondence:
| | - Rebecca Wolfe
- Department of Psychology, College of Arts and Sciences, University of Nebraska–Lincoln, Lincoln, NE 68588, USA; (R.W.); (W.S.)
| | - Will Spaulding
- Department of Psychology, College of Arts and Sciences, University of Nebraska–Lincoln, Lincoln, NE 68588, USA; (R.W.); (W.S.)
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He S, Ke XJ, Wu Y, Kong XY, Wang Y, Sun HQ, Xia DZ, Chen GH. The stigma of patients with chronic insomnia: a clinical study. BMC Psychiatry 2022; 22:449. [PMID: 35790932 PMCID: PMC9254637 DOI: 10.1186/s12888-022-04091-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/24/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The objective of this study was to explore the stigma and related influencing factors in individuals with chronic insomnia disorder (CID). METHODS A total of 70 CID patients and 70 healthy controls (CON) were enrolled in the study. All subjects completed the assessments of sleep, emotion, and cognition. Their stigma and life quality were measured using the Chronic Stigma Scale and the 36-Item Short-Form Health Survey (SF-36). RESULTS The ratio of individuals with stigma was significantly different between CID and CON groups (C2 = 35.6, p < 0.001). Compared with the CON group, the CID group had higher scores for total stigma (U = 662.0, p < 0.001), internalized stigma (U = 593.0, p < 0.001), enacted stigma (U = 1568.0, p < 0.001), PSQI (U = 2485.0, p < 0.001) and HAMD-17 (U = 69.5, p < 0.001) as well as lower scores for MoCA-C (U = 3997.5, p < 0.001) and most items of SF-36. Partial correlation analysis showed that different items of the Chronic Stigma Scale were positively correlated with illness duration, PSQI and HAMD-17 scores, while negatively correlated with one or more items of the SF-36. Multivariate regression analysis showed that illness duration and the Mental Health domain of the SF-36 were independent risk factors for one or more items of stigma in CID patients. CONCLUSION Patients with CID have an increased risk of stigma. Moreover, illness duration and Mental Health may be primary factors related to stigma.
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Affiliation(s)
- Shuo He
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Xue-Jia Ke
- grid.477985.00000 0004 1757 6137Department of Geriatrics, Hefei First People’s Hospital, Hefei, 230092 China
| | - Yan Wu
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Xiao-Yi Kong
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Yun Wang
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Hui-Qin Sun
- Department of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, Chaohu, China.
| | - Deng-Zhi Xia
- Department of Outpatient, The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, Chaohu, China.
| | - Gui-Hai Chen
- Department of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, Chaohu, China.
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Zhang X, Li Y, Zhong Y, Wang Z. Variables Associated With Body Image Concerns in Acromegaly Patients: A Cross-Sectional Study. Front Psychol 2022; 13:733864. [PMID: 35756208 PMCID: PMC9226896 DOI: 10.3389/fpsyg.2022.733864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Acromegaly is often characterized by altered physical (including facial) appearance. However, there is little medical or psychological research on body image concerns in patients with acromegaly. The aim of this study was to identify factors influencing the body image distress in patients with acromegaly and to explore the possible effects of stigma on body image concerns. Design Cross-sectional study. Methods A total of 68 individuals with acromegaly were enrolled in the study. A total of 70 persons with nonfunctional pituitary adenomas were randomly recruited as a healthy control group. Using structured questionnaires, we explored perceived body image using the Body Image Concern Inventory. We also used the Hamilton Anxiety Scale, the Stigma Scale for Chronic Illness, the Brief Illness Perception Questionnaire, and the 36-Item Short-Form Health Survey to evaluate health-associated variables and to analyze factors that affect body image concerns in patients with acromegaly. Results Of the 68 participants, 31 were men and 37 women (mean age ± standard deviation: 46.36 ± 12.47 years). The mean body image concern score was 47.49 ± 13.81 for patients with acromegaly and 21.10 ± 7.44 for patients with nonfunctional pituitary adenoma. The difference between the two groups was statistically significant. A multiple stepwise regression analysis showed that the related factors for body image distress were gender (P = 0.001), age at diagnosis (P = 0.01), and internalized stigma (P < 0.001, Adj. R2 = 0.756). Conclusions People with acromegaly have substantial body image concerns, and these concerns are increased by the stigma associated with this disease; such concerns lead to poor quality of life (QoL). Physicians need to find better ways to control patients' hormone levels, and nurses should provide more information on how to improve body image or find ways to reduce patients' body image distress.
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Affiliation(s)
- Xiaomei Zhang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Yanqing Li
- Medical College, Nantong University, Nantong, China
| | - Yueping Zhong
- Department of Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Ziheng Wang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China.,Medical College, Nantong University, Nantong, China
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Islam SS, Neargarder S, Kinger SB, Fox-Fuller JT, Salazar RD, Cronin-Golomb A. Perceived stigma and quality of life in Parkinson’s disease with additional health conditions. Gen Psychiatr 2022; 35:e100653. [PMID: 35846485 PMCID: PMC9226861 DOI: 10.1136/gpsych-2021-100653] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 05/20/2022] [Indexed: 11/04/2022] Open
Abstract
BackgroundParkinson’s disease (PD) is associated with perceived stigma and affects quality of life (QoL). Additional health conditions may influence these consequences of PD.AimsThis study assessed the impact of health conditions on perceived stigma and QoL in persons with PD. We hypothesised that individuals with more health conditions would report more stigma and poorer QoL. We also examined the contributions of demographic and clinical characteristics to the correlations between health conditions and perceived stigma/QoL.MethodsWe identified 196 eligible participants from the Boston University Online Survey Study of Parkinson’s Disease and examined their health history, performance on multiple stigma measures, and scores on the 39-item Parkinson’s Disease Questionnaire assessing QoL.ResultsAt least one health condition was reported by 79% of the sample, with a median of 2 and a range of 0–7 health conditions. More perceived stigma and poorer QoL were associated with thyroid disease, depression, anxiety, and the total number of health conditions. These correlations were related to younger age, less education, and earlier disease onset. Other health conditions (high blood pressure, back/leg surgery, headache, cancer/tumours, and heart disease) were not significantly correlated with stigma or QoL.ConclusionsHaving more health conditions, or thyroid disease, depression, or anxiety, was associated with more perceived stigma and poorer QoL, with younger age, less education, and earlier disease onset affecting the associations. It is important to consider the burden of health conditions and how they affect persons with PD with specific clinical characteristics.
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Affiliation(s)
- Samia S Islam
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Sandy Neargarder
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
- Department of Psychology, Bridgewater State University, Bridgewater, Massachusetts, USA
| | - Shraddha B Kinger
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Joshua T Fox-Fuller
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Robert D Salazar
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
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Begasse de Dhaem O, Sakai F. Migraine in the workplace. eNeurologicalSci 2022; 27:100408. [PMID: 35774055 PMCID: PMC9237352 DOI: 10.1016/j.ensci.2022.100408] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/15/2022] Open
Abstract
Migraine is prevalent, disabling, and peaks during people's peak productive years. The impact of migraine on people's professional lives, work productivity, and interpersonal relationships at work eventually affects everyone, has a significant detrimental effect on people with migraine, and a huge cost in terms of lost productivity. People with migraine want to work, so they do their best to work despite the varied migraine related and associated symptoms. Most of migraine-related productivity loss (89%) is due to presenteeism. People are less than half effective during a migraine attack due to the pain, migraine symptoms, attack unpredictability, migraine comorbidities, emotional impact, under-diagnosis and under-management, and the stigma. Migraine-related productivity loss may negatively affect people's career choice, job status and/or security, financial status, work relationships, mood, and confidence. Migraine is estimated to represent 16% of total US workforce presenteeism. Thankfully, there are ways to help support people with migraine in the workplace and increase their productivity such as: workplace migraine education programs, workplace migraine education and management programs, migraine-friendly work environment, migraine treatment optimization and advocacy. The example of the successful workplace migraine education and management program developed and run in collaboration between Fujitsu, the Japanase Headache Society, and the International Headache Society Global Patient Advocacy Coalition is discussed. Migraine-related productivity loss is costly to people with migraine, to employers, and to everyone in one way or another. Workplace migraine education and/or management programs and migraine-friendly environment help people with migraine at work. Neurologists can help support their patients in the workplace and get involved in advocacy in many ways.
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Affiliation(s)
| | - Fumihiko Sakai
- Saitama International Headache Center, Saitama Neuropsychiatric Institute, Saitama, Japan
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Basoglu Koseahmet F, Polat B, Gozubatik-Celik RG, Baytekin I, Soylu MG, Ceyhan Dirican A, Ozturk M. An invisible cause of disability: stigma in migraine and epilepsy. Neurol Sci 2022; 43:3831-3838. [DOI: 10.1007/s10072-022-05888-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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Li Y, Zhang X, Zhang J, Zhang D, Wang Y, Zhu Y, Xu X. Stigma and unhealthy psychological characteristics in patients with acromegaly: A cross-sectional study and identification of the associated factors. Acta Neurochir (Wien) 2022; 164:2069-2081. [PMID: 35597876 DOI: 10.1007/s00701-022-05246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/03/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Stigma, besides aggravating the damage caused by the disease, may also lead to unhealthy characteristics in patients and unhealthy situations in society. Individuals with acromegaly disease may suffer from stigma concerns, and the associated factors remain largely unknown. Therefore, the present cross-sectional study aimed to investigate the levels of perceived stigma in patients with acromegaly and explore the associated factors. METHODS A total of 138 patients with acromegaly were evaluated for having stigma using five previously validated scales: (i) the Stigma Scale for Chronic Illness, (ii) the Hamilton Anxiety Scale, (iii) the Rosenberg Self-Esteem Scale, (iv) the Body Image Concern scale, and (v) the Acromegaly Quality of Life scale. The potential determinants of stigma were evaluated using the univariate statistical analysis. A multivariate linear regression model was adopted to assess the predictors of stigma in patients with acromegaly. Pearson's correlation analysis was performed to analyze the relationship between stigma and the quality of life of the patients. RESULTS Among the 138 respondents, 102 provided consent for participation.The evaluated patients exhibited critically high levels of perceived stigma. The multiple regression analysis revealed high BMI, serious body image concerns, inferiority complex personality, and critical levels of anxiety as the potential predictors of stigma in patients with acromegaly. The overall stigma and internalized stigma were significantly correlated with QoL in these patients. CONCLUSION The patients with acromegaly exhibited critically high levels of perceived stigma, which led to psychological distress and disruptions in their daily lives. This finding highlights the importance of addressing the stigma concerns and the necessity for providing additional support to these patients in this regard during follow-up sessions. Further research should focus on developing intervention strategies to decrease the levels of perceived stigma in patients with acromegaly to promote their quality of life and for the psychosocial rehabilitation of these patients.
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Bettlach CR, Gibson E, Daines JM, Payne ER, Vuong LN, Merrill CM, Pet MA. The stigma of digital amputation: a survey of amputees with analysis of risk factors. J Hand Surg Eur Vol 2022; 47:461-468. [PMID: 34496665 DOI: 10.1177/17531934211044642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to quantify the stigma associated with digital amputation and examine factors associated with it. One hundred and sixty-four digital amputees completed the Neurological Quality of Life-Stigma questionnaire and a battery of Patient-Reported Outcome Measurement Information System instruments. Multivariable analysis examined factors associated with stigma experience. The mean observed stigma score of 47 (SD 8, range 36-64) was similar to the mean value of the normal population. Younger age, a worker's compensation claim and depression were each independently associated with a more severe experience of stigma after digital amputation. Socioeconomic variables, anatomical details and mechanism of injury were not independently associated with stigma. Digital amputation is not highly stigmatizing overall. Surgeons should consider referring at-risk patients to a mental health provider for support during the coping and adjustment process after amputation.Level of evidence: III.
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Affiliation(s)
- Carrie Roth Bettlach
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Ella Gibson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - John M Daines
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Emma R Payne
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Linh N Vuong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Corinne M Merrill
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
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Ashton-James CE, Anderson SR, Mackey SC, Darnall BD. Beyond pain, distress, and disability: the importance of social outcomes in pain management research and practice. Pain 2022; 163:e426-e431. [PMID: 34252908 PMCID: PMC8742845 DOI: 10.1097/j.pain.0000000000002404] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Claire E Ashton-James
- School of Medicine, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Steven R Anderson
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, United States
| | - Sean C Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, United States
| | - Beth D Darnall
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, United States
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