Factors associated with stigma in community-dwelling stroke survivors in China: A cross-sectional study

Relationship between social support, functional outcomes and health-related quality of life in working-aged adults at three months after ischemic stroke: results from the FRAILTY study

BACKGROUND

The relationship between social support and functional outcomes and health-related quality of life (HRQoL) after ischemic stroke (IS) remains unclear, especially in working-aged patients.

AIM

To assess the relationship between perceived social support, functional outcomes, post-stroke psychosocial symptoms, and HRQoL in working-aged adults three months after IS.

METHODS

A prospective and correlational design was used. Patients of working age (18-65 years) admitted for first-ever IS were enrolled in the prospective FRAILTY (Factors Affecting the Quality of Life After Ischemic Stroke in Young Adults) study (NCT04839887). HRQoL (using the Stroke Impact Scale, Quality of Life in Neurological Disorders), social support (using the Multidimensional Scale of Perceived Social Support), functional outcomes (using a modified Rankin Scale-mRS), and post-stroke psychosocial symptoms were assessed three months after IS. Descriptive statistics, Wilcoxon signed-rank test, Spearman's correlations and multiple linear regression were used for analysis.

RESULTS

A total of 121 (54.5% males, mean age 51.7 ± 8.4 years) IS patients were analyzed. Of those, 87.7% had excellent clinical outcomes (mRS 0-1) after three months. Patients reported significant improvement in all domains of self-reported HRQoL except memory and communication after three months. The overall perceived social support was not associated with HRQoL domains. Post-stroke depression was negatively associated with all domains of HRQoL. Living arrangements (living alone) and post-stroke depression were negatively associated with perceived social support after IS.

CONCLUSIONS

More insight into the relationship between variables of HRQoL in working-aged adults might increase their social participation, strengthen supportive relationships, and promote their recovery and rehabilitation process. Focusing on the management of emotional problems and supporting functional outcomes may be modifiable factors that may represent targets for strategies to improve the HRQoL. Further research is needed to clarify the relationship between pre-stroke perceived social support and its types and post-stroke psychosocial symptoms in the long term.

Development and validation of a dynamic nomogram to predict alexithymia in young and middle aged stroke patients

Alexithymia, characterized by difficulty in expressing and recognizing emotions, is prevalent among young and middle-aged stroke survivors and can significantly impact rehabilitation outcomes. This study aims to develop and validate a dynamic nomogram to predict the risk of alexithymia in this population. This cross-sectional study was conducted from November 2022 to August 2023 at two tertiary hospitals in Jinzhou City and Cangzhou City, enrolling 319 patients. Predictive factors for alexithymia, such as Activities of Daily Living (ADL) scores, social support levels, lesion location, educational background, and National Institutes of Health Stroke Scale (NIHSS) scores, were identified through univariate and multivariate analyses. These factors were integrated into a web-based dynamic nomogram. The model's accuracy was evaluated using Receiver Operating Characteristic (ROC) curves and 1000 bootstrap resamples. In the training cohort, 47.8% of patients were diagnosed with alexithymia. The nomogram demonstrated excellent fit and reliability, with an Area Under the Curve (AUC) of 0.837 (95% CI: 0.787-0.889) in the training cohort and 0.847 (95% CI: 0.767-0.928) in the validation cohort, enabling reliable early detection of alexithymia. The dynamic nomogram provides healthcare professionals with an important tool for early detection and management of alexithymia in young and middle-aged stroke survivors. While the model shows high predictive accuracy, its applicability may be limited to similar clinical settings. Future studies should evaluate its utility across diverse healthcare systems. This tool has the potential to significantly improve rehabilitation outcomes by supporting personalized therapeutic strategies and interventions.

Felt stigma as a determinant of health-related quality of life among community-dwelling stroke survivors in China: A cross-sectional study

OBJECTIVES

To assess the role of felt stigma versus enacted stigma in the health-related quality of life of community--dwelling stroke survivors in China.

MATERIALS AND METHODS

A sample of 189 community--dwelling stroke survivors were investigated with the Stigma Scale for Chronic Illness (SSCI), 12-item Short Form-12 Health Survey (SF-12), modified Barthel index (MBI), Zung Self-Rating Depression Scale (ZSDS), and demographic and disease-related characteristics. Hierarchical multiple regression analysis was used to estimate the influence of felt stigma and enacted stigma on quality of life after controlling for depression, activities of daily living, and patient characteristics.

RESULTS

In total, 189 S survivors were included in the study. Overall stigma, felt stigma, and enacted stigma were moderately and strongly positively and significantly correlated with quality of life, depression, and activity in daily living (P < 0.05). Felt stigma significantly explained 2.2 % (P < 0.01) of the variance in the physical component summary (PCS). Felt stigma significantly explained 8.6 % (P < 0.01) of the variance in the mental component summary (MCS). However, enacted stigma had no effect on PCS or MCS.

CONCLUSION

Felt stigma significantly and independently contributed to the PCS and MCS quality of life of community-dwelling stroke survivors after adjustment for depression, activity of daily living and patient characteristics.

The Anticipated Stigma and Concealment Questionnaire (ASCQ): Psychometric properties of a Spanish version in a Chilean sample of brain injury survivors

Stigma represents a major obstacle in rehabilitation and community reintegration after brain injury. However, appropriate tools to measure stigma in Spanish-speaking countries are lacking. This study examined the psychometric properties of the Spanish version of the Anticipated Stigma and Concealment Questionnaire (ASCQ). An observational cross-sectional study was conducted with 103 participants who completed the ASCQ and other measures. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were performed to assess the scale's structure. Associations between the ASCQ and other mental health measures were explored to establish its nomological validity. All ASCQ items loaded significantly onto a single factor, with factor loadings ranging from .7 to .84. While χ2 (35) = 56.282, p < .05, some fit indices indicated excellent model fit (CFI = .997 and TLI = .996), while others suggested a good fit (RMSEA = .077, 90% CI [.036, .113], and SRMR = .060). Significant associations were found between the ASCQ and measures of loneliness, depressive symptoms, quality of life, and self-esteem. The ASCQ is a valid and reliable tool for assessing anticipated stigma and the motivation to conceal information after acquired brain injury. It can aid rehabilitation professionals in identifying individuals with interpersonal difficulties during community reintegration.

Empowering post-stroke older adults through wheelchair development: a conceptual synthesis for stigma reduction and well-being enhancement

Purpose: After a stroke, older adults may encounter social stigma due to their disability and age. This can cause emotions of shame, low self-esteem, and social isolation. The use of assistive devices can make the stigmatizing conditions even more difficult. This study attempts to establish a conceptual framework for designing wheelchairs that can help reduce stigma and improve the well-being of older people with lived experience of stroke.Method: The study utilized the research question construct classification to identify three primary research questions. To address these questions, a bibliographic search was performed using Scopus, Web of Science databases, and PubMed. Articles were selected based on their relevance to the development of wheelchairs and their focus on reducing stigma or enhancing well-being for post-stroke older adults.Results: Seventy articles were chosen to be meticulously reviewed and categorized into sub-themes. This categorization led to the creation of a comprehensive synthesis summary to address each question. The results are further synthesized to formulate a potential theoretical proposition for future investigation. The results suggest enhancing wheelchair design focusing on visibility, symbolism, usefulness, aesthetics, and adaptability through user empowerment and cultural interventions that can effectively reduce stigma, thereby improving the well-being, self-competence, and life quality of post-stroke older adults.Conclusion: The findings offer a design framework for wheelchair innovation specifically aimed at reducing the stigmatizing conditions to improve the well-being of post-stroke older adults through an interdisciplinary perspective. This study suggests further research to explore specific design strategies for wheelchair innovation across various contexts and cultures.

Stigma, coping strategies, distress and wellbeing in individuals with cervical dystonia: a cross-sectional study

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.

Stigma and related influencing factors in brain cancer patients: a cross-sectional study and parallel mediation analysis

PURPOSE

Patients with brain cancer and painful symptoms of the disease experience heavy pressure and negative inner experiences, leading to a sense of stigma. Therefore, this study assessed the level of stigma in patients with brain cancer and analyzed the risk factors for stigma to analyze the underlying relationships among depression, social support, low self-esteem, and stigma.

METHODS

Patients completed the Social Impact Scale, Self-rating Depression Scale, Rosenberg Self-Esteem Scale, Herth Hope Index, Social Support Rating Scale, and Self-Perceived Burden Scale. Multiple linear regression analysis was used to identify factors independently associated with stigma. Parallel mediation analysis was used to evaluate the mediating role of the relationship between psychoemotional factors and stigma.

RESULTS

A multivariate linear regression analysis demonstrated significant associations between age (β =  - 0.189, P = 0.002), treatment (β = 0.184, P = 0.003), self-esteem (β =  - 0.128, P = 0.046), depression (β = 0.273, P < 0.001), hope (β =  - 0.217, P = 0.003), and self-perceived burden (β = 0.260, P < 0.001) with brain cancer. It was observed that the social support received by brain cancer patients directly impacted their stigma (total effect, - 0.851, P = 0.001). Additionally, this relationship was influenced by depression and self-esteem through two distinct pathways.

CONCLUSION

Increased stigma among brain cancer patients was found to be associated with severe depression, feelings of inferiority, diminished hope, and a heavy perceived burden. The structural equation modeling (SEM) revealed that social support negatively influenced stigma through depression and self-esteem. It is imperative to grasp patients' inner needs, implement psychological interventions, and cultivate a cancer-friendly social environment to prevent stigmatization and discrimination based on their patient status.

Stigma following acquired brain injury and spinal cord injury: relationship to psychological distress and community integration in the first-year post-discharge

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.

The cognitive appraisal path of stroke knowledge, coping traits, family functioning and stigma among stroke patients: A moderated parallel mediation model

AIMS

To establish a cognitive appraisal path model that examines the impact of stroke knowledge on stigma with the parallel mediating effects of negative and positive coping traits, as well as the moderating effects of family functioning.

BACKGROUND

Stroke-related stigma, a 'mixture' of negative emotions involving internal criticism and external judgement, has been shown to impair patients' health outcomes. However, the specific factors underlying cognitive appraisals and their pathways remain unknown.

DESIGN

A cross-sectional design.

METHODS

The cross-sectional sample was from two stroke centres in China. Questionnaires were administered to collect sociodemographic data, stroke knowledge, coping traits, family functioning and stigma. Hierarchical regression models and the moderated parallel mediation model were constructed to analyse influencing pathways. The study adhered to the strengthening the reporting of observational studies in epidemiology guideline.

RESULTS

All 144 samples reported stigma symptoms with a moderate-to-high standardising score. The best hierarchical regression model explains 55.5% of the variance in stigma. The parallel mediation model indicated that negative and positive coping traits co-mediating the association of stroke knowledge and stigma. After adding the family functioning as a moderator, the moderated parallel mediation model was confirmed with adequate fit indices.

CONCLUSION

Among the cognitive appraisal factors affecting stroke-related stigma, stroke knowledge reduces stigma by modifying coping traits, while poor family functioning may serve as an opposing moderator. Notably, when family support is insufficient, enhanced stroke knowledge might paradoxically exacerbate the stigma.

RELEVANCE TO CLINICAL PRACTICE

This study contributes knowledge on transforming health education and emphasises the pivotal roles of clinical nursing practitioners. In similar global contexts, the study highlights integrating health education, psychological counselling and family support to advance systematic nursing practices.

PATIENT OR PUBLIC CONTRIBUTION

None.

Trends and disparities in non-communicable diseases in the Western Pacific region

The WHO Western Pacific region bears disproportionate deaths from non-communicable diseases (NCDs), with increased overall NCD proportional mortality over the past two decades. The disease burden of mental health increased, resulting from rapid ageing, enhanced stress, and the COVID-19 pandemic, but it was largely neglected. The highly diverse cultures, religions, political systems, socioeconomic contexts, lifestyles, and environmental factors probably have led to massive disparities across countries in NCD mortality, risk factors, and NCD management. Geographically, East Asia had the lowest NCD mortality whilst Pacific islands had the highest. Economic booms, ageing, nutrition transition, social stress, prevalent tobacco use, and fast-increasing obesity and hyperglycaemia are important drivers of NCDs. Men tended to have more adverse behavioural and metabolic risk factors. Rural residents are catching up with their urban counterparts in metabolic risk factors and conditions. Sustainable strategies tailored to NCD patterns are needed to fight the NCD epidemic and related disparities.

Plasma levels of urea cycle related amino acids in association with risk of ischemic stroke: Findings from a nested case-control study

OBJECTIVES

The role of urea cycle related amino acids in the development of ischemic stroke (IS) remains unclear. The study aimed to evaluate the association of these amino acids with IS.

MATERIALS AND METHODS

We conducted a case-control study nested within a cohort study in Changshu, Eastern China. A total of 321 cases and 321 controls matched by age and gender were finally included. Plasma levels of ornithine, arginine, spermidine, and proline were measured using ultra-high performance liquid chromatography-tandem mass-spectrometry (UHPLC-MS/MS). Odds ratios (ORs) and their 95 % confidence intervals (CIs) were calculated by conditional logistic regression analyses.

RESULTS

Plasma ornithine was inversely associated with risk of IS [crude OR: 0.62 (95 % CI: 0.40-0.97)]. After adjustment for body mass index, smoking, hypertension, family history of stroke, estimated glomerular filtration rate, and total cholesterol, the corresponding ORs for the highest compared to the lowest quartiles was essentially unchanged [adjusted OR: 0.62 (95 % CI: 0.39-0.99)]. The risk association remained significant after repeating the analyses by excluding the first two years of follow-up. Plasma arginine, spermidine, and proline were not associated with the risk of IS.

CONCLUSION

We observed that higher plasma levels of ornithine were associated with a lower risk of incident IS. Our novel findings suggest a protective role of ornithine in the pathogenesis of IS.

Factors Influencing Stroke Internal Stigma Among Stroke Survivors

Introduction

Poststroke internal stigmatization in patients is often overlooked, yet it makes significant contribution to their recovery and quality of life. After stroke, the survivors often have negative perception toward themselves triggered by the internal stigma. Consequently, it affects the rehabilitation outcomes and increases the risk of long-term complications. Therefore, deeper analysis related to the factors influencing the internal stigma was crucial in order to develop an appropriate and innovative strategy to overcome this issue and optimize the recovery in stroke survivors.

Objective

This study aimed to identify predominant factors influencing the internal stigma in stroke survivors in Indonesia.

Methods

This study used descriptive analytical design and applied stratified nonprobability consecutive sampling involving 439 poststroke respondents from nine hospitals in Bali throughout 2023. This study used various instruments, namely stroke stigma scale (SSS), perceived family support, stroke self-efficacy scale (SSEQ), stroke awareness questionnaire, self-acceptance scale, knowledge of stroke and the respondents' demographic data. The analysis was conducted using Pearson product-moment correlation and multiple regression.

Results

The results from multiple regression analysis showed that self-acceptance (β = .374, p = .000), self-awareness (β = .132, p = .000), self-efficacy (β = .154, p = .000), family support (β = .090, p = .015), age (β = .083, p = .000), and stroke symptoms (β = -.347, p = .000) could explain the internal stigma for 62.8% (F = 124.266, p = .000).

Conclusion

Self-acceptance became the most predominant factor towards internal stigma in the stroke survivors because it showed the ability in accepting changes after stroke, which eventually helped them to overcome the challenge and free themselves from internal stigma that interrupted the process of recovery and adaptation to poststroke physical and psychosocial changes.

The many faces of stigma after Acquired Brain Injury: a systematic review

Background Stigma after Acquired Brain Injury (ABI) has been described as a significant obstacle for the recovery of survivors. Despite its theoretical and clinical relevance, studies dedicated to stigma after ABI are just starting to emerge. The goal of this systematic review was to integrate the existing scientific evidence and develop a model of stigma after brain injury that can guide interventions at different levels. Method Three electronic databases were employed. A search strategy was adapted for each database. Articles that explored stigma in adult ABI populations were included. All articles used quantitative, qualitative or mixed method designs and were published in English, Spanish or Portuguese. Results A total of 21 articles were selected. They considered three types of stigma after ABI: (1) self-stigma, (2) stigma-by-association and (3) public stigma. It was also found that information can be processed at implicit and explicit levels across all three forms of stigma. Definitions of each type of stigma used with ABIs are provided as well as related concepts and theoretical frameworks employed. Evidence emerging from different forms of stigma after ABI is summarised. Conclusion Research on stigma after ABI is heterogeneous, and existing studies have explored its impact at individual, family and public levels. A model of stigma after ABI should consider all these levels as well as the interactions that can occur between them. Future studies should explore how to incorporate stigma management as part of neuropsychological rehabilitation programs.

The mediation effect of social support between stigma and social alienation in patients with stroke

Background

Social alienation is prevalent and causes adverse outcomes in stroke. Previous studies have linked stigma with social alienation. However, little is known about the mechanisms behind this relationship. This study explored the mediation effects of social support between stigma and social alienation.

Methods

A cross-sectional design was used to study 248 patients with stroke admitted to a tertiary rehabilitation hospital in Beijing, China, from December 2022 to July 2023. Patients were assessed using a general information questionnaire, the Stroke Stigma Scale, the Social Support Rating Scale, and the Generalized Social Alienation Scale. The PROCESS macro in SPSS was used to examine the mediation model.

Results

The results showed that stigma has a negative effect on social support (β = -0.503, p<0.001); stigma has a positive effect on social alienation (β = 0.768, p<0.001). Social support mediated the relationship between stigma and social alienation, with a mediation effect of 0.131 (95%CI: 0.060, 0.214), and indirect effects accounted for 17.06% of the total effect.

Conclusion

Social support mediated the relationship between stigma and social alienation. These findings suggest that intervention targeting the enhancement of social support may prevent or reduce social alienation among patients with stroke.

Relationship of family function and pre-hospital delay among Chinese patients with recurrent ischaemic stroke and the mediation effect of stigma

AIMS

Pre-hospital delay refers to the time span from the onset of symptoms to arrival at a hospital ≥ 3 h and is the main limitation of stroke reperfusion therapies. Family factors and stroke-related stigma may influence pre-hospital delay. However, few studies have confirmed the influence of stigma on pre-hospital delay or explored the relationships between family function, stigma, and pre-hospital delay among patients with recurrent stroke. This study aimed to explore the relationship between family function and pre-hospital delay among patients with recurrent stroke and examine the mediation role of stigma in this relationship.

METHODS AND RESULTS

A cross-sectional study was performed at the neurology departments of two hospitals in Guangzhou, China between July 2021 and April 2022. A total of 115 patients with recurrent stroke completed questionnaires and were included in the analysis. Data were collected using the Short Form Family Assessment Device, the Stroke Stigma Scale, and the Stroke Knowledge Questionnaire. Spearman's correlation and a structural equation model were used for data analysis. Family function directly influenced pre-hospital delay [β=0.27, P = 0.033, 95%CI = (0.02-0.51)] and indirectly influenced pre-hospital delay [β=0.17, P = 0.038, 95%CI = (0.02-0.34)] through stigma. Moreover, stigma partially mediated the effect of family function on pre-hospital delay.

CONCLUSION

Family function and stigma directly and indirectly influenced pre-hospital delay among patients with recurrent stroke. Future health education and interventions need to focus on strengthening and improving emotional support from family members to improve family function and reduce stigma, thereby reducing pre-hospital delay among patients with recurrent stroke.

The mediating effect of stigma between self-perceived burden and loneliness in stroke patients

Introduction

Stroke patients may experience reduced socialization and feelings of isolation due to post-stroke sequelae such as impaired motor function and cognitive deficits. Factors associated with loneliness need to be explored to develop targeted interventions. However, little is known about the impact of self-perceived burden and illness stigma on loneliness in this population.The aim of this study was to explore the mediating effect of stigma on self-perceived burden and loneliness in stroke patients.

Methods

The cluster random sampling method was adopted to select 1028 stroke patients from the neurology department of third-grade A hospitals and second-grade A hospitals in 5 cities of Henan Province from May 2022 to August 2022. A general data questionnaire, self-perceived burden scale, stroke stigma scale, and loneliness scale were used to investigate. The structural equation model was used to analyze the mediating effect of stigma between self-perceived burden and stigma.

Results

The loneliness of stroke patients was positively correlated with self-perceived burden and stigma. The results of the mediation analysis showed that stigma played a complete mediating role between self-perceived burden and loneliness.

Discussion

The results of the study revealed the relationship between self-perceived burden, stigma, and loneliness in stroke patients. Stigma mediated the relationship between self-perceived burden and loneliness in this population.Stigma should be emphasized as an important modifiable psychological factor that affects loneliness of stroke patients.

An investigation of the level of stigma and the factors influencing it in the rehabilitation of young and middle-aged stroke patients-a cross-sectional study

BACKGROUND

There are few reported studies on stigma in young and middle-aged stroke patients during the rehabilitation period, however, the rehabilitation period plays a key role in the patients' disease regression. Exploring the level of stigma and the influencing factors in young and middle-aged stroke patients during the rehabilitation period is crucial for determining how to reduce the level of stigma and improve the patients' motivation for rehabilitation treatment. Therefore, this study investigated the level of stigma in young and middle-aged stroke patients and analyzed the factors influencing stigma in order to provide a reference or basis for healthcare professionals to develop effective and targeted stigma intervention programs.

METHODS

Using a convenience sampling method, 285 young and middle-aged stroke patients admitted to the rehabilitation medicine department of a tertiary care hospital in Shenzhen, China, from November 2021 to September 2022 were selected and surveyed using a general information questionnaire, the Stroke Stigma Scale(SSS), the Barthel Index(BI), and the Positive and Negative Emotions Scale(PANAS), and multiple linear regression and smoothed curve fitting were used to analyze the factors influencing the stigma of young and middle-aged stroke patients during the rehabilitation period.

RESULTS

SSS score of 45.08 ± 11.06, univariate analysis of age, occupation, education level, pre-stroke monthly income, insurance type, comorbid chronic disease status, primary caregiver, BI, positive and negative emotion as factors influencing stigma. Multiple linear regression showed that age, pre-stroke monthly income, BI, positive and negative emotions were independent influences on stigma in young and middle-aged stroke patients, explaining 58.0% of the total variance in stigma. A smoothed curve fit revealed a curvilinear relationship between the above influences and stigma.

CONCLUSION

Young and middle-aged stroke patients have a moderate level of stigma. Medical staff should focus on young patients aged 18-44 years, those with high monthly income before the stroke, those with poor self-care ability, and those with low positive and high negative emotion scores, and conduct early assessments and adopt targeted intervention programs according to the influencing factors to reduce the stigma of young and middle-aged stroke patients, improve their motivation for rehabilitation, and help them return to their families and society as soon as possible.

TRIAL REGISTRATION

Registration number of China Clinical Trials Registration Center: 20,220,328,004-FS01.

Independent and combined effect of income and education attainment on the incidence of stroke events: a large-scale cohort study from rural communities in China

OBJECTIVES

Few studies have longitudinally evaluated income and education, and their combined effect on incident of stroke in China.

METHODS

The present study was based on a cohort with a baseline survey in China. A total of 15,913 participants were finally included. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were calculated to evaluate the association of income, education, and their combination with stroke risk by Cox proportional hazard model.

RESULTS

Lower income and less years of education was significantly associated with an increased risk of total stroke [income: adjusted HR: 1.54 (95% CI: 1.22-1.95); education: adjusted HR: 1.59 (95% CI: 1.11-2.28)]. Notably, the highest risk for total stroke was seen among those with lower income and higher education (adjusted HR: 2.46, 95% CI: 1.36-4.47). Sensitivity analysis by excluding the first year of follow-up showed similar findings with the primary analysis.

DISCUSSION

Lower income and education attainment were associated with an increased risk of stroke in Chinese countrysides. A joint effect of income and education existed on the risk of developing stroke. Special attention should be paid for rural community residents, especially for people with low income levels.

Understanding the effects of COVID-19 stigmatisation on job performance: a survey of frontline healthcare workers

The level of stigmatisation among health care providers has increased during the COVID-19 pandemic, and understanding the effect of COVID-19 stigmatisation on job performance has become increasingly important. The study explores the influence of COVID-19 stigmatisation on job performance among frontline health workers via the mediating role of anxiety. Furthermore, the moderating effect of resilience in the association between COVID-19 stigmatisation and anxiety is further examined. Participants were made up of 820 frontline health workers working in the epicentres of the Bono Ahafo, Western, Greater Accra, and Northern regions of Ghana. The hierarchical regression technique was employed in estimating the relationship between the variables. COVID-19 stigmatisation among frontline health workers directly affected anxiety and performance. In addition, the results showed that resilience moderated the relationship between COVID-19 stigmatisation and anxiety. The findings again demonstrated that anxiety partially mediated the association between concern for disclosure and public attitude and negative experience and job performance, whereas personalised stigma was insignificant. The study provides implications for establishing anti-stigma interventions and programs to enhance job performance among health workers.Key messagesMany healthcare workers are subject to stigmatisation during the COVID-19 pandemic.The study employs hierarchical regression methods to examine the impacts of COVID-19 stigmatisation on job performance among frontline health workers.The health management team should strengthen interventions to control the stigma experienced by health workers during COVID-19 treatments.

The association between comorbidities and stigma among breast cancer survivors

This study aimed to explore the association between types and numbers of comorbidities and stigma among breast cancer survivors (BCSs). A cross-sectional study was conducted among 937 BCSs in Shanghai Cancer Rehabilitation Club. All participants were asked to fill in an online questionnaire including Stigma Scale for Chronic Illnesses 8-item version (SSCI-8) and questions on sociodemographic characteristics and health status. Multivariate linear regression was used to analyze the association between comorbidities and stigma, adjusting for confounding factors. Results showed that nearly 70% of the participants had one or more comorbidities. The participants with stroke, digestive diseases or musculoskeletal diseases had significantly higher stigma than those without the above comorbidities. In addition, stigma was higher among survivors in the group with a greater number of comorbidities. Thus, it is important to strengthen the management of stigma in BCSs, especially for those with comorbidities.

Stigma and unhealthy psychological characteristics in patients with acromegaly: A cross-sectional study and identification of the associated factors

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.

Stigma and related influencing factors in postoperative oral cancer patients in China: a cross-sectional study

PURPOSE

To examine the level of stigma and identify its influencing factors among postoperative oral cancer patients in China.

METHODS

In total, 274 postoperative oral cancer patients were recruited from a Grade A Tertiary Hospital in China using convenience sampling methods. Patients completed the Social Impact Scale (SIS), Medical Coping Mode Questionnaire (MCMQ), Social Support Rating Scale (SSRS), and General Self-efficacy Scale (GSE).

RESULTS

Stigma reported by postoperative oral cancer patients was moderate (50.17 ± 21.24). Stepped multiple linear regression showed that the related factors influencing their feelings of stigma were educational level (β =  - 0.110, P = 0.001), smoking (β =  - 0.152, P < 0.001), betel quid (β =  - 0.120, P = 0.001), tumor location (β =  - 0.390, P < 0.001), tumor stage (β = 0.219, P < 0.001), self-efficacy (β =  - 0.253, P < 0.001), and confrontation (β =  - 0.117, P = 0.001) and avoidance (β = 0.123, P < 0.001), which explained 74.2% of the total variation in stigma (F = 99.378, P < 0.001).

CONCLUSIONS

Stigma was positively predicted by tumor stage and avoidance but negatively predicted by education level, smoking, betel quid, tumor location, confrontation, and self-efficacy. Further work should focus on developing interventions to reduce stigma by improving protective factors and decreasing risk factors.

Correlates of stigma for poststroke patients: A meta-analysis

AIMS

A meta-analysis was carried out to review and identify correlates of stigma in poststroke patients.

BACKGROUND

Patients suffer from impaired physical functions and sequelae of stroke. Stroke-related stigma hinders the recovery process and produces poorer clinical outcomes of stroke, leading to compromised quality of life.

DESIGN

A systematic review and meta-analysis was reported by following PRISMA 2020 guidelines.

REVIEW METHODS

Nine databases were searched from their inception to May 2021 to identify studies focused on the relationships among demographics, disease-related factors, psychosocial factors and poststroke stigma. Included studies were assessed by using the Agency for Healthcare Research and Quality (AHRQ) scale. The statistical software R studios were used to perform statistical analysis.

RESULTS

Nineteen studies were included in the meta-analysis. Four demographic factors (age, caregiver, residence, monthly income), seven stroke-related characteristics (type of stroke, mRS, ADLs, stroke duration, recurrence, sequelae, chronic disease comorbidity) and three psychosocial factors (depression, social support, quality of life) showed significant associations with stroke-related stigma.

CONCLUSIONS

The results of our study can serve as a foundation for designing interventions to reduce stigma and improve the overall quality of life of poststroke patients and may produce positive clinical outcomes. Healthcare professionals should be aware of stroke patients who are characterised by correlates of stigma. Relevance to clinical practice Poststroke patients showed a moderate-to-high level of stigma, and this issue warrants more attention. This review provides a preliminary foundation for healthcare professionals to develop interventions to address stroke-related stigma by focusing on demographic, disease-related and psychosocial factors. Additionally, stigma identification should be a part of clinical nursing evaluation. The involvement of clinical and community nursing is very important to screen stroke-related stigma and pay attention to this population.

The effect of stigma on social participation in community-dwelling Chinese patients with stroke sequelae: A cross-sectional study

OBJECTIVE

To explore the effect of stigma on social participation in community-dwelling Chinese patients with stroke sequelae.

DESIGN

A cross-sectional survey study.

SETTING

The study was conducted in two community centres in Tianjin, China.

SUBJECTS

Community-dwelling Chinese patients with stroke sequelae.

MEASURES

Chinese version of Stigma Scale for Chronic Illness, Chinese version of Impact on Participation and Autonomy, Modified Barthel index, Self-Rating Depression Scale, Social Support Rating Scale, Medical Coping Modes Questionnaire, background and disease-related questions. Pearson's correlation coefficients were computed between stigma and social participation. The impact of stigma on social participation was estimated by hierarchical multiple regression analysis after controlling for demographic, physical and psychosocial characteristics.

RESULTS

In total, 136 patients with stroke sequelae were included in this study, with a mean age of 67.8 years. The Chinese version of the Stigma Scale for Chronic Illness had a mean score of 48.4 (SD 16.9), and the Chinese version of the Impact on Participation and Autonomy was 67.1 (SD 21.1). Significant correlations were found between stigma and social participation. Pearson's correlation coefficient ranged from 0.354 to 0.605 (P < 0.01). Enacted stigma provided a significant explanation for the variance of social participation by 1.1% (P < 0.05). Felt stigma provided a significant explanation for the variance of social participation by 2.9% (P < 0.001).

CONCLUSION

Felt stigma and enacted stigma have independent associations with social participation. Patients with stroke sequelae who reported higher stigma experienced a lower level of social participation.

Study of Physical, Psychological, and Spiritual Impact of Family Caregiver In Home-Based Stroke Treatment: A Systematic Review

BACKGROUND: Family support during stroke treatment at home is crucial. However, post-stroke patients’ long-term care will be a problem for families, reducing the level of life satisfaction and physical burden for caregivers. Furthermore, families may experience depression. AIM: Analyzing family conditions related to physical, psychological, and spiritual conditions that receive home-based health worker interventions. METHODS: Study implemented systematic review design with Prisma guidelines, initially with the identification of article sources, following by article screening, checking the eligibility of studies then appraised the selected articles. Three databases were used, Ebsco, PubMed, and PROQUEST. Only studies using quasi-experimental, pre-experimental, and RCT designs were included in this study. Furthermore, those articles were published between 2014 until 2019, full type article and conducted anykind of home intervention for stroke patients and/or family member. Keywords that were employed “Stroke, Apoplexy, Cerebrovascular Accident, Vascular Accident, Home Care Services, home care, Home Health Care, Domiciliary Care, Physical, Physics, Psychological Factors, Psychological Side Effects, Psychosocial Factors, Spirituality.” Totally, 19,528 articles were obtained. Finally, only six eligible articles met review requirements. RESULTS: Implementation of home-based care lowered the physical fatigue of the family. In psychological responses showed that home-based care could reduce the incidence of depression and anxiety levels. Another impact was that the family felt helped because patients could more independently do their activities. Furthermore, the family always supported to motivate the patients to do their daily tasks. CONCLUSION: Home-based interventions for stroke patients can reduce depression, anxiety, and fatigue for the family caregiver.

Stigma, depression, and post-traumatic growth among Chinese stroke survivors: A longitudinal study examining patterns and correlations

Background: With the development of positive psychology, several studies show that positive and negative emotions are not always opposing. Understanding how positive and negative emotions correlate and the factors contributing to resilience in stroke survivors requires further research.Objectives: To identify the patterns and correlations of stigma, depression, and posttraumatic growth (PTG) among stroke survivors.Methods: Stroke-related stigma, depression, PTG, and neurological status were evaluated at 1-month and 3 months post-stroke using the Stroke Stigma Scale (SSS), Patient Health Questionnaire-9 (PHQ-9), Chinese version of the Posttraumatic Growth Inventory (C-PTGI), modified Rankin Scale (mRS), and Social Support Rating Scale (SSRS). The paired t-test, nonparametric test, and Spearman's correlation test were used to analyze differences and relationships between results at the two time points.Results: At 3 months compared to 1-month post-stroke, we found significant reductions in mRS and stigma scores, and an increase in PTGI scores, while the PHQ-9 scores reduced non-significantly. SSS, PHQ-9, and mRS scores were positively correlated with each other at time1 (all P < .01), and all showed no significant relationships with PTGI scores (all P > .05). Social support scores were negatively correlated with stigma (P < .01), PHQ-9 (P < .01), and PTGI scores (P > .05) at 3 months.Conclusions: Stroke-related stigma is strongly associated with depression while neither of them has significant relationships with PTG during the early stage of survivors' rehabilitation in our study. Neurological impairment is a risk factor for negative emotions and increasing individualized support may reduce stigma, depression, and promote PTG in the long term.