Cumulative consequences of stigma: Possessing multiple concealable stigmatized identities is associated with worse quality of life

Abstract

Large health disparities exist between stigmatized and nonstigmatized groups. In addition to experiencing and anticipating greater discrimination, members of stigmatized groups also tend to demonstrate greater ruminative tendencies in response, which may lead to these poor health outcomes. Even among stigmatized groups, differences in the visibility of stigma lead to different mechanisms through which stigma takes its toll. Previous work has primarily focused on the impact of belonging to a single marginalized group; however, people often belong to multiple marginalized groups, and this likely affects both their health outcomes and their anticipation of stigma. In the current study, we focused on individuals with concealable stigmatized identities (CSIs)—socially stigmatized identities that are not immediately apparent to others—and created a measure of concealable marginalization that captures multiple group memberships. We predicted that those possessing a greater number of CSIs would anticipate more stigma from others, and, in turn, ruminate more about the stigma, which would negatively impact the health. Surveying N = 288 adults with CSIs, we found that possessing a greater number of marginalized concealable identities predicted worse self‐reported physical quality of life. These relationships were partially mediated by greater anticipated stigma and brooding rumination in regard to their CSI. This work illuminates a more complete picture of how living with CSIs can take its toll on health.

Recognizing the cumulative burden of childhood adversities transforms science and practice for trauma and resilience.

“…For example, the original research team used multiple approaches to assess family focused trauma; specifically, childhood neglect was included only in Wave 2 of the original ACE studies (Dong et al, 2004; Felitti et al, 1998). Other approaches to capturing trauma dose, such as a recent study of multiple concealable stigmas (Reinka et al, 2020), obtained results that are largely consistent with prior work.…”

Women’s Disempowerment and Preferences for Skin Lightening Products That Reinforce Colorism: Experimental Evidence From India

“…Our research advances extant knowledge by (a) experimentally testing theoretical arguments about how societal-level colorism combines with women's chronic and situational disempowerment, leading them to prefer products that put their health at risk and (b) answering calls by social scientists for increased work on the intersectionality of multiply disadvantaged social groups (Bettache, 2020;Cole, 2009;Reinka et al, 2020;Remedios & Snyder, 2015;Rosenthal, 2016). Based on our findings, we offer recommendations (see General Discussion section) for scholars, educators, practitioners, and policy makers in connection to these critical social issues.…”

Stigma, health, and academic performance in university students with physical and mental chronic health conditions: Baseline data report.

“…Although a study examined QoL and loneliness in students with physical or mental CHCs, only one student reported having both (Herts et al, 2014). In the broader CHC literature, prior work suggests that those with more CHCs and other concealable identities (e.g., gender identity minority) are at risk for greater anticipated stigma and worse QoL (Reinka et al, 2020). However, there appear to be no studies examining how stigma constructs and their associations with performance measures and QoL in individuals (e.g., university students) with co-occurring physical and mental CHCs might compare to those with mental or physical CHCs.…”

“…The present study had two aims to address the two gaps in the literature (see ):To compare levels of awareness of negative stereotypes of CHCs (i.e., stigma awareness), internalized stigma, academic performance, and health across students with mental, physical, or both mental and physical CHCs. Although some work suggests that additional health, performance, and stigma-related risks are conferred with more CHCs (Hagerty et al, 2019; Kessler et al, 2003; Reinka et al, 2020), other work suggests that having any combination of CHC may be associated with similar negative stereotypes, possibly leading to similar detrimental psychosocial effects across those with physical, mental, or both physical and mental CHCs (Van Brakel, 2006). To examine whether stigma-related processes (awareness of stigma and internalized stigma) were independently associated with academic performance and health outcomes in students with CHCs.…”

“…In addition, Royster and Marshall (2008) state that students with physical CHCs "face specific issues such as : : : unpredictable relapses during the term, and the invisibility of their illnesses, which can make them the subject to disbelief and claims of malingering" (p. 121). Taken together, students with either physical or mental CHCs have reported experiencing stigmas, despite how physical or mental CHCs can be concealed (O'Donnell & Habenicht, 2022;Reinka et al, 2020). Given the increased online instruction in the wake of the COVID-19 pandemic, it is likely that fewer students' CHCs are recognized by educational staff, faculty, and classmates.…”