Depressive symptoms and sickle cell pain: The moderating role of internalized stigma.

Abstract

Recent studies describe the clinical implications of sickle cell disease (SCD) stigma. However, little is known about its link to depressive symptoms or its relative influence on the association between depressive symptoms and SCD pain. We examined whether internalized stigma about SCD moderated the relation between depressive symptoms and pain among 69 adults attending a SCD clinic who reported pain episodes and healthcare use over the past three months. Unadjusted bivariate analyses showed a marginal association between depressive symptoms and SCD pain frequency (r = .21, p < .10). Further analyses adjusting for health care use indicated a moderating effect of internalized stigma (b = −.10, p < .05): a significant association between depressive symptoms and pain was observed among participants low in internalized stigma, but this relationship was attenuated at moderate and high stigma levels. These results denote counterintuitive consequences of internalized attitudes about SCD and suggest a need for further study of the psychosocial and clinical implications of SCD stigma.

Stigma of Sickle Cell Disease: A Systematic Review

“…Of the 27 studies reviewed, five used scales adapted for stigma of SCD (Bediako et al, 2014; Blake et al, 2017; Holloway, McGill, & Bediako, 2016; Jenerette, Brewer, Crandell, & I. Ataga, 2012; Jenerette, Brewer, Edwards, Mishel, & Gil, 2014). The remainder did not include a scale, adapted a scale about stigma or a stigma-related concept fromanother population, or interviewed participants about stigma and stigma-related concepts.…”

“…The majority of SCD literature focuses on perceived stigma in SCD and its effects on patient-provider relationships, care-seeking behaviors, and the mental and physical wellbeing of individuals with SCD. However, the impact of internalized stigma also needs to be assessed, as Holloway et al (2016) found a positive relationship between internalized stigma and depressive symptoms. Additionally, SCD stigma often goes unrecognized, unaddressed, and is not measured in studies assessing psychological wellbeing in SCD, despite all of the literature confirming that stigma is associated with poor psychological outcomes.…”

“…They are at risk for internalized stigma. Depressive symptoms, including feeling hopeless and loss of interest in daily activities, have been positively associated with internalized stigma in people with SCD (Holloway et al, 2016). Additionally, individuals who experience high rates of stigma are more likely to report anxiety, depressive symptomatology, stress, and anger in comparison to those reporting low rates of stigma (M.…”

Communalism Moderates the Association Between Racial Centrality and Emergency Department Use for Sickle Cell Disease Pain

“…Thus, patients in the former group would be less likely to utilize health care services when in pain, while those in the latter group would be more likely to do so. Conversely, individuals with a stronger racial self-concept may be more sensitive to perceived discrimination and stigmatization (Haywood et al, 2014; Holloway et al, 2016) and may be hesitant—even when in severe pain—to engage with the traditional health care system in order to avoid being treated unfairly. This might explain why individuals high in racial centrality report fewer emergency department visits.…”

“…We evaluated pain severity by asking participants to rate the global intensity of these episodes on a scale ranging from 0 ( no pain at all ) to 10 ( pain as bad as it can be ). These indicators have been used for more than two decades in SCD research with adults and are highly correlated with objective clinical indicators of disease severity (Holloway, McGill, & Bediako, 2016). …”