Psychological and behavioural patterns of stigma among patients with type 2 diabetes: a cross-sectional study

Abstract

ObjectivesThe aim of this study was to test the psychological and behavioural patterns of stigma (self-esteem and social participation) and their relationship to self-stigma, patient activation for engaging in self-care and glycaemic control among patients with type 2 diabetes mellitus (T2DM).DesignA cross-sectional study.Setting2 tertiary-level hospitals and 2 secondary-level hospitals in Japan.ParticipantsA consecutive sample of 209 outpatients with T2DM. Inclusion criteria were as follows: presence of T2DM, age 20–74 years, no diagnosis of dementia and/or psychosis, and no need for urgent medical procedures.Outcome measuresStudy measures included a self-administered questionnaire to assess the Rosenberg Self-Esteem Scale (SES), the 3 subscales of 36-question Short Form Health Survey (SF-36; Social Function, Role Physical, Role Emotional), Self-Stigma Scale and Patient Activation Measure (PAM-13). Glycated haemoglobin was obtained from same day blood work. In our previous qualitative study, we found that psychological and behavioural patterns of stigma varied according to patients' levels of illness-related self-esteem as well as attitudes towards social participation. For quantitative consistency, we used the SES scale to measure self-esteem and the SF-36 subscales to measure social participation. We then divided participants into 4 groups by exhibited psychological and behavioural patterns: group A (high SES/high SF-36), group B (high SES/low SF-36), group C (low SES/high SF-36) and group D (low SES/low SF-36).ResultsUsing analysis of covariance after controlling for age and sex, there was a significant difference in self-stigma levels between the four groups (F[3203]=15.70, p<0.001). We observed the highest mean self-stigma levels in group D. Group D also had significantly lower PAM-13 scores than those of groups A (p<0.001) and B (p=0.02).ConclusionsThe psychological and behavioural pattern of group D was found to be associated with higher levels of self-stigma and poorer patient activation for self-care.

Non-Communicable Diseases-Related Stigma: A Mixed-Methods Systematic Review

“…Five studies reported on the prevalence of perceived stigma ranging from 12% to 86% [ 12 , 37 , 60 , 61 , 62 ] and three on experienced stigma ranging from 5.6% to 68.5% [ 30 , 60 , 61 ]. Six studies measured and reported the mean levels/scores of stigma, the range of which varied based on the scale used [ 10 , 12 , 38 , 59 , 63 , 64 ]. Table 3 shows the reported prevalence and/or mean levels/scores of stigma across different NCDs.…”

“…The other source of stigma identified in the articles included societal actors who played part in stigmatization as a result of the influence and enforcement of societal norms which discredit and devalue those with health conditions, viz. family [ 8 , 9 , 11 , 28 , 29 , 31 , 32 , 36 , 38 , 59 ], friends [ 9 , 28 , 29 , 31 , 32 , 38 , 59 ], doctors/healthcare providers [ 9 , 28 , 29 , 34 , 38 , 59 ], employers [ 30 , 33 , 62 ], and colleagues at the workplace [ 9 , 38 , 62 ]. Most studies identified and examined the role of family and friends as perpetuators of stigma, followed by healthcare providers, employers, and work colleagues.…”

“…Meanwhile, experiences of social exclusion and distancing in relationships were reported across the conditions, and those with COPD, breast and cervical, and head and neck cancers also reported too much sympathy and over-concern from others to be stigmatizing [ 8 , 11 ]. Discrimination in the workplace was reported by seven articles which ranged from experiences of avoidance by colleagues and supervisors to exclusion from decision-making opportunities and denying opportunities to assume important tasks and responsibilities [ 9 , 28 , 30 , 31 , 33 , 38 , 60 ].…”

“…Many people living with cancers, CVDs, CRDs, and diabetes are known to encounter similar stigma-related manifestations like avoidance and isolation [ 8 , 9 , 27 ], exclusion from social participation [ 28 , 29 , 30 ], both perceived and experienced unfair and unjust treatment in social, education, employment, and healthcare settings [ 8 , 9 , 31 , 32 , 33 ], feelings of shame and guilt for having the disease [ 11 , 27 , 31 , 34 ], and fear of discrimination and ostracization [ 32 , 35 , 36 ]. Such experiences are known to discourage help-seeking and the disclosure of health status, which in turn can potentially hamper the treatment and management of these conditions [ 8 , 33 , 37 , 38 ].…”

Sex differences in the association of psychological status with measures of physical activity and sedentary behaviour in adults with type 2 diabetes

“…In the light of this evidence, novel approaches to reduce sedentary behaviours are urgently needed, as well as updated public health recommendations increasing awareness of the risk associated with these behaviours. This is particularly relevant for individuals with T2D, as they are exposed to an increased demand of self-care and, simultaneously, they typically display an increased vulnerability to psychological distress [2,35,36], which, in turn, is associated with poorer clinical outcomes and a higher occurrence of un-healthy behaviours.…”