Anticipated stigma and quality of life among people living with chronic illnesses, 2011, Earnshaw et al

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Objectives: We examined the process by which anticipated stigma relates to quality of life among people living with chronic illnesses. We hypothesized that stress, social support and patient satisfaction mediate the relationships between three sources of anticipated stigma and quality of life.

Methods: Data were collected from adults living with chronic illnesses recruited from support groups and online communities, and were analysed with path analysis.
Results: Results demonstrated that stress mediated the relationships between anticipated stigma from friends and family, and work colleagues with quality of life; social support mediated the relationships between anticipated stigma from friends and family, and work colleagues with quality of life; and patient satisfaction mediated the relationship between anticipated stigma from healthcare providers with quality of life. The final path model fit the data well (χ2 (8) = 8.66, p = 0.37; RMSEA = 0.02; CFI = 0.99; SRMR = 0.03), and accounted for 60% of the variance in participants’ quality of life.

Discussion: This work highlights potential points of intervention to improve quality of life. It calls attention to the importance of differentiating between sources of anticipated stigma in clinical settings, interventions and research involving people living with chronic illnesses.

 

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From the discussion:

Importantly, this work suggests that people living with chronic illnesses do not have to actually experience enacted stigma (i.e. experiences of prejudice, stereotyping and discrimination directed at the self from others) to suffer negative outcomes associated with stigma. They merely have to believe that it may occur to them in the future.

Participants were not asked if they experienced enacted stigma, so the anticipation of experiencing stigma may well have been due to already experienced events/knowledge of ongoing stigma Also in the results they state that "... participants who anticipated greater stigma from friends and family members and from work colleagues perceived less social support..."

The use of "anticpated" and "perceived" throughout make it sound like the stigma and lack of social support aren't actually occuring. At the end it is suggested patients should receive CBT to "address stress associated with anticipated stigma". In fairness it is also mentioned that interventions that improve social support should also be looked at.