Consequences of Perceived Stigma Among Patients with Cirrhosis
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- Vaughn-Sandler, V., Sherman, C., Aronsohn, A. et al. Dig Dis Sci (2014) 59: 681. doi:10.1007/s10620-013-2942-0
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Among patients with diseases such as HIV, cancer and mental illness, perceived stigma is common and is linked to quality of life (QOL), depression and healthcare-seeking behavior.
We aimed to determine the prevalence and consequences of stigma in patients with cirrhosis.
A survey was developed and mailed to 300 patients with cirrhosis from a variety of etiologies. Among the 149 respondents, stigma was measured using a composite of previously validated scales. Correlates of stigma were measured using an a priori theoretical construct in order to investigate hypothesized consequences such as impaired social support, depression and reduction in healthcare-seeking behavior.
Eighty-nine percent of respondents chose “agree” or “strongly agree” for at least one of the 18 stigma-related questions, indicating they felt stigmatized in at least one aspect of their lives. Patient factors associated with more perceived stigma on multivariable linear regression included younger age (p = 0.008), and hepatitis C (p = 0.001) or alcohol (p = 0.01) as the etiology of liver disease. Patients with higher levels of perceived stigma had less social support (r2 = 0.898, p < 0.001), were less likely to seek medical care (r2 = 0.108, p < 0.001), suffered from more depression (r2 = 0.17 p < 0.001) and had worse QOL (r2 = 0.175, p < 0.001).
Perceived stigma is common among patients with cirrhosis, and is associated with adverse attitudes and behaviors such as decreased healthcare-seeking behavior. Healthcare providers need to be aware of these perceptions and their potential impact on patients’ interaction with the medical system.