Digestive Diseases and Sciences

, Volume 59, Issue 3, pp 681–686

Consequences of Perceived Stigma Among Patients with Cirrhosis

  • Valerie Vaughn-Sandler
  • Carey Sherman
  • Andrew Aronsohn
  • Michael L. Volk
Original Article

DOI: 10.1007/s10620-013-2942-0

Cite this article as:
Vaughn-Sandler, V., Sherman, C., Aronsohn, A. et al. Dig Dis Sci (2014) 59: 681. doi:10.1007/s10620-013-2942-0



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.


Social supportHealth behaviorStigmaCirrhosisQuality of life

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Valerie Vaughn-Sandler
    • 1
  • Carey Sherman
    • 2
  • Andrew Aronsohn
    • 3
  • Michael L. Volk
    • 4
  1. 1.Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborUSA
  2. 2.Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  3. 3.Center for Liver DiseasesUniversity of ChicagoChicagoUSA
  4. 4.Division of GastroenterologyUniversity of Michigan Medical SchoolAnn ArborUSA