Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.
Health Psychology and Behavior Medicine Research Group, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
J Adv Nurs. 2021 Aug;77(8):3412-3423. doi: 10.1111/jan.14881. Epub 2021 May 10.
To investigate the roles of total stigma, enacted stigma, and internalized stigma in the prediction of psychological distress among breast cancer patients, and to evaluate the mediating effect of body image in this process.
Cross-sectional.
Between Oct-2014 to May-2015, a cross-sectional study was conducted with participation of 223 patients from three cancer centres located in Tehran, Iran. The study variables were assessed using the stigma scale for chronic illnesses 8-item version (SSCI-8), body image scale (BIS), and depression anxiety stress scale (DASS-21). Structural equation modelling using MLR estimator was employed based on the two-step procedure to validate both the full measurement models and the structural models. Five models were tested to determine predictability of all stigma constructs for psychological distress, including stress, anxiety, and depression, through the mediation of body image. Three equivalent models were further examined to re-evaluate the direction of the relationships.
Psychological distress and body image were largely predicted by total stigma, enacted stigma, and internalized stigma. The effect of stigma on psychological distress was mediated through body image. In a serial mediation model, the significance of the pathway of enacted stigma > internalized stigma > body image > psychological distress was confirmed. The serial model in which internalized stigma precedes body image was also supported by the equivalent models.
Stigma has been identified as a major source of psychological distress among women with breast cancer. Enacted stigma not only psychologically disturbs the patients but also triggers a chain of other identity transformations (i.e. internalization of stigma and distortion of body image), their ultimate result being a full-blown psychological distress.
Both enacted and internalized stigma distorts breast cancer patients' perception of their body image, which in turn renders them psychologically distressed. The serial process of enacted stigma, internalized stigma, and body image plays an important role in perpetuating distress in these patients. To break this chain of psychological consequences and for interventions to have a greater impact on overall well-being of patients, the effect of enacted stigma on distress via the sequence of two mediators needs to be specifically targeted at each stage.
探讨总污名、表现污名和内化污名在乳腺癌患者心理困扰预测中的作用，并评价身体意象在这一过程中的中介作用。
横断面研究。
2014 年 10 月至 2015 年 5 月，对伊朗德黑兰三家癌症中心的 223 名患者进行了一项横断面研究。使用慢性病污名量表 8 项版本（SSCI-8）、身体意象量表（BIS）和抑郁焦虑应激量表（DASS-21）评估研究变量。采用 MLR 估计量的结构方程模型，根据两步程序验证全测量模型和结构模型。共测试了五个模型，以确定通过身体意象对所有污名结构对心理困扰（包括压力、焦虑和抑郁）的预测能力。进一步检验了三个等效模型，以重新评估关系的方向。
心理困扰和身体意象主要由总污名、表现污名和内化污名预测。污名对心理困扰的影响通过身体意象来介导。在一个序列中介模型中，证实了表现污名>内化污名>身体意象>心理困扰这一路径的显著性。内化污名先于身体意象的序列模型也得到了等效模型的支持。
污名已被确定为乳腺癌女性心理困扰的主要来源。表现污名不仅会给患者带来心理困扰，还会引发一系列其他身份转变（即污名内化和身体意象扭曲），其最终结果是全面的心理困扰。
表现污名和内化污名都会扭曲乳腺癌患者对自己身体形象的感知，从而使她们感到心理困扰。表现污名、内化污名和身体意象的序列过程在使这些患者持续处于困境中起着重要作用。为了打破这种心理后果的链条，并使干预措施对患者的整体幸福感产生更大的影响，需要针对每个阶段，专门针对表现污名对通过两个中介的痛苦的影响。
