JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Jockey Club School of Public Health and Primary Care, Room 508, Postgraduate Education Centre, Prince of Wales Hospital, School of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Int J Behav Med. 2024 Apr;31(2):241-251. doi: 10.1007/s12529-023-10176-z. Epub 2023 Apr 3.
Studies have suggested that type 2 diabetes mellitus (T2DM) are at risk of self-stigmatization (i.e., internalized sense of shame about having diabetes). Self-stigma has been found to be associated with poorer psychological outcomes among chronic disease patients; relevant studies examining such an association and its psychosocial mechanisms are scarce among Chinese T2DM patients. This study aimed to examine the association between self-stigma and psychological outcomes among T2DM patients in Hong Kong. Self-stigma was hypothesized to be associated with higher psychological distress and lower quality of life (QoL). Such associations were also hypothesized to be mediated by lower perceived social support, lower self-care self-efficacy, plus higher self-perceived burden to significant others.
T2DM patients (N = 206) recruited from hospitals and clinics in Hong Kong were invited to complete a cross-sectional survey measuring the aforementioned variables.
After controlling for covariates, multiple mediation analysis results indicated the indirect effects from self-stigma to psychological distress via increased self-perceived burden (β = 0.07; 95% CI = 0.02, 0.15) and decreased self-care self-efficacy (β = 0.05; 95% CI = 0.01, 0.11) were significant. Moreover, the indirect effect from self-stigma to QoL via decreased self-care self-efficacy was also significant (β = -0.07; 95% CI = -0.14, -0.02). After considering the mediators, the direct effects from self-stigma to higher psychological distress and lower QoL remained significant (βs = 0.15 and -0.15 respectively, ps < .05).
Self-stigma could be linked to poorer psychological outcomes through increased self-perceived burden and decreased self-care self-efficacy among T2DM patients. Targeting those variables when designing interventions might facilitate those patients' psychological adjustments.
研究表明，2 型糖尿病（T2DM）患者存在自我污名化的风险（即对患有糖尿病感到羞耻）。自我污名与慢性病患者较差的心理结局有关；在华裔 T2DM 患者中，相关研究很少探讨这种关联及其心理社会机制。本研究旨在探讨香港 T2DM 患者自我污名与心理结局之间的关系。假设自我污名与较高的心理困扰和较低的生活质量（QoL）相关。假设这种关联还通过较低的感知社会支持、较低的自我护理自我效能感以及更高的自我感知对他人的负担来介导。
从香港的医院和诊所招募了 206 名 T2DM 患者，邀请他们完成一项横断面调查，测量上述变量。
在控制了协变量后，多中介分析结果表明，自我污名与心理困扰之间的间接效应通过增加自我感知的负担（β=0.07；95%CI=0.02，0.15）和降低自我护理自我效能感（β=0.05；95%CI=0.01，0.11）而显著。此外，自我污名通过降低自我护理自我效能感对 QoL 的间接效应也显著（β=-0.07；95%CI=-0.14，-0.02）。考虑到这些中介因素后，自我污名与较高的心理困扰和较低的 QoL 之间的直接效应仍然显著（β值分别为 0.15 和-0.15，p 值均<0.05）。
在 T2DM 患者中，自我污名可能通过增加自我感知的负担和降低自我护理自我效能感与较差的心理结局相关。在设计干预措施时针对这些变量可能有助于这些患者的心理调整。
