Consequences of perceived stigma among patients with cirrhosis

Abstract

Background: 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.

Aims: We aimed to determine the prevalence and consequences of stigma in patients with cirrhosis.

Methods: 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.

Results: 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 (r (2) = 0.898, p < 0.001), were less likely to seek medical care (r (2) = 0.108, p < 0.001), suffered from more depression (r (2) = 0.17 p < 0.001) and had worse QOL (r (2) = 0.175, p < 0.001).

Conclusions: 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.

Figure 1. Conceptual Model of Stigma

Correlations between Stigma and the various subgroups of the survey (solid arrows) as well as their hypothesized relation with outcomes (dashed arrows). The p-value associated with adherence (ns) is not statistically significant.