Stigma, Intrusiveness, and Distress in Parents of Children with a Disorder/Difference of Sex Development

Abstract

Objective: The impact of parent-reported stigma due to their child's disorder/difference of sex development (DSD) on parent psychosocial adjustment is poorly understood. In other pediatric populations, perceived interference of medical conditions into daily activities (i.e., illness intrusiveness ) mediates the relationship of stigma to adjustment. This study assessed relationships between parent-focused and child-focused stigma → illness intrusiveness → depressive and anxious symptoms . Exploratory analyses sought to identify patient characteristics associated with stigma.

Method: Caregivers (59 women and 43 men) of 63 children diagnosed with a DSD up to age 4 years completed measures of demographics, parent-focused and child-focused stigma, illness intrusiveness, and depressive and anxious symptoms.

Results: Increased parent-focused and child-focused stigma were associated with increased illness intrusiveness, which, in turn, was associated with increased depressive and anxious symptoms for parents nested within dyads. Among children with DSD family histories, parents reported greater child-focused stigma.

Conclusion: Parents who experience DSD-related stigma report greater interference of their child's DSD into their daily activities, which is associated with poorer psychosocial adjustment. Findings support developing clinical interventions related to parents' perceptions of stigma and illness intrusiveness to improve parent adjustment.

Figure 1

depicts separate mediation path analysis models; A) illness intrusiveness significantly mediated the relationship between parent-focused stigma and depressive symptoms, B) illness intrusiveness significantly mediated the relationship between parent-focused stigma and anxious symptoms, C) illness intrusiveness significantly mediated the relationship between child-focused stigma and depressive symptoms, D) illness intrusiveness significantly mediated the relationship between child-focused stigma and anxious symptoms.