Stigmatization and psychological distress (anxiety, stress, depressive symptoms) among Iranian breast cancer patients

Abstract

Background: The aim of this study was to investigate the degree to which Iranian breast cancer patients experienced stigmatization and its subtypes (enacted and internalized stigma) and whether there is any relationship between stigmatization and its subtypes with psychological distress (anxiety, stress, depressive symptoms). Methods: In a three center study, 224 Patients were recruited from October 2014 to May 2015. Using measures of Socio-demographic questionnaire, levels of distress (DASS-21) and Stigma Scale for Chronic illnesses (SSCI-8), data were collected face-to-face. Statistical analysis was performed using Descriptive, Pearson’s correlation, and linear regression tests. Findings: The mean scores of enacted stigma (possible range of 5 to 25), internalized Stigma(3-15) and total stigma (8-40) were respectively 6.97±3.4, 4.97±2.6 and 11.74±5.5 which shows low level of stigma in these patients. 39.7%, 48.2% and 37.1% of the patients were suffering from moderate to extreme depression, anxiety and stress, respectively. There were significant correlations between total stigma, and its subscales (enacted and internalized), with all distress symptoms (from r=0.387 to 0.505; p<0.001). Regression analysis revealed that both enacted and internalized stigma could predict depression (R2=0.249), anxiety (R2=0.178) and stress (R2=0.24) significantly (p<0.001). Discussion: The study demonstrated that a significant proportion of Iranian women with breast cancer have suffered from psychological distress. Despite low to moderate stigma level in Iranian breast cancer patients comparing some studies, but our study showed that stigma is a remarkable predictor of psychological distress Iranian breast cancer patients. Cultural interventions is needed to more reduce stigma and its psychological consequences.