Stigma and Health-Related Adjustment in Lung Cancer Patients: A Longitudinal Analysis of Moderators and Mediators
- Author(s): Williamson, Timothy John
- Advisor(s): Stanton, Annette L
- et al.
Stigma and discrimination confer risk for poor mental and physical health for lung cancer patients, and research is needed to understand how and for whom stigma and discrimination are associated with poorer health-related adjustment. Although research has consistently demonstrated that the majority of lung cancer patients report experiences of stigma, longitudinal studies are needed to assess temporal relationships between lung cancer stigma and health-related adjustment. Additionally, no study has tested the unique contributions of lung cancer stigma and discrimination on psychological and physical health-related outcomes. Study 1 examined internalized lung cancer stigma (i.e., feelings of guilt, shame, and self-blame about one’s lung cancer diagnosis) and perceived subtle discrimination (i.e., perceptions of unfair treatment due to one’s lung cancer status that are ambiguous or low in intensity) as predictors of psychological and physical health outcomes across 12 weeks in 101 men and women on active treatment for lung cancer (any stage, any diagnosis duration). Based on theory and evidence, Study 2 tested whether sleep disturbance mediated relationships between lung cancer stigma and discrimination with poorer health-related adjustment in the same sample of lung cancer patients. Participants completed questionnaires at study entry and at 6- and 12-week follow-up.
Findings from Study 1 indicated that internalized stigma and perceived subtle discrimination were uniquely and significantly associated with worse global quality of life and poorer psychological outcomes at study entry. Internalized stigma also predicted significant declines in global quality of life and increases in depressive symptoms and anxiety across time. Overall, the pattern of findings indicated that higher internalized stigma was a robust and independent predictor of declines in health-related outcomes across 12 weeks, whereas perceived discrimination was not. Study 1 also tested whether protective psychological processes (i.e., self-compassion, coping strategies) attenuated significant relationships between stigma and discrimination with health outcomes. Higher self-compassion and lower avoidant coping significantly moderated relationships between stigma and discrimination and psychological health. Specifically, when self-compassion was relatively high and avoidant coping was relatively low, internalized stigma and discrimination were not associated significantly with poorer psychological health. When self-compassion was relatively low and avoidant coping was relatively high, however, higher internalized stigma and higher perceived discrimination were associated with higher depressive symptoms and cancer-related anxiety, respectively.
Results from Study 2 demonstrated that lung cancer patients evidenced prominent sleep disturbance, as measured through subjective and objective measures. Perceived subtle discrimination (but not internalized stigma) was associated significantly with higher subjective sleep disturbance at study entry and across time, and subjective sleep disturbance was robustly associated with poorer psychological and physical health. At study entry, higher subjective sleep disturbance significantly mediated the association between higher perceived subtle discrimination and higher depressive symptoms, worse global and cancer-specific quality of life, higher cancer-related anxiety, and more bothersome physical symptoms. Overall, the pattern of findings in Study 2 indicated that higher perceived discrimination was robustly associated with poor sleep, which may explain, in part, the significant relationships observed between higher perceived discrimination and poorer psychological and physical health-related outcomes in Study 1. Future research is recommended to develop health care provider- and patient-focused interventions to reduce lung cancer stigma and test whether such interventions promote health and well-being for this underserved and understudied population.