Body image mediates the effect of cancer-related stigmatization on depression: A new target for intervention

TY - JOUR

T1 - Body image mediates the effect of cancer-related stigmatization on depression

T2 - A new target for intervention

AU - Esser, Peter

AU - Mehnert, Anja

AU - Johansen, Christoffer

AU - Hornemann, Beate

AU - Dietz, Andreas

AU - Ernst, Jochen

N1 - Copyright © 2017 John Wiley & Sons, Ltd.

PY - 2018/1

Y1 - 2018/1

N2 - Objective: Because cancer-related stigmatization is prevalent but difficult to change, research on its impact on psychological burden and respective intervening variables is needed. Therefore, we investigated the effect of stigmatization on depressive symptomatology and whether body image mediates this relationship. Methods: This bicentric study assessed patients of 4 major tumor entities. We measured stigmatization (SIS-D), depressive symptomatology (PHQ-9), and body image (FKB-20). Applying multiple mediator analyses, we calculated the total effect of stigmatization on depressive symptomatology and the indirect effects exerted via the 2 body image scales rejecting body evaluation and vital body dynamics. Results: Among the 858 cancer patients recruited (breast: n = 297; prostate: n = 268; colorectal: n = 168; lung: n = 125), stigmatization showed total effects on depressive symptomatology across all stigma dimensions (all ptotal sample <.001). Except for lung cancer patients, this result was replicated for each cancer group. Body image as a whole was shown to mediate the effect across all samples (γtotal sample =.04, 95%-CI: 0.03-0.06). Among the total sample and prostate cancer patients, the mediating effect of rejecting body evaluation was significantly larger than the effect of vital body dynamics (dtotal sample =.02, 95%-CI: 0.01-0.04). Conclusions: Perceived stigmatization is an important and generalizable risk factor for depressive symptomatology among cancer patients. Apart from interventions addressing stigmatization, improving body image could additionally help to reduce the psychological burden in stigmatized patients.

AB - Objective: Because cancer-related stigmatization is prevalent but difficult to change, research on its impact on psychological burden and respective intervening variables is needed. Therefore, we investigated the effect of stigmatization on depressive symptomatology and whether body image mediates this relationship. Methods: This bicentric study assessed patients of 4 major tumor entities. We measured stigmatization (SIS-D), depressive symptomatology (PHQ-9), and body image (FKB-20). Applying multiple mediator analyses, we calculated the total effect of stigmatization on depressive symptomatology and the indirect effects exerted via the 2 body image scales rejecting body evaluation and vital body dynamics. Results: Among the 858 cancer patients recruited (breast: n = 297; prostate: n = 268; colorectal: n = 168; lung: n = 125), stigmatization showed total effects on depressive symptomatology across all stigma dimensions (all ptotal sample <.001). Except for lung cancer patients, this result was replicated for each cancer group. Body image as a whole was shown to mediate the effect across all samples (γtotal sample =.04, 95%-CI: 0.03-0.06). Among the total sample and prostate cancer patients, the mediating effect of rejecting body evaluation was significantly larger than the effect of vital body dynamics (dtotal sample =.02, 95%-CI: 0.01-0.04). Conclusions: Perceived stigmatization is an important and generalizable risk factor for depressive symptomatology among cancer patients. Apart from interventions addressing stigmatization, improving body image could additionally help to reduce the psychological burden in stigmatized patients.

KW - Adult

KW - Aged

KW - Body Image/psychology

KW - Breast Neoplasms/psychology

KW - Colorectal Neoplasms/psychology

KW - Depression/psychology

KW - Female

KW - Humans

KW - Lung Neoplasms/psychology

KW - Male

KW - Middle Aged

KW - Prostatic Neoplasms/psychology

KW - Risk Factors

KW - Social Stigma

KW - Stereotyping

U2 - 10.1002/pon.4494

DO - 10.1002/pon.4494

M3 - Journal article

C2 - 28685499

SN - 1057-9249

VL - 27

SP - 193

EP - 198

JO - Psycho-Oncology

JF - Psycho-Oncology

IS - 1

ER -