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24-10-2022 | ORIGINAL PAPER

Effects of Perceived Stigma on Depressive Symptoms and Demoralization in Maintenance Hemodialysis Patients: Self-warmth and Self-coldness as Mediators

Auteurs: Mengxin Lu, Yaoyao Yang, Guangmei Wang, Hui Wang, Danjun Feng

Gepubliceerd in: Mindfulness | Uitgave 12/2022

Abstract

Objectives

Patients with maintenance hemodialysis (MHD) experience stigma due to their dependence on machines and changes in appearance, which contributes to negative psychological outcomes. This study investigated the effect of perceived stigma on depressive symptoms and demoralization in MHD patients and explored the mediating roles of self-warmth and self-coldness.

Methods

This study included 301 MHD patients in a cross-sectional design. The participants completed self-reported measures of perceived stigma, self-warmth, self-coldness, depressive symptoms, and demoralization. Structural equation modeling was used to test the relationships among the main variables.

Results

The results suggested that perceived stigma was directly and positively correlated with depressive symptoms and demoralization. Both relationships were mediated by self-warmth and self-coldness. Additionally, the mediating effect of self-coldness was significantly greater than self-warmth in both the depressive symptoms and demoralization models.

Conclusions

Perceived stigma was a risk factor for depressive symptoms and demoralization in MHD patients. Self-coldness played a more important mediating role than self-warmth in the relationship between perceived stigma and two negative psychological outcomes.

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Adie, T., Steindl, S. R., Kirby, J. N., Kane, R. T., & Mazzucchelli, T. G. (2021). The relationship between self-compassion and depressive symptoms: Avoidance and activation as mediators. Mindfulness, 12(7), 1748–1756. https://doi.org/10.1007/s12671-021-01637-1CrossRef

Allen, A. B., & Leary, M. R. (2010). Self-compassion, stress, and coping. Social and Personality Psychology Compass, 4(2), 107–118. https://doi.org/10.1111/j.1751-9004.2009.00246.xCrossRef

Andersen, M. M., Varga, S., & Folker, A. P. (2022). On the definition of stigma. Journal of Evaluation in Clinical Practice, 28(5), 847–853. https://doi.org/10.1111/jep.13684CrossRef

Bewernick, B. H., Hurlemann, R., Matusch, A., Kayser, S., Grubert, C., Hadrysiewicz, B., Axmacher, N., Lemke, M., Cooper-mahkorn, D., Cohen, M. X., Brockmann, H., Lenartz, D., Sturm, V., & Schlaepfer, T. E. (2010). Nucleus ccumbens deep brain stimulation decreases ratings of depression and anxiety in treatment-resistant depression. Biological Psychiatry, 67(2), 110–116. https://doi.org/10.1016/j.biopsych.2009.09.013CrossRef

Bian, C., He, X., Qian, J., Wu, W., & Li, C. (2009). The reliability and validity of a modified patient health questionnaire for screening depressive syndrome in general hospital outpatients. Journal of Tongji University (Medical Science), 30(5), 136–140.

Booth, N. R., McDermott, R. C., Cheng, H. L., & Borgogna, N. C. (2019). Masculine gender role stress and self-stigma of seeking help: The moderating roles of self-compassion and self-coldness. Journal of Counseling Psychology, 66(6), 755–762. https://doi.org/10.1037/cou0000350CrossRef

Bradburn, N. M., Rips, L. J., & Shevell, S. K. (1987). Answering autobiographical questions: The impact of memory and inference on surveys. Science, 236(4798), 157–161. https://doi.org/10.1126/science.3563494CrossRef

Brenner, R. E., Heath, P. J., Vogel, D. L., & Credé, M. (2017). Two is more valid than one: Examining the factor structure of the self-compassion scale (SCS). Journal of Counseling Psychology, 64(6), 696–707. https://doi.org/10.1037/cou0000211CrossRef

Brenner, R. E., Vogel, D. L., Lannin, D. G., Engel, K. E., Seidman, A. J., & Heath, P. J. (2018). Do self-compassion and self-coldness distinctly relate to distress and well-being? A theoretical model of self-relating. Journal of Counseling Psychology, 65(3), 346–357. https://doi.org/10.1037/cou0000257CrossRef

Cadden, M. H., Arnett, P. A., Tyry, T. M., & Cook, J. E. (2018). Judgment hurts: The psychological consequences of experiencing stigma in multiple sclerosis. Social Science and Medicine, 208, 158–164. https://doi.org/10.1016/j.socscimed.2018.01.015CrossRef

Campos, C. G. P., Mantovani, M. D. F., Nascimento, M. E. B. D., & Cassi, C. C. (2015). Social representations of illness among people with chronic kidney disease. Revista Gaúcha De Enfermagem, 36(2), 106–112. https://doi.org/10.1590/1983-1447.2015.02.48183CrossRef

Casey, J. R., Hanson, C. S., Winkelmayer, W. C., Craig, J. C., Palmer, S., Strippoli, G. F. M., & Tong, A. (2014). Patients’ perspectives on hemodialysis vascular access: A systematic review of qualitative studies. American Journal of Kidney Diseases, 64(6), 937–953. https://doi.org/10.1053/j.ajkd.2014.06.024CrossRef

Cavelti, M., Kvrgic, S., Beck, E., Rüsch, N., & Vauth, R. (2012). Self-stigma and its relationship with insight, demoralization, and clinical outcome among people with schizophrenia spectrum disorders. Comprehensive Psychiatry, 53(5), 468–479. https://doi.org/10.1016/j.comppsych.2011.08.001CrossRef

Cavelti, M., Rusch, N., & Vauth, R. (2014). Is living with psychosis demoralizing? Insight, self-stigma, and clinical outcome among people with schizophrenia across 1 year. The Journal of Nervous and Mental Disease, 202(7), 521–529. https://doi.org/10.1097/NMD.0000000000000160CrossRef

Chen, J., Yan, L., & Zhou, L. (2011). Reliability and validity of Chinese version of Self-compassion Scale. Chinese Journal of Clinical Psychology, 19(6), 734–736. https://doi.org/10.16128/j.cnki.1005-3611.2011.06.006CrossRef

Chio, F. H. N., Mak, W. W. S., & Yu, B. C. L. (2021). Meta-analytic review on the differential effects of self-compassion components on well-being and psychological distress: The moderating role of dialecticism on self-compassion. Clinical Psychology Review, 85, 101986. https://doi.org/10.1016/j.cpr.2021.101986CrossRef

Cirillo, L., Cutruzzulà, R., Somma, C., Gregori, M., Cestone, G., Pizzarelli, C., Toccafondi, A., Pizzarelli, F., & Dattolo, P. C. (2018). Depressive symptoms in dialysis: Prevalence and relationship with uremia-related biochemical parameters. Blood Purification, 46(4), 286–291. https://doi.org/10.1159/000491014CrossRef

Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Routledge.

Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 1(1), 16–20.

Costa, J., Marôco, J., Pinto-Gouveia, J., Ferreira, C., & Castilho, P. (2016). Validation of the psychometric properties of the self-compassion scale. Testing the factorial validity and factorial invariance of the measure among borderline personality disorder, anxiety disorder, eating disorder and general populations. Clinical Psychology and Psychotherapy, 23(5), 460–468. https://doi.org/10.1002/cpp.1974CrossRef

Costanza, A., Baertschi, M., Richard-Lepouriel, H., Weber, K., Berardelli, I., Pompili, M., & Canuto, A. (2020). Demoralization and its relationship with depression and hopelessness in suicidal patients attending an emergency department. International Journal of Environmental Research and Public Health, 17(7), 2232. https://doi.org/10.3390/ijerph17072232CrossRef

Dschaak, Z. A., Spiker, D. A., Berney, E. C., Miller, M. E., & Hammer, J. H. (2021). Collegian help seeking: The role of self-compassion and self-coldness. Journal of Mental Health, 30(3), 284–291. https://doi.org/10.1080/09638237.2019.1677873CrossRef

Eriksson, T., Germundsjö, L., Åström, E., & Rönnlund, M. (2018). Mindful self-compassion training reduces stress and burnout symptoms among practicing psychologists: A randomized controlled trial of a brief web-based intervention. Frontiers in Psychology, 9, 2340. https://doi.org/10.3389/fpsyg.2018.02340CrossRef

Esser, P., Mehnert, A., Johansen, C., Hornemann, B., Dietz, A., & Ernst, J. (2018). Body image mediates the effect of cancer-related stigmatization on depression: A new target for intervention. Psycho-Oncology, 27(1), 193–198. https://doi.org/10.1002/pon.4494CrossRef

Ferreira, C., Moura-Ramos, M., Matos, M., & Galhardo, A. (2022). A new measure to assess external and internal shame: Development, factor structure and psychometric properties of the external and internal shame scale. Current Psychology, 41(4), 1892–1901. https://doi.org/10.1007/s12144-020-00709-0CrossRef

Fife, B. L., & Wright, E. R. (2000). The dimensionality of stigma: A comparison of its impact on the self of persons with HIV/AIDS and cancer. Journal of Health and Social Behavior, 41(1), 50–67. https://doi.org/10.2307/2676360CrossRef

Forbes, Y., & Donovan, C. (2019). The role of internalized weight stigma and self-compassion in the psychological well-being of overweight and obese women. Australian Psychologist, 54(6), 471–482. https://doi.org/10.1111/ap.12407CrossRef

Forbes, J. M., & Kaserman, D. L. (2000). Suicide as an indicator of quality of life: Evidence from dialysis patients. Contemporary Economic Policy, 18(4), 440–448. https://doi.org/10.1111/j.1465-7287.2000.tb00040.xCrossRef

Fredrick, E. G., LaDuke, S. L., & Williams, S. L. (2020). Sexual minority quality of life: The indirect effect of public stigma through self-compassion, authenticity, and internalized stigma. Stigma and Health, 5(1), 79–82. https://doi.org/10.1037/sah0000176CrossRef

Fung, J., Chen, G., Kim, J., & Lo, T. (2021). The relations between self-compassion, self-coldness, and psychological functioning among north American and Hong Kong college students. Mindfulness, 12(9), 2161–2172. https://doi.org/10.1007/s12671-021-01670-0CrossRef

Gamwell, K. L., Baudino, M. N., Bakula, D. M., Sharkey, C. M., Roberts, C. M., Grunow, J. E., Jacobs, N. J., Gillaspy, S. R., Mullins, L. L., & Chaney, J. M. (2018). Perceived illness stigma, thwarted belongingness, and depressive symptoms in youth with inflammatory bowel disease (IBD). Inflammatory Bowel Diseases, 24(5), 960–965. https://doi.org/10.1093/ibd/izy011CrossRef

Ghimire, M., Vaidya, S., & Upadhyay, H. P. (2021). Prevalence of newly diagnosed end-stage renal disease patients in a tertiary hospital of central Nepal, Chitwan: A descriptive cross-sectional study. Journal of the Nepal Medical Association, 59(233), 61–64. https://doi.org/10.31729/jnma.4971CrossRef

Gu, M., Jin, D., Zhong, Y., Zhang, H., Tong, F., Wu, J., Chen, Y., & Zhao, Y. (2022). Positive coping style reduction in elderly end-stage renal disease patients: Mediating role of white matter mean diffusivity. Neuroradiology, 64(4), 817–824. https://doi.org/10.1007/s00234-022-02904-1CrossRef

Guan, X., Sun, T., Yang, H., Liu, J., & Wang, K. (2011). Reliability and validity of Chinese version Social Impact Scale applied in study of stigma in urinary incontinent women. Journal of Nursing Science, 26(7), 63–65.

Guarneri, J. A., Oberleitner, D. E., & Connolly, S. (2019). Perceived stigma and self-stigma in college students: A literature review and implications for practice and research. Basic and Applied Social Psychology, 41(1), 48–62. https://doi.org/10.1080/01973533.2018.1550723CrossRef

Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813–821. https://doi.org/10.2105/AJPH.2012.301069CrossRef

Hilbert, A., Braehler, E., Schmidt, R., Lowe, B., Hauser, W., & Zenger, M. (2015). Self-compassion as a resource in the self-stigma process of overweight and obese individuals. Obesity Facts, 8(5), 293–301. https://doi.org/10.1159/000438681CrossRef

Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. https://doi.org/10.1080/10705519909540118CrossRef

Ignatius, J., & De La Garza, R. (2019). Frequency of demoralization and depression in cancer patients. General Hospital Psychiatry, 60, 137–140. https://doi.org/10.1016/j.genhosppsych.2019.04.013CrossRef

Ivins-Lukse, M., & Lee, E.-J. (2021). Self-compassion mediates stigma for parents of transition-age youth with intellectual and developmental disabilities. Rehabilitation Psychology, 66(3), 265–272. https://doi.org/10.1037/rep0000382CrossRef

Kerklaan, J., Hannan, E., Hanson, C., Guha, C., Cho, Y., Christian, M., Hamiwka, L., Ryan, J., Sinha, A., Wong, G., Craig, J., Groothoff, J., & Tong, A. (2020). Perspectives on life participation by young adults with chronic kidney disease: An interview study. British Medical Journal Open, 10(10), 1–12. https://doi.org/10.1136/bmjopen-2020-037840CrossRef

Kissane, D. W., Wein, S., Love, A., Lee, X. Q., Kee, P. L., & Clarke, D. M. (2004). The demoralization scale: A report of its development and preliminary validation. Journal of Palliative Care, 20(4), 269–276. https://doi.org/10.1177/082585970402000402CrossRef

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9 validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRef

Link, B. G., Cullen, F. T., Struening, E., Shrout, P. E., & Dohrenwend, B. P. (1989). A modified labeling theory approach to mental disorders: An empirical assessment. American Sociological Review, 54(3), 400. https://doi.org/10.2307/2095613CrossRef

Liu, A., Wang, W., & Wu, X. (2021). The mediating role of rumination in the relation between self-compassion, posttraumatic stress disorder, and posttraumatic growth among adolescents after the Jiuzhaigou earthquake. Current Psychology. https://doi.org/10.1007/s12144-021-01643-5 Advance online publication.CrossRef

Liu, P. (2018). A correlation study of demoralization syndrome with social support and coping style in primary hepatic cancer patients. Master's thesis, Yanan University.

López, A., Sanderman, R., Smink, A., Zhang, Y., & Sonderen, E. V. (2015). A reconsideration of the self-compassion scale’s total score: Self-compassion versus self-criticism. PLoS ONE, 10(7), e0132940. https://doi.org/10.1371/journal.pone.0132940CrossRef

López, A., Sanderman, R., & Schroevers, M. J. (2018). A close examination of the relationship between self-compassion and depressive symptoms. Mindfulness, 9(5), 1470–1478. https://doi.org/10.1007/s12671-018-0891-6CrossRef

Mackinnon, D. P., Lockwood, C. M., Hoffman, J. M., & West, S. G. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7(1), 83–104. https://doi.org/10.1037/1082-989x.7.1.83CrossRef

MacKinnon, D. P., & Fairchild, A. J. (2009). Current directions in mediation analysis. Current Directions in Psychological Science, 18(1), 16–20. https://doi.org/10.1111/j.1467-8721.2009.01598.xCrossRef

Mak, W. W. S., Chio, F. H. N., Chong, K. S. C., & Law, R. W. (2021). From mindfulness to personal recovery: The mediating roles of self-warmth, psychological flexibility, and valued living. Mindfulness, 12(4), 994–1001. https://doi.org/10.1007/s12671-020-01568-3CrossRef

Mangelli, L., Fava, G. A., Grandi, S., Grassi, L., Ottolini, F., Porcelli, P., Rafanelli, C., Rigatelli, M., & Sonino, N. (2005). Assessing demoralization and depression in the setting of medical disease. Journal of Clinical Psychiatry, 66(3), 391–394. https://doi.org/10.4088/JCP.v66n0317CrossRef

Muris, P., & Petrocchi, N. (2017). Protection or vulnerability? A meta-analysis of the relations between the positive and negative components of self-compassion and psychopathology. Clinical Psychology and Psychotherapy, 24(2), 373–383. https://doi.org/10.1002/cpp.2005CrossRef

Neff, K. (2003a). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85–101. https://doi.org/10.1080/15298860309032CrossRef

Neff, K. (2003b). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223–250. https://doi.org/10.1080/15298860390209035CrossRef

Nunnally, J. C. (1967). Psychometric theory. McGraw-Hill.

Orientation, L., Scale, B. H., Questionnaire, A. S., & Pleasure, S. (1999). Depression and demoralization among Russian-Jewish immigrants in primary care. Psychosomatics, 40(2), 117–125. https://doi.org/10.1016/S0033-3182(99)71257-0CrossRef

Pattyn, E., Verhaeghe, M., Sercu, C., & Bracke, P. (2014). Public stigma and self-stigma: Differential association with attitudes toward formal and informal help seeking. Psychiatric Services, 65(2), 232–238. https://doi.org/10.1176/appi.ps.201200561CrossRef

Podsakoff, P. M., MacKenzie, S. B., Lee, J. Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879–903. https://doi.org/10.1037/0021-9010.88.5.879CrossRef

Reyes, D. (2012). Self-compassion: A concept analysis. Journal of Holistic Nursing, 30(2), 81–89. https://doi.org/10.1177/0898010111423421CrossRef

Russo, S. J., & Nestler, E. J. (2013). The brain reward circuitry in mood disorders Nature Reviews Neuroscience, 14(9), 609–625. https://doi.org/10.1038/nrn3381CrossRef

Rzeszut, M., & Assael, R. (2021). Differentiating depression from demoralization in organ transplantation recipients. Progress in Transplantation, 31(1), 88–90. https://doi.org/10.1177/1526924820978602CrossRef

Sadeghpour, F., Heidarzadeh, M., Kohi, F., Asadi, R., Aghamohammadi-Kalkhoran, M., & Abbasi, F. (2020). The relationship between “self-care ability” and psychological changes among hemodialysis patients. Indian Journal of Palliative Care, 26(3), 276–280. https://doi.org/10.4103/IJPC.IJPC_129_19CrossRef

Strada, E. A. (2009). Grief, demoralization, and depression: Diagnostic challenges and treatment modalities. Primary Psychiatry, 16(5), 49–55.

Stynes, G., Leão, C. S., & McHugh, L. (2022). Exploring the effectiveness of mindfulness-based and third wave interventions in addressing self-stigma, shame and their impacts on psychosocial functioning: A systematic review. Journal of Contextual Behavioral Science, 23, 174–189. https://doi.org/10.1016/j.jcbs.2022.01.006CrossRef

Sy, J., McCulloch, C. E., & Johansen, K. L. (2019). Depressive symptoms, frailty, and mortality among dialysis patients. Hemodialysis International, 23(2), 239–246. https://doi.org/10.1111/hdi.12747CrossRef

Tang, P. L., Wang, H. H., & Chou, F. H. (2015). A systematic review and meta-analysis of demoralization and depression in patients with cancer. Psychosomatics, 56(6), 634–643. https://doi.org/10.1016/j.psym.2015.06.005CrossRef

Thomas, Z., Novak, M., Platas, S. G. T., Gautier, M., Holgin, A. P., Fox, R., Segal, M., Looper, K. J., Lipman, M., Selchen, S., Mucsi, I., Herrmann, N., & Rej, S. (2017). Brief mindfulness meditation for depression and anxiety symptoms in patients undergoing hemodialysis a pilot feasibility study. Clinical Journal of the American Society of Nephrology, 12(12), 2008–2015. https://doi.org/10.2215/CJN.03900417CrossRef

Van der Gucht, K., Takano, K., Raes, F., & Kuppens, P. (2018). Processes of change in a school-based mindfulness programme: Cognitive reactivity and self-coldness as mediators. Cognition & Emotion, 32(3), 658–665. https://doi.org/10.1080/02699931.2017.1310716CrossRef

Walker, R. C., Walker, S., Morton, R. L., Tong, A., Howard, K., & Palmer, S. C. (2017). Māori patients’ experiences and perspectives of chronic kidney disease: A New Zealand qualitative interview study. British Medical Journal Open, 7(1), e013829. https://doi.org/10.1136/bmjopen-2016-013829CrossRef

Watson-Singleton, N. N., Womack, V. Y., Holder-Dixon, A. R., & Black, A. R. (2021). Racism’s (un)worthiness trap: The mediating roles of self-compassion and self-coldness in the link between racism and distress in African Americans. Cultural Diversity & Ethnic Minority Psychology, 28(4), 557–566. https://doi.org/10.1037/cdp0000398CrossRef

Wong, C. C. Y., Mak, W. W. S., & Liao, K. Y. H. (2016). Self-compassion: A potential buffer against affiliate stigma experienced by parents of children with autism spectrum disorders. Mindfulness, 7(6), 1385–1395. https://doi.org/10.1007/s12671-016-0580-2CrossRef

Yang, Y., Lu, M., Wang, G., Wang, H., & Feng, D. (2022). The effect of attachment style on posttraumatic growth in maintenance hemodialysis patients: The mediating roles of self-warmth and self-coldness. Mindfulness, 13(3), 637–646. https://doi.org/10.1007/s12671-021-01819-xCrossRef

Yip, S. Y., Mak, W. W., Chio, F. H., & Law, R. W. (2017). The mediating role of self-compassion between mindfulness and compassion fatigue among therapists in Hong Kong. Mindfulness, 8(2), 460–470. https://doi.org/10.1007/s12671-016-0618-5CrossRef

Yue, X., Xu, T., Wang, Y., & Si, F. (2021). Development of hemodialysis patients’ participation in dialysis safety assessment indicator system. Journal of Nurses Training, 36(12), 1098–1101.

Zheng, W. (2020). Study on the status and influencing factors of stigma in patients with two different methods of renal replacement therapy. Master's thesis, Nanjing University.

Zhu, L., Wang, J., Liu, S., Xie, H., Hu, Y., Yao, J., Ranchor, A. V., Schroevers, M. J., & Fleer, J. (2020). Self-compassion and symptoms of depression and anxiety in Chinese cancer patients: The mediating role of illness perceptions. Mindfulness, 11(10), 2386–2396. https://doi.org/10.1007/s12671-020-01455-xCrossRef

Titel: Effects of Perceived Stigma on Depressive Symptoms and Demoralization in Maintenance Hemodialysis Patients: Self-warmth and Self-coldness as Mediators
Auteurs: Mengxin Lu
Yaoyao Yang
Guangmei Wang
Hui Wang
Danjun Feng
Publicatiedatum: 24-10-2022
Uitgeverij: Springer US
Gepubliceerd in: Mindfulness / Uitgave 12/2022
Print ISSN: 1868-8527
Elektronisch ISSN: 1868-8535
DOI: https://doi.org/10.1007/s12671-022-02011-5

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Abstract

Objectives

Methods

Results

Conclusions

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