title: Consequences of perceived stigma among patients with cirrhosis.
abstract: BACKGROUND
  Among patients with diseases such as HIV, cancer and mental illness, perceived stigma is common and is linked to quality of life (QOL), depression and healthcare-seeking behavior.
  
  
  OBJECTIVE
  We aimed to determine the prevalence and consequences of stigma in patients with cirrhosis.
  
  
  METHODS
  A survey was developed and mailed to 300 patients with cirrhosis from a variety of etiologies. Among the 149 respondents, stigma was measured using a composite of previously validated scales. Correlates of stigma were measured using an a priori theoretical construct in order to investigate hypothesized consequences such as impaired social support, depression and reduction in healthcare-seeking behavior.
  
  
  RESULTS
  Eighty-nine percent of respondents chose "agree" or "strongly agree" for at least one of the 18 stigma-related questions, indicating they felt stigmatized in at least one aspect of their lives. Patient factors associated with more perceived stigma on multivariable linear regression included younger age (p = 0.008), and hepatitis C (p = 0.001) or alcohol (p = 0.01) as the etiology of liver disease. Patients with higher levels of perceived stigma had less social support (r (2) = 0.898, p < 0.001), were less likely to seek medical care (r (2) = 0.108, p < 0.001), suffered from more depression (r (2) = 0.17 p < 0.001) and had worse QOL (r (2) = 0.175, p < 0.001).
  
  
  CONCLUSIONS
  Perceived stigma is common among patients with cirrhosis, and is associated with adverse attitudes and behaviors such as decreased healthcare-seeking behavior. Healthcare providers need to be aware of these perceptions and their potential impact on patients' interaction with the medical system.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Vaughn-Sandler
authors.forename: Carey
authors.initials: C
authors.lastname: Sherman
authors.forename: Andrew
authors.initials: A
authors.lastname: Aronsohn
authors.forename: Michael L
authors.initials: ML
authors.lastname: Volk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008103:Liver Cirrhosis / Q000209:etiology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011788:Quality of Life; D057545:Social Stigma; D012944:Social Support; D055815:Young Adult