title: Life after cancer: how does public stigma increase psychological distress of childhood cancer survivors?
abstract: BACKGROUND
  Public stigma is a major source of stress for cancer survivors. However, factors that buffer or exacerbate the negative effects of public stigma on psychological distress have not been elucidated.
  
  
  OBJECTIVE
  This study examined how perceived public stigma affects psychological distress as mediated by cancer disclosure, internalized reactions to stigma, and social support availability.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  The study was conducted in South Korea.
  
  
  METHODS
  The study sample was 223 adolescent and young adult survivors of childhood cancer diagnosed before the age of 19 and currently between 15 and 39 years old.
  
  
  METHODS
  Psychological distress was assessed using the Brief Symptom Inventory-18. Structural equation modeling was used with 1000 bootstrap samples.
  
  
  RESULTS
  The goodness of model fit was acceptable. Public stigma perceived by cancer survivors influenced psychological distress via cancer disclosure, internalized shame, and social support availability. Higher levels of perceived public stigma predicted higher levels of internalized shame and self-blame and lower levels of social support availability, which subsequently increased psychological distress. Higher levels of perceived public stigma predicted lower levels of disclosure about cancer history and experiences. Cancer disclosure indirectly ameliorated psychological distress by reducing internalized shame.
  
  
  CONCLUSIONS
  This study offers evidence that cognitive and social factors play important roles in mediating the effects of perceived public stigma on psychological distress in Korean cancer survivors. A greater understanding of factors that influence psychological distress may help psychosocial oncology service providers to identify childhood cancer survivors in need of psychosocial services and provide them with appropriate resources and interventions.
authors.affiliation: School of Social Welfare, Yonsei University, Seoul, Republic of Korea.
authors.forename: Min Ah
authors.initials: MA
authors.lastname: Kim
authors.affiliation: College of Social Work, University of Utah, Salt Lake City, USA. Electronic address: jaehee.yi@utah.edu.
authors.forename: Jaehee
authors.initials: J
authors.lastname: Yi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D006801:Humans; D009369:Neoplasms / Q000523:psychology*; D056910:Republic of Korea; D012944:Social Support; D013240:Stereotyping; D013315:Stress, Psychological; D017741:Survivors; D055815:Young Adult
keywords: Disclosure; Long-term survivors; Psychological stress; Social stigma; Social support