Psychological distress and quality of life in lung cancer: the role of health-related stigma, illness appraisals and social constraints.
OBJECTIVE
Health-related stigma is associated with negative psychological and quality of life outcomes in lung cancer patients. This study describes the impact of stigma on lung cancer patients' psychological distress and quality of life and explores the role of social constraints and illness appraisal as mediators of effect.


METHODS
A self-administered cross-sectional survey examined psychological distress and quality of life in 151 people (59% response rate) diagnosed with lung cancer from Queensland and New South Wales. Health-related stigma, social constraints and illness appraisals were assessed as predictors of adjustment outcomes.


RESULTS
Forty-nine percent of patients reported elevated anxiety; 41% were depressed; and 51% had high global distress. Health-related stigma was significantly related to global psychological distress and quality of life with greater stigma and shame related to poorer outcomes. These effects were mediated by illness appraisals and social constraints.


CONCLUSIONS
Health-related stigma appears to contribute to poorer adjustment by constraining interpersonal discussions about cancer and heightening feelings of threat. There is a need for the development and evaluation of interventions to ameliorate the negative effects of health-related stigma among lung cancer patients.
Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia.|Cancer Council Queensland, Brisbane, Australia.|Health and Wellness Institute, Edith Cowan University, Perth, Australia.|Centre for Clinical Research, University of Queensland, Brisbane, Australia.
Suzanne K
SK
Chambers
Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia.|Cancer Council Queensland, Brisbane, Australia.|School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
Peter
P
Baade
Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia.|Cancer Council Queensland, Brisbane, Australia.|School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
Philippa
P
Youl
Cancer Council Queensland, Brisbane, Australia.
Joanne
J
Aitken
Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia.
Stefano
S
Occhipinti
Liverpool Cancer Therapy Centre, Sydney, Australia.|Macarthur Cancer Therapy Centre, Sydney, Australia.|University of NSW, Sydney, Australia.|University of Western Sydney, Sydney, Australia.
Shalini
S
Vinod
Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Patricia C
PC
Valery
Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Gail
G
Garvey
Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia.|Thoracic Research Centre, University of Queensland, Brisbane, Australia.
Kwun M
KM
Fong
Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia.|The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
David
D
Ball
Cancer Australia, Sydney, Australia.
Helen
H
Zorbas
Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia.|Cancer Council Queensland, Brisbane, Australia.|School of Social Science, University of Queensland, Brisbane, Australia.
Jeff
J
Dunn
Cancer Council New South Wales, Sydney, Australia.|School of Population Health and Community Medicine, University of NSW, Sydney, Australia.|School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.|Sydney Medical School - Public Health, University of Sydney, Sydney, Australia.
Dianne L
DL
O'Connell
D000223:Adaptation, Psychological; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011788:Quality of Life / Q000523:psychology*; D011793:Queensland / Q000453:epidemiology; D012752:Shame; D057545:Social Stigma; D013315:Stress, Psychological / Q000453:epidemiology*