title: Determinants of stigma in a cohort of hellenic patients suffering from multiple sclerosis: a cross-sectional study.
abstract: BACKGROUND
  Patients suffering from several neurologic disorders may bear the "stigma" of their disease, being disqualified from full social acceptance. Although stigma is considered to be present in Multiple Sclerosis (MS), the factors that influence its levels are ambiguous. Aim of our study was to examine, for the first time in the literature, the basic determinants of stigma in a Hellenic MS-patients cohort, as well as how stigma affects their Quality-of-Life (QoL) profiles.
  
  
  METHODS
  Three hundred forty two patients were recruited in this study. Data collected concerned sociodemographic and disease-related variables, mental illness assessment, Multiple-Sclerosis-QoL-54 (MSQoL-54) and Stigma-Scale-for-Chronic-Illness-24 (SSCI-24) questionnaires. Potential determinants were evaluated with univariate statistical analyses for their contribution to total, internalized (inner-self derived) and externalized (society derived) stigma. Important findings were further evaluated on hierarchical regression models.
  
  
  RESULTS
  Disability levels were found to be the most powerful predictor in all stigma categories, followed by the presence of mental illness. Working and caregiving status were also ascertained as determinants of internalized stigma. Stigma levels displayed strong negative correlation with all composites of MSQoL-54.
  
  
  CONCLUSIONS
  Stigma is present in the social environment of MS patients and was confirmed as a barrier (according to the International Classification of Functioning, Disability and Health), with detrimental effects on their QoL levels and functioning performances. Disability and mental illness were shown as the principal determinants of stigma, while financial characteristics were not as equally involved. Further validation of these results in other MS populations may provide safer conclusions, towards more efficacious patient-centered care outcomes.
authors.affiliation: 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece. managnost@med.uoa.gr.
authors.forename: Maria
authors.initials: M
authors.lastname: Anagnostouli
authors.affiliation: 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece.
authors.forename: Serafeim
authors.initials: S
authors.lastname: Katsavos
authors.affiliation: 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece.
authors.forename: Artemios
authors.initials: A
authors.lastname: Artemiadis
authors.affiliation: 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece.
authors.forename: Markos
authors.initials: M
authors.lastname: Zacharis
authors.affiliation: 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Argyrou
authors.affiliation: 1st Department of Psychiatry, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece.
authors.forename: Ilia
authors.initials: I
authors.lastname: Theotoka
authors.affiliation: 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece.
authors.forename: Fotini
authors.initials: F
authors.lastname: Christidi
authors.affiliation: 1st Department of Neurology, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Zalonis
authors.affiliation: 1st Department of Psychiatry, Medical School of National and Kapodistrian University of Athens, Aeginition Hospital, Vas.Sophias ave 72-74, Athens, 115-28, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Liappas
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D011788:Quality of Life; D057545:Social Stigma; D011795:Surveys and Questionnaires
keywords: Hellenic population; Multiple sclerosis; Quality of life; Socioeconomic parameters; Stigma; Stigma Scale for Chronic Illness (SSCI) Questionnaire