title: Signs of stigma and poor mental health among carriers of MRSA.
abstract: BACKGROUND
  Many countries have implemented guidelines to prevent transmission of meticillin-resistant Staphylococcus aureus (MRSA). Important contextual factors of stigma can be identified in the context of MRSA. Over the past decade, concerns have been raised over a possible stigmatizing effect of these actions.
  
  
  OBJECTIVE
  To identify and quantify the occurrence of MRSA-associated stigma, and to explore its association with mental health in a country with an MRSA 'search and destroy' policy.
  
  
  METHODS
  In 2014, a questionnaire study among 57 Dutch MRSA carriers (people that carry MRSA without signs of MRSA infection) was performed. Stigma was measured with an adjusted version of the Berger HIV Stigma Scale. Mental health was measured with the five-item RAND Mental Health Inquiry.
  
  
  RESULTS
  Thirty-two (56%) MRSA carriers reported stigma; of these, eight (14%) reported 'clear stigma' (Berger score >110) and 24 (42%) reported 'suggestive for stigma' (Berger score 76-110). Educational level, female sex and intensive MRSA eradication therapy were associated with higher stigma scores. Poor mental health (RAND score <60) was reported by 33% of MRSA carriers. Stigma and mental health scores were inversely correlated. Stigma was experienced most frequently in healthcare settings, and was seldom experienced in the religious community or at sport facilities.
  
  
  CONCLUSIONS
  A substantial proportion of MRSA carriers reported stigma due to MRSA, and stigma was associated with poor mental health. Anticipation of MRSA-associated stigma is warranted, both in the way that care is delivered by hospital staff and in the way that care is organized within the hospital.
authors: Department of Infectious Disease Control, Regional Health Service Utrecht Region, Zeist, The Netherlands; Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands; Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: babette.rump@rivm.nl.
authors: B
authors: B
authors: Rump
authors: Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
authors: M
authors: M
authors: De Boer
authors: Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands; Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands; University of Cape Town, Cape Town, South Africa.
authors: R
authors: R
authors: Reis
authors: Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: M
authors: M
authors: Wassenberg
authors: Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands; Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
authors: J
authors: J
authors: Van Steenbergen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000382:microbiology* / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D009426:Netherlands; D057545:Social Stigma; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Isolation; MRSA; Mental health; Quarantine; Stigma