title: Psychological and behavioural patterns of stigma among patients with type 2 diabetes: a cross-sectional study.
abstract: The aim of this study was to test the psychological and behavioural patterns of stigma (self-esteem and social participation) and their relationship to self-stigma, patient activation for engaging in self-care and glycaemic control among patients with type 2 diabetes mellitus (T2DM).
  
  
  
  A cross-sectional study.
  
  
  
  2 tertiary-level hospitals and 2 secondary-level hospitals in Japan.
  
  
  
  A consecutive sample of 209 outpatients with T2DM. Inclusion criteria were as follows: presence of T2DM, age 20-74 years, no diagnosis of dementia and/or psychosis, and no need for urgent medical procedures.
  
  
  
  Study measures included a self-administered questionnaire to assess the Rosenberg Self-Esteem Scale (SES), the 3 subscales of 36-question Short Form Health Survey (SF-36; Social Function, Role Physical, Role Emotional), Self-Stigma Scale and Patient Activation Measure (PAM-13). Glycated haemoglobin was obtained from same day blood work. In our previous qualitative study, we found that psychological and behavioural patterns of stigma varied according to patients' levels of illness-related self-esteem as well as attitudes towards social participation. For quantitative consistency, we used the SES scale to measure self-esteem and the SF-36 subscales to measure social participation. We then divided participants into 4 groups by exhibited psychological and behavioural patterns: group A (high SES/high SF-36), group B (high SES/low SF-36), group C (low SES/high SF-36) and group D (low SES/low SF-36).
  
  
  
  Using analysis of covariance after controlling for age and sex, there was a significant difference in self-stigma levels between the four groups (F[3203]=15.70, p<0.001). We observed the highest mean self-stigma levels in group D. Group D also had significantly lower PAM-13 scores than those of groups A (p<0.001) and B (p=0.02).
  
  
  
  The psychological and behavioural pattern of group D was found to be associated with higher levels of self-stigma and poorer patient activation for self-care.
authors.affiliation: Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan.|The Health Care Science Institute, Tokyo, Japan.
authors.forename: Asuka
authors.initials: A
authors.lastname: Kato
authors.affiliation: Department of Internal Medicine, School of Medicine, Teikyo University, Tokyo, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Fujimaki
authors.affiliation: Department of Internal Medicine, School of Medicine, Teikyo University, Tokyo, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Fujimori
authors.affiliation: Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Isogawa
authors.affiliation: The Institute for Adult Diseases Asahi Life Foundation, Tokyo, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Onishi
authors.affiliation: Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Suzuki
authors.affiliation: Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Yamauchi
authors.affiliation: Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kohjiro
authors.initials: K
authors.lastname: Ueki
authors.affiliation: Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kadowaki
authors.affiliation: Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Hashimoto
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D007564:Japan; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012648:Self Care; D012649:Self Concept; D057545:Social Stigma; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin
keywords: Diabetes education; Psychosocial, behavioral medicine; Stigma