Background Skin disorders can cause mental health problems associated with stigmatization and social isolation. We found that 26% of individuals with chronic cutaneous lupus erythematosus (CCLE) reported moderate to severe depressive symptoms. While patients perceptions of disrespectful office staff increased the risk of depression, emotional support was associated with a reduction. In this study, we examined the relationships between stigma, social isolation, and depression. We further examined if social isolation mediates the relationship between stigma and depression and whether sociodemographic characteristics may moderate those relationships.
Methods We conducted a cross-sectional study in a predominantly African American cohort of patients with primary CCLE from metropolitan Atlanta, Georgia, U.S. Depression, stigma and social isolation were assessed using the NIH PROMIS short forms. Linear and multiple regression were used to examine the relationship between depression, stigma and social isolation. Education attainment, poverty and race were explored as potential moderators.
Results Among 118 patients with a documented diagnosis of primary CCLE, 104 (88%) were female, 96 (81%) were African American, 54 (46.2%) completed high school or less, 40 (40.8%) lived in poverty and 34 (28.8%) self-reported moderate to severe depressive symptoms. Stigma and social isolation T-scores were above the general population average (T-score=50) in 69 (58.5%) and 57 (48.3%) participants, respectively. Higher levels of both stigma and social isolation correlated with more severe depression (=0.527, p<0.0001 and=0.551, p<0.0001, respectively). Social isolation correlated with stigma (=0.945, p<0.0001) and the effect of stigma on depression was no longer significant (=−0.018, p=0.88) after we examined the mediator effect of social isolation and controlled for sociodemographics (table 1, Model 1). Lower education ( high school vs some college or higher) significantly increased the strength of correlation between stigma and depression after controlling for sociodemographics (table 1, Model 2). Poverty and African American race also increased the strength of the relationship but were not significant.
Conclusions Nearly a third with CCLE reported moderate to severe depressive symptoms. Social stigma contributed to depression through feelings of social isolation, and those with lower education were more vulnerable to the impact of stigma on depression. Clinical and public health programs should help strengthen social connections in people with CCLE and reduce stigmatization in the community, particularly among those from socioeconomically disadvantaged groups.
Funding Source(s): Centers for Disease Control and Prevention (CDC) grant U01DP005119.
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