Psychological and behavioural patterns of stigma among patients with type 2 diabetes: a cross-sectional study

Objectives: The aim of this study was to test the psychological and behavioural patterns of stigma (selfesteem and social participation) and their relationship to self-stigma, patient activation for engaging in selfcare and glycaemic control among patients with type 2 diabetes mellitus (T2DM). Design: A cross-sectional study. Setting: 2 tertiary-level hospitals and 2 secondarylevel hospitals in Japan. Participants: 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. Outcome measures: 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 SF36). Results: 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 selfstigma 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). Conclusions: 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.