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Table 7 Results of quantitative studies examining effects of stigma-related negative evaluations on psychosocial outcomes

From: A systematic review of the impact of stigma and nihilism on lung cancer outcomes

Study

Participants

Study Factor(s)

Outcome

Main findings

LoConte 2008: Else-Quest 2009, USA

Stage IV NSCLC

  

Association between stigma or self blame and outcomes

Perceived stigma

(1 item)

Self esteem (RSES)

NS**

Direct effect

p< 0.01# Negative association

Indirect effects via self-blame (SSGS)

 

Anxiety (State-Trait Anxiety Inventory)

p< 0.01**Positive association

Direct effect

p< 0.05# Positive association

Indirect effects via self-blame (SSGS)

 

Anger (State-Trait Anger Inventory)

p< 0.01** Positive association

Direct effect

p< 0.01# Positive association

Indirect effects via self-blame (SSGS)

 

Depression (shortened CES-D)

p< 0.01** Positive association

Direct effect

p< 0.01# Positive association

Indirect effects via self-blame (SSGS)

 

Self Blame (SSGS) adjusted for perceived stigma

Self esteem (RSES)

p< 0.01** Negative association

Anxiety (State-Trait Anxiety Inventory)

p< 0.01** Positive association

Anger (State-Trait Anger Inventory)

p< 0.01** Positive association

Depression (shortened CES-D)

p< 0.01** Positive association

Cataldo 2011, USA

All types and stages of lung cancer

   

Lung cancer stigma scale (Cataldo scale - 43 items)

Depression (CES-D)

p< 0.01* Positive association

Quality of life (Quality of Life Inventory)

p< 0.01* Negative association

Self esteem (RSES)

p< 0.01* Negative association

Social support (Social Support Indices)

 

Availability

p< 0.01* Negative association

Validation

p< 0.01* Negative association

Subjective social integration (Social Support Indices)

p< 0.01* Negative association

Social conflict (Social Support Indices)

p< 0.01* Positive association

Lung cancer stigma scale Stigma and shame subscale (19 items)

Depression (CES-D)

p< 0.01* Positive association

Quality of life (Quality of Life Inventory)

p< 0.01* Negative association

Self esteem (RSES)

p< 0.01* Negative association

Social support (Social Support Indices)

 

Availability

p< 0.01* Negative association

Validation

p< 0.01* Negative association

Subjective social integration (Social Support Indices)

p< 0.01* Negative association

Social conflict (Social Support Indices)

p< 0.01* Positive association

Devitt 2010, Victoria, Australia

42% Stage IV 74% NSCLC

Shame about lung cancer

Participation in a support group

10% of patients reported shame as a potential barrier

29% of support group facilitators thought patients’ shame was a potential barrier

Lobchuk 2008b, Canada

Primary caregivers of lung cancer patients

  

Correlation between caregiver blame and caregiver assistance

58% advanced disease

Primary caregiver blame re patient’s efforts to control the disease (single item)

Primary caregiver assistance in coping with lung cancer and its symptoms (single item)

r = 0.044, p = 0.66

76% NSCLC

 

Siminoff 2010, USA, Ohio

Stage III or IV NSCLC

Family blames cancer on the patient

 

Regression coefficient for blame and depression

Patient agrees

Patient Depression (CES-D)

 

Familial cohesion

 

p< 0.051 Positive association

Familial expressiveness

p< 0.052 Positive association

Familial conflict

p< 0.053 Positive association

Caregiver agrees

Patient Depression (CES-D)

 

Familial cohesion

p< 0.051 Positive association

Familial expressiveness

p< 0.052 Positive association

Familial conflict

p< 0.053 Positive association

  1. ECOG = Eastern Co-operative Oncology Group; NSCLC = Non small cell lung cancer; SCLC = Small cell lung cancer; SSGS = State Shame and Guilt Scale; CES-D = Center for Epidemiological Studies Depression Scale; NA = Not applicable; NS = Not statistically significantly different; RSES = Rosenberg’s Self-Esteem Scale; r = correlation coefficient; * Two-sided test; ** Multiple regression analyses; # bootstrapping; 1 Multi-level model including age, gender, physical health, relationship of caregiver to patient, familial cohesion; 2 Multi-level model including age, gender, physical health, relationship of caregiver to patient, familial expressiveness; 3 Multi-level model including age, gender, physical health, relationship of caregiver to patient, familial.