Evaluating the implications of stigma-induced identity threat for health and health care.

Abstract

Introduction: Individuals with a stigmatized social identity may experience identity threat in the form of discrimination, prejudice, stereotype threat or internalized prejudice. Identity threat is a stressor that can contribute to physiological and psychological outcomes. In a health care setting, increased vigilance for identity threat can affect communication and impede individuals' ability to attain high-quality health care. Methods: This dissertation consists of three manuscripts that examine the implications of stigma and identity threat in the health care domain for three sets of stakeholders: patients, caregivers, and providers. The first manuscript assesses whether perceived discrimination as well as other facets of expected stigma are associated with mental and social health outcomes in a sample of 70 individuals who provide care for veterans with a traumatic brain injury. The second manuscript uses a sample of 1109 men who have been diagnosed with colorectal cancer to assess whether stigma related to cancer and self-blame or the perception that others blame them for the disease are associated with depressive symptoms. The third manuscript explores the theoretical underpinnings of identity threat as it relates to the medical encounter, provides several examples of how identity threat may affect the quality and substance of a medical encounter, and suggests evidence-based strategies to ameliorate the effects of the threat. Results: In manuscript 1, perceived discrimination and other facets of stigma were associated with strain, depressive symptoms, anxiety symptoms, and social isolation in multivariable models. In manuscript 2, cancer stigma and self-blame for acquiring cancer were associated with greater depressive symptoms, after adjustment for several known clinical and non-clinical stressors. In manuscript 3, several evidence-based strategies are presented which providers may use to communicate to clients and patients that identity threats are non-normative and individuals with stigmatized identities are safe and welcome. Conclusions: Having a stigmatized social identity and experiencing behavioral reactions to that identity has potentially numerous negative health and health behavior consequences for patients and caregivers. Health care systems and providers can create clinical environments that communicate safety for all social identities, and may improve care outcomes for several marginalized and stigmatized social groups.