Body image mediates the effect of cancer-related stigmatization on depression: a new target for intervention

Abstract

Objective

Since cancer-related stigmatization is prevalent but difficult to change, research on its impact on psychological burden and intervening variables is needed. Therefore, we investigated the effect of stigmatization on depressive symptomatology and whether body image mediates this relationship.

Methods

This bi-centric study assessed patients of four major tumor entities. We measured stigmatization (SIS-D), depressive symptomatology (PHQ-9) and body image (FKB-20). Applying multiple mediator analyses, we calculated the total effect of stigmatization on depressive symptomatology and the indirect effects exerted via the two body image scales rejecting body evaluation and vital body dynamics.

Results

Among the 858 cancer patients recruited (breast: n=297; prostate: n=268; colorectal: n=168; lung: n=125), stigmatization showed total effects on depressive symptomatology across all stigma dimensions (all p_{total sample}<.001). Except for lung cancer patients, this result was replicated for each cancer group. Body image was shown to mediate the effect across all samples (γ_{total sample} = .04, 95 %- CI: 0.03 – 0.06). Among the total sample and prostate cancer patients, the mediating effect of rejecting body evaluation was significantly larger than the effect of vital body dynamics (d_{total sample} = .02, 95 %-CI: 0.01 – 0.04).

Conclusions

Perceived stigmatization is an important and generalizable risk factor for depressive symptomatology among cancer patients. Apart from interventions addressing stigmatization, improving body image could additionally help to reduce the psychological burden in stigmatized patients.

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