Health-Related Stigma in Adolescents with Functional Abdominal Pain: Instrument Development and Model Testing

Abstract

Stigma is a feature of many chronic health conditions, contributing to a “hidden burden of illness” that compounds the negative impact of a health condition on physical and mental well-being. The current study used a theory-driven approach to improve upon existing stigma measures and clarify the psychological stigma facets relevant to adolescents with functional abdominal pain (FAP). The newly developed Health-Related Stigma and Concealment Questionnaire (HSCQ) was found to have good internal consistency and construct validity in a sample of 153 adolescents with FAP. Exploratory factor analysis identified two major components of the HSCQ – felt stigma and stigma concealment. Although a two-factor solution was used for the majority of study analyses, there may be some value in distinguishing two components of felt stigma (anticipated vs. internalized stigma). Support for their differentiation comes from a-priori theory and the stronger relation between mental health symptoms and internalized vs. anticipated stigma. Internal consistency was acceptable for the internalized and anticipated stigma scales. Thus, future researchers using the HSCQ may benefit from exploring both a two-factor and a three-factor scale, as the utility of these psychological stigma constructs is likely to vary by population and research question. The HSCQ may help advance research on health-related stigma in FAP and other chronic health conditions by allowing for more precise assessment of psychological stigma constructs. In the second part of the study, cross-sectional data were used to identify possible mechanisms by which stigma affects health-related outcomes in adolescents with FAP. Data did not support a model in which concealment mediates the effect of anticipated stigma or felt stigma on health-related outcomes. By contrast, data were consistent with a theory-based model in which internalized stigma mediates the effect of anticipated stigma on outcomes. This suggests that internalized stigma may be an effective target of psychological interventions. In sum, psychotherapies for adolescents with FAP may do better to challenge what these adolescents say to themselves about their condition than what they say to others.