Abstract
A sample of heroin users (n = 250) in methadone maintenance treatment (MMT) was used in this cross-sectional study to clarify the mechanisms of the effects of stigma on quality of life (QoL) through psychological distress and social functioning. All the participants had their self-stigma, psychological distress, social functioning, and QoL measured. Psychological distress and social functioning were proposed to be mediators between self-stigma and QoL. Several linear models using structural equation modeling were conducted to examine the mediated effects. The negative effects of self-stigma on QoL were significantly mediated by psychological distress, as self-stigma directly and significantly influenced psychological distress, but not social functioning. This study demonstrated a linear model describing the effects of self-stigma on QoL for opioid-dependent individuals; psychological distress was also an important mediator between self-stigma and their QoL. Clinicians were able to notice the importance of reducing self-stigma for opioid-dependent individuals according to the following results: higher levels of self-stigma were associated with high psychological distress, decreased social functioning, and impaired QoL. Our mediation findings suggest that treating psychological distress is better than treating social functioning if we want to eliminate the effects of self-stigma on QoL for heroin users.
Highlights
Research and discussion on stigma grew substantially after Goffman [1] (p. 3) defined stigma as an “attribute that is deeply discrediting.” Since different types of stigma have been defined according to different systems
Our results further demonstrated that the effects of self-stigma were diminished when using psychological distress as a mediator; while effects existed when using social functioning as a mediator
Unlike the reported effects of self-stigma on social functioning [31], our findings showed that self-stigma did not have direct impacts on social functioning but rather had indirect effects through the mediator of psychological distress
Summary
Research and discussion on stigma grew substantially after Goffman [1] (p. 3) defined stigma as an “attribute that is deeply discrediting.” Since different types of stigma have been defined according to different systems. Research and discussion on stigma grew substantially after Goffman [1] 3) defined stigma as an “attribute that is deeply discrediting.”. Different types of stigma have been defined according to different systems. Brohan et al [3] and Corrigan and Rao [4] used awareness, experience, and acceptance to define different types of stigma as perceived stigma, experienced stigma, and self-stigma. Some researchers have discussed the stigma of the friends and relatives of the stigmatized population, such as courtesy stigma [1], associative stigma [5], and affiliate stigma [6,7]. A trend toward in-depth discussion of self-stigma is developing because more and more studies have confirmed its importance [9,10,11,12,13]
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