Perceived Stigmatization Questionnaire Research Articles

Social cure model: testing the link between identity centrality and body appreciation in diverse sexual orientation and gender identity groups

BackgroundThe level of experienced sociocultural pressure to have an idealized body can vary depending on a person’s gender identity and sexual orientation. The current study explored whether differences in levels of body appreciation among people with different sexual orientations and gender identities vary because of differing levels of experienced pressure by in-group members and varying levels of experienced hostile behaviors because of their looks or body. Thereby, the study tests the social cure model, according to which high levels of identity centrality are associated with better mental health.MethodsAn online cross-sectional questionnaire study was conducted with 1,587 people (51.3% cisgender women, 39.3% cisgender men, 9.5% non-binary; 52.9% identified as heterosexual, 27.7% identified as bisexual/pansexual, 11.2% identified as gay/lesbian, 8.2% identified as asexual/demi/queer; Mage = 32.9, SD = 12.6) from German-speaking countries. Variables were assessed with German-language versions of the Multidimensional and Multicomponent Measure of Social Identification, Body Appreciation Scale-2, the Perceived Stigmatization Questionnaire, and the Sociocultural Attitudes Towards Appearance Questionnaire-4, revised. A manifest-path model was calculated.ResultsNon-binary persons reported lower levels of body appreciation than did cisgender men and sexual minority persons reported lower levels of body appreciation than did heterosexual persons. Furthermore, sexual minority persons experienced more hostile behaviors directed towards them because of their looks or body than did heterosexual persons. Similarly, non-binary persons experienced more hostile behaviors than did men. Non-binary persons were subjected to lower levels of in-group pressure than were men. Gay/lesbian persons and asexual persons were subjected to lower levels of in-group pressure than were heterosexual persons. More hostile behaviors and stronger in-group pressure were related to lower body appreciation. In cisgender women and men indirect links revealed associations between strong identity centrality and low levels of body appreciation through the mediator of high in-group pressure.ConclusionsData in sexual minority individuals or non-binary persons supported the social cure model, according to which persons can find support and validation for their looks and body from in-group members. In cisgender women and men, strong identification as a woman or man can be related to stronger in-group pressure and in turn to lower body appreciation.

Effectiveness, safety and impact of guselkumab on sexuality and perceived stigmatization in patients with psoriasis in routine clinical practice: Week 28 results from the prospective German multicentre G-EPOSS study.

G-EPOSS is a prospective, non-interventional, German multicentre study of patients with moderate-to-severe plaque psoriasis receiving guselkumab, a therapeutic monoclonal antibody targeting interleukin-23, in a real-world setting. The objective of the study was to evaluate the effectiveness and safety of guselkumab, including its impact on skin, health-related quality of life (HRQoL), sexuality, and perceived stigmatization. Patients (≥18 years old) received guselkumab per routine clinical practice. The primary endpoint was the proportion of patients achieving absolute Psoriasis Area and Severity Index (PASI) ≤ 3 at Week (W)28. Secondary endpoint assessments over 28 weeks included the Nail Psoriasis Severity Index (NAPSI), anogenital Physician's Global Assessment (aPGA), and Dermatology Life Quality Index (DLQI). Sexuality and perceived stigmatization were assessed by patients using the Relationship and Sexuality Scale (RSS) and Perceived Stigmatization Questionnaire (PSQ), respectively. Overall, 293 patients were included in the evaluable set population. Mean age and disease duration were 45.6 and 17.6 years, respectively. At baseline, mean PASI, aPGA and DLQI scores were 15.3, 2.7 and 11.3, respectively. In total, 25.9% of patients had received a prior biologic. Overall, 83.0% of patients achieved PASI ≤ 3, and 56.2%/35.1% achieved PASI ≤ 1/PASI = 0, respectively, at W28. Among those with NAPSI ≥ 1 and aPGA ≥ 1 at baseline, NAPSI = 0 and aPGA = 0 were achieved by 39.2% and 61.1% of patients, respectively, and 61.4% of patients achieved DLQI 0-1 at W28. Improvements were observed over 28 weeks across individual items of the DLQI, RSS and PSQ, indicating improved HRQoL and sex life, and decreased perceived stigmatization. Based on DLQI Question (Q)9, 53.6% of patients experienced sexual difficulties at baseline, which decreased to 12.1% at W28. DLQI Q9 responses were consistent with RSS item responses, highlighting DLQI Q9 as a sentinel for sexual impairment. Guselkumab improved overall skin symptoms and HRQoL in patients with psoriasis and decreased sexual impairment and perceived stigmatization. No new safety signals were observed. CNTO1959PSO4008.

In People who Identify as Gender Minority People the Social Cure Model and in People who Identify as LGBTQ* People the Intragroup Status and Health Model might Explain the Link between Identity Centrality and Body Appreciation

IntroductionSexual and gender minority (SGM) people are often found to have lower levels of body appreciation than do cis-heteronormative people.Objectives The current study utilizes the social cure model and the intragroup status and health model to investigate whether identification with a SGM social group and identity centrality (i.e., the degree to which a specific social identity is important to an individual) is linked to experiences of hostile behaviors because of a person’s looks or body and consequently, to body appreciation.Methods A cross-sectional online-questionnaire study was conducted with 1,680 German-speaking participants (49.2% cisgender women, 37.7% cisgender men, 9.0% non-binary, 4.1% transgender; Mage = 32.7, SD = 12.5). The Multidimensional and Multicomponent Measure of Social Identification, the Body Appreciation Scale-2, the Perceived Stigmatization Questionnaire and the Sociocultural Attitudes Towards Appearance Questionnaire-4, revised were used. A manifest path model was calculated.ResultsPeople who identified as gender minority (GM) people and LGBTQ* people reported lower levels of body appreciation. Sexual minority (SM) individuals who identified with a social group other than LGBTQ* people reported levels of body appreciation similar to those of individuals who identified as women. Individuals who identified as GM people experienced fewer instances of hostile behaviors because of their looks or body the higher their level of identity centrality was. On the other hand, individuals who identified as LGBTQ* people more frequently encountered hostile behaviors because of their looks or body when their identity centrality was strong. Frequent experiences of hostile behaviors because of a person’s looks or body was linked to poor body appreciation in all social groups.Conclusions Identity centrality might help alleviate experiences of discrimination, especially in people who identify as GM people, as the social cure model suggests. In line with the intragroup status and health model, individuals who strongly identify as LGBTQ* people might be more visible as SM people and experience more discrimination than do SM people who identify with another social group.Disclosure of InterestNone Declared

Perceived Stigmatization in Iranian Children With Deformities or Scars Caused by Burns Referred to Treatment Centers in Tehran, Iran

Background & Aims Experiencing stigmatization behaviors in children with post-burn deformities can leave lasting negative effects on their mental and social health, and is considered an important issue in the child's growth and development. This research aims to investigate the perceived stigmatization in children with deformities or visible scars caused by burns referred to treatment centers in Tehran, Iran. Materials & Methods In this cross-sectional study, 190 children aged 8-18 years with a history of burns resulted in deformities or visible scars participated. Sampling was done using a convenience method from October 20, 2021, to October 20, 2022. The 21-item perceived stigmatization questionnaire (PSQ) was used to collect information. Data analysis was performed in SPSS software, version 21 using independent T-tests and analysis of variance. Results The mean total score of PSQ was 2.199 ± 0.562. The domain of confusing/staring behaviors had the highest score of 2.517±0.820. Perceived stigmatization showed significant relationships with children’s age (P=0.030), gender (P= 0.010), educational level (P< 0.001), time since burn (P<0.001), and frequency of reconstructive burn surgery (P=0.009). Moreover, perceived stigma in children was significantly correlated with their mothers' education level (P=0.007) and occupation (P=0.003). Conclusion Female children with deformities or visible scars caused by burns tend to experience stigmatization behaviors more frequently than males. These children experience these behaviors mostly during early adolescence. Additionally, a higher number of reconstructive surgeries and a shorter time since the burn accident are linked to high perception of stigmatization in these children. Moreover, children of employed mothers and those whose mothers have higher educational levels report more perceived stigmatization. It is important for nurses to identify these issues and refer the cases who require additional support to available social treatment centers for further assistance.

Living with visible scars: The social stigmatization of burn survivors.

Objective: To assess the social stigmatism, in adult burn survivors with visible scars, that they face in the society. Study Design: Cross-sectional study. Setting: Department of Plastic Surgery and Burns, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan. Period: May 2022 to April 2023. Material & Methods: The study included 64 participants aged 16 to 55 years who were awaiting reconstructive surgery and had experienced visible scarring from burns for over six months. Data on perceived stigmatization were collected using the Perceived Stigmatization Questionnaire (PSQ). The demographic profile, burn characteristics, and socio-economic factors of the participants were also analyzed. Statistical analysis was performed using SPSS 27, including post-stratification chi-square tests. Results: Of the 64 participants, 87.5% reported experiencing perceived stigmatization, with gender being a significant factor. Notably, 91.7% of females reported stigmatization, compared to 75% of males. Marital status, educational level, scarred body parts, visibility of scars in public, and age at the time of burn were also strongly associated with perceived stigmatization. The study revealed the mean scores for three domains: Absence of friendly behavior (2.58 ± 0.64), Confused/Staring behavior (3.15 ± 0.57), and Hostile behavior (2.19 ± 0.72). Conclusion: This study underscores the prevalence of perceived stigmatization among burn survivors, particularly those with visible scars on their face and hands. The findings emphasize the importance of social support and awareness campaigns in mitigating these challenges. Greater efforts are needed to address the psychosocial issues faced by burn survivors and promote empathy and inclusivity in society. Further research is crucial to understanding the experiences of burn survivors from diverse backgrounds.

RF14 | PSAT115 Impact of Definitive Surgery for Graves’ Disease on Adolescent Health-Related Quality of Life and Psychosocial Functioning

Abstract Introduction Pediatric Graves’ disease (GD) is associated with hyperthyroid symptoms broadly impacting psychosocial functioning. Total thyroidectomy (TT) is a definitive treatment option that replaces long-term antithyroid medication (ATD) for GD. While studies have examined health-related quality of life (hrQOL) in adults, there are no data describing impacts of definitive surgery in pediatrics. In this prospective, longitudinal study, we explored the impact of definitive surgery on hrQOL and psychosocial functioning in adolescent patients with GD. Methods Patients 12-19 years old pursuing definitive surgery for GD and their parents were recruited to complete surveys before and at least six months following TT. Parents pre-operatively completed a demographic questionnaire, parent rating scale assessing perceived symptom severity, and motivations for pursuing TT questionnaire. Patients pre- and post-operatively completed the Pediatric Quality of Life Scales (PedsQL), Quality of Life Questionnaire for Patients with Thyroid Disease (ThyPRO), Perceived Stigmatization Questionnaire (PSQ), Body Esteem Scale for Adolescents and Adults (BESAA), and European Group on Graves’ Orbitopathy GO Quality of Life Questionnaire (EUGOGO-QOL). Patients and parents post-operatively completed the Patient and Observer Scar Assessment Scale (POSAS) and a post-surgical satisfaction scale. Longitudinal paired scores were compared using Wilcoxon rank-sum test with Bonferroni-Holm correction. Survey subscore associations were assessed using Spearman tests with Benjamin-Hochberg correction. P-values < 0.10 for survey association analyses and all other p-values < 0. 05 were considered statistically significant. Results Thirty-six patient/parent dyads completed baseline surveys, including 19 patient/parent dyads completing both pre- and post-TT surveys. Families reported that patients’ GD and ATD significantly interfered with quality of life. Motivations for definitive surgery included ease of monitoring hypothyroidism as opposed to hyperthyroidism, access to a 'high-volume' surgeon, desire to reduce goiter symptoms, and opposition to radioactive medication. At baseline, patients reported high physical and cognitive GD symptomology via ThyPRO, specifically hyperthyroid symptoms, tiredness, anxiety, and emotional susceptibility. Psychosocial functioning via PedsQL, specifically in school settings, was depressed. Disease-specific hrQOL (ThyPRO) significantly improved following TT, with notable improvements in goiter (p=0. 002), hyperthyroid symptoms (p=0. 002), tiredness (p=0. 003), and anxiety (p=0. 003). Physical (p=0. 006) and school-related functioning (p=0. 003) improved post-TT (PedsQL), while variables captured by PSQ, BESAA, and EUGOGO-QOL were not significant pre- and post-TT. Reported GD-associated eye symptomology was minimal at baseline and further improved following surgery (p=0. 007). ThyPRO and PedsQL subscores were significantly associated at baseline and change after surgery, suggesting interconnectedness between disease-specific hrQOL and psychosocial functioning. Patients and parents reported median recovery of two months and high satisfaction with the outcomes of definitive surgery, with minimal scar appearance concerns. Conclusions In the setting of a high-volume surgeon with low complication rates, definitive surgery for GD in pediatric populations has substantial, beneficial effects on disease-specific hrQOL and psychosocial functioning, with minimal adverse scar appearance complaints. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Sunday, June 12, 2022 12:48 p.m. - 12:53 p.m.

Facial acne causes stigmatization among adolescents: Across-sectional study.

Stigmatization is defined as a discrediting mark which sets the person from others and hindering interpersonal relationships. Literature data on stigma in acne subjects are scarce. This study was undertaken to assess feelings of stigmatization in adolescents with facial acne. The study was performed on 730 high-school students aged 15 to 19 years with the mean age of 17.05 ± 1.18 years. Self-reported acne was found in 74.9% of subjects. The severity of acne was self-assessed with the standardized color images based on Investigators Global Assessment (IGA). Stigmatization was studied with 6-Item Stigmatization Scale (6-ISS) and Perceived Stigmatization Questionnaire (PSQ). Additionally, quality of life (QoL) was evaluated with Dermatology Life Quality Index (DLQI). 58% of adolescents with acne presented with feelings of stigmatization. Within the acne population, stigmatization was significantly more common in females than in males (p< 0.001). The mean level of stigmatization according to 6-ISS was significantly higher in acne sufferers than in those free from acne (1.68 ± 2.42 points and 0.55 ± 1.50 points, respectively; p< 0.001). Feelings of stigmatization were significantly more pronounced by females than males (p< 0.001). Staring at the skin and the fact that others are not attracted to person due to skin lesions were main problems raised by the study participants with acne. 6-ISS scores correlated with acne severity (r= 0.278; p< 0.001) and both 6-ISS and PSQ scores with QoL impairment (r= 0.530; p< 0.001 and r= 0.341; p< 0.001, respectively). Facial acne is a highly stigmatized skin disease and requires a holistic therapeutic approach.

Perceived stigmatization and fear of negative evaluation: Two distinct pathways to body image dissatisfaction and self-esteem in burn survivors

Objective Scars resulting from burn injury can pose social and psychological problems that may affect body image and self-esteem. This study aimed to investigate whether burn severity, age and female gender are associated with body image dissatisfaction and self-esteem, through an association with perceived stigmatization and fear or negative evaluation. Design & Main Outcome Measures Burn survivors (N = 224) completed the Fear of Negative Evaluation scale (FNE) and the Perceived Stigmatization Questionnaire (PSQ) at 3 months post-burn, and the Rosenberg Self-Esteem scale (RSE) and the Satisfaction with Appearance scale (SWAP) at 6 months post-burn. Path analysis was used to test the relationships. Results Body image dissatisfaction and self-esteem were moderately associated. Burn severity was directly and indirectly associated with body image dissatisfaction through perceived stigmatization. Female gender and age were indirectly associated with body image dissatisfaction though fear of negative evaluation. Age was indirectly associated with both perceived stigmatization and fear of negative evaluation. Perceived stigmatization and fear of negative evaluation were associated with self-esteem through body image dissatisfaction, the first indirectly and the latter both directly and indirectly. Conclusions Findings highlight that both burn-specific factors and psychological vulnerability should be taken into account to deal with social challenges that may affect body image and self-esteem after burns.

"Better If They Laugh with Me than at Me": The Role of Humor in Coping with Obesity-Related Stigma in Women.

This study investigated the role of perceived stigmatization in the relationship between humor styles and coping with stress among young women suffering from stigma due to obesity. In the 21st century, obesity is an increasing global health issue with many physical and mental consequences for obese women. As a chronic stigmatizing disease, it requires that the affected individuals cope with social consequences; women with obesity are more prone to such consequences than men. Humor fosters the breaking of stereotypes and alleviating the consequences of stigmatization. A total of 127 young adult women (age M = 25.74, SD = 2.73) participated in the study (n = 54 with overfat and n = 73 with healthy fat). Participants filled out the Humor Styles Questionnaire, Perceived Stigmatization Questionnaire, and the Brief COPE Scale. Anthropometric data were gathered using a body composition analyzer. Results indicate that, when perceiving hostile behaviors toward themselves and using humor as a coping strategy, women with overfat select maladaptive styles of humor (i.e., self-defeating and aggressive styles). Women with overfat were also more likely to use humor as a coping strategy in difficult situations. Furthermore, none of the participants were satisfied with their body mass. At the same time, among women without obesity, a lack of compliments was not treated as a problem, even if they had high body fat.

Psychosocial Predictors of Quality of Life in Patients With Vitiligo

The present study was designed to examine psychosocial predictors of quality of life (QoL) such as body image, self-esteem, impact of Vitiligo (psychologically and socially), and perceived stigmatization in patients with Vitiligo. The sample (N =120) comprised of individuals with Vitiligo recruited from dermatology units of different hospitals in Lahore. Body Image State Scale (Cash, Fleming, Alindogan, Steadman, &amp; Whitehead 2002), Rosenberg Self-Esteem Scale (Rosenberg, 1965), Vitiligo Impact Scale (Rammam, Khaitan, Mehta, Sreenivas, &amp; Gupta, 2014), Perceived Stigmatization Questionnaire (Lawrence, Fauerbach, Heinberg, &amp; Thomas, 2006) and Dermatology Life Quality Index (Finlay &amp; Khan, 1994) were used as assessment measures. Results revealed that most of the individuals with Vitiligo reported poorer perception of QoL; while, men with Vitiligo expressed better perceived QoL as compared to women. Individuals with both types of Vitiligo (lesions on exposed/unexposed regions) expressed poor body image, negative impact of Vitiligo on their psycho-social functioning, and higher levels of perceived stigmatization. Individuals with exposed Vitiligo affected regions exhibited lower self-esteem. In addition, body image, impact of Vitiligo (psychologically and socially), and perceived stigmatization (absence of friendly behavior) significantly predicted QoL. It was concluded that Vitiligo had a greater impact on individual’s psychological health and social functioning rather than physiological complications.

Reliability and structural validity of the Dutch version of Perceived Stigmatization Questionnaire in adults with burns

ObjectiveBurn scars can attract attention from others which can be perceived as stigmatizing behavior with negative psychological consequences. The Perceived Stigmatization Questionnaire (PSQ) is a validated instrument measuring the perception of stigmatization in burn survivors. The objective of this study was to examine the psychometric properties of the Dutch version of the PSQ, specifically its factor structure, reliability, and associations with other relevant constructs. MethodPatients (N = 220) completed the PSQ at 3 months after burn. The factor structure was examined with explorative (EFA) and confirmatory (CFA) factor analyses at 3 and 12 months after burn, and reliability was examined using Cronbach’s alpha. Three months measurements were used to examine associations of the PSQ with ‘depressive mood’ (Beck Depression Inventory, BDI-II), ‘interpersonal relations’ and ‘body image’ (Burn Specific Health Scale-Brief, BSHS-B), and two scales of the Illness Invalidation Inventory (3*I). ResultsA four factor model showed the best fit to the data. Two factors, ‘confused/staring behavior’ and ‘hostile behavior’, were identical to the original PSQ. The third original factor, ‘absence of friendly behavior’, was now divided into two factors separating absence of friendly behavior of strangers and other people. Internal consistency ranged from .60 to .88. Especially the ‘confused/staring behavior’ factor was related to the other questionnaire scores. ConclusionThe current study shows acceptable reliability and structural validity of the Dutch version of the PSQ in a 4-factor solution. Further research into measurement invariance across languages is recommended to establish a uniform multicultural instrument.

Handling traumatic experiences in facially disfigured female burn survivors

BackgroundThis research deals with the impact of resilience, perceived stigmatization, social comfort and coping strategies on quality of life among female burn survivors with facial disfigurement, man many of which are found in Asian countries. MethodsUsing cross-sectional research design, female burn survivors with severe facial disfigurement (N = 100) were drawn by using purposive sampling strategy from a public sector hospital and an organization working in Lahore, Pakistan. Perceived Stigmatization Questionnaire (PSQ) (Lawrence et al., 2006), Social Comfort Questionnaire (SCQ) (Lawrence et al., 2006), State-Trait Resilience Scale, Coping with Burns Questionnaire (CBQ) (Willebrand et al., 2001) and World Health Organization Quality of Life Brief Questionnaire (WHOQOL-BREF Questionnaire; World Health Organization, 2014) were used for assessment. ResultsThe analyses showed a significant positive relationship among resilience, coping with burns and social comfort. A significant negative relationship was found between perceived stigmatization and coping with burns, resilience and social comfort. All these variables were tested for differentiation on the basis of survivor’s age (less vs. more than 30 years), occupation (housewife vs. gainfully employed), education (less vs. more than matriculation), social status (low vs. middle class), family system (nuclear vs. joint), siblings (yes vs. no), residence (living in home vs. shelter home) and psychological help received or not after the burn injury. Results indicate a mixed type of phenomenon among variable’s differentiation. Path analysis through AMOS resulted into a model showing no direct relationship of quality of life with coping with burns, perceived stigmatization and resilience; however, social comfort mediates the relationship between quality of life and coping with burns, perceived stigmatization and resilience. ConclusionIt is found that quality of life is dependent on coping with burns, perceived stigmatization and resilience through social comfort. The findings hold implications for the mental health professionals and rehabilitation service providers to emphasize on the restorative strategy for burn survivors to elevate their social comfort, to assist them in handling their injuries and develop a curative plan to support them in their coping skills.

Depression in Tourette Syndrome.

The aim of the study is to show relationship between severity of depressive symptoms and the severity of tics, declared feeling of stigmatization and feelings about the body. The study included 13 people with Tourette syndrome and 13 people in a comparative group - matching method, taking into account compatibility of gender, age, number of years of education, and size of the place of residence. The study used: Polish adaptation of the Yale Global Tic Severity Scale (YGTSS), Questionnaire for Measuring Depression (Kwestionariusz do Pomiaru Depresji -KPD), Perceived Stigmatization Questionnaire (PSQ), Questionnaire of feelings about the body. Wilcoxon signed-rank test analysis showed that the declared general depression rate is significantly higher in the group of people with Tourette syndrome (Z = - 2.691; p < 0.01). The indicator differentiating the declared feeling of stigmatization among people with TS was the feeling of embarrassment due to other people's stare/the stare of bystanders (ZG) (Z = - 1.888; p < 0.05). The general assessment of one's body image is not different in the group of people with TS and comparative group, but two important factors have been distinguished: "My body is alien to me" (Z = - 1.897; p < 0.05), "It is difficult for me to understand changes in my body" (Z = 1.950; p < 0.05). It is concluded that the severity of tics, the feeling of stigmatization and selected body image indexes are related to both the general severity of symptoms of depression and its individual indicators.

Comparison of the perceived stigmatization measures between the general population and burn survivors in Brazil

ObjectivesTo compare perceived stigmatization, symptoms of depression and self-esteem of adults from Brazilian general population with Brazilian burns survivors and to verify the possible correlations between these populations. MethodThe general population and burn survivors administered the adapted Brazilian versions of the Perceived Stigmatization Questionnaire (BR-PSQ-R), Beck Depression Inventory (BDI) and Rosenberg Self-Esteem Scale (RSES). The Student's t-test for independent samples was employed to identify significant differences between the means of the results from the BR-PSQ-R, BDI and RSES instruments, and the Pearson correlation was used to detect correlations between constructs. The significance level was set at 0.05. ResultsParticipants of this study included: 102 individuals from the general population and 240 burn survivors. The difference between the BR-PSQ-R mean scores of the two groups was not statistically significant (p = 0.077). The mean scores for the BDI (p = 0.001) and RSES (p = 0.001) where found to be lower in the general population, when compared to burn survivors. Moderate correlations were identified between the perceived stigmatization and depression (r = 0.43; p < 0.001) and perceived stigmatization and self-esteem (r = −0.35; p < 0.001). ConclusionsParticipants from the general population and burn survivors exhibit similar levels of perception of stigmatization; the general population presented fewer symptoms of depression and a higher self-esteem when compared to burn survivors.

The Body as an Object of Stigmatization in Cultures of Guilt and Shame: A Polish-Vietnamese Comparison.

The aim of this paper is to examine cross-cultural differences in body stigmatization between the individualistic Christian culture of guilt (Poland) and the collectivistic Buddhist/Confucian culture of honor and shame (Vietnam). The study included 1290 university students from Poland (n = 586) and Vietnam (n = 704). Subjects filled in the body esteem scale and the perceived stigmatization questionnaire, and body measurements were collected to calculate anthropometric indices. Participants from Vietnam were less satisfied with their appearance than their Polish peers. Men in both countries assessed themselves more favorably. No anthropometric index predicted body esteem in Vietnamese women, while only indices related to fat levels were predictors in Polish women. Men with a V-shaped body assessed themselves as stronger and as having a better physical condition. A possible explanation of the observed cross-cultural differences is that interdependent self-construal makes young adults in collectivistic societies more susceptible to criticism, and the Confucian values of modesty and shame lead to them not perceiving their bodies as sexual objects. The Christian sense of guilt does not influence the perception of sexuality. Absence of friendly behavior mediated the relation between anthropometric indices and body esteem in both cultures.

Validation of the Perceived Stigmatization Questionnaire for Brazilian adult burn patients.

Currently, there is no questionnaire to assess perceived stigmatization among people with visible differences in Brazil. The Perceived Stigmatization Questionnaire (PSQ), developed in the United States, is a valid instrument to assess the perception of stigmatizing behaviours among burn survivors. The objective of this cross-sectional and multicentre study was to assess the factor structure, reliability and validity of the Brazilian Portuguese version of the PSQ in burn patients. A Brazilian version of the 21-item PSQ was answered by 240 adult burn patients, undergoing rehabilitation in two burns units in Brazil. We tested its construct validity by correlating PSQ scores with depression (Beck Depression Index-BDI) and self-esteem (Rosenberg Self-Esteem Scale-RSE), as well as with two domains of the Revised Burn Specific Health Scale—BSHS-R: affect and body image, and interpersonal relationships. We used Confirmatory Item Factor Analysis (CIFA) to test whether the data fit a measurement model involving a three-factor structure (absence of friendly behaviour; confusing/staring behaviour; and hostile behaviour). We conducted Exploratory Factor Analyses (EFA) of the subscale in a 50% random sample of individuals (training split), treating items as ordinal categorical using unweighted least squares estimation. To assess discriminant validity of the Brazilian version of the PSQ we correlated PSQ scores with known groups (sex, total body surface area burned, and visibility of the scars) and assessed its reliability by means of Cronbach's alpha and using test-retest. Goodness-of-fit indices for confirmatory factor analysis were satisfactory for the PSQ, but not for the hostile behaviour subscale, which was modified to improve fit by eliminating 3 items. Cronbach’s alphas for the PSQ refined version (PSQ-R) ranged from 0.65 to 0.88, with test-retest reliability 0.87 for the total score. The PSQ-R scores correlated strongly with depression (0.63; p < 0.001), self-esteem (-0.57; p < 0.001), body image (-0.63; p < 0.001), and interpersonal relationships (-0.55; p < 0.001). PSQ-R total scores were significantly lower for patients with visible scars (effect size = 0.51, p = 0.029). The PSQ-R showed reliability and validity comparable to the original version. However, the cross-cultural structure of the subscale “hostile behaviour” and sensitivity to change of the PSQ should be further evaluated.

Clinical course, treatment modalities, and quality of life in patients with congenital melanocytic nevi - data from the German CMN registry.

Congenital melanocytic nevi (CMN) are associated with mental stress as well as medical risks for those affected. The German CMN registry was initiated in 2005. Herein, we present results from an interim analysis focusing on disease course, treatment modalities, and quality of life. One hundred patients enrolled in the registry between 2005 and 2012 were included in this prospective cohort study, and asked to participate in a follow-up survey. In addition, standardized questionnaires were used to collect data on quality of life (dermatology life quality index, DLQI) and perceived stigmatization (perceived stigmatization questionnaire, PSQ; social comfort questionnaire, SCQ). Eighty-three percent of patients (or their parents) provided answers to the survey questions (mean patient age: 11.2 years, median: 6 years; mean follow-up: 4.4 years). Overall, four individuals were diagnosed with melanoma, including two pediatric cases with CNS melanoma, one adult with cutaneous melanoma, and one case which later turned out to be a proliferative nodule. Four children were diagnosed with neurocutaneous melanocytosis, three of whom exhibited neurological symptoms. Eighty-eight percent (73/83) of patients underwent surgery. Seventy-eight percent reported no or only minor impact of the CMN on quality of life. In general, perceived stigmatization and impairment of social well-being were also low. Our results provide an overview of the situation of CMN patients in Germany, Austria, and Switzerland. Three percent of patients developed melanoma; 4% showed CNS involvement.

Psychosocial Distress at Different Time Intervals after Burn Injury

Burn injuries can result in long-term mental and physical health problems. We investigated if patients at different time periods since the burn injury differed with regard to psychosocial impairment. Patients who were treated as inpatients because of burn injury between 2006 and 2012 were asked about quality of life (Burn Specific Health Scale - Brief; BSHS-B), anxiety and depression (Hospital Anxiety and Depression Scale - Deutsche Version; HADS-D), posttraumatic stress disorder (Impact of Event Scale - Revised; IES-R), stigmatization (Perceived Stigmatization Questionnaire; PSQ) and social support (Fragebogen zur sozialen Unterstützung; F-SozU-7). The sample (146 patients) was divided into 4 groups according to the time period elapsed since the burn injury. There were no significant differences in psychosocial distress between the 4 groups. The same applied to sociodemographic and burn specific variables. 18 (12.4%) patients had the cutoff of ≥11 for anxiety and 22 (15.2%) for depression on the HADS; 16 (11.1%) patients screened positive for posttraumatic stress disorder (PTSD). No differences were found for current psycho(pharmaco)therapy and the wish for psychotherapy. The results suggest persistence of psychosocial burden over time after burn injury. Psychosocial interventions might thus be indicated even many years after burn injuries.

Translation and cultural adaptation of the Perceived Stigmatization Questionnaire for burn victims in Brazil

This methodological study aimed to describe the process of translation and cultural adaptation of the Perceived stigmatization Questionnaire (PSQ) and analyze the internal consistency of the items in the step of pre-testing. The PSQ was developed to evaluate the perception of stigmatizing behaviors of burn victims. The adaptation process was carried out from August 2012 to February 2013, comprising the steps outlined in the literature. As part of this process, the pre-test with 30 adult burn victims was held. All participants at this step reported to understand the instrument items and the scale of responses. There were no suggestions or changes in the tested version. The value of Cronbach's alpha at pre-test was 0.87. The contribution of this study is to describe the operation of each of the steps of this methodological process and show the internal consistency of the items in the pre-test.

Self- and parent-perceived stigmatisation in children and adolescents with congenital or acquired facial differences

The risk of social stigmatisation is an important determinant in the decision for plastic and reconstructive surgery in children and adolescents. The purposes of this cross-sectional study were threefold: (1) to assess self- and proxy-reported stigma experiences of children and adolescents with congenital or acquired facial differences; (2) to compare patients versus controls; and (3) to identify predictors of perceived stigmatisation. Data were obtained from a cohort of 87 children (ages 9 months to 16 years) with facial burn scars, port-wine stains, infantile haemangioma or congenital melanocytic nevi, using parent questionnaires (n=85) and standardised interviews in children older than 7 years (n=29). Perceived stigmatisation was assessed with the Perceived Stigmatization Questionnaire. Self-reported stigmatisation was compared versus a matched control group consisting of 29 children and adolescents without a facial difference. Medical, demographic and parental psychological variables were examined as predictors of proxy-perceived stigmatisation. Patients with a facial difference reported significantly higher levels of stigma experiences than control subjects. A majority of the patients reported having experienced expressions of pity, staring or startled reactions; and about one-quarter had been teased about their facial difference. Multivariate analysis indicated that proxy-perceived stigmatisation was predicted by larger size of the facial difference and greater age of the child. Gender and type of facial difference (acquired vs. congenital) had no significant impact. These results demonstrate that children with a facial difference are at higher risk of experiencing stigmatisation than children without a visible difference. Children with a facial difference that covers more than 25% of their face are particularly vulnerable to stigmatisation and therefore need special monitoring.