Influence of dialysis-related stigma on health-related indicators in Japanese patients undergoing hemodialysis
Corresponding Author
Hidehiro Sugisawa
Gerontology Program, J. F. Oberlin University Graduate School of International Studies, Tokyo, Japan
Correspondence
Hidehiro Sugisawa, J. F. Oberlin University Graduate School of International Studies, Sendagaya Campus 1-1-12 Sendagaya, Shikuya-ku, Tokyo, 151-0051, Japan.
Email: [email protected]
Search for more papers by this authorYumiko Shimizu
The Jikei University School of Nursing, Tokyo, Japan
Search for more papers by this authorTamaki Kumagai
School of Health Sciences, International University of Health and Welfare, Odawara, Kanagawa, Japan
Search for more papers by this authorToshio Shinoda
Advanced Course for Clinical Engineering, Teikyo University Junior College, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Hidehiro Sugisawa
Gerontology Program, J. F. Oberlin University Graduate School of International Studies, Tokyo, Japan
Correspondence
Hidehiro Sugisawa, J. F. Oberlin University Graduate School of International Studies, Sendagaya Campus 1-1-12 Sendagaya, Shikuya-ku, Tokyo, 151-0051, Japan.
Email: [email protected]
Search for more papers by this authorYumiko Shimizu
The Jikei University School of Nursing, Tokyo, Japan
Search for more papers by this authorTamaki Kumagai
School of Health Sciences, International University of Health and Welfare, Odawara, Kanagawa, Japan
Search for more papers by this authorToshio Shinoda
Advanced Course for Clinical Engineering, Teikyo University Junior College, Tokyo, Japan
Search for more papers by this authorAbstract
Introduction
Focusing on impacts to health-related indicators in older Japanese patients, this study analyzed both the direct influence of dialysis-related stigma and influences of its intersectionality with other stigmatized characteristics.
Methods
Data were collected through a cross-sectional survey of 7461 outpatients in dialysis facilities. Other stigmatized characteristics include lower income, lower education, disabled activities of daily living, and diabetic end-stage renal disease (ESRD) as a cause for starting dialysis treatment.
Results
The average rate of an “agree” response on dialysis-related stigma items was 18.2%. Dialysis-related stigma significantly influenced all three health-related indicators, including suspected depression, informal networks, and compliance with dietary therapy. In addition, each interaction between dialysis-related stigma and educational attainment, gender, and diabetic ESRD significantly influence one health-related indicator.
Conclusion
These results suggest that dialysis-related stigma has both a significant direct and synergic influence with other stigmatized characteristics on health-related indicators.
CONFLICT OF INTEREST STATEMENT
The authors have no conflicts of interest to report in relation to this study.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author
REFERENCES
- 1Liem YS, Bosch JL, Arends LR, Heijenbrok-Kal MH, Hunink MG. Quality of life assessed with the medical outcomes study short form 36-item health survey of patients on renal replacement therapy: a systematic review and meta-analysis. Value Health. 2007; 10(5): 390–7. https://doi.org/10.1111/j.1524-4733.2007.00193.x
- 2Valderrábano F, Jofre R, López-Gómez JM. Quality of life in end-stage renal disease patients. Am J Kidney Dis. 2001; 38(3): 443–64. https://doi.org/10.1053/ajkd.2001.26824
- 3Weisbord SD, Fried LF, Arnold RM, Fine MJ, Levenson DJ, Peterson RA, et al. Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients. J Am Soc Nephrol. 2005; 16(8): 2487–94. https://doi.org/10.1681/ASN.2005020157
- 4Gillanders S, Wild M, Deighan C, Gillanders D. Emotion regulation, affect, psychosocial functioning, and well-being in hemodialysis patients. Am J Kidney Dis. 2008; 51(4): 651–62. https://doi.org/10.1053/j.ajkd.2007.12.023
- 5Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol. 2001; 27: 363–85. https://doi.org/10.1146/annurev.soc.27.1.363
- 6Weiss MG, Ramakrishna J. Stigma interventions and research for international health. Lancet. 2006; 367(9509): 536–8. https://doi.org/10.1016/S0140-6736(06)68189-0
- 7Abdul Rahman N, Rajaratnam V, Burchell GL, Peters RMH, Zweekhorst MBM. Experiences of living with leprosy: a systematic review and qualitative evidence synthesis. PLoS Negl Trop Dis. 2022; 16(10):e0010761. https://doi.org/10.1371/journal.pntd.0010761
- 8Jarlais DCD, Galea S, Tracy M, Tross S, Vlahov D. Stigmatization of newly emerging infectious diseases: AIDS and SARS. Am J Public Health. 2006; 96(3): 561–7. https://doi.org/10.2105/AJPH.2004.054742
- 9Link BG, Yang LH, Phelan JC, Collins PY. Measuring mental illness stigma. Schizophr Bull. 2004; 30(3): 511–41. https://doi.org/10.1093/oxfordjournals.schbul.a007098
- 10Jacoby A. Stigma, epilepsy, and quality of life. Epilepsy Behav. 2002; 3(6S2): 10–20. https://doi.org/10.1016/s1525-5050(02)00545-0 PMID: 12609301.
- 11Puhl RM, Brownell KD. Psychosocial origins of obesity stigma: toward changing a powerful and pervasive bias. Obes Rev. 2003; 4(4): 213–27. https://doi.org/10.1046/j.1467-789x.2003.00122.x
- 12Chambers SK, Dunn J, Occhipinti S, Hughes S, Baade P, Sinclair S, et al. A systematic review of the impact of stigma and nihilism on lung cancer outcomes. BMC Cancer. 2012; 12:184. https://doi.org/10.1186/1471-2407-12-184
- 13Reber L, Kreschmer JM, James TG, Junior JD, DeShong GL, Parker S, et al. Ableism and contours of the attitudinal environment as identified by adults with long-term physical disabilities: a qualitative study. Int J Environ Res Public Health. 2022; 19(12):7469. https://doi.org/10.3390/ijerph19127469
- 14Schabert J, Browne JL, Mosely K, Speight J. Social stigma in diabetes: a framework to understand a growing problem for an increasing epidemic. Patient. 2013; 6(1): 1–10. https://doi.org/10.1007/s40271-012-0001-0
- 15 United States Renal Data System. 2022 USRDS annual data report: epidemiology of kidney disease in the United States [Internet]. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. 2022. Available from: https://usrds-adr.niddk.nih.gov/2022/end-stage-renal-disease/11-international-comparisons access at 2022/11/18
- 16Tao Z, Shi A, Zhao J. Epidemiological perspectives of diabetes. Cell Biochem Biophys. 2015; 73: 181–5. https://doi.org/10.1007/s12013-015-0598-4
- 17Griva K, Ng HJ, Loei J, Mooppil N, McBain H, Newman SP. Managing treatment for end-stage renal disease: a qualitative study exploring cultural perspectives on facilitators and barriers to treatment adherence. Psychol Health. 2013; 28(1): 13–29. https://doi.org/10.1080/08870446.2012.703670
- 18Manookian A, Dehghan Nayeri N, Yakubu ND, Tabari F, Buunaaim ADB, Afoko VA. Heideggerian phenomenological study of the lived experiences of Ghanaian patients living with end-stage renal disease. Clin Nurs Res. 2022; 31(4): 690–701. https://doi.org/10.1177/10547738211035456
- 19Stangl AL, Earnshaw VA, Logie CH, van Brakel W, Simbayi LC, Barré I, et al. The health stigma and discrimination framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019; 17: 31. https://doi.org/10.1186/s12916-019-1271-1273
- 20Rai SS, Peters RMH, Syurina EV, Irwanto I, Naniche D, Zweekhorst MBM. Intersectionality and health-related stigma: insights from experiences of people living with stigmatized health conditions in Indonesia. Int J Equity Health. 2020; 19(1): 206. https://doi.org/10.1186/s12939-020-01318-w
- 21Ciciurkaite G, Perry BL. Body weight, perceived weight stigma and mental health among women at the intersection of race/ethnicity and socioeconomic status: insights from the modified labelling approach. Sociol Health Illn. 2018; 40(1): 18–37. https://doi.org/10.1111/1467-9566.12619
- 22Zhang Z, Sun K, Jatchavala C, Koh J, Chia Y, Bose J, et al. Overview of stigma against psychiatric illnesses and advancements of anti-stigma activities in six Asian societies. Int J Environ Res Public Health. 2019; 17(1):280. https://doi.org/10.3390/ijerph17010280
- 23Griffiths KM, Nakane Y, Christensen H, Yoshioka K, Jorm AF, Nakane H. Stigma in response to mental disorders: a comparison of Australia and Japan. BMC Psychiatry. 2006; 6:21. https://doi.org/10.1186/1471-244X-6-21
- 24Browne JL, Ventura AD, Mosely K, Speight J. Measuring the stigma surrounding type 2 diabetes: development and validation of the type 2 diabetes stigma assessment scale (DSAS-2). Diabetes Care. 2016; 39(12): 2141–8. https://doi.org/10.2337/dc16-0117
- 25Bono C, Ried LD, Kimberlin C, Kimberlin C, Vogel B. Missing data on the center for epidemiologic studies depression scale: a comparison of 4 imputation techniques. Res Social Adm Pharm. 2007; 3(1): 1–27. https://doi.org/10.1016/j.sapharm.2006.04.001
- 26Borrell C, Artazcoz L, Gil-González D, Pérez G, Rohlfs I, Pérez K. Perceived sexism as a health determinant in Spain. J Womens Health. 2010; 19(4): 741–50. https://doi.org/10.1089/jwh.2009.1594
- 27Fuller-Rowell TE, Evans GW, Ong AD. Poverty and health: the mediating role of perceived discrimination. Psychol Sci. 2012; 23(7): 734–9. https://doi.org/10.1177/0956797612439720
- 28Alonso J, Buron A, Rojas-Farreras S, de Graaf R, Haro JM, de Girolamo G, et al. Perceived stigma among individuals with common mental disorders. J Affect Disord. 2009; 118(1–3): 180–6. https://doi.org/10.1016/j.jad.2009.02.006
- 29Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health. 2013; 103(5): 813–21. https://doi.org/10.2105/AJPH.2012.301069
- 30Fung KM, Tsang HW, Corrigan PW, Lam CS, Cheng WM. Measuring self-stigma of mental illness in China and its implications for recovery. Int J Soc Psychiatry. 2007; 53(5): 408–18. https://doi.org/10.1177/0020764007078342
- 31Furukawa TA, Kawakami N, Saitoh M, Ono Y, Nakane Y, Nakamura Y, et al. The performance of the Japanese version of the K6 and K10 in the world mental health survey Japan. Int J Methods Psychiatr Res. 2008; 17(3): 152–8. https://doi.org/10.1002/mpr.257
- 32Sakurai K, Nishi A, Kondo K, Yanagida K, Kawakami N. Screening performance of K6/K10 and other screening instruments for mood and anxiety disorders in Japan. Psychiatry Clin Neurosci. 2011; 65(5): 434–44. https://doi.org/10.1111/j.1440-1819.2011.02236.x
- 33Sugisawa H, Shinoda T, Shimizu Y, Kumagai T, Sugisaki H. Psychosocial mediators between socioeconomissc status and dietary restrictions among patients receiving hemodialysis in Japan. Int J Nephrol. 2019; 2019:7647356. https://doi.org/10.1155/2019/7647356
- 34Sugisawa H, Shimizu Y, Kumagai T, Shishido K, Shinoda T. Influences of financial strains over the life course sbefore initiating hemodialysis on health outcomes among older Japanese patients: a retrospective study in Japan. Int J Nephrol Renovasc Dis. 2022; 15: 63–75. https://doi.org/10.2147/IJNRD.S352174
- 35Dawson JF. Moderation in management research: what, why, when, and how. J Bus Psychol. 2014; 29(1): 1–19. https://doi.org/10.1007/s10869-013-9308-7
- 36Asparouhov T, Muthén B. First-order derivative warning message, condition number, and non-identification [Internet]. 2022 Available from: https://statmodel.com/download/ConditionNumber.pdf
- 37Muthén BO, Muthén LK, Asparouhov T. Regression and mediation analysis using Mplus. Los Angeles, CA: Muthén & Muthén; 2016.
- 38Cho J, Choi EK, Kim SY, Shin DW, Cho BL, Kim CH, et al. Association between cancer stigma and depression among cancer survivors: a nationwide survey in Korea. Psychooncology. 2013; 22(10): 2372–8. https://doi.org/10.1002/pon.3302
- 39Phelan SM, Griffin JM, Jackson GL, Zafar SY, Hellerstedt W, Stahre M, et al. Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer. Psychooncology. 2013; 22: 65–73. https://doi.org/10.1002/pon.204
- 40Yilmaz M, Dissiz G, Usluoğlu AK, Iriz S, Demir F, Alacacioglu A. Cancer-related stigma and depression in cancer patients in a middle-income country. Asia-Pac J Oncol Nurs. 2020; 7(1): 95–102. https://doi.org/10.4103/apjon.apjon_45_19
- 41Pearl RL, Puhl RM, Lessard LM, Himmelstein MS, Foster GD. Prevalence and correlatses of weight bias internalization in weight management: a multinational study. SSM-Popul Health. 2021; 13:100755. https://doi.org/10.1016/j.ssmph.2021.100755
- 42Pachankis JE, Hatzenbuehler ML, Wang K, Burton CL, Crawford FW, Phelan JC, et al. The burden of stigma on health and well-being: a taxonomy of concealment, course, disruptiveness, aesthetics, origin, and peril across 93 stigmas. Pers Soc Psychol Bull. 2018; 44(4): 451–74. https://doi.org/10.1177/0146167217741313
- 43Nosek MA, Hughes RB, Swedlund N, Taylor HB, Swank P. Self-esteem and women with disabilities. Soc Sci Med. 2003; 56(8): 1737–47. https://doi.org/10.1016/s0277-9536(02)00169-7
- 44Turan JM, Elafros MA, Logie CH, Banik S, Turan B, Crockett KB, et al. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med. 2019; 17(1): 7. https://doi.org/10.1186/s12916-018-1246-9
- 45Gonzalez JS, Peyrot M, McCarl LA, Collins EM, Serpa L, Mimiaga MJ, et al. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care. 2008; 31(12): 2398–403. https://doi.org/10.2337/dc08-1341
- 46Roy T, Lloyd CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord. 2012; 42(Suppl): S8–21. https://doi.org/10.1016/S0165-0327(12)70004-6
- 47Hedayati SS, Minhajuddin AT, Toto RD, Morris DW, Rush AJ. Prevalence of major depressive episode in CKD. Am J Kidney Dis. 2009; 54(3): 424–32. https://doi.org/10.1053/j.ajkd.2009.03.017
- 48Kato A, Fujimaki Y, Fujimori S, Izumida Y, Suzuki R, Ueki K, et al. A qualitative study on the impact of internalized stigma on type 2 diabetes self-management. Patient Educ Couns. 2016; 99(7): 1233–9. https://doi.org/10.1016/j.pec.2016.02.002
- 49Sakurai N. The moderating effects of positive appraisal on the burden of family caregivers of older people. Jpn J Psychol. 1999; 70(3): 203–10. https://doi.org/10.4992/jjpsy.70.203 (in Japanese).
- 50Lasalvia A, Van Bortel T, Bonetto C, Jayaram G, van Weeghel J, Zoppei S, et al. Cross-national variations in reported discrimination among people treated for major depression worldwide: the ASPEN/INDIGO international study. Br J Psychiatry. 2015; 207(6): 507–14. https://doi.org/10.1192/bjp.bp.114.156992
- 51Fukuhara S, Lopes AA, Bragg-Gresham JL, Kurokawa K, Mapes DL, Akizawa T, et al. Worldwide dialysis outcomes and practice patterns study. Health-related quality of life among dialysis patients on three continents: the dialysis outcomes and practice patterns study. Kidney Int. 2003; 64(5): 1903–10. https://doi.org/10.1046/j.1523-1755.2003.00289.x
- 52Freidl M, Piralic Spitzl S, Aigner M. How depressive symptoms correlate with stigma perception of mental illness. Int Rev Psychiatry. 2008; 20(6): 510–4. https://doi.org/10.1080/09540260802565422