Stigma and Distress among Cancer Patients: The Mediating Effect of Self-blame

Kyung Mi Yang; Myeong Jeong Chae; Hyang Sook So

doi:10.7475/KJAN.2018.30.1.89

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Yang, Chae, and So: Stigma and Distress among Cancer Patients: The Mediating Effect of Self-blame

Original Research

Korean J Adult Nurs 2018;30(1):89-97.

Published online: 18 February 2018

DOI: https://doi.org/10.7475/KJAN.2018.30.1.89

Stigma and Distress among Cancer Patients: The Mediating Effect of Self-blame

Kyung Mi Yang¹, Myeong Jeong Chae², Hyang Sook So^3,

^¹Chonnam Research Institute of Nursing Science, Gwangju, Korea

^²Department of Nursing, Kwangju Women's University, Gwangju, Korea

^³College of Nursing, Chonnam National University, Gwangju, Korea

Corresponding author: So, Hyang Sook https://orcid.org/0000-0002-2919-5900 College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea. Tel: +82-62-530-4939, Fax: +82-62-220-4544, E-mail: hsso0075@jnu.ac.kr

Received 7 November 20174 January 2018 Accepted 16 February 2018

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the mediating effect of reported self-blame in the relationship between stigma and distress among cancer patients.

Methods

A convenience sample of 247 inpatients and out-patients diagnosed with one of the five major cancers was recruited. A cross-sectional survey design was used. Data were collected from June 2013 to November 2013. The instruments used for data collection were the Korean Cancer Stigma Scale, the Psychological Symptom Inventory, and the Social Shame and Guilt Scale. Data were analyzed using descriptive statistics, correlation, and multiple regression using Baron and Kenny steps for mediation.

Results

The mean score reported for cancer stigma was 35.34, the mean score for distress was 13.77, and the mean for self-blame was 19.25. There was a significant correlation among stigma, distress, and self-blame. Self-blame was directly affected by stigma (R²=34.3%). Distress was directly affected by stigma (R²=13.0%). Stigma and self-blame impacted reported distress (R²=20.9%). Self-blame had a partial mediating effect (β=.35, p<.001) in the relationship between stigma and distress (Sobel test: Z=3.64, p<.001).

Conclusion

Based on the findings of this study, nursing intervention programs focusing on reducing stigma and decreasing self-blame may relieve the distress reported by patients with cancer.

Keywords: Social stigma, Shame, Guilt, Neoplasms, Mediating

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Figure 1.

Mediating effect of self-blame in the relationship between stigma and distress.

Table 1.

Stigma, Self-blame, and Distress according to General Characteristics of Participants (N=247)

Variables	Categories	n (%) or M±SD	Stigma		Self-blame		Distress
Variables	Categories	n (%) or M±SD	M± SD	t or F (p)	M± SD	t or F (p)	M± SD	t or F (p)
Age (year)	40~49	72(29.3)	36.49±9.00	1.23	20.57±7.96	2.11	9.63±6.43	1.30
	50~59	60(24.4)	35.42±9.70	(.300)	19.63±7.77	(.100)	7.68±7.42	(.275)
	60~69	68(27.6)	35.60±8.40		17.51±6.28		7.68±7.00
	≥70	46(18.7)	33.24±9.22		19.22±7.15		7.83±6.77
		57.3±12.3	35.37±9.07		19.24±7.38		8.28±6.91
Gender	Men	98(39.7)	36.11±9.26	1.08	18.48±6.84	-1.34	6.06±5.88	-4.20
Gender	Women	149(60.3)	34.84±8.93	(.281)	19.76±7.66	(.182)	9.71±7.16	(＜.001)
Spouse	Yes	215(87.0)	34.90±8.81	-1.99	18.99±7.37	-1.44	8.05±6.69	-1.28
Spouse	No	32(13.0)	38.31±10.27	(.047)	21.00±7.17	(.150)	9.72±8.17	(.202)
Religion	None	85(34.4)	34.39±8.22	1.14	18.19±6.98	0.85	8.27±6.86	0.52
	Protestantism	75(30.4)	36.32±10.29	(.336)	19.96±7.64	(.496)	7.53±6.48	(.723)
	Catholicism	24(9.7)	37.63±9.06		19.83±8.00		8.96±7.26
	Buddhism	60(24.3)	34.83±8.58		19.78±7.39		9.00±7.40
	Others	3(1.2)	30.00±6.56		16.33±4.93		6.00±7.94
Monthly household income (10,000 won)	50~＜100	97(39.3)	34.15±8.34	1.06	19.14±7.30	1.28	7.41±7.38	0.85
	100~＜200	93(37.7)	35.84±9.88	(.369)	18.49±7.33	(.281)	8.69±6.72	(.466)
	200~＜300	32(13.0)	36.84±10.14		21.19±6.85		9.31±6.95
	≥300	25(10.0)	36.48±6.91		20.48±8.46		8.48±5.65
Education level	Illiteracy	15(6.0)	34.93±11.76	1.71	21.60±7.78	2.20	9.80±9.69	2.10
	Elementary	47(19.0)	32.77±6.39	(.149)	17.28±5.66	(.069)	6.51±6.16	(.081)
	Middle school	58(23.5)	34.69±8.47		18.21±6.58		7.38±7.05
	High school	91(36.8)	36.63±10.14		19.88±7.90		8.66±6.67
	≥ College	36(14.7)	36.69±8.44		20.94±8.39		10.33±6.40
Cancer stage	I	58(23.5)	33.45±7.67	1.19	18.03±7.15	8.79	8.91±7.19	1.69
	II	41(16.6)	36.22±8.70	(.310)	20.29±6.46	(.452)	10.05±7.34	(.170)
	III	47(19.0)	35.36±10.54		19.11±7.72		7.38±6.29
	IV	101(40.9)	36.07±9.18		19.59±7.66		7.57±6.76
Diagnosis	Colon cancer ^a	50(20.3)	38.20±11.30	1.96	20.06±7.56	2.50	8.80±5.48	8.70
	Breast cancer ^b	51(20.6)	33.94±7.71	(.101)	18.73±7.86	(.044)	8.53±6.44	(.001)
	Cervix cancer ^c	50(20.3)	35.55±9.16		21.30±7.14		12.34±7.73	c＞ d, e
	Gastric cancer ^d	49(19.8)	35.28±8.40		16.90±6.53		5.90±5.96
	Lung cancer ^e	47(19.0)	33.76±8.00		19.23±7.19		5.53±6.72

Table 2.

Descriptive Statistics of Research Variables (N=247)

Variables	M± SD	Item number (scoring)	Range		Mean/item± SD
Variables	M± SD	Item number (scoring)	Possible	Actual	Mean/item± SD
Stigma	35.34±9.07	24 (1~4)	24~96	24~86	1.41±0.36
Self-blame	19.25±7.36	10 (1~5)	10~50	10~46	1.93±0.74
Distress	8.26±6.90	3 (0~10)	0~30	0~30	2.75±2.30

Table 3.

Relationships between Stigma, Self-blame, and Distress (N=247)

Variables	Stigma	Self-blame	Distress
Variables	r (p)	r (p)	r (p)
Stigma	1	.59 (＜.001)	.37 (＜.001)
Self-blame		1	.45 (＜.001)
Distress			1

Table 4.

Mediating Effect of Self-blame in the Relationships between Stigma and Distress (N=247)

Step		Variables		B	β	t	p	Adj. R²	F	p
Step 1	Stigma	→	Self-blame	.48	.59	11.39	＜.001	.343	129.66	＜.001
Step 2	Stigma	→	Distress	.49	.37	6.14	＜.001	.130	37.64	＜.001
Step 3	Stigma, Self-blame	→	Distress					.209	33.48	＜.001
	1) Stigma	→	Distress	.21	.16	2.23	.027
	2) Self-blame	→	Distress	.59	.35	5.06	＜.001
Sobel test : Z=3.64, p＜.001

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