source: The Journal of Pain

year: 2016

authors: M. Ezenwa, Y. Yao, R. Molokie, Z. Wang, M. Suarez, Z. Zhao, J. Carrasco, V. Angulo, D. Shuey, K. Roach, G. Oraifo, D. Wilkie

Stigma is associated with adverse health outcomes. Patients with sickle cell disease (SCD) experience stigma because of their minority status, frequency of their acute healthcare utilization, and chronic use of opioids for pain management. There is minimal research on the association of sickle cell-related stigma (stigma) with physical and emotional symptoms in adult patients with SCD. This descriptive comparative study was conducted to determine the association of stigma with physical (pain and fatigue) and emotional (anger, anxiety, and depression) symptoms in patients with SCD. Patients (N=52, mean age 36.1±10.9 years [ranged from 22-74 years], 96% African-American, 56% female) recruited between March-November 2015 completed PAINReportIt, a computerized pain measure, demographic questions, the Sickle Cell Stigma Scale, and the PROMIS measures (anger, anxiety, and depression). Data were analyzed using the statistical software R. The mean scores for the study variables were: Stigma (2.3±1.0); average pain intensity (4.0±2.3); fatigue (56.3±9.5); anger (51.1±12.6); anxiety (52.8±9.3); and depression (51.8±10.2). Our comparative analysis results indicated that there were statistically significant differences between Low Stigma (<=2, n=26) and High Stigma (>2, n=26) groups on study variables. Patients who reported high stigma were more likely to report increased: fatigue (p<.001); anger (p<.001); anxiety (p<.001); and depression (p<.001) than patients who reported low stigma. Patient who reported high stigma and those who reported low stigma did not differ on average pain intensity (p=.07). Findings provide preliminary evidence of the association of stigma with fatigue, anger, anxiety, and depression in patients with SCD. Results from future studies will provide additional evidence to better understand the influence of stigma on physical and emotional symptoms in patients with SCD, and likely inform future intervention studies to decrease stigma in this vulnerable pain patient population.

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