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

Kyung Mi Yang1, Myeong Jeong Chae2, Hyang Sook So3
Korean Journal of Adult Nursing 2018;30(1):89-97.
Published online: February 18, 2018

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: November 7, 2017   • Accepted: February 16, 2018

© 2018 Korean Society of Adult Nursing

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.

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  • 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.
  • Key Words: Social stigma; Shame; Guilt; Neoplasms; Mediating
Figure 1.
Mediating effect of self-blame in the relationship between stigma and distress.
kjan-30-89f1.jpg
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
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
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
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
Possible Actual
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
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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    DOI: https://doi.org/10.7475/kjan.2018.30.1.89
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    Stigma and Distress among Cancer Patients: The Mediating Effect of Self-blame
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    DOI: https://doi.org/10.7475/kjan.2018.30.1.89
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    Stigma and Distress among Cancer Patients: The Mediating Effect of Self-blame
    Image
    Figure 1. Mediating effect of self-blame in the relationship between stigma and distress.

    Figure 1.

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

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

    Variables Categories n (%) or M±SD Stigma Self-blame Distress
    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
    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
    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  

    Descriptive Statistics of Research Variables (N=247)

    Variables M± SD Item number (scoring) Range Mean/item± SD
    Possible Actual
    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

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

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

    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
    Table 1. Stigma, Self-blame, and Distress according to General Characteristics of Participants (N=247)

    Table 2. Descriptive Statistics of Research Variables (N=247)

    Table 3. Relationships between Stigma, Self-blame, and Distress (N=247)

    Table 4. Mediating Effect of Self-blame in the Relationships between Stigma and Distress (N=247)

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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