The role of self-esteem as moderator of the relationship between experienced stigma and anxiety and depression among tuberculosis patients

Abstract

Anxiety and depression are very common in tuberculosis (TB) patients and can adversely affect TB treatment adherence, ultimately leading to higher morbidity, mortality and drug resistance. Therefore, the aim of this study was to identify the association among experienced stigma, self-esteem and anxiety and depression, and to further explore whether self-esteem could be a moderator in the association between experienced stigma and anxiety and depression in TB patients. A total of 473 TB patients from Dalian, Liaoning Province, Northeast China participated in a cross-sectional survey. A structured questionnaire was developed to collect data. Hierarchical multiple regression was used to analyze the association among experienced stigma, self-esteem and experienced stigma × self-esteem interaction with anxiety and depression. Simple slope analysis was applied to visualize the interaction. Experienced stigma was positively associated with anxiety (B = 0.307, P < 0.01) and depression (B = 0.277, P < 0.01), and self-esteem was negatively associated with anxiety (B = − 0.215, P < 0.01) and depression (B = − 0.351, P < 0.01) in TB patients. The association between experienced stigma and anxiety was different in the low (1 standard deviation (SD) below the mean, B = 0.376, standard error (SE) = 0.056, P < 0.01) and high (1 SD above the mean, B = 0.228, SE = 0.060, P < 0.01) groups of self-esteem. Additionally, the association between experienced stigma and depression was also different in the low (1 SD below the mean, B = 0.363, SE = 0.053, P < 0.01) and high (1 SD above the mean, B = 0.179, SE = 0.056, P < 0.01) groups of self-esteem. Self-esteem could moderate the association between experienced stigma and anxiety and depression. In addition to reducing experienced stigma, enhancing self-esteem as a way to reduce the impact of experienced stigma on anxiety and depression can also help improve the mental health of TB patients.

Programmatic implementation of depression screening and remote mental health support sessions for persons recently diagnosed with TB in Lima, Peru during the COVID-19 pandemic

“…While our data limits our ability to differentiate between these two possibilities, the high prevalence of depressive symptoms may be due to a variety of acute psychosocial stressors related to receiving a TB diagnosis and/or transitioning to receiving TB treatment (Sweetland et al, 2017 ). In particular, the perceived stigma associated with a TB diagnosis is notably high among persons with TB, and its sequelae (e.g., discrimination) are common means by which persons with TB may develop and experience depressive symptoms (Lee et al, 2017 ; Sweetland et al, 2017 ; Mohammedhussein et al, 2020 ; Chen et al, 2023 ). Thus, our findings suggest that the integration of early depression screening within TB screening programs could be useful in identifying a large sample of patients who may benefit from concurrent mental health care during their TB treatment, especially around the time of TB diagnosis and initiation of TB treatment.…”

Coping efforts made: Psychological burden of people living with tuberculosis due to social stigma in society. A qualitative phenomenology study

“…For this reason, people living with tuberculosis should explore the coping resources that can be used, to make them feel strong, resourceful, and flexible and use the coping resources they have to resolve the mental stress they feel [ 15 , 68 – 70 ]. Apart from that, other studies also report that discriminatory behavior due to public stigma aimed at TB sufferers is used as a trigger to increase self-esteem [ 71 ]. This makes them challenged to solve their problems, in the end, they have great hopes for achieving prosperity [ 72 ], and they must realize that the stigma against tuberculosis does exist, so it is important to expand the identification of the resources they have [ 73 ].…”

Prevalence and Determinants of Anxiety and Depression Among Healthcare Workers in Liaoning Province, China

“…It should also be noted that self-esteem has a direct impact on psychological distress, and moderates the relationship between negative events and emotional responses, ultimately offering protection for one's mental health. 53 People with low self-esteem often hold a negative view of themselves, which can worsen symptoms of anxiety and depression. When treating depression, it is important to focus on rebuilding and improving the patient's self-esteem.…”