Impact of disease- and race-based discrimination in health care on pain outcomes among adults living with sickle cell disease in the United States: The mediating roles of internalized stigma and depressive symptoms.

Studies have shown that disease- and race-based discrimination in healthcare exacerbate pain, yet little is known about the role of psychological processes and symptoms, such as internalized stigma and depressive symptoms, in the relationship between discrimination (i.e., enacted stigma) and pain. In a sample of 284 Black adults living with sickle cell disease (SCD) (54% women, Mage = 35.37), we examined internalized stigma and depressive symptoms as mediators between disease- and race-based discrimination in healthcare and pain severity and interference. Disease-based but not race-based discrimination in healthcare was associated with internalized stigma, depressive symptoms, and pain severity and interference. Furthermore, internalized stigma and depressive symptoms partially mediated the association between disease-based discrimination in healthcare and pain severity and interference. Results suggest that individuals with SCD who experience discrimination, including based on their SCD status, may internalize these discriminatory messages from others, leading to negative thoughts and feelings about having SCD. These negative internalized beliefs may then contribute to depressive symptoms and subsequent worse pain. Internalized stigma and depressive symptoms may be potential treatment targets in behavioral and psychological interventions. More research is needed to understand the impact of intersecting experiences of discrimination and stigma on health outcomes in adults living with SCD.