The Association between Illness-Related Stigma and Mental Well-Being among Cancer Survivors in Yunnan, China

Background: Stigma affects the mental well-being of cancer survivors. However, data are scarce regarding the extent to which specific types of stigmas, enacted stigma (stigma from others), and self-stigma (internalized stigma), affect mental well-being. The objective of this study is to describe the extent to which overall illness-related stigma, self-stigma, and enacted stigma are associated with mental well-being among cancer survivors. Methods: A cross-sectional study in Kunming, Yunnan, China, was conducted. Eligible participants were adult cancer survivors who completed a phone-to-WeChat, self-administered survey. Illness-related stigma was measured with the Stigma Scale for Chronic Illnesses, 8-item version (SSCI-8). Mental well-being was assessed with the WHO-5 (range: 0 to 100 points). We analyzed data using multivariable regression analyses with adjustment for age, sex, education, income, occupation, social support (measured using the MSPSS), resilience (measured using the CD-RISC-10), and financial burdens (measured using the EORTC QLQ-C30). Results: We summarized characteristics and used multivariable linear regression to assess the association between stigma and WHO-5, adjusting a priori for confounders. In logistic regression, we modeled low well-being (WHO-5 < 50 points) with logistic regression and explored dose-response using stigma quartiles. Of 480 invited patients, 432 (90.0%) participated. Overall, 62% had good mental well-being (WHO-5 > 50 points); ~60% reported high social support, 50% high resilience, and ~30% financial burdens. In multivariable models, overall stigma was inversely and significantly associated with well-being (β = −0.27, 95% CI: −0.52, −0.02), enacted stigma was not (β = −0.35; 95% CI: −0.75, 0.05), and self-stigma showed a stronger inverse association (β = −0.85, 95% CI: −1.47, −0.23). Conclusions: Logistic regression using stigma quartiles and a binary WHO-5 outcome showed the same pattern, with self-stigma effects plateauing in higher quartiles and overall/enacted stigma following an inverse U-shape. Self-stigma was adversely associated with mental well-being among cancer survivors in Yunnan. The findings provide potentially useful basic information for stakeholders in oncology and mental health.