Abstract
Purpose: This study aimed to (1) assess perceived stigma, behavioural self-blame (BSB) and characterological self-blame (CSB) among Vietnamese advanced cancer patients, and (2) to investigate the associations between perceived stigma and psychosocial well-being, and between self-blame (behavioural and characterological) and psychosocial well-being.
Methods: This study involved 200 Vietnamese stage-4 solid cancer patients. Psychosocial well-being was measured using Center for Epidemiologic Studies Depression Scale (CES-D), and the social wellbeing (SWB) and emotional well-being (EWB) domains of the Functional Assessment of Cancer Therapy-General. Perceived stigma was assessed using sense of stigma subscale from Kissane’s Shame and Stigma Scale. BSB and CSB were identified when patients reported their behaviour or character as the reason for their cancers. Multivariable linear or logistic regressions were used to investigate the associations while controlling for patient characteristics.
Results: A large proportion of patients reported perceived stigma [%, 95% Confidence Interval(CI)=79.0% (72.7%,84.1%)], BSB [%(CI)=56.3% (49.3%,63.1%)] or CSB [%(CI)=62.3% (36.9%,50.7%)]. Patients who perceived stigma reported lower EWB [ß(CI)=-0.3 (-0.4,-0.1); p=0.004) and greater depressive symptoms [ß(CI)=0.6 (0.3,0.9); p=0.000). BSB was not significantly associated with poorer psychosocial outcomes while patients with CSB reported lower EWB [ß(CI)=-1.8 (-3.4,-0.3); p=0.021] and greater depressive
symptoms [ß(CI)=2.7 (0.1,5.4); p=0.045].
Conclusion: This study showed that most patients perceived stigma and reported BSB or CSB; and perceived stigma and CSB were associated with lower EWB and greater depressive symptoms among Vietnamese patients. Interventions should be developed to reduce perceived stigma and self-blame among this population.
References
Conlon A, Gilbert D, Jones B, Aldredge P. Stacked stigma: oncology social workers’ perceptions of the lung cancer experience. Journal of psychosocial oncology 2010;28:98-115
Else-Quest NM, LoConte NK, Schiller JH, Hyde JS. Perceived stigma, self-blame, and adjustment among lung, breast and prostate cancer patients. Psychology and Health 2009;24:949-964
Gulyn LM, Youssef F. Attribution of blame for breast and lung cancers in women. Journal of Psychosocial Oncology 2010;28:291-301
Holland JC, Kelly BJ, Weinberger MI. Why psychosocial care is difficult to integrate into routine cancer care: stigma is the elephant in the
room. Journal of the National Comprehensive Cancer Network 2010;8:362-366
Vodermaier A, Esplen MJ, Maheu C. Can self-esteem, mastery and perceived stigma predict long-term adjustment in women carrying a
BRCA1/2-mutation? Evidence from a multicenter study. Familial cancer 2010;9:305-311
Goffman E, Stigma: Notes on the Management of Spoiled Identity Penguin. 1968, Harmonds.
Gonzalez BD, Jacobsen PB. Depression in lung cancer patients: the role of perceived stigma. Psycho‐Oncology 2012;21:239-246
Lee JL, Kim KSJJoKON. The relationships between stigma, distress, and quality of life in patients with lung cancer. 2011;11:237-246
Nipp RD, El‐Jawahri A, Fishbein JN, Eusebio J, Stagl JM, Gallagher ER, et al. The relationship between coping strategies, quality of life,
and mood in patients with incurable cancer. 2016;122:2110-2116
Phelan SM, Griffin JM, Jackson GL, Zafar SY, Hellerstedt W, Stahre M, et al. Stigma, perceived blame, self‐blame, and depressive symptoms in men with colorectal cancer. Psycho‐oncology 2013;22:65-73
Ernst J, Mehnert A, Dietz A, Hornemann B, Esser P. Perceived stigmatization and its impact on quality of life-results from a large register-based study including breast, colon, prostate and lung cancer patients. BMC cancer 2017;17:741
Janoff-Bulman R. Characterological versus behavioral self-blame: Inquiries into depression and rape. Journal of personality and social psychology 1979;37:1798
Li L, Zhu X, Yang Y, He J, Yi J, Wang Y, et al. Cognitive emotion regulation: characteristics and effect on quality of life in women with breast cancer. Health and quality of life outcomes 2015;13:51
Plaufcan MR, Wamboldt FS, Holm KEJJopr. Behavioral and characterological self-blame in chronic obstructive pulmonary disease. 2012;72:78-83
Tangney JP, Dearing RL, Shame and guilt. 2003: Guilford Press.
(IARC) IAfRoC. Global Cancer Observatory-Vietnam Population fact sheets. 26-Mar-2020]; Available from: http://gco.iarc.fr/today/data/factsheets/populations/704-viet-nam-factsheets.pdf.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians 2018;68:394-424
Anh PTH, Duc NB. The situation with cancer control in Vietnam. Japanese Journal of Clinical Oncology 2002;32:S92-S97
Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychosocial factors contribute to cancer incidence and survival? Nature clinical practice Oncology 2008;5:466-475
Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. American journal of public health
;103:813-821
Kissane DW, Patel SG, Baser RE, Bell R, Farberov M, Ostroff JS, et al. Preliminary evaluation of the reliability and validity of the Shame and Stigma Scale in head and neck cancer. Head & neck 2013;35:172-183
Thomas JL, Jones GN, Scarinci IC, Mehan DJ, Brantley PJ. The utility of the CES-D as a depression screening measure among low-income women attending primary care clinics. The International Journal of Psychiatry in Medicine 2001;31:25-40
DC, Manual of the Functional Assessment of Chronic Illness Therapy (FACIT Scales) (Version 4.1). 2004: Evanston, IL: Center on Outcomes Research and Education (CORE) Evanston Northwestern Healthcare.
Tseng W-T, Lee Y, Hung C-F, Lin P-Y, Chien C-Y, Chuang H-C, et al. Validation of the Chinese version of the shame and stigma scale in patients with head and neck cancer. Cancer Management and Research 2019;11:10297
Chambers SK, Baade P, Youl P, Aitken J, Occhipinti S, Vinod S, et al. Psychological distress and quality of life in lung cancer: the role of health‐related stigma, illness appraisals and social constraints. Psycho‐Oncology 2015;24:1569-1577
Brown Johnson CG, Brodsky JL, Cataldo JK. Lung cancer stigma, anxiety, depression, and quality of life. Journal of psychosocial oncology
;32:59-73
Tilghman-Osborne C, Cole DA, Felton JW, Ciesla JA. Relation of guilt, shame, behavioral and characterological self-blame to depressive symptoms in adolescents over time. Journal of Social and Clinical Psychology 2008;27:809-842
Bennett KK, Compas BE, Beckjord E, Glinder JGJJoBM. Self-blame and distress among women with newly diagnosed breast cancer. 2005;28:313-323
Glinder JG, Compas BEJHP. Self-blame attributions in women with newly diagnosed breast cancer: A prospective study of psychological adjustment. 1999;18:475
Malcarne VL, Compas BE, Epping-Jordan JE, Howell DCJJoBM. Cognitive factors in adjustment to cancer: Attributions of self-blame and perceptions of control. 1995;18:401-417
Dalton R, Ong N-N, Hac PM, Nghi PT. Social relations and social capital in Vietnam: Findings from the 2001 World Values Survey. Comparative Sociology 2002;1:369-386
Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Kwete XJ, et al. Alleviating the access abyss in palliative care and pain relief an imperative of universal health coverage: the Lancet Commission report. The Lancet 2018;391:1391-1454
Published | 03-03-2025 | |
Fulltext |
|
|
Language |
|
|
Issue | No. 64 (2020) | |
Section | Original article | |
DOI | 10.38103/jcmhch.2020.64.2 | |
Keywords | perceived stigma, behavioural self-blame, characterological self-blame, Vietnam, advanced cancer |

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2020 Journal of Clinical Medicine Hue Central Hospital