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Psychological and behavioural patterns of stigma among patients with type 2 diabetes: a cross-sectional study
  1. Asuka Kato1,2,
  2. Yuko Fujimaki3,
  3. Shin Fujimori3,
  4. Akihiro Isogawa4,
  5. Yukiko Onishi5,
  6. Ryo Suzuki6,
  7. Toshimasa Yamauchi6,
  8. Kohjiro Ueki6,
  9. Takashi Kadowaki6,
  10. Hideki Hashimoto1
  1. 1Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
  2. 2The Health Care Science Institute, Tokyo, Japan
  3. 3Department of Internal Medicine, School of Medicine, Teikyo University, Tokyo, Japan
  4. 4Mitsui Memorial Hospital, Tokyo, Japan
  5. 5The Institute for Adult Diseases Asahi Life Foundation, Tokyo, Japan
  6. 6Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  1. Correspondence to Dr Asuka Kato; asukakato-tky{at}


Objectives The aim of this study was to test the psychological and behavioural patterns of stigma (self-esteem and social participation) and their relationship to self-stigma, patient activation for engaging in self-care and glycaemic control among patients with type 2 diabetes mellitus (T2DM).

Design A cross-sectional study.

Setting 2 tertiary-level hospitals and 2 secondary-level hospitals in Japan.

Participants A consecutive sample of 209 outpatients with T2DM. Inclusion criteria were as follows: presence of T2DM, age 20–74 years, no diagnosis of dementia and/or psychosis, and no need for urgent medical procedures.

Outcome measures Study measures included a self-administered questionnaire to assess the Rosenberg Self-Esteem Scale (SES), the 3 subscales of 36-question Short Form Health Survey (SF-36; Social Function, Role Physical, Role Emotional), Self-Stigma Scale and Patient Activation Measure (PAM-13). Glycated haemoglobin was obtained from same day blood work. In our previous qualitative study, we found that psychological and behavioural patterns of stigma varied according to patients' levels of illness-related self-esteem as well as attitudes towards social participation. For quantitative consistency, we used the SES scale to measure self-esteem and the SF-36 subscales to measure social participation. We then divided participants into 4 groups by exhibited psychological and behavioural patterns: group A (high SES/high SF-36), group B (high SES/low SF-36), group C (low SES/high SF-36) and group D (low SES/low SF-36).

Results Using analysis of covariance after controlling for age and sex, there was a significant difference in self-stigma levels between the four groups (F[3,203]=15.70, p<0.001). We observed the highest mean self-stigma levels in group D. Group D also had significantly lower PAM-13 scores than those of groups A (p<0.001) and B (p=0.02).

Conclusions The psychological and behavioural pattern of group D was found to be associated with higher levels of self-stigma and poorer patient activation for self-care.

  • Psychosocial, behavioral medicine
  • Diabetes education
  • Stigma

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  • Correction notice This article has been corrected since it was first published. The author proof corrections were missed out of the original version and have now been added in. Commas have been added into the F values throughout the paper to make them statistically correct.

  • Contributors AK conceptualised and designed the study. AK coordinated the study; acquired, analysed and interpreted the data; and prepared the paper. HH helped to analyse and interpret the data. AK and HH held primary responsibility for data access. YF, SF, AI, YO, RS, TY, KU and TK made significant contributions to the critical interpretation of results with regard to important practical content. All authors read and approved the final version of the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Research Ethics Committee of the University of Tokyo Graduate School of Medicine and Faculty of Medicine, and each participating facility.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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