(PS2-B45) Stigma and Perception of Depression and Chronic Pain Among Healthy Individuals

Background: Important healthcare decisions are often made by individuals who do not themselves have an illness, such as caregivers, policymakers, and providers. Factors such as stigma are likely to affect decisions regarding health and especially about mental illness (Bathje and Pryor, 2011; Corrigan et al., 2005). Tools from health economics have been used to understand individuals’ utility valuation (i.e., perceived desirability or undesirability) of their health states, including mental health (Konig et al., 2012). However, little research has analyzed whether stigma regarding mental and physical illnesses is related to the valuation of mental and physical illnesses by healthy individuals.

Methods: 60 healthy participants (mean age = 41.92, SD = 15.04; 55% Male) were recruited via flyers, local posts on Craigslist, and other local advertisements, as part of a larger study (Leykin et al., 2017). Participants underwent a clinical interview and completed several measures, including Depression Self Stigma Scale (Kanter et al. 2008), with was also converted to measure chronic pain (Naushad et al., 2018), and further adjusted for healthy controls by presenting some questions as hypotheticals and eliminating one subscale. Participants were administered utility elicitation tasks including the time-trade-off (TTO). TTO measures the utility of health states based on willingness to hypothetically give up years of life to attain better health. Participants evaluated two previously piloted (Leykin et al., 2017) descriptions of major depression and chronic pain; perfect health and a more ecologically valid mild version of the illness were used as reference points.

Results: Higher scores on two depression stigma subscales – Secrecy (depression should be kept a secret) and Treatment (treating depression is stigmatizing) were associated with higher utility values for description of depression (ps < .05), but only when the more ecologically valid mild depression was used as a comparator. Depression stigma subscales were not associated with utility values for description of chronic pain. Higher scores on two pain subscales – Public stigma (individuals with pain are inferior) and Treatment – were also related to higher utility values for depression, both with perfect health and mild depression as comparators (ps: .042 - .077). Pain stigma subscales were not associated with chronic pain utilities. Examining relative utilities for pain and depression, it appears that higher Public stigma and Treatment stigma for both depression and for chronic pain were associated with higher relative utilities for depression than for pain (all ps < .05).

Conclusion: Current results indicated that different aspects of stigma towards depression and chronic pain differentially impacted judgments of physical and mental health states for healthy individuals. These results may suggest that individuals more prone to stigmatizing health conditions may perceive depression to be more tolerable than chronic pain, which may indicate that some healthy individuals may underestimate the distress caused by depression.