The Contribution of Stigma on Depression Symptoms and Depression Status Among Individuals Living with Multiple Sclerosis

Background: Individuals diagnosed with multiple sclerosis (MS) often experience social stigma (Cook, Germano, & Stadler, 2016), but little is known about how stigma affects those in this population. Given both the debilitating physical symptoms of MS and its heavy toll on psychological health (i.e., approximately 50% of individuals with MS develop depression during their disease course (Patten, Fridhandler, Beck, & Metz, 2003)) research is needed to examine these issues.

Objectives: The goal of the current study was to clarify the role stigma plays in depression both concurrently and longitudinally among individuals living with MS.

Methods: Data were collected from 5,413 people living with MS as part of the semi-annual survey conducted by the North American Research Committee on Multiple Sclerosis (NARCOMS). Participants’ perceptions of stigma and their ratings of depression were collected in spring 2013; one year later ratings of depression were collected again. Hierarchical linear regressions tested stigma’s contribution to depression symptoms both concurrently and prospectively, while controlling for demographic and health behavior covariates. Psychosocial reserve, a composite made from measures of agency, a sense of belonging, and social support, was examined as a potential moderator of the stigma-depression relationship. 

Results: Controlling for covariates, stigma positively predicted concurrent depression and accounted for approximately 39% of the explained variance (F(1, 5313) = 835, p<.001). Stigma continued to predict significantly higher levels of depression one year later, even after additionally controlling for baseline depression. These analyses were replicated using a dichotomous measure of clinical depression status (depressed, not depressed) based on criteria from Marrie, Cutter, Tyry, Campagnolo, & Vollmer (2008).  Psychosocial reserve was found to moderate the concurrent relationship between stigma and depression symptoms (F(1,5312)=66.5, p<.001), such that stigma was more strongly predictive of depression for people with lower levels of reserve than those with higher levels.

Conclusions: Individuals with MS who report feeling stigmatized are more likely to be clinically depressed and are at a greater risk of increased depression one-year later. High levels of psychosocial reserve attenuate the relationship between stigma and depression.