The role of shame and self-esteem in the relationship between internalized health-related stigma and mental health symptoms in adults with chronic health conditions.

Internalized stigma has frequently been observed among people with chronic health conditions and is recognized as a distressing process that can harm emotional health. However, the disease-specific scope of previous studies has impeded the development of a nimbler framework of how the transdiagnostic concepts of stigma, shame, and self-esteem relate to mental health. The present research examined this through a preregistered cross-sectional analysis of 300 adults who reported at least one stigmatized chronic health condition (cancer, chronic pain, HIV, obesity, diabetes, or skin diseases). Moderated mediation analyses found that shame was positively associated with elevated depression (B = 0.13, p = 0.007), generalized anxiety (B = 0.13, p = 0.002), and social anxiety (B = 0.35, p < 0.001), and positively mediated the relationships between internalized health-related stigma and these outcomes (all p < 0.05). Higher self-esteem weakened shame's relationship with social anxiety (B = -0.01, p < 0.05). The results support further research into improving emotional health among chronic illness populations by addressing shame and fostering self-esteem.