2204. In HCV-Infected Patients, Internalized Stigma, but not Experienced Stigma, Is Correlated with Psychological State and Health-Related Quality of Life: Baseline Data from the PROP UP Study

Abstract

Background

Chronic viral infections often give rise to stigma, whether experienced from others and society or internalized as feelings of shame or embarrassment. Stigma in turn may influence psychological state and health-related quality of life (HRQOL). Stigma in hepatitis C virus (HCV) infection has been studied qualitatively. However, a quantitative analysis of experienced stigma (ExpSt) and internalized stigma (IntSt) in people with chronic HCV infection has not yet been reported.

Methods

The SSCI-8 scale, also known as the NeuroQOL-Stigma, is an eight-item patient reported outcome (PRO) instrument validated in the NIH PROMIS collaboration. Of the SSCI-8 items, six are associated with ExpSt and 2 with IntSt. The SSCI-8 was administered to 1,602 participants with HCV infection at the baseline visit of the PROP UP Study, an investigation of PRO before, during, and after HCV therapy. The subscores (ExpSt and IntSt) were each examined for association with demographic factors (DF: age, birth sex, race, educational level, household income, marital status, and employment status). Multivariate linear regression, adjusting for DF, was used to evaluate correlation of ExpSt and IntSt to PRO measures tapping mental health constructs (depression, anxiety, anger, fatigue, and sleep disturbance) and overall HCV-specific HRQOL (the HCV-PRO scale).

Results

Of the 1,602 participants receiving the baseline survey, 1,300 answered all eight stigma items; of this subset, less than 10 had missing data for any other individual question studied. IntSt items were endorsed more frequently (55.8% at least 1 of 2) than ExpSt items (38.8% at least 1 of 6; P < 0.001). In multivariable analyses, ExpSt was independently correlated with age, marital status, and employment status; and IntSt with all DF except education. After adjusting for DF, IntSt, but not ExpSt, independently predicted depression ( β = 2.2), anxiety ( β = 2.1), anger ( β = 1.9), fatigue ( β = 2.0), sleep disturbance ( β = 1.6), and HRQOL ( β = −6.1; all P < 0.001).

Conclusion

In persons living with HCV, IntSt (but not ExpSt) is correlated with multiple PRO measures of psychological state and HRQOL.

Disclosures

D. Evon, Gilead: Investigator, Research support.