Unveiling the cognitive burden: The impact of stigma on distorted thinking among individuals living with hepatitis B

Hepatitis B (HBV) is a prevalent chronic illness affecting approximately 254 million individuals worldwide, with China accounting for nearly one-third of cases. Despite its widespread impact, stigma associated with HBV significantly hinders access to testing, diagnosis, and treatment. This study investigates the relationship between HBV stigma and cognitive distortions among individuals living with HBV by analyzing 35,697 posts from Yiyou Forum, China's largest HBV online community. Utilizing a large language model (LLM) for stigma classification, posts were categorized into stigma-related (S-posts) and non-stigma-related (N-posts). A schema comprising 235 n-grams was employed to identify 12 types of cognitive distortions within these posts. Statistical analyses revealed that S-posts had a prevalence ratio (PR) of 1.824 (95%CI [1.636, 2.074]) for cognitive distortions compared to N-posts, indicating that distorted thinking patterns were approximately 1.8 times more common in stigma-related discussions. Specific distortions such as disqualifying the positive, labeling and mislabeling, mental filtering, and should statements were significantly more prevalent in S-posts. User-level analysis confirmed that individuals engaging in stigma-related posts consistently displayed higher levels of cognitive distortions. These insights underscore the potential of targeted cognitive-behavioral therapy (CBT) interventions to address and mitigate cognitive distortions, thereby alleviating the psychological burden of HBV stigma. Additionally, this study demonstrates the efficacy of advanced computational methods in psychological research.