Self-Esteem and Coping Modes as Mediators of the Social Support-Stigma Relationship in Rheumatoid Arthritis Patients:...

To explore the chain mediating effects of self-esteem and coping modes on the relationship between social support and stigma with rheumatoid arthritis patients and to identify actionable targets for nursing interventions.

A multicentre, cross-sectional, correlational study.

Using convenience sampling, RA patients were recruited from the rheumatology departments of four hospitals in China, from June to September 2023. The Internalized Stigma of Mental Illness Scale-Rheumatoid Arthritis (ISMI-RA), Social Support Rating Scale (SSRS), Rosenberg Self-Esteem Scale (RSES) and Medical Coping modes Questionnaire (MCMQ) were used to assess the patients' stigma, social support, self-esteem and coping styles. SAS 9.4 software was used for statistical analysis. Normally distributed continuous data were described using means and standard deviations. Independent sample t-tests and analysis of variance (ANOVA) were used for comparisons between groups. The Pearson correlation coefficient was used to describe the degree of correlation between variables. The chain mediating model was constructed using AMOS 24.0 software, and the maximum likelihood method was used for model parameter estimation, and the model was adjusted according to the modification index.

Mean participant age was 53.62 ± 12.40 years. Stigma scores differed significantly by family history, income, education, morning stiffness duration, DAS28 and pain level (all p < 0.001). Stigma correlated negatively with self-esteem (r = -0.482), confrontation coping (r = -0.512) and social support (r = -0.590) and positively with avoidance (r = 0.251) and acceptance coping (r = 0.462). Social support was directly associated with stigma (β = -0.502) and also indirectly associated through self-esteem and coping modes, with the indirect pathways accounting for 31.51% of the total association.

The findings suggest that patients with RA frequently experience moderate stigma, and that self-esteem and coping modes may serve as chain mediators between social support and stigma. Nurses may consider assisting patients in building positive social support networks, enhancing their self-esteem and promoting positive coping modes as potential strategies to reduce stigma.