The extent to which individuals perceive stigma from others and internalize stigmatizing beliefs is increasingly recognized as a contributor to psychological and physical distress. Individuals in poverty may feel increasingly stigmatized as a result of financial hardship; however, little research has examined the linkage of financial stigma to health outcomes, nor the potential underlying explanatory mechanisms of such an association. According to self-determination theory, loss of social capital, which often occurs when a person is stigmatized, may deleteriously affect health outcomes, yet this premise has not been tested. We assessed the incremental impact of sociodemographic characteristics, and experienced and internalized financial stigma, on health-related quality of life (HRQL), as well as the mediating effect of belongingness, in a sample of 100 working, uninsured primary care patients. Results confirmed that experienced and internalized perceived stigma contributed additional variance, over the effects of sociodemographic factors, to poor HRQL, and belongingness was a significant mediator. Financial stigma may increase isolation, reducing opportunities for meaningful social connections, thereby deleteriously impacting mental and physical health outcomes. Therapeutically addressing stigma, and bolstering social connectedness, may improve HRQL in the underserved and impoverished.

Recent changes in health care policy, which mandate the monitoring of illness symptoms and improving the satisfaction of medical patients, may shed light on possible points of intervention to improve patient-centered outcomes. Health-related quality of life (HRQL), or one’s appraisal of their mental and physical functioning, is a frequently-used metric relevant to improved health care outcomes. HRQL may be impacted by multiple inter- and intra-personal factors, whether an adaptive (e.g., social problem solving ability) or maladaptive effect (e.g., thwarted interpersonal needs, depression). We examined the association between social problem solving ability and mental and physical HRQL, and the potential mediating roles of thwarted interpersonal needs and depressive symptoms. Participants (N=223) were middle-aged and recruited from a primary care clinic. Our hypotheses that thwarted interpersonal needs and depressive symptoms would sequentially mediate the association between independent scales of social problem solving (negative problem orientation, positive problem orientation, rational problem solving, impulsive/careless style, avoidant style) and HRQL (mental and physical), were largely supported. Our findings highlight the importance of social problem solving ability as a potential point of intervention to improve mood, interpersonal functioning, and mental and physical health in an integrated care setting. Strategies such as Social Problem Solving Therapy might be particularly effective in bolstering social problem solving, with consequent beneficial effects on interpersonal functioning and mood, thereby improving overall health-related quality of life.

Stigmatization involves the application of labels to individuals in social contexts, leading to impaired access to social, economic, and political power. Although actual stigmatizing beliefs that society holds about particular groups are important, the extent to which individuals themselves perceive stigma from others and internalize stigmatizing beliefs is being increasingly recognized as a cause of psychological and physical distress. Little research has been done on explanatory mechanisms of the relations between perceived stigma and health outcomes, particularly in the area of stigma related to finances. Two important dimensions of overall health include depressive symptoms and health-related quality of life. According to Self-Determination Theory feeling controlled by external forces decreases subjective vitality, a measure of energy that is available to self for engaging in life pursuits. Changes in subjective vitality may, in turn, affect health outcomes. Interpersonal variables including how connected one feels with others and whether or not one feels like a burden may affect the manner in which stigma relates to subjective vitality and health. In the current study a sample of 100 individuals receiving medical treatment from a primary clinic that targets the working uninsured population in a region of Appalachia completed questionnaires assessing for perceived stigma of finances, depressive symptoms, health-related quality of life, subjective vitality, thwarted belongingness, and perceived burdensomeness. Results confirmed that experienced and internalized perceived stigma were moderately associated with poorer health outcomes and lower subjective vitality. Thwarted belongingness and perceived burdensomeness were, likewise, associated with worse health outcomes. In mediation analyses subjective vitality significantly explained the relations between each dimension of stigma and each outcome. Subsequent conditional indirect effect analyses found that thwarted belongingness moderated the mediation effect for some of the models by impacting the relation between stigma and subjective vitality or by moderating the relation between subjective vitality and the dependent variable. The findings suggest the importance of subjective vitality and feelings of belongingness in understanding how perceived stigma negatively affects health. Results and implications are discussed along with considerations for future research and interventions.