Open Access

ARTICLE

The Association between Illness-Related Stigma and Mental Well-Being among Cancer Survivors in Yunnan, China

Yueting Zhang^1,2, Sawitri Assanangkornchai², Wit Wichaidit^2,*
1 The Second Affiliated Hospital, Kunming Medical University, Kunming, China
2 Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
* Corresponding Author: Wit Wichaidit. Email:

International Journal of Mental Health Promotion https://doi.org/10.32604/ijmhp.2026.079559

Received 23 January 2026; Accepted 25 March 2026; Published online 24 April 2026

Abstract

Background: Stigma affects the mental well-being of cancer survivors. However, data are scarce regarding the extent to which specific types of stigmas, enacted stigma (stigma from others), and self-stigma (internalized stigma), affect mental well-being. The objective of this study is to describe the extent to which overall illness-related stigma, self-stigma, and enacted stigma are associated with mental well-being among cancer survivors. Methods: A cross-sectional study in Kunming, Yunnan, China, was conducted. Eligible participants were adult cancer survivors who completed a phone-to-WeChat, self-administered survey. Illness-related stigma was measured with the Stigma Scale for Chronic Illnesses, 8-item version (SSCI-8). Mental well-being was assessed with the WHO-5 (range: 0 to 100 points). We analyzed data using multivariable regression analyses with adjustment for age, sex, education, income, occupation, social support (measured using the MSPSS), resilience (measured using the CD-RISC-10), and financial burdens (measured using the EORTC QLQ-C30). Results: We summarized characteristics and used multivariable linear regression to assess the association between stigma and WHO-5, adjusting a priori for confounders. In logistic regression, we modeled low well-being (WHO-5 < 50 points) with logistic regression and explored dose-response using stigma quartiles. Of 480 invited patients, 432 (90.0%) participated. Overall, 62% had good mental well-being (WHO-5 > 50 points); ~60% reported high social support, 50% high resilience, and ~30% financial burdens. In multivariable models, overall stigma was inversely and significantly associated with well-being (β = −0.27, 95% CI: −0.52, −0.02), enacted stigma was not (β = −0.35; 95% CI: −0.75, 0.05), and self-stigma showed a stronger inverse association (β = −0.85, 95% CI: −1.47, −0.23). Conclusions: Logistic regression using stigma quartiles and a binary WHO-5 outcome showed the same pattern, with self-stigma effects plateauing in higher quartiles and overall/enacted stigma following an inverse U-shape. Self-stigma was adversely associated with mental well-being among cancer survivors in Yunnan. The findings provide potentially useful basic information for stakeholders in oncology and mental health.

---

Keywords

Cancer survivors; stigma; mental well-being; China; cross-sectional study

---