Dispositional shame and guilt as predictors of depressive symptoms and anxiety among adults with lung cancer: The mediational role of internalized stigma.

The current study investigated whether dispositional tendencies to experience shame and guilt (i.e., shame- and guilt-proneness) were associated with higher levels of internalized stigma and, in turn, higher depressive symptoms and anxiety in adults with lung cancer. Participants (N = 50; 56.0% female) were men and women who received a clinical consultation for lung cancer and completed validated questionnaires. Mediation modeling using bootstrapping was used to characterize relationships between shame- and guilt-proneness, lung cancer stigma, depressive symptoms, and anxiety. Higher guilt-proneness was associated significantly with higher anxiety (b = 0.69, SE = 0.28, 95% confidence interval [CI: 0.13, 1.26]), and higher shame-proneness was associated significantly with higher depressive symptoms (b = 0.56, SE = 0.19, 95% CI [0.18, 0.93]), beyond sociodemographic, medical, and smoking-related characteristics. Higher lung cancer stigma also significantly mediated the relationship between guilt-proneness and anxiety (indirect effect = 0.43, SE = 0.20, 95% CI [0.08, 0.89]) but not between shame-proneness and depressive symptoms. Shame- and guilt-proneness were associated significantly with depressive symptoms and anxiety, respectively, and the relationship between guilt-proneness and anxiety was explained in part by internalized stigma in a sample of newly diagnosed lung cancer patients. Findings carry implications for the early identification of lung cancer patients in need of additional supportive care services and highlight internalized stigma as a target for psychosocial intervention.