Illness Stigma, Health Anxiety, Illness Intrusiveness, and Depressive Symptoms in Adolescents and Young Adults: A Path Model

Adolescents and young adults (AYAs) with a chronic medical condition (CMC) transition to adulthood with the burden of independently managing their health care. AYAs with a CMC are at elevated risk for depression, and available research suggests that illness-related cognitive appraisals play a critical role in this risk. Bakula et al. (2019) demonstrated that illness stigma and illness intrusiveness are two particularly salient cognitive appraisals (illness stigma -> illness intrusiveness -> depressive symptoms). The present study replicated and extended those findings by testing health anxiety as a mediator between stigma and illness intrusiveness in the serial mediation model (illness stigma -> health anxiety -> illness intrusiveness -> depressive symptoms). College students (N = 97) with a CMC completed self-report measures of illness-related stigma, health-related anxiety, illness intrusiveness, and depressive symptoms. The illness stigma -> illness intrusiveness -> depressive symptoms simple mediation path was significant, ab = .50, 95% CI [0.27-0.73]. The illness stigma health anxiety -> illness intrusiveness -> depressive symptoms serial mediation path was also significant, a(1)d(21)b(2) = 0.16, 95% CI [0.05-0.31]. Illness stigma indirectly related to depressive symptoms through the consecutive influence of illness stigma on health anxiety and health anxiety on illness intrusiveness. The present study replicated and extended findings by Bakula et al. by identifying that illness stigma may elicit anxiety about health and amplify perceived illness intrusiveness, thus increasing depressive symptoms in AYAs with a CMC. These findings further confirm the importance of assessing cognitive appraisals among AYAs with a CMC. When working with AYAs with a CMC who endorse depression, it may be particularly important to assess health anxiety, illness stigma, and illness intrusiveness.