The role of stigma and depression in the reduced adherence among young breast cancer patients in Hungary.

BACKGROUND: The main aim of our study was to investigate the role of depression, stigmatization, body shame and self-compassion in the adherence of young Hungarian breast cancer patients aged between 18 and 45 years. METHODS: In a cross-sectional online survey, data were collected from 99 young breast cancer patients (BC). Participants completed self-report questionnaires on socio-demographic and cancer-specific parameters as well as psychological factors (adherence: 12-item Medication Adherence Scale; depression: Hospital Anxiety and Depression Scale; stigmatization: Stigma Scale for Chronic Illnesses; body shame: Experience of Shame Scale; self-compassion: Self-Compassion Scale). We tested the predictors and mediators of adherence using hierarchical regression, mediation and moderation analysis among BC patients. RESULTS: We found that adherence was significantly associated with body shame and stigmatization in our BC sample. In addition, stigmatization alone was a significant predictor of lower adherence. Finally, in mediation models, where body shame was a mediator, we found a significant direct effect between stigma and adherence, in other words body shame had a significant mediating effect between these variables. According to our moderation analysis, self-compassion as a significant moderator acts as a protective factor in the linear relationship between stigma and lower adherence. CONCLUSIONS: Our results highlight the importance of stigma and body shame in the development of adherence in oncological care among young Hungarian BC patients aged between 18 and 45 years. Assessment of stigma, body shame, self-compassion, and the improvement of the availability of evidence-based psychological interventions may increase the adherence of young Hungarian BC patients, leading to more favourable rates of survival.

[A study on self-compassion and stigmatisation in female patients with breast cancer]. / Önegyüttérzés és stigmatizáció vizsgálata emlodaganatos nok körében.

Background: The number of patients with cancer is increasing rapidly: in only one year, in 2020 19.3 million new cases were registered and as many as 10 million deaths occurred due to tumours worldwide. Shame and self-blame for developing cancer deteriorate patients' quality of life and correlate significantly with poor adaptation and physical health, consequently may be risk factors in the final negative outcome. It is proven that stigmatisation may cause torturing emotional symptoms like shame leading to depressive symptoms, which, in turn, may deteriorate the patient's capacity to cope and her well-being, thus growing the risk of mortality. For all the above, a high level of self-compassion may be a potential solution. Numerous studies have already proven that self-compassion may significantly decrease the level of shame, depression, frustration as well as the perception of being stigmatised while resulting in a measurably better quality of life. The purpose of the investigation was to point out the relationship between shame, stigmatisation, depression on the one hand, and selfcompassion on the other while providing support for the effectiveness of self-compassionbased interventions among female breast cancer patients. Methods: The present study is part of the fi rst phase of a translational research, in other words it is part of a basic research already carried out. This cross-sectional study collected data using online questionnaires based on self-reports with female breast cancer patients aged between 18 and 45, who had been diagnosed in the past two years and did not present with distant metastases (n=79, mean age: 39.05 years, SD= 7.37). To measure constructs standardised scales were applied including the Experience of Shame Scale (ESS), the Stigma Scale for Chronic Illnesses 8-item version (SSCI8), the Hospital Anxiety and Depression Scale (HADS) and the Self-Compassion Scale (SCS). The research hypotheses were tested by hierarchic regression, correlation, and mediation analyses. Results: Stigmatisation shows a positive and strong (r = 0.56, p < 0.01) relationship with physical shame while self-compassion has a negative and strong relationship with the same (r = 0.71, p < 0.01). Hierarchical regression revealed that self-compassion was the only predictive factor in female breast cancer patients regarding physical shame (ß = - 0.09, p < 0.001) after controlling for age, marital status, exposure to operation, stigmatisation, and depression. According to mediation models a higher level of stigmatisation may result in a more expressed feeling of shame and depression through a lower level of self-compassion. We found a full mediation between shame and depression, which means that shame causes a higher level of depression entirely indirectly, through a decrease in self-compassion. Conclusions: The results of this work highlight the expected effectiveness of developing self-compassion in terms of alleviating shame, stigmatisation, and depression, thus contributing to a better quality of life among cancer patients. The main purpose of the translational research that was the basis of the present study was to develop a complex cognitive therapeutic programme that would, in a gap-filling way, offer oncological patients an effective psychological intervention supported by investigation. The results of the present study prove beyond doubt the rationale of the programme and involve the basic elaboration of a significant psycho-oncological practice.

Dermatitis linearis outbreak associated with Paederus balcanicus in Austria.

BACKGROUND: Dermatitis linearis is a toxic skin lesion caused by contact with certain beetles of the genus Paederus (Coleoptera: Staphylinidae). Dermatitis linearis outbreaks have been described mainly in tropical and subtropical regions, but so far not in Central Europe, and are considered an emerging public health concern potentially associated with climate change. MATERIAL AND METHODS: Following diagnosis of dermatitis linearis in a cluster of six adults and one child with reported exposure to beetles with morphological characteristics of Paederus species at a recreational public open-air bath at Lake Neusiedl (Illmitz, Burgenland, Austria), we performed on-site inspection and installed light and pitfall traps. Collected beetle specimens of the genus Paederus were classified using morphological characteristics and DNA barcoding. RESULTS: A total of 32 Paederus beetles were collected using an aspirator (n = 2) and light traps (n = 30). No individuals of the genus Paederus were captured with the pitfall traps. Morphological analyses identified them as members of the Paederus balcanicus species, which was confirmed by genetic specification of four arbitrarily chosen individuals. Dermatitis linearis lesions were treated with topical steroids and healed but partly leaving scars and hyperpigmentation, over the course of a few weeks in all affected persons. CONCLUSION: We report for the first time (a) an outbreak of dermatitis linearis associated with exposure to autochthonous Paederus species in Austria, and (b) that contact to the species Paederus balcanicus may cause dermatitis linearis in humans. Adequate measures should be taken to prevent dermatitis linearis outbreaks in areas with resident Paederus occurrence.