As a kind of social pain, stigma refers to the negative characteristics of individuals or groups that are not accepted by mainstream culture. Mental illness is one of the most typical labels and results in discrimination and internalized stigma that will cause serious interference to personal life. Meanwhile, depression, as the most common mental illness, is inevitably discriminated against by the public. Clinical studies have shown that depression is closely related to physical pain, which is one of the main clinical manifestations of patients with depression. Research on social pain reveals that there are similar neural mechanisms and complex interactions between social pain and individual physical pain. These works suggest that stigma may affect patients' physical pain perception to some extent. Previous studies on pain perception of depressive patients mostly focused on the clinical symptoms, with less attention paid to the possible effects of the social environment, such as mental illness stigma. Therefore, this study combines three experiments to explore the pain perception of patients with depression from the perspective of stigmatization.
Experiment1investigatedtheeffectofstigmatizationexperienceonself-reported pain perception in patients with depression. The results showed that depressedpatientswithstigmaexperiencehadstrongerawarenessofpaincatastrophizing than those without stigma experience. Meanwhile, the level ofdepression and the severity of anxiety mediated the effects of patients’ stigma experience on self-reported pain perception.
Experiment 2 investigated the effects of stigmatization experience of depressive patients on their perception of induced thermal pain. It revealed that stigma can aggravate the patient's perception of thermal pain stimulation, and the depressive patients with stigma experience not only have stronger pain-related awareness than the healthy controls but also show significantly higher pain concerns than the depressive patients without stigma experience; In addition, the difference in pain perception between patients and the controls is mainly reflected in the self-reported pain severity.
Experiment 3 explored the effect of depression stigma cues on the perception of induced thermal pain in patients with depression and its neural mechanism by combining behavioral tasks and EEG recording. The results showed that theinternalized stigma of patients was positively correlated with their self-reported pain perception; the level of depression and the severity of anxiety mediated the effects of patients’ stigma experience on self-reported pain perception; stigma cues significantly exacerbated patients' perception of induced thermal pain.
This study systematically investigated the impact of stigmatization experience onpain perception of patients with depression in the clinical, behavioral, andelectrophysiological levels. The study’s main conclusions are that stigmatization experience could exacerbate patients' self-reported and evoked pain perception, andrelevant clinical characteristics mediated the process. These results are not only conducive to an in-depth understanding of the essence of pain in patients withdepression, more importantly, they can provide new ideas for effective analgesic treatment for patients.
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