Stigma concerns and depressive symptoms among people ever infected with COVID-19 in Hong Kong: cross-sectional mediation via perceived stress and maladaptive cognitive emotion regulation

Vollständiger Abstract

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Abstract Background Stigma concerns are common during outbreaks of emerging respiratory infectious diseases and have been associated with mental distress such as depressive symptoms. This study investigated the associations between stigma concerns related to COVID-19 infection and depressive symptoms among people who had ever contracted COVID-19 (PECC), and whether these associations would be significantly mediated by perceived stress and maladaptive cognitive emotion regulation of rumination and catastrophizing. Methods A population-based, random, and anonymous cross-sectional telephone survey was conducted among Chinese adults (aged ≥ 18 years) in Hong Kong who self-reported having ever tested positive for COVID-19 ( n = 277) from June to August 2022, during the territory’s fifth-wave outbreak. Structural equation modeling (SEM) were used to test the indirect associations, adjusting for background factors (employment status, chronic disease status, knowing people having long COVID, and history of home quarantine due to own COVID-19 infection). Results The prevalence of mild or more severe depressive symptoms was 8%, and overall symptom levels were low. Adjusting for background factors, stigma concerns, perceived stress, rumination, and catastrophizing were positively associated with depressive symptoms. The SEM result showed that the association between stigma concerns and depressive symptoms was significantly mediated by indirect paths via perceived stress alone and via perceived stress followed by maladaptive cognitive emotion regulation; the direct association between stigma concerns and depressive symptoms was statistically non-significant. Conclusions Among PECC with generally low depressive symptom levels, stigma concerns were positively associated with depressive symptoms, and this association was significantly mediated via elevated perceived stress and maladaptive cognitive emotion regulation. If corroborated, interventions addressing stigma concerns, stress management, and emotional regulation skills may benefit this population, and stigma-related distress warrants early monitoring in future outbreaks of respiratory infectious diseases.