{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T23:40:14Z","timestamp":1793230814535,"version":"4.5.0"},"reference-count":32,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000002","name":"national institutes of health","doi-asserted-by":"publisher","award":["DP2MH132938"],"award-info":[{"award-number":["DP2MH132938"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Health Psychol"],"abstract":"<jats:p>\n                    Internalized stigma has frequently been observed among people with chronic health conditions and is recognized as a distressing process that can harm emotional health. However, the disease-specific scope of previous studies has impeded the development of a nimbler framework of how the transdiagnostic concepts of stigma, shame, and self-esteem relate to mental health. The present research examined this through a preregistered cross-sectional analysis of 300 adults who reported at least one stigmatized chronic health condition (cancer, chronic pain, HIV, obesity, diabetes, or skin diseases). Moderated mediation analyses found that shame was positively associated with elevated depression (\n                    <jats:italic toggle=\"yes\">B<\/jats:italic>\n                    \u2009=\u20090.13,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.007), generalized anxiety (\n                    <jats:italic toggle=\"yes\">B<\/jats:italic>\n                    \u2009=\u20090.13,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.002), and social anxiety (\n                    <jats:italic toggle=\"yes\">B<\/jats:italic>\n                    \u2009=\u20090.35,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.001), and positively mediated the relationships between internalized health-related stigma and these outcomes (all\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.05). Higher self-esteem weakened shame\u2019s relationship with social anxiety (\n                    <jats:italic toggle=\"yes\">B<\/jats:italic>\n                    \u2009=\u2009\u22120.01,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.05). The results support further research into improving emotional health among chronic illness populations by addressing shame and fostering self-esteem.\n                  <\/jats:p>","DOI":"10.1177\/13591053261486749","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T07:12:03Z","timestamp":1789110723000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The role of shame and self-esteem in the relationship between internalized health-related stigma and mental health symptoms in adults with chronic health conditions"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1311-9583","authenticated-orcid":false,"given":"Elijah P.","family":"Mudryk","sequence":"first","affiliation":[{"name":"University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca L.","family":"Pearl","sequence":"additional","affiliation":[{"name":"University of Florida, Gainesville, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"crossref","unstructured":"Barta T Kiropoulos L (2023) The mediating role of stigma internalized shame and autonomous motivation in the relationship between depression anxiety and psychological help-seeking attitudes in multiple sclerosis. 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