Experienced stigma and applied coping strategies during the COVID-19 pandemic in Germany: a mixed-methods study

Abstract

Objective: Health-related stigma is considered a social determinant of health equity and a hidden burden of disease. This study aimed to assess the level and dimensions of stigma and respective coping mechanisms in COVID-19 survivors.

Methods: A mixed-methods study with sequential explanatory design was conducted at the University Hospital of Ulm, Germany. Stigma was assessed using the Social Impact Scale (SIS) including adult COVID-19 survivors with mild-to-severe disease. Subsequently, 14 participants were sampled with regard to gender, age and severity of disease for in-depth interviews to understand how stigma was experienced and coping strategies were applied. The questionnaire was analysed using descriptive statistics, t-test and analysis of variance. Content analysis was used for qualitative data.

Results: From 61 participants, 58% were men and mean age was 51 years. The quantitative analysis of the SIS indicated an intermediate level of experienced stigma. Participants experienced stigma mainly as 'social rejection' (M=14.22, SD=4.91), followed by 'social isolation' (M=10.17, SD=4.16) and 'internalised shame' (M=8.39, SD=3.32). There was no significant difference in experienced stigma regarding gender, education, occupational status or residual symptoms. However, participants between 30 and 39 years of age experienced higher levels of stigma than other age groups (p=0.034). The qualitative analysis revealed how stigma seemed to arise from misconceptions creating irrational fear of infection, leading to stereotyping, vilification, discrimination and social exclusion of COVID-19 survivors, leaving them feeling vulnerable. Stigma cut through all social levels, from the individual level at the bottom to the institutional and societal level at the top. Social networks protected from experiencing stigma.

Conclusion: COVID-19-related stigma is a relevant burden in the ongoing pandemic. Providing accurate information and exposing misinformation on disease prevention and treatment seems key to end COVID-19-related stigma.

Keywords: COVID-19; mental health; social medicine.