# Self-stigma and depression among community-dwelling adults with physical disabilities in China: the chain mediating role of social participation and self-esteem

## TL;DR

This study explores how self-stigma affects depression in people with physical disabilities in China, highlighting the roles of social participation and self-esteem.

## Contribution

It identifies a chain mediating pathway involving social participation and self-esteem linking self-stigma to depression.

## Key findings

- Self-stigma directly and indirectly affects depression through social participation and self-esteem.
- Social participation and self-esteem mediate the relationship between self-stigma and depression.
- The effects of self-stigma on depression are partially explained by these mediating factors.

## Abstract

Against the backdrop of a rapidly aging population, the number of people with physical disabilities in China is on a steady rise. Physical disabilities contribute to the development of unique psychological characteristics among this group, seriously affecting their thoughts, behaviors, and quality of life. Therefore, this study aims to explore the action paths and predictive values of self-stigma, social participation, self-esteem, and their influence on depression among community-dwelling people with physical disabilities in China based on the modified labeling theory.

A cross-sectional study was conducted from April to September 2023 among 280 community-dwelling persons with physical disabilities recruited from 8 counties and cities in Yanbian Prefecture, China. Validated multidimensional scales were used to measure depression, self-stigma, social participation, and self-esteem. SPSS 26.0 was employed for descriptive statistical analysis, and AMOS 26.0 was used to construct a structural equation model (SEM) and analyze the mediating effect.

The average score of depression was (40.94 ± 8.27). Pearson correlation analysis showed that self-stigma and social participation were significantly positively correlated with depression, while self-esteem was significantly negatively correlated with depression (all p < 0.05). Path analysis results indicated that self - stigma could directly affect depression (β = 0.297, p < 0.001), and also indirectly affect depression through social participation (β = 0.265, p < 0.01), self-esteem (β = 0.106, p < 0.01), and both social participation and self-esteem (β = 0.076, p < 0.01), with the proportions of these effects being of 39.92, 35.62, 14.25, and 10.22%, respectively.

Social participation and self-esteem play a chain-mediating role between self-stigma and depression among community-dwelling people with physical disabilities. This offers a reference for developing social intervention strategies to improve the mental health of people with physical disabilities.