Social Network Characteristics and Mental Health Stigma Among Latinx Patients with Type 2 Diabetes Mellitus

Background and Purpose: Mental health stigma continues to be prevalent across cultural groups in the United States (U.S.) despite new treatment modalities. Stigma prevents individuals from seeking needed treatment and, among treatment-seekers, leads to diminished adherence and premature service termination. Individuals with physical chronic illnesses, such as type 2 diabetes mellitus (T2DM), are more likely to hold stigmatizing beliefs about mental health. Recent research suggests stigma may be situated within social interactions that are influenced by cultural meanings among individuals. Social networks have been found to affect mental health stigma positively and negatively. To further study this influence, we examined social network characteristics and their impact on mental health stigma among a sample of Latinx adults with T2DM.

Methods: Latinx adults with T2DM were recruited from a community health center in the Southwest region of the United States. Cross-sectional surveys were completed by a bilingual interviewer with 102 patients between February and December 2019. Personal network analysis was completed with each participant consisting of nine name generating questions (e.g., “Who do you discuss your health with?”) and a series of name interpreting questions (e.g., “How often do you discuss health matters with [network member]?”). To measure social network characteristics, we examined the proportion of participants’ networks comprised of people with whom they discussed important matters, health matters, and with whom they socialized. We also measured proportion of family members and proportion of network members that cohabitate with the participants. To measure mental health stigma, we administered a validated tool that assesses stigma-related barriers to treatment. We controlled for patient-level attributes that may confound the relationship between social network attributes and mental health stigma, such as gender, age, and country of origin. Collinearity between social network correlates is well-documented; therefore, we conducted a series of separate logistic regression analyses with a single attribute of social networks and the likelihood that a patient would exhibit mental health stigma (N = 93).

Results: Latinx patients with a greater proportion of network members with whom they both talked to about health and socialized were less likely to exhibit mental health stigma (OR = 0.97, 95% CI [0.947, 0.999]). Latinx patients were less likely to exhibit stigma if they had a greater proportion of network members living in their home (OR = 0.97, 95% CI [0.936, 0.999]) and a greater proportion of children or grandchildren living in their home (OR = 0.95, 95% CI [0.905, 0.996]). Latinx patients with a greater proportion of alters who were nominated for discussing important matters were more likely to exhibit stigma (OR = 1.02, 95% CI [1.001, 1.042]).

Conclusions and Implications: Results support previous findings suggesting social networks have positive and negative impacts on mental health stigma. These findings suggest that Latinx individuals may be influenced by their children and grandchildren with whom they live, perhaps due to changing viewpoints about mental health treatment in younger generations. Our findings suggest studies are needed to understand the dynamics of family cohesion and mental health stigma among Latinxs with chronic illness.