Weight Stigma Predicts Avoidance of Psychiatric Mental Healthcare

Purpose: Weight stigma is pervasive in the United States, and its presence in healthcare settings can lead to an avoidance of healthcare services. Weight stigma also exists in mental healthcare settings and with providers, and research suggests the implications of such biases can further exacerbate distressing mental health symptoms. It is important to understand if weight stigma is related to the avoidance of psychiatric services, and in particular psychiatric/mental health medication visits where weight is often a common factor in treatment decisions. This study examined whether experienced weight stigma or weight self-stigma predicted avoidance of psychiatric/mental health medication visits for cisgender adult women in the United States.

Methods: Data were collected using a cross-sectional online survey design on the topic of stigma and healthcare. A convenience sample of 384 self-identified cisgender women living in the U.S. were recruited via social media. Participants had a mean age of 33.18 (SD = 7.43), an average body mass index (BMI) of 28.36 (SD = 8.17), most were Caucasian/White/European American (66.4%). and 32.8% were without health insurance within the past 12 months. Weight stigma and psychiatric mental health care were measured using the Weight Self-Stigma Questionnaire (Lillis et al., 2012), the Weight Stigma Scale (Puhl et al., 2011), and a single item: "Have you ever avoided a psychiatric/mental healthcare medication visit?" Data were analyzed to determine predictive likelihood values of avoidance of services with experienced weight stigma and weight self-stigma regressed on two binary logistic regression models, controlling for age, BMI, race/ethnicity, and health insurance status.

Results: Both models of experienced weight stigma and weight self-stigma showed significance in avoidance of services. Experienced weight stigma explained 14% of the variance for psychiatric/ mental healthcare medication visit avoidance (X2= 33.73, df=6, and p<.001), yielding an odds ratio of 2.47 [95% CI (1.16, 5.22)], thus increasing the odds of avoidance by 147% if any form of stigma was experienced. Weight self-stigma explained 18% of the variance for avoidance (X2= 41.05, df=7, and p<.001) with an odds ratio of 1.10 [95% CI (1.01, 1.20)], increasing the odds of avoidance by 10% for every one-point increase in weight self-stigma.

Implications: Results showed both forms of weight stigma, experienced and self-stigma, predicted avoidance of psychiatric/mental health medical visits. These findings are consistent with research on general healthcare avoidance and warrants concern. The presence of weight stigma, experienced or internalized, is associated with higher rates of psychological distress, thus putting this population at a greater need for mental healthcare in general. Settings that provide support for mental health distress should be a safe zone from practices that generate initial disturbances. Interventions directed at healthcare providers may reduce biases and stigma that can result in patient-perceived discrimination. Future research is necessary within domains of psychiatric/mental health care to provide a clearer understanding of weight stigma and precipitating factors of avoidance of care.