Disability Attitudes, Affiliate Stigma, Maladaptive Coping, and Depression: A Serial Mediation Model in Adult Siblings of Individuals with ID/ASD in South Korea

Background and Purpose

Intellectual and autism spectrum disabilities are typically diagnosed in early childhood and require long-term care and support. These conditions place psychosocial difficulties on family members, including caregiving stress, family conflict, and affiliate stigma. Adult non-disabled siblings, in particular, experience close and sustained relationships with their disabled siblings from childhood to adulthood. These experiences have been found to play a direct role in shaping individuals' attitudes toward people with disabilities, while also influencing their emotional responses and coping mechanisms.

Unlike members of the general public who encounter disability through brief exposure, non-disabled siblings internalize disability as a part of everyday life. Their attitudes become embedded psychological structures that guide how they interpret disability-related situations, respond emotionally, and manage stress. Negative attitudes may intensify affiliate stigma—an internalized sense of shame by association—which in turn promotes maladaptive coping such as avoidance or self-blame, ultimately increasing depressive symptoms.

While previous studies have emphasized structural family factors in explaining depression among non-disabled siblings, limited research has addressed the psychological mechanisms linking attitudes, stigma, and coping. This study examines a serial mediation model to determine whether attitudes toward people with disabilities influence depression via affiliate stigma and maladaptive coping.

Methods

Participants were recruited through convenience sampling in cooperation with the Seoul Support Center for Families with Disabilities. From August to October 2020, face-to-face surveys were conducted with 218 adult non-disabled siblings in Seoul. Of these, data from 152 individuals who reported having a sibling diagnosed with intellectual or autism spectrum disabilities were analyzed.

Attitudes toward people with disabilities were measured using a 15-item Korean adaptation of the Scale of Attitudes for Disabled Persons (SADP) and the Attitudes Toward Disabled Persons Scale–Original (ATDP-O) developed by Antonak (1982). Affiliate stigma was assessed using the 22-item Affiliate Stigma Scale (Chang et al., 2015), maladaptive coping with 28 selected items from the Brief COPE (Carver, 1997), and depression with the 9-item PHQ-9. Control variables included gender, age, religion, education, economic status, subjective health, cohabitation status, type of disability, and frequency of challenging behaviors. Serial mediation analysis was conducted using SPSS 27 and PROCESS Macro 4.2 (Model 6)

Results

Negative attitudes significantly increased affiliate stigma, which led to more maladaptive coping and higher depression levels. The direct effect of attitudes on depression was not significant, indicating full mediation. The serial indirect effect was statistically significant, with a bootstrapped 95% confidence interval of [−0.822, −0.042].

Conclusions and Implications

Attitudes toward people with disabilities, as formed by non-disabled siblings, function as core psychological mechanisms influencing depression through stigma and coping. These findings highlight the need for early, preventive interventions to foster healthier attitudes. Mental health programs should address affiliate stigma and promote adaptive coping strategies among adult non-disabled siblings.