Signs of Stigma and Poor Mental Health Among Carriers of Methicillin-Resistant Staphylococcus aureus

Abstract

Background. Many countries implemented guidelines to prevent transmission of methicillin-resistant Staphylococcus aureus (MRSA). Concerns have been raised over a stigmatizing effect of these actions. Important contextual factors of stigma can be identified in the context of MRSA (Figure 1). Aim of this study was to identify and quantify the occurrence of MRSA-associated stigma and to explore its association with mental health in a country with a MRSA “search and destroy” policy. Methods. In 2014, we performed a questionnaire study among Dutch MRSA-carriers (people colonized with MRSA without signs of MRSA infection). We measured stigma with an adjusted version of the Berger HIV Stigma Scale. Mental health was assessed with the 5-item RAND Mental Health Inquiry. Results. From October 2013 to April 2014, 139 MRSA carriers were identified in the databases of 4 participating institutions. 61 Questionnaires were returned (response rate 44%); 57 of which were eligible. Of the respondents, 24 (42%) were under 40 years old, 28 (49%) were male and 31 (55%) had received intensive MRSA eradication therapy i.e. topical treatment and oral antibiotics. We found that 32 (56%) MRSA carriers reported stigma: 8 (14%) “clear stigma” (Berger score >110) and 24 (42%) “suggestive for stigma” (Berger score 76-110). Educational level, female gender and intensive MRSA eradication therapy were associated with higher stigma scores (p < 0.05, ANOVA and Student t-tests, respectively). Poor mental health (RAND score <60) was reported by 33% of MRSA carriers. Stigma and mental health scores were inversely correlated (Pearson correlation -0.7, p < 0.01; Figure 2). Stigma was experienced most frequently in health care settings and seldom in the religious community or at sport facilities. Conclusion. This exploratory study shows that a substantial proportion of MRSA carriers reports stigma due to MRSA. An association was found between stigma and poor mental health. Therefore, further study of stigma in MRSA carriers as well as anticipation of stigma during care for MRSA carriers is warranted. (Figure Presented) .