IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v265y2020ics0277953620306687.html
   My bibliography  Save this article

Stigma of persons with disabilities in South Africa: Uncovering pathways from discrimination to depression and low self-esteem

Author

Listed:
  • Trani, Jean-Francois
  • Moodley, Jacqueline
  • Anand, Paul
  • Graham, Lauren
  • Thu Maw, May Thu

Abstract

Despite the fact that universal inclusion is a basic principle of the Sustainable Development Goals, the inclusion of persons with disabilities in humanitarian interventions and development policies remains elusive. Persons with disabilities face high risks of poverty, poor nutrition, limited inclusion in labor markets and poor mental health as a result. Stigma is likely to play a negative role in this regard and yet, no study has investigated the impact of stigma on depression and self-esteem of persons with disabilities. To address this gap in the literature, we conducted in June 2017 a random sample disability case control household study in Soweto, a township in Johannesburg, South Africa. Using propensity score analysis and structural equation modeling, we investigated the relationship between disability, stigma, depression and self-esteem controlling for socioeconomic covariates. Our main empirical results showed that stigma significantly mediates the association between disability and higher depression on the one hand and between disability and lower self-esteem on the other. This mediating effect exists even after controlling for age, gender, marital status, education, employment and wealth. We also found strong direct associations between disability and depressive mood, somatic indicators and negative feelings such as unhappiness and low self-esteem. Unemployment aggravates depression and low self-esteem while low education worsens self-esteem only. In addition, depression exacerbates low self-esteem. Both unemployment and low education are more common among persons with disabilities aggravating the disability, depression, poor self-esteem nexus. Similarly, persons with disabilities who are more likely to be depressed are also at higher risk of low self-esteem. These results point to a vicious reinforcing circle of exclusion from society, despair and self-deprecation, which could prove difficult to break. Substantial psycho-social support and anti-stigma policies anchored in local cultural values, engaging persons with disabilities and their communities, are required to break this vicious circle.

Suggested Citation

  • Trani, Jean-Francois & Moodley, Jacqueline & Anand, Paul & Graham, Lauren & Thu Maw, May Thu, 2020. "Stigma of persons with disabilities in South Africa: Uncovering pathways from discrimination to depression and low self-esteem," Social Science & Medicine, Elsevier, vol. 265(C).
    • Handle: RePEc:eee:socmed:v:265:y:2020:i:c:s0277953620306687
    DOI: 10.1016/j.socscimed.2020.113449
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953620306687
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2020.113449?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Lukachko, Alicia & Hatzenbuehler, Mark L. & Keyes, Katherine M., 2014. "Structural racism and myocardial infarction in the United States," Social Science & Medicine, Elsevier, vol. 103(C), pages 42-50.
    2. Richard Blundell & Monica Costa Dias, 2009. "Alternative Approaches to Evaluation in Empirical Microeconomics," Journal of Human Resources, University of Wisconsin Press, vol. 44(3).
    3. Suguru Mizunoya & Sophie Mitra & Izumi Yamasaki & UNICEF Office of Research - Innocenti, 2016. "Towards Inclusive Education: The impact of disability on school attendance in developing countries," Papers inwopa845, Innocenti Working Papers.
    4. Anonymous, 2014. "Introduction to the Issue," Journal of Wine Economics, Cambridge University Press, vol. 9(1), pages 1-2, May.
    5. Mizunoya, Suguru & Mitra, Sophie, 2013. "Is There a Disability Gap in Employment Rates in Developing Countries?," World Development, Elsevier, vol. 42(C), pages 28-43.
    6. Arne H Eide & Hasheem Mannan & Mustafa Khogali & Gert van Rooy & Leslie Swartz & Alister Munthali & Karl-Gerhard Hem & Malcolm MacLachlan & Karin Dyrstad, 2015. "Perceived Barriers for Accessing Health Services among Individuals with Disability in Four African Countries," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-13, May.
    7. Marco Caliendo & Sabine Kopeinig, 2008. "Some Practical Guidance For The Implementation Of Propensity Score Matching," Journal of Economic Surveys, Wiley Blackwell, vol. 22(1), pages 31-72, February.
    8. Bakhshi, Parul & Babulal, Ganesh M. & Trani, Jean-Francois, 2018. "Education and disability in a conflict affected context: Are children with disabilities less likely to learn and be protected in Darfur?," World Development, Elsevier, vol. 106(C), pages 248-259.
    9. Guido W. Imbens, 2015. "Matching Methods in Practice: Three Examples," Journal of Human Resources, University of Wisconsin Press, vol. 50(2), pages 373-419.
    10. Uppal, Sharanjit, 2006. "Impact of the timing, type and severity of disability on the subjective well-being of individuals with disabilities," Social Science & Medicine, Elsevier, vol. 63(2), pages 525-539, July.
    11. Hatzenbuehler, Mark L. & Bellatorre, Anna & Lee, Yeonjin & Finch, Brian K. & Muennig, Peter & Fiscella, Kevin, 2014. "Structural stigma and all-cause mortality in sexual minority populations," Social Science & Medicine, Elsevier, vol. 103(C), pages 33-41.
    12. Guido W. Imbens, 2004. "Nonparametric Estimation of Average Treatment Effects Under Exogeneity: A Review," The Review of Economics and Statistics, MIT Press, vol. 86(1), pages 4-29, February.
    13. Paul Anand & Graham Hunter & Ian Carter & Keith Dowding & Francesco Guala & Martin Van Hees, 2009. "The Development of Capability Indicators," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 10(1), pages 125-152.
    14. Anonymous, 2014. "Introduction to the Issue," Journal of Wine Economics, Cambridge University Press, vol. 9(2), pages 109-110, August.
    15. Tellez, Juan & Krishnakumar, Jaya & Bungener, Martine & Le Galès, Catherine, 2016. "Capability deprivation of people with Alzheimer's disease: An empirical analysis using a national survey," Social Science & Medicine, Elsevier, vol. 151(C), pages 56-68.
    16. Whittle, Henry J. & Palar, Kartika & Ranadive, Nikhil A. & Turan, Janet M. & Kushel, Margot & Weiser, Sheri D., 2017. "“The land of the sick and the land of the healthy”: Disability, bureaucracy, and stigma among people living with poverty and chronic illness in the United States," Social Science & Medicine, Elsevier, vol. 190(C), pages 181-189.
    17. Trani, Jean-Francois & Bakhshi, Parul & Brown, Derek & Lopez, Dominique & Gall, Fiona, 2018. "Disability as deprivation of capabilities: Estimation using a large-scale survey in Morocco and Tunisia and an instrumental variable approach," Social Science & Medicine, Elsevier, vol. 211(C), pages 48-60.
    18. Livingston, James D. & Boyd, Jennifer E., 2010. "Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis," Social Science & Medicine, Elsevier, vol. 71(12), pages 2150-2161, December.
    19. Stanislav Kolenikov & Gustavo Angeles, 2009. "Socioeconomic Status Measurement With Discrete Proxy Variables: Is Principal Component Analysis A Reliable Answer?," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 55(1), pages 128-165, March.
    20. Yang, Lawrence H. & Chen, Fang-pei & Sia, Kathleen Janel & Lam, Jonathan & Lam, Katherine & Ngo, Hong & Lee, Sing & Kleinman, Arthur & Good, Byron, 2014. "“What matters most:” A cultural mechanism moderating structural vulnerability and moral experience of mental illness stigma," Social Science & Medicine, Elsevier, vol. 103(C), pages 84-93.
    21. Kamal Lamichhane & Tomoo Okubo, 2014. "The Nexus between Disability, Education, and Employment: Evidence from Nepal," Oxford Development Studies, Taylor & Francis Journals, vol. 42(3), pages 439-453, September.
    22. Green, Sara E., 2003. ""What do you mean 'what's wrong with her?'": stigma and the lives of families of children with disabilities," Social Science & Medicine, Elsevier, vol. 57(8), pages 1361-1374, October.
    23. Nosek, Margaret A. & Hughes, Rosemary B. & Swedlund, Nancy & Taylor, Heather B. & Swank, Paul, 2003. "Self-esteem and women with disabilities," Social Science & Medicine, Elsevier, vol. 56(8), pages 1737-1747, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Rocco Servidio & Ivan Giuseppe Cammarata & Costanza Scaffidi Abbate & Stefano Boca, 2024. "Classical and Modern Prejudice toward Individuals with Intellectual Disabilities: The Role of Experienced Contact, Beliefs in a Just World and Social Dominance Orientation," IJERPH, MDPI, vol. 21(3), pages 1-13, March.
    2. Kristel Amor M. Balala & Hanes Sydney Claveria & Jasmine M. Favia & Maria Franchezca T. Quintana & Rheana L. Santural & Ezequiel D. Quijano & Paul John A. Estrella, 2024. "An Action Research on Employability Assessment, Challenges, and Coping Mechanism of Persons with Disabilities (PWDs) in Applying for a Job," International Journal of Research and Innovation in Social Science, International Journal of Research and Innovation in Social Science (IJRISS), vol. 8(7), pages 841-861, July.
    3. Nan Luo & Fangyuan Jiang & Namjeong Jo, 2024. "Emotional Intelligence and Meaning in Life: Mediation by Sense of Security and Self-Esteem," SAGE Open, , vol. 14(3), pages 21582440241, September.
    4. Hervie, Vyda Mamley, 2023. "Social inclusion of children with intellectual disabilities in Accra, Ghana: Views of parents/guardians and teachers," Children and Youth Services Review, Elsevier, vol. 147(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Trani, Jean-Francois & Ballard, Ellis & Peña, Juan B., 2016. "Stigma of persons with disabilities in Afghanistan: Examining the pathways from stereotyping to mental distress," Social Science & Medicine, Elsevier, vol. 153(C), pages 258-265.
    2. Jean-Francois Trani & Kyle A. Pitzer & Juanita Vasquez Escallon & Parul Bakhshi, 2022. "Access to Services from Persons with Disabilities in Afghanistan: Is Community Based Rehabilitation Making a Difference?," IJERPH, MDPI, vol. 19(10), pages 1-26, May.
    3. Lars Thiel, 2015. "Leave the Drama on the Stage: The Effect of Cultural Participation on Health," SOEPpapers on Multidisciplinary Panel Data Research 767, DIW Berlin, The German Socio-Economic Panel (SOEP).
    4. Timmermans, Stefan & Tietbohl, Caroline, 2018. "Fifty years of sociological leadership at Social Science and Medicine," Social Science & Medicine, Elsevier, vol. 196(C), pages 209-215.
    5. Winskell, Kate & Sabben, Gaëlle, 2016. "Sexual stigma and symbolic violence experienced, enacted, and counteracted in young Africans’ writing about same-sex attraction," Social Science & Medicine, Elsevier, vol. 161(C), pages 143-150.
    6. Binder, Martin & Coad, Alex, 2013. "“I'm afraid I have bad news for you…” Estimating the impact of different health impairments on subjective well-being," Social Science & Medicine, Elsevier, vol. 87(C), pages 155-167.
    7. Philip Verwimp & Sisi Zhang, 2018. "The welfare impact of Vietnam’s national target programme ‘building a new countryside’: A quasi-experimental evaluation," WIDER Working Paper Series 164, World Institute for Development Economic Research (UNU-WIDER).
    8. Marchesano, Katia & Musella, Marco, 2020. "Does volunteer work affect life satisfaction of participants with chronic functional limitations? An empirical investigation," Socio-Economic Planning Sciences, Elsevier, vol. 69(C).
    9. Christian Volpe Martincus, 2010. "Odyssey in International Markets: An Assessment of the Effectiveness of Export Promotion in Latin America and the Caribbean," IDB Publications (Books), Inter-American Development Bank, number 16458, February.
    10. Metzl, Jonathan M. & Hansen, Helena, 2014. "Structural competency: Theorizing a new medical engagement with stigma and inequality," Social Science & Medicine, Elsevier, vol. 103(C), pages 126-133.
    11. Loi, Massimo & Rodrigues, Margarida, 2012. "A note on the impact evaluation of public policies: the counterfactual analysis," MPRA Paper 42444, University Library of Munich, Germany.
    12. Jones A.M & Rice N, 2009. "Econometric Evaluation of Health Policies," Health, Econometrics and Data Group (HEDG) Working Papers 09/09, HEDG, c/o Department of Economics, University of York.
    13. Takasaki, Yoshito, 2020. "Impacts of disability on poverty: Quasi-experimental evidence from landmine amputees in Cambodia," Journal of Economic Behavior & Organization, Elsevier, vol. 180(C), pages 85-107.
    14. Morey, Brittany N. & Gee, Gilbert C. & Muennig, Peter & Hatzenbuehler, Mark L., 2018. "Community-level prejudice and mortality among immigrant groups," Social Science & Medicine, Elsevier, vol. 199(C), pages 56-66.
    15. Gaur, Diptanshu & Pandey, Shivendra Kumar & Sharma, Dheeraj, 2024. "Inequalities in educational achievement: Effect of individuals’ capabilities & social identity," Journal of Policy Modeling, Elsevier, vol. 46(3), pages 494-513.
    16. Seonho Shin, 2022. "Evaluating the Effect of the Matching Grant Program for Refugees: An Observational Study Using Matching, Weighting, and the Mantel-Haenszel Test," Journal of Labor Research, Springer, vol. 43(1), pages 103-133, March.
    17. Erlend E. Bø & Elin Halvorsen & Thor O. Thoresen, 2019. "Heterogeneity of the Carnegie Effect," Journal of Human Resources, University of Wisconsin Press, vol. 54(3), pages 726-759.
    18. Verena Lauber & Johanna Storck, 2016. "Helping with the Kids? How Family-Friendly Workplaces Affect Parental Well-Being and Behavior," SOEPpapers on Multidisciplinary Panel Data Research 883, DIW Berlin, The German Socio-Economic Panel (SOEP).
    19. Wright, Christopher, 2006. "Estimating the Effect of the Chesapeake Bay Program on Application Rates for Enrollment in the Environmental Quality Incentive Program: A Case Study of Pennsylvania," 2006 Annual meeting, July 23-26, Long Beach, CA 21164, American Agricultural Economics Association (New Name 2008: Agricultural and Applied Economics Association).
    20. Stefano Iandolo & Anna Ferragina, 2021. "International activities and innovation: Evidence from Italy with a special regressor approach," The World Economy, Wiley Blackwell, vol. 44(11), pages 3300-3325, November.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:265:y:2020:i:c:s0277953620306687. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.