Racial and Ethnic Differences in the Associations Between COVID-19 Stigma and Mental Health in a Population-Based Study of Adults with SARS-CoV-2 Infection

Introduction: Many individuals with coronavirus disease 2019 (COVID-19) faced stigmatization, which may contribute to poor health. However, very few studies have explored the relationship between COVID-19 stigma and health, and even less is known about differences in the relationship by race and ethnicity. This article examines associations between COVID-19 stigma and mental health overall and by race and ethnicity. Methods: We used a population-based probability sample of Michigan adults with SARS-CoV-2 infection between March 2020 and May 2022. We captured COVID-19 stigma based on perceived COVID-19 stigma, fear of COVID-19 disclosure to friends or family, and fear of COVID-19 disclosure at work. We conducted modified Poisson regression with robust standard errors to estimate associations of COVID-19 stigma with depressive and anxiety symptoms adjusting for confounding factors. Results: Individuals who experienced perceived COVID-19 stigma had 1.44 times higher prevalence of depressive symptoms (95% confidence intervals [CIs]: 1.23-1.69) and 1.48 times higher prevalence of anxiety symptoms (95% CI: 1.30-1.69) compared with individuals who did not experience perceived stigma. Moreover, individuals who were afraid to disclose their COVID-19 diagnosis to friends or family, or who were afraid to disclose their diagnosis at work, had a higher prevalence of depressive symptoms and anxiety symptoms, compared with those who were not afraid. These associations were more pronounced among racial and ethnic minoritized individuals than non-Hispanic White individuals. Discussion: COVID-19 stigma was associated with depressive and anxiety symptoms. There is a critical need to examine long-lasting effects of stigma, particularly among racial and ethnic minoritized individuals.