Stigmatization of children with chronic diseases, exemplified by type 1 diabetes mellitus. : Differences between India and Norway

Abstract

Abstract Background The term stigma refers to a mark of disgrace associated with a particular circumstance, quality or person, which leaves the object being unacceptably different from "the others". The individual suffers from stereotyping, labeling and devaluing from the society and from the people whom he or she routinely interacts. It could lead to a reduction in psychological wellbeing and physical health, as well as reduced health care seeking and inequitable treatment. It also carries shame, fear and guilt. Diabetes mellitus is a group of chronic metabolic diseases characterized by high concentration of glucose in the blood. The most common types are type 1 diabetes (T1D) and type 2 diabetes (T2D),. The disease is associated with high morbidity and mortality. Quality of treatment is essential to control the disease and avoid complications. Aims The aims of this study were to find out more about stigma, how it presents and how it could affect chronic diseases, especially how it could affect children and adolescents with T1D. Stigma vary from different settings, it is socially constructed. Therefore we wanted to explore the differences in the presentation of stigma between Norway, a developed country, and India, a developing country. Methods In a semi-structured search in PubMed, Cochrane and Google, we searched for articles about stigma, diabetes, stigma of chronic diseases, stigma of diabetes in Norway, the western world and India. We used a questionnaire based on international guidelines to collect information about T1D in children less than 15 years of age. We interviewed health personnel at King Edward Memorial (K.E.M) Hospital in India and at Elverum Hospital in Norway, observed the daily routines and had conversations with patients. Discussion There are few studies found regarding stigma of diabetes mellitus in children in the western world including Norway, more studies are found from India which could be indicative of more stigma attached to T1D in India compared to Norway and the western world. To be diagnosed with T1D in India comes with a totally different range of problems than for children diagnosed with T1D in Norway. The children in India early experiences long term and short term complications and the mean age of death is low. In both countries the children with T1D experience different components of stigma, but the stigma is more pronounced and has worse consequences in India. In India there is an additional stigma of being a girl, which leads to a double burden of stigma for girls with T1D. There is also an economical issue, which makes the treatment of T1D difficult in India. This economical issue is not a factor in Norway, with a public health insurance system that secures treatment to all layers of the population. Conclusion The feeling of stigma is part of having diabetes. The consequences, however, vary largely between Norway and India. The feeling of being different and stigmatized affects the treatment of the child with T1D, which in turn affects the risk of both short and long term complications. Because of the possible serious consequences of diabetes complications, it is important to increase the general knowledge about diabetes, and thus try to reduce the stigma as much as possible.