Degree Name

PhD (Doctor of Philosophy)



Date of Award


Committee Chair or Co-Chairs

Jameson K. Hirsch

Committee Members

Chad E. Lakey, Jon R. Webb, Andrea D. Clements


Stigmatization involves the application of labels to individuals in social contexts, leading to impaired access to social, economic, and political power. Although actual stigmatizing beliefs that society holds about particular groups are important, the extent to which individuals themselves perceive stigma from others and internalize stigmatizing beliefs is being increasingly recognized as a cause of psychological and physical distress. Little research has been done on explanatory mechanisms of the relations between perceived stigma and health outcomes, particularly in the area of stigma related to finances. Two important dimensions of overall health include depressive symptoms and health-related quality of life. According to Self-Determination Theory feeling controlled by external forces decreases subjective vitality, a measure of energy that is available to self for engaging in life pursuits. Changes in subjective vitality may, in turn, affect health outcomes. Interpersonal variables including how connected one feels with others and whether or not one feels like a burden may affect the manner in which stigma relates to subjective vitality and health. In the current study a sample of 100 individuals receiving medical treatment from a primary clinic that targets the working uninsured population in a region of Appalachia completed questionnaires assessing for perceived stigma of finances, depressive symptoms, health-related quality of life, subjective vitality, thwarted belongingness, and perceived burdensomeness. Results confirmed that experienced and internalized perceived stigma were moderately associated with poorer health outcomes and lower subjective vitality. Thwarted belongingness and perceived burdensomeness were, likewise, associated with worse health outcomes. In mediation analyses subjective vitality significantly explained the relations between each dimension of stigma and each outcome. Subsequent conditional indirect effect analyses found that thwarted belongingness moderated the mediation effect for some of the models by impacting the relation between stigma and subjective vitality or by moderating the relation between subjective vitality and the dependent variable. The findings suggest the importance of subjective vitality and feelings of belongingness in understanding how perceived stigma negatively affects health. Results and implications are discussed along with considerations for future research and interventions.

Document Type

Dissertation - unrestricted


Copyright by the authors.