COVID-19 stigma and mental health: Who hid their illness, who shared and why it still matters

More than a third of Michigan adults who have had COVID-19 report being treated badly due to their infection, say University of Michigan researchers.

The latest in a series of statewide surveys exploring Michigan residents' experiences with COVID focused on social stigma and found that of 4,618 adults surveyed, 35% say they were treated badly, threatened or harassed or had people act afraid of them.

In addition, more than 20% were afraid to tell friends or family of their COVID diagnosis, and 16% of the employed respondents feared disclosing their health status in the workplace, according to the Michigan COVID-19 Recovery Surveillance Study.

MI CReSS is a joint project between U-M's School of Public Health and the Michigan Department of Health and Human Services to translate pandemic data into better prevention and response for the next public health crisis.

Overall, compared to 2020, the latest survey tracked a large decrease in perceived stigma and fear of COVID disclosure to friends or family and at work. But even as the COVID public health emergency is expected to officially be lifted May 11, the need for knowledge and understanding of how the virus played out continues.

"Historically, disease outbreaks have always been accompanied by stigma, which leads to poor health outcomes," said MI CReSS researcher Soomin Ryu, a postdoctoral research fellow at U-M's School of Public Health.

"It's important to understand how common COVID-19 stigma is and who is at risk of having COVID-19 stigma so that governments and communities can provide anti-stigma campaigns and prevent adverse effects of stigma."

The report highlights the need to apply what we learned during this pandemic toward future pandemics, says study co-author and senior investigator Nancy Fleischer, associate professor of epidemiology at the U-M School of Public Health.

"These findings point toward the importance of communication at the start of a pandemic," she said. "To avoid stigmatizing people who become ill, government officials and public health professionals must emphasize that it is not the fault of the individual who has become ill."

The latest survey, which was taken by Michigan residents with confirmed COVID-19 prior to March 2022, also details differences in perception of stigma and fear of disclosure based on levels of income, education, employment, age, gender, race, health insurance coverage and other demographics.

Findings include:

• Perceived COVID stigma and fear of disclosure were greater among females, younger people and for nonwhite respondents.
• Perceived COVID stigma decreased with age with 40% of 35-to-44-year-olds being most affected by negative stigma and nearly 23% of people 65 and older being least affected. At 39%, 18-to-24-year-olds were a close second in highest percentage for perceived COVID stigma.
• Perceived COVID stigma was most prevalent among non-Hispanic Black respondents, 43%. Fear of COVID disclosure to friends or family was most prevalent among Hispanic respondents at 31%.
• Perceived COVID stigma was more common among respondents with lower household income, those who were employed and respondents who had nonprivate health insurance.
• The prevalence of anxiety and depressive symptoms among respondents with COVID stigma was twice as high as the prevalence of those symptoms among respondents without COVID stigma.

"Our findings suggest that populations marginalized in society were more likely to suffer from COVID-19 stigma," Ryu said. "As mental health problems were more common among people who had COVID-19 stigma, we need to keep monitoring populations who experienced COVID-19 stigma."

Natasha Bagdasarian, MDHHS chief medical executive, said that addressing racial disparities, especially for mental and physical health, are a priority for MDHHS.

"Our efforts through the Racial Disparities Task Force and our Stay Well program that began with COVID, will continue to expand to support both physical and behavioral health needs with our more at-risk populations," she said.

The report on stigma and mental health is the sixth in a series of reports produced since MI CReSS launched in 2020. Prior reports examined topics such as differences in COVID-19 for Black and white communities, for people with disabilities, for people across occupations and long COVID.

MI CReSS recently completed baseline interviews of participants with confirmed COVID-19 onset through May 31, 2022, and the MI CReSS team is continuing to follow up with prior participants to learn if, and how, the pandemic has continued to affect their lives.