D1.251 - High Cost of Stigma: Anticipated Workplace Stigma Drives Absenteeism while Healthcare Stigma Provokes Anxiety in HAE

While the physical burden of Hereditary Angioedema (HAE) attacks is well-documented, the invisible psychological barrier of "anticipated stigma" remains largely unexplored. Patients often face distinct challenges in professional environments versus medical settings. We aimed to dissect the specific impact of workplace and healthcare-related stigma on disease outcomes, aiming to clarify their roles in quality of life (QoL) and economic productivity. 

In this cross-sectional study, we evaluated the psychosocial landscape of 60 adult patients with confirmed HAE. To quantify the hidden burden of stigmatization, we utilized the Chronic Illness Anticipated Stigma Scale (CIASS). These scores were correlated with validated patient-reported outcome measures, including the Hospital Anxiety and Depression Scale (HADS), Angioedema Quality of Life Questionnaire (AE-QoL), and the Work Productivity and Activity Impairment Questionnaire (WPAI). Linear regression models were employed to identify key predictors of work-related impairment. 

Our analysis revealed a dichotomy in how stigma impacts HAE patients. Workplace stigma emerged as a primary driver of economic loss, showing a strong positive correlation with absenteeism (r=0.521, p<0.01) and activity impairment (r=0.374, p<0.01). In contrast, healthcare stigma—fear of judgment by medical personnel—was significantly linked to psychological distress, specifically anxiety levels (r=0.277, p<0.05). Furthermore, regression analysis highlighted that poor disease-specific QoL (AE-QoL) is a robust predictor of both absenteeism (R²=0.461) and overall work impairment (R²=0.489).

Stigma in HAE is not uniform; it manifests with distinct consequences depending on the setting. While workplace discrimination drives patients away from productivity (absenteeism), stigma in healthcare settings fuels anxiety. Effective HAE management requires a paradigm shift: clinicians must screen for anticipated stigma to prevent not only psychological distress but also significant workforce loss.