Purpose: As a group, adults who stutter (AWS) are vulnerable to experiencing distress and other negative psychological health outcomes. However, not all AWS experience elevated levels of distress, and little is known about why some people are resilient while others struggle to cope. In the current study, stuttering was conceptualized as a type of concealable stigmatized identity (CSI). The purpose of this study was to determine if stigma-identity constructs that contribute to variability in distress among groups of people with other types of CSIs also contribute to psychological health outcomes among AWS. The specific stigma-identity constructs that were examined include salience (the extent that a person thinks about stuttering), centrality (how much a person defines themselves by stuttering), concealment (the extent that a person attempts to keep stuttering a secret from others), and disclosure (the frequency in which a person tells others about stuttering).
Methods: A sample of 505 AWS completed an online survey that included measures of salience, centrality, concealment, disclosure, demographics, self-rated stuttering severity, psychological distress, and adverse impact of stuttering on quality of life. Correlational and hierarchical regression analyses were performed to (1) determine the extent that stigma-identity constructs explain variability in psychological health outcomes among AWS and (2) identify unique relationships between each of the stigma-identity constructs and psychological health outcomes. Additionally, self-rated stuttering severity was investigated as a potential moderator of the relationships between stigma-identity constructs and psychological health outcomes.
Results: Together, the stigma-identity constructs accounted for a significant proportion of the variability in distress (~25%) and adverse impact of stuttering on quality of life (~30%) among AWS. Salience, centrality, and concealment were positively associated with and predictive of distress and adverse impact of stuttering on quality of life after controlling for demographics and neuroticism. Further, self-rated stuttering severity moderated the relationship between centrality and adverse impact of stuttering on quality of life. Specifically, high centrality was only associated with more adverse impact of stuttering on quality of life among people with moderate and high self-rated stuttering severity. Disclosure did not have a consistent reliable relationship with either psychological health outcome.
Conclusions: The results from this study provide evidence that it is both appropriate and useful to conceptualize stuttering as a type of CSI. That is, variability in psychological health outcomes among AWS can be explained to a large extent by individual differences in the ways people think about and behave in relation to their stuttering identity. Speech-language pathologists should be aware of the relationships that salience, centrality, and concealment have with psychological health outcomes among AWS and should consider the implications for stuttering intervention.