The effect of personalized invalidation of symptoms by healthcare providers on patient depression: The mediating role of self-esteem

Allyson C. Bontempo
Patient education and counseling · 2021 · vol. 105(6) , pp. 1598–1605 · doi:10.1016/j.pec.2021.09.034 · PMID:34666932 · W3206782356
Observational OA: closed CC0 ⤵ 5 in-corpus citations
View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This study examined how personalized invalidation of symptoms by healthcare providers impacts patient depression, exploring the mediating influence of self-esteem.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Abstract

OBJECTIVES: Qualitative research has thoroughly investigated the diagnostic journeys of patients, who have often reported difficulty with healthcare providers regarding the acknowledgement of an organic, pathological cause for their symptoms (hereafter referred to as invalidation of symptoms). These encounters also reportedly contributed to reductions in self-esteem and to feelings of depression, particularly prior to diagnosis. The aim of this research was to quantitatively validate these observed relationships and examine the potential compounding effect of personalization of this reported invalidation. METHODS: Participants were 609 patients with self-reported endometriosis from a larger online research study. Invalidation and personalization of invalidation were measured with survey items developed for this research. Self-esteem and depression were assessed with well-known validated and reliable self-report instruments. Hierarchical linear regressions were performed, with path analysis to test for mediation. RESULTS: Invalidation predicted self-esteem but not depression. However, when personalized, invalidation predicted both self-esteem and depression. Path analysis testing the effect of personalization of invalidation on depression through self-esteem was significant, demonstrating full mediation. CONCLUSIONS: Results confirm qualitative research and provide the first known quantitative support that invalidation, particularly when personalized, can be associated with reduced self-esteem and, in turn, greater depression. PRACTICE IMPLICATIONS: These findings demonstrate an important barrier to patient-centered communication.

My notes (saved in your browser only)

MeSH descriptors

Depression Depression Depression Depression Self Concept Self Concept Communication Communication Female Female Health Personnel Health Personnel Humans Humans Surveys and Questionnaires Surveys and Questionnaires

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (88)

Cited by (5)

Source provenance

europepmc
last seen: 2026-10-17T06:09:56.316927+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-10-08T21:32:46.934654+00:00
unpaywall
last seen: 2026-10-17T06:24:38.187582+00:00
License: CC0 · commercial use OK