From stigma to support: the mediating role of sympathy between nurses’ perceived stigma and helping behavior tendency for alcohol use disorder

Background: The detrimental effect of stigma on healthcare for individuals with alcohol use disorders (AUDs) is well-established, often resulting in social distance and diminished helping behavior tendencies. However, contemporary neuroscience reconceptualizes addiction as a brain disease, potentially altering emotional responses to stigma. This study examines a seemingly paradoxical possibility: that under specific conditions, perceived stigma is primarily associated with sympathy (rather than anger or fear), which in turn is linked to helping behavior tendencies among nurses. Methods: A cross-sectional survey was administered to 348 clinical nurses from tertiary hospitals in China. Participants completed standardized scales assessing perceived stigma of patients with AUDs, causal attributions, emotional responses (including sympathy, anger, and fear), and helping behavior tendencies. Data were analyzed using Pearson correlation and mediation analysis (PROCESS macro, Model 4) with 5,000 bootstrap samples to test the mediating role of sympathy. Results: Perceived stigma showed a significant positive correlation with sympathy (r= .160, p<.05), which was in turn positively correlated with helping behavior tendencies (r= .269, p<.05). Critically, mediation analysis revealed that sympathy fully mediated the relationship between perceived stigma and helping behavior tendencies. The standardized indirect effect was significant (β= 0.15, 95% CI [0.08, 0.23]), accounting for the total observed relationship, as the direct effect was non-significant. Additionally, compared to non-psychiatric nurses, psychiatric nurses perceived patients as significantly less dangerous and reported lower levels of fear and anger, along with a stronger intention to help and a lower tendency to avoid patients. Conclusion: Challenging conventional perspectives, this study supports a dual-pathway model in which perceived stigma can indirectly associated with professional helping behavior tendencies through the elicitation of sympathy. While other emotions like anger and fear were also measured, the findings highlight the pivotal role of cognitive-affective processes, shaped by neurobiological understandings of addiction, in determining nursing care. Specifically, sympathy, but not anger or fear, was found to mediate the stigma-helping relationship. Enhancing neuroscience-informed education and targeted empathy training, particularly for general nurses, could transform stigmatizing attitudes into supportive care, ultimately improving outcomes for patients with AUDs.