Social Discrimination and Self-Stigma among Adults Hospitalized with COVID-19 in Mongolia: An Exploratory Secondary Analysis of a Prospective Cohort

COVID-19-related stigma may compound psychological distress, yet evidence from Central Asia remains limited. We conducted an exploratory secondary analysis of baseline data from 399 adults hospitalized with PCR-confirmed COVID-19 in Ulaanbaatar, Mongolia. Two study-specific 12-item indices represented social discrimination/stigma and self-stigma/self-exclusion. We examined score distributions, internal consistency, exploratory internal structure, multivariable correlates, and concurrent associations with PHQ-9, GAD-7, ISI, and PCL-5 scores. Mean scores were 32.14 (SD 6.96) and 29.62 (SD 6.77), with Cronbach's alpha values of 0.903 and 0.891, respectively. The indices were moderately correlated (r = 0.451, 95% CI 0.369-0.526). Parallel analysis suggested two dimensions for the social discrimination/stigma items and one for self-stigma/self-exclusion. In residence-adjusted HC3 models, larger household size was associated with higher self-stigma (B = 0.59, 95% CI 0.18-1.00), although the demographic and clinical models explained little variance. In adjusted sensitivity analyses, self-stigma remained associated with depressive, anxiety, and PTSD symptom burden. Findings are exploratory because original item wording, response anchors, and translation procedures were unavailable; formal cultural adaptation and validation are required before clinical or prevalence use.