The experience of stigma and associated depression is commonly reported for wheelchair users. Wheelchair use can impact several dimensions of a person’s psychological and social well-being, with varied responses and consequences. Depression among wheelchair users is a complex and multifaceted phenomenon, likely to arise from pain, reduced physical and social activity, abuse, lack of access to appropriate healthcare, other health-related variables, or diminished community integration 1, 2. Physical barriers such as broken elevators, inaccessible transportation, and limited room to navigate public spaces are also significant obstacles. 3, 4. Although physical barriers are the most visible, social exclusion and the mental health consequences that stem from stigma and discrimination are also harmful [5]. Perhaps the association between disability and depression is spurious, with the relationship better explained by the underlying stigma and ableism present within society.

Engel [6] developed the biopsychosocial model that allows professionals to understand a person’s experience with medical issues in the context of physiological factors (bio) with psychological (psycho), personal, and societal components (social). This framework highlights the complex interplay of experiences for wheelchair users. As an example, a person using a wheelchair because of a spinal cord injury may experience spasticity, changes in mood, fatigue, a new living situation, and the need for adaptive equipment, while also managing the effects of stigma and bias [3].

Stigma occurs when society attaches a negative meaning to the behaviors or attributes of a particular individual. Goffman [6] defined stigma as the use of individual or group attributes to disempower and devalue people in society. According to Goffman [7], stigma is attached to three kinds of attributes: (1) physical features, (2) perceived character traits, and (3) group identities. Link and Phelan [8] argued that stigma exists when labeling, stereotyping, separation, status loss, and discrimination occur together.

Disability can be viewed as a form of involuntary social deviance, signified by physical signs, that causes negative responses [9]. Disability stigma stems from how society understands and attaches meaning to the disability experience [10]. The meanings attached are often deeply rooted in ableism, which Slesaransky-Poe and García [11] discussed as the belief that disability makes someone less deserving of many things like respect, education, and access within the community. Ableism can take the form of actions, thoughts, policies, and systems that people engage in that dehumanize and isolate disabled people [12]. These attitudes can impact the mental health of disabled people. Brown [13] found that societal devaluation was predictive of depressive symptoms in men and women with physical disabilities.

There are distinct frameworks that address how society responds to and perceives disability. The medical model positions disability as a physiological difference, impairment, or injury that is a deficit or a failure of a bodily system [14]. Individuals are viewed as abnormal, less-than, weak, and incapable. Consequently, stereotypes faced by disabled people are reinforced, including fear, pity, shame, and avoidance [15]. The disability community has largely rejected the medical model, as it ignores systemic social structures that produce and sustain disability in daily life. In turn, many disabled people and disability activists support the social model of disability, which argues that the environment is disabling, not the individual. Disability is no longer described in terms of functional limitations but rather shared oppression. The environment unnecessarily isolates disabled people from full participation in society [15]. Strict proponents of the social model would argue that when someone is perceived as impaired and thus stigmatized, the result is disabling 10, 15.

A review of the literature shows limited information on the occurrence of stigma experienced by wheelchair users, regardless of their disability type. Stigma has been explored in a variety of disabled populations, such as those with mental illnesses 11, 16, 17, or invisible impairments like chronic fatigue, chemical sensitivities, or fibromyalgia [18]. Social isolation and loneliness from stigma were increased in disabled individuals compared to non-disabled individuals, which can amplify depression 10, 19, 20. Stigma following the onset of spinal cord and traumatic brain injuries has also been reported to increase depression 1, 21, 22. However, there is a gap in the research regarding stigma among the broader category of wheelchair users, especially as it relates to mental health.

The aim of this research was to gain insight into perceived stigma among wheelchair users and the impact stigma may have on mental health. We purposely used the broad term of wheelchair users to a) challenge the hierarchy that often exists between manual and power wheelchair users and b) acknowledge that there are many impairments that may lead to wheelchair use beyond physical disabilities. We hypothesized that depression in wheelchair users would be associated with attitudinal and structural barriers present in the community. The following questions were considered for survey construction and data analysis:

What role does the environment play in wheelchair users' experiences related to stigma?

How does the lived experience of wheelchair use impact mental health outcomes?

How does stigma related to wheelchair use impact participation in society?