Coauthored by Marisa Krauter, MS, and Kathleen Bogart, Ph.D.

People with facial differences are sometimes stigmatized for looking different. These experiences—such as being stared at, receiving unsolicited attention, and being asked privacy-invading questions—can lead to worse mental health outcomes.

New research investigates how these stigmatizing behaviors did or did not change after face masks became common due to the COVID-19 pandemic. For people with facial differences, this may have been the first time they were able to conceal their differences in public.

In a study of 288 people, we analyzed the effects of stigma on the mental health and attitudes around mask-wearing for adults with facial differences. We found two main results:

1. Stigma harms mental health.

In our study, we found that people with facial differences had higher anxiety and depression levels than found in the population as a whole. We also determined that 47 percent of our sample met the criteria for social phobia. Those with facial differences seem to be experiencing more mental health concerns than the general public, on average.

The more stigma people had experienced, the higher their levels of depression, anxiety, and social phobia. This adds further evidence to the idea that stigma is a well-known contributor to worse mental health outcomes for those with facial differences. However, it was previously unknown how face masks would affect stigma for those with facial differences.

2. Mask-wearing helps reduce some stigmatizing behaviors and generates some positive emotions for wearers.

From February to July of 2022, 82 percent of our participants reported that they wore masks while out in public. Their experience of feeling stigmatized changed as a result: 79 percent reported that when they wore a mask, people stared less, and 78 percent thought others asked fewer questions about their faces. This suggests that some common stigmatizing behaviors decreased with mask-wearing.

Being able to wear a face mask may have also affected how people with facial differences felt about themselves. Most of our participants—82 percent—felt less self-conscious about their own appearance while wearing a mask. When removing a face mask in public, like when eating, 64 percent felt more self-conscious.

However, there was less consensus on some questions regarding stigma. When asked whether people were nicer to them when wearing a face mask, 52 percent of people with facial differences disagreed. Regarding whether they wanted to continue wearing a mask in public because it made their facial difference less noticeable, 51 percent disagreed.

A Mask Paradox

It seems as though some stigmatizing experiences decreased with mask-wearing. However, those with facial differences also seemed to not want to utilize masks as a way to conceal their difference over the long term.

This paradox is even more interesting when we consider that increased amounts of stigma also predicted more positive mask-wearing attitudes. So those with facial differences who have been stigmatized may feel positively about wearing masks—but it seems like, for the majority, the reduction in stigma is not enough to motivate people to continue wearing them.

When not wearing a mask, people may be stigmatized due to their facial differences. However, when choosing to wear a mask, people may then face stigma associated with disability or political beliefs. People with facial differences may have to choose which form of stigma they are better able to cope with.

Marisa Krauter, MS, is a Ph.D. student in the School of Psychological Science at Oregon State University and Lab Manager of the Disability and Social Interaction Lab.