Psychometric Evaluation of the Internalized Stigma of Mental Illness Scale for Patients with Mental Illnesses: Measurement Invariance across Time

Abstract

BackgroundThe current investigation examined the psychometric properties of the Internalized Stigma of Mental Illness (ISMI) scale in a sample of patients with mental illness. In addition to the internal consistency, test-retest reliability, and concurrent validity that previous studies have tested for the ISMI, we extended the evaluation to its construct validity and measurement invariance using confirmatory factor analysis (CFA).MethodsThree hundred forty-seven participants completed two questionnaires (i.e., the ISMI and the Depression and Somatic Symptoms Scale [DSSS]), and 162 filled out the ISMI again after 50.23±31.18 days.ResultsThe results of this study confirmed the frame structure of the ISMI; however, the Stigma Resistance subscale in the ISMI seemed weak. In addition, internal consistency, test-retest reliability, and concurrent validity were all satisfactory for all subscales and the total score of the ISMI, except for Stigma Resistance (α = 0.66; ICC = 0.52, and r = 0.02 to 0.06 with DSSS). Therefore, we hypothesize that Stigma Resistance is a new concept rather than a concept in internalized stigma. The acceptable fit indices supported the measurement invariance of the ISMI across time, and suggested that people with mental illness interpret the ISMI items the same at different times.ConclusionThe clinical implication of our finding is that clinicians, when they design interventions, may want to use the valid and reliable ISMI without the Stigma Resistance subscale to evaluate the internalized stigma of people with mental illness.

Psychometric properties of the Internalized Stigma of Mental Illness scale adapted for people who use psychoactive substances

“…Regarding the reliability of the scale, the obtained coefficients were coincident with previously noted in the original study of Ritsher (1) and other versions (3,(11)(12)(13)15) , including versions of Luoma and Soares with people with substance use (5,6) , where the "Stigma resistance" sub-scale had less reliability.…”

“…From the layout of an instrument widely used in different languages and versions (11) to determine the internalized-stigma in people with mental disorders, this study concludes with the adaptation of the instrument in people who consume psychoactive substances. The scores of internalized-stigma in this sample were higher than those observed by other authors in patients with mental disorders (1,(12)(13)(14) ; while there is a similar behavior when compared to the Taft version (15) who applied in patients with inflammatory bowel disease, or the study of Stevelink (4) who applied in people living with HIV/AIDS and leprosy.…”

Comparing Self-stigma Between People With Different Mental Disorders in Taiwan

“…In addition, there were no significant differences between patients who had been hospitalized or manifested suicidal behavior and those who had not. Others (Brohan et al, 2010;Chang et al, 2014;Sibitz et al, 2011a) suggest that Stigma Resistance cannot be viewed as internalized stigma; instead, Stigma Resistance is considered an import part of fighting stigma (Sibitz et al, 2011b). Therefore, our findings indicated that people with different psychiatric diagnoses and patients who had and had not been hospitalized or manifested suicidal behavior struggle in the same way in a society unfriendly to them because of their mental illness.…”

Mixed-methods analysis of internalized stigma correlates in poorly adherent individuals with bipolar disorder

“…The ISMI scale was originally validated in a population of 127 Veterans Administration patients, for whom the scale produced an internal consistency reliability of α=0.90, a test-retest reliability of 0.92 (N=16, p <0.05), and concurrent validity with the Devaluation-Discrimination scale (r=0.35, p <0.01) and Center for Epidemiologic Studies Depression scale depressive symptoms (r=0.53, p <0.01) [5]. Multinational studies have tested the psychometric properties of the ISMI, finding an internal consistency reliability of α>0.90 and a test-retest reliability of between 0.62 and 0.90 [22]. For BD patients specifically, the items means range was 1.61–3.50 (SD range 0.54–1.03) and the internal consistency reliability was α=0.80 (N=18) [14].…”