The Stigma Resistance Scale: A multi-sample validation of a new instrument to assess mental illness stigma resistance

Abstract

Although associated with key recovery outcomes, stigma resistance remains under-studied largely due to limitations of existing measures. This study developed and validated a new measure of stigma resistance. Preliminary items, derived from qualitative interviews of people with lived experience, were pilot tested online with people self-reporting a mental illness diagnosis (n = 489). Best performing items were selected, and the refined measure was administered to an independent sample of people with mental illness at two state mental health consumer recovery conferences (n = 202). Confirmatory factor analyses (CFA) guided by theory were used to test item fit, correlations between the refined stigma resistance measure and theoretically relevant measures were examined for validity, and test-retest correlations of a subsample were examined for stability. CFA demonstrated strong fit for a 5-factor model. The final 20-item measure demonstrated good internal consistency for each of the 5 subscales, adequate test-retest reliability at 3 weeks, and strong construct validity (i.e., positive associations with quality of life, recovery, and self-efficacy, and negative associations with overall symptoms, defeatist beliefs, and self-stigma). The new measure offers a more reliable and nuanced assessment of stigma resistance. It may afford greater personalization of interventions targeting stigma resistance.

Self-stigma in PTSD: Prevalence and correlates

“…stigma resistance have been published in recent years (e.g., see Firmin et al, 2017); future research would benefit from using these instead of the Stigma Resistance subscale on the ISMIS, which displays consistently low internal consistency (Boyd et al, 2014). Alternatively, if our finding does not represent a type II error, results may suggest that the ability to resist stigma is relatively independent of metacognitive capabilities in those with PTSD.…”

Stigma Resistance and Its Associated Factors among People with Bipolar Disorder at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

“…It is a continuous and active process of using one's experiences, skills, and knowledge to develop an optimistic identity toward mental illness. Theoretical work on SR suggests that resisting stigma has an important role in fighting internalized stigma, facilitating the recovery from psychiatric illness, adherence, promoting their self-esteem, empowerment, quality of life, functionality, and community reengagement [ 7 , 9 , 26 , 27 ]. In previous studies, cut-off point at 2.5 and above on the mean item score of the SR subscale was used to define moderate to high (referred to as “high”) stigma resistance and less than 2.5 for low stigma resistance [ 9 , 28 ].…”

The Stigma Resistance Scale for people with mental illness: Transcultural adaption and validation of the Chinese version

“…Nevertheless, the factor analysis showed that a three‐factor model demonstrated a more acceptable fit with the Chinese data, different from the original scale of five factors (Firmin et al, 2017). Of note, the original scale was developed from a conceptual model of stigma resistance concerning (1) personal stigma resistance, (2) peer stigma resistance, and (3) public stigma resistance (Firmin et al, 2017).…”

“…The SRS was developed in 2017 to assess multiple domains of stigma resistance (Firmin et al, 2017). It is a 20‐item scale with five factors.…”

“…The items are evaluated on a 5‐point Likert scale according to the degree of agreement. This scale had an acceptable internal consistency for each subscale (0.72–0.88) and the total scale (0.93; Firmin et al, 2017). The measure has also demonstrated excellent stability over 3 weeks ( r = 0.74) (Firmin et al, 2017).…”