Abstract
Research suggests that accurate measurement is essential in evaluating internalized stigma and abilities to combat with stigma for treatment compliances and outcomes in individuals with mental illness. The purpose of this study was to assess the reliability and validity of the Chinese version of the Internalized Stigma of Mental Illness Scale (ISMIS-C), which is one of the few tools available to measure internalized stigma and stigma resistance (SR) simultaneously. A total of 160 outpatients with (n = 103) and without (n = 57) psychotic disorders were administrated with the ISMIS-C, and measures of self-esteem, self-efficacy, depression, and hopelessness. Overall, the 29-item ISMIS-C was presented to be internal reliable (Cronbach’s alpha = 0.90), and reliable over time (intraclass correlation coefficients = 0.36–0.73). The construct validity of the ISMIS-C derived from the factor analysis was nearly identical to the original version. ISMIS-C dimension scores were well correlated with each other and measures of self-esteem, self-efficacy, depression, and hopelessness. Our data also demonstrated that psychotic patients experienced higher internalized stigma scores than those without psychotic diagnoses, but endorsed indifferently on SR scores. This scale can be used as an informative device when investigating “internalized stigma” and “SR” among individuals with or without psychotic disorders.
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References
Ritsher JB, Otilingam PG, Grajales M.: Internalized stigma of mental illness: Psychometric properties of a new measure. Psychiatry Research 121(1):31–49, 2003.
Brohan E, Gauci D, Sartorius N, Thornicroft G: Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 14 European countries: The GAMIAN-Europe study. Journal of Affective Disorders 129(1–3):56–63, 2011.
Livingston JD, Boyd JE: Correlates and consequences of internalized stigma for people living with mental illness stigma: A systemic review and meta-analysis. Social Science and Medicine 71(12):2150–61, 2010.
Corrigan PW, Watson AC: The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice 9:35–53, 2002.
Watson AC, Corrigan P, Larson JE, Sells M: Self-stigma in people with mental illness. Schizophrenia Bulletin 33(6):1312–8, 2007.
Corrigan PW, Larson JE, Rusch N: Self-stigma and the “why-try” effect: impact on life goals and evidence-based practice. World Psychiatry 8(2):75–81, 2009.
Rusch N, Corrigan PW, Wassel A, et al: A stress-coping model of mental illness stigma: I. Predictors of cognitive stress appraisal. Schizophrenia Research 110(1–3):59–64, 2009.
Rusch N, Corrigan PW, Wassel A, et al: A stress-coping model of mental illness stigma: II. Emotional stress responses, coping behavior and outcome. Schizophrenia Research 110(1–3): 65–71, 2009.
Munoz M, Sanz M, Perez-Santos E, Quiroga M de los A: Proposal of a socio-cognitive -behavioral structural equation model of internalized stigma in people with severe and persistent mental illness. Psychiatry Research 186(2–3):402–8, 2011.
Yang LH: Application of stigma theory to Chinese groups with mental illness: Synthesis and new directions. Singapore Medical Journal 48(11):977–85, 2007.
Yang L, Kleinman A, Link B, Phelan J, Lee S, Good B: Culture and stigma: Adding moral experience to stigma theory. Social Science and Medicine 64(7):1524–35, 2007.
Thornicroft G, Brohan E, Rose D, Sartorius N, Leeaw M: Global pattern of experienced and anticipated discrimination against people with schizophrenia: A cross-sectional survey. Lancet 373(9661):408–15, 2009.
Hsu LKG, Wan YM, Chang H, Summergrad P, Tsang BYP, Chen H: Stigma of depression is more severe in Chinese American than Caucasian Americans. Psychiatry 71(3):210–8, 2008.
Yang LH, Phillips MR, Lo G, Chou Y, Zhang X, Hopper K: “Excessive Thinking” as explanatory models for schizophrenia: Impacts on stigma and “moral” status in Mainland China. Schizophrenia Bulletin 36(4):836–45, 2010.
Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ: Stigmatization of people with mental illnesses. British Journal of Psychiatry 177:4–7, 2000.
Brohan E, Elgie R, Sartorius N, Thornicroft G: Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophrenia Research 122(1–3):232–8, 2010.
Ritsher JB, Phelan JC: Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Research 129(3):257–65, 2004.
Lysaker PH, Roe D, Yanos PT: Toward understanding the insight paradox: Internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophrenia Bulletin 33(1):192–9, 2007.
Sibitz I, Unger A, Woppmann A, Zidek T, Amering M: Stigma resistance in patients with schizophrenia. Schizophrenia Bulletin 37(2):316–23, 2011.
Yanos PT, Roe D, Markus K, Lysaker PH: Pathway between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatric Services 59(12):1437–42, 2008.
Staring ABP, Gaag M Van der, Berge M Van den, Duivenvoorden HJ, Mulder CL: Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum disorder. Schizophrenia Research 115(2–3):363–9, 2009.
Corrigan PW, Rafacz J, Rusch N. Examining a progressive model of self-stigma and its impact on people with severe mental illness. Psychiatry Research 189(3):339–43, 2011.
Lysaker PH, Tsai J, Yanos P, Roe D: Associations of multiple domains of self-esteem with four dimensions of stigma in schizophrenia. Schizophrenia Research 98(1–3):194–200, 2008.
Vauth R, Kleim B, Wirtz M, Corrigan P: Self-efficacy and empowerment as outcome of self-stigmatizing and coping schizophrenia. Psychiatry Research 150(1):71–80, 2007.
Park SG, Bennett ME, Couture SM, Blanchard JL: Internalized stigma in schizophrenia: Relations with dysfunctional attitudes, symptoms, and quality of life. Psychiatry Research 205(1–2):43–7, 2013.
Brohan E, Slade M, Clement S, Thornicroft G: Experiences of mental illness stigma, prejudice and discrimination: a review of measures. BMC Health Services Research 25(10):80, 2010.
Ho WWN, Chiu MYL, Lo WTL, Yiu MGC: Recovery components as determinants of the health-related quality of life among patients with schizophrenia: structural equation modeling analysis. Australian & New Zealand Journal of Psychiatry 44(1):71–84, 2010.
Tang IC, Wu HC: Quality of life and self-stigma in individuals with schizophrenia. Psychiatric Quarterly 83(4):497–507, 2012.
Lv Y, Wolf A, Wang X: Experienced stigma and self-stigma in Chinese patients with schizophrenia. General Hospital Psychiatry 35(1):83–8, 2013.
American Psychiatric Association: Diagnostic and statistical manual of mental disorders, 4th edn., Text Revision. Washington, American Psychiatric Association, 2000.
Rosenberg M: Conceiving the self. New York, Basic Books, 1979.
Cheng ST, Hamid PN: An error in the use of translated scales: The Rosenberg self-esteem scale for Chinese. Perceptual and Motor Skills 81(2):431–4, 1995.
Schwarzer R, Aristi B. Optimistic self-beliefs: Assessment of general perceived self-efficacy in Thirteen cultures. Word Psychology 3(1–2):177–90, 1997.
Chiu FPF, Tsang HWH: Validation of the Chinese general self-efficacy scale among individuals with schizophrenia. International Journal of Rehabilitation Research 27(2):159–61, 2004.
Beck AT, Steer RA, Ball R, Ranieri W: Comparison of Beck depression inventories -IA and -II in psychiatric outpatients. Journal of Personality Assessment 67(3):588–97, 1996.
Lu ML, Che SS, Chang SW, Shen WW: Reliability and validity of the Chinese version of the Beck depression inventory-II. Taiwanese Journal of Psychiatry 16:301–10, 2002.
Beck AT, Weissman A, Lester D, Trexler L: The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology 42(6):861–5, 1974.
Kao YC, Liu YP, Lu CW, Cheng TH: Beck hopelessness scale: Exploring its dimensionality in patients with schizophrenia. Psychiatric Quarterly 83(2):241–55, 2012.
Portney LG, Watkins MP: Foundations of Clinical Research: Applications to Practice, 2nd edn. Upper Saddle River, Prentice-Hall, 2000.
Nunnally JC, Bernstien IH: Psychometric Theory, 3rd edn., New York, MacGraw-Hill, 1994.
Sorsdahl KR, Kakuma R, Wilson Z, Stein DJ: The internalized stigma experienced by members of a mental health advocacy group in South Africa. International Journal of Social Psychiatry 58(1):55–61, 2012.
Ehrlich-Ben Or S, Hasson-Ohayon I, Feingold D, et al.: Meaning life, insight and self-stigma among people with severe mental illness. Comprehensive Psychiatry 54(2):195–200, 2013.
Mashiach-Eizenberg M, Hasson-Ohayon H, Yanos PT, Lysaker PH, Roe D: Internalized stigma and quality of life among persons with severe mental illness: The mediating roles of self-esteem and hope. Psychiatry Research 208(1):15–20, 2013.
Beck AT, Baruch E, Balter JM, Steer AS, Warman DM: A new instrument for measuring insight: The Beck cognitive insight scale. Schizophrenia Research 68(2–3):319–29, 2004.
Lysaker PH, Davis LW, Warman DM, Strasburger A, Beattie N: Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: Associations across 6 months. Psychiatry Research 149(1–3):89–95, 2007.
Assefa D, Shibre T, Asher L, Fekadu A. Internalized stigma among patients with schizophrenia in Ethiopia: a cross-sectional facility-based study. BMC Psychiatry 12:239, 2012.
Lysaker PH, Roe D, Ringer J, Gilmore EM, Yanos PT: Changes in self-stigma among persons with schizophrenia enrolled in rehabilitation: Associations with self-esteem and positive and emotional discomfort symptoms. Psychological Services 9(3):240–7, 2012.
Angermeyer M, Matschinger H: Public beliefs about schizophrenia and depression: similarities and differences. Social Psychiatry and Psychiatric Epidemiology 38(9):526–34, 2003.
Pescosolido BA, Medina TR, Martin JK, Long JS: The “backbone” of stigma: identifying the global core of public prejudice associated with mental illness. American Journal of Public Health 103(5):853–60, 2013.
Hori H, Richards M, Kawamoto Y, Kunugi H: Attitudes toward schizophrenia in the general population, psychiatric staff, physician, and psychiatrists: A web-based survey in Japan. Psychiatry Research 186(2–3):183–9, 2011.
Sajatovic M, Jenkins JH: Is antipsychotic medication stigmatizing for people with mental illness. International Review of Psychiatry 19(2):107–112, 2007.
Acknowledgments
The authors would like to express their sincere thanks to Prof. Ritsher, the original ISMIS designer, for her permission to administer the ISMIS in our study. We also thank all participants who kindly volunteered to take part in this study. This study was supported by Grants from the National Science Council, Taiwan (NSC 101-2314-B-002 -139).
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On behalf of all authors, the corresponding author states that there is no conflict of interest.
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Lien, YJ., Kao, YC., Liu, YP. et al. Internalized Stigma and Stigma Resistance Among Patients with Mental Illness in Han Chinese Population. Psychiatr Q 86, 181–197 (2015). https://doi.org/10.1007/s11126-014-9315-5
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DOI: https://doi.org/10.1007/s11126-014-9315-5