The Internalized Stigma of Mental Illness (ISMI) scale: validation of the Japanese version

Associations of internalized stigma with psychosocial functioning and quality of life in people with schizophrenia

BACKGROUND

Schizophrenia is associated with poor functional recovery. Internalized stigma is one of the factors related to the functioning of individuals with schizophrenia. We aimed to investigate whether internalized stigma was associated with subjective and objective recovery-related outcomes after controlling for neurocognition and other important confounders in individuals with schizophrenia.

METHOD

We assessed the socio demographic background, psychopathology, neurocognition, internalized stigma, psychosocial functioning, and quality of life of 86 patients who had schizophrenia. Correlation analyses and multiple linear regression were used to investigate the association of internalized stigma and other variables with recovery-related outcomes.

RESULTS

We found that the negative symptom scores of the Positive and Negative Syndrome Scale but not internalized stigma was associated with psychosocial functioning as measured by the Personal and Social Performance global score. In contrast, internalized stigma was associated with the Psychological, Social relationships, and Environment scores of the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF). Depression was also associated with the Physical health, Psychological, and Social relationships sores of the WHOQOL-BREF.

CONCLUSIONS

While internalized stigma was associated with several domains of quality of life, it was not associated with clinician-rated psychosocial functioning. The effects of internalized stigma on the subjective and objective recovery-related outcomes of individuals with schizophrenia might be divergent.

Exploring negative symptoms heterogeneity in patients diagnosed with schizophrenia and schizoaffective disorder using cluster analysis

BACKGROUND

Dissecting the heterogeneity of schizophrenia may help foster progress in understanding its etiology and lay the groundwork for the development of new treatment options for primary or enduring negative symptoms (NS). In this regard, the present study aimed to: (1) to use cluster analysis to identify subgroups of Lebanese patients diagnosed with either schizophrenia or schizoaffective disorder based on NS clusters, and (2) to relate the statistically-derived subgroups to clinically relevant external validators (including measures if state and trait depression, stigma, insight, loneliness, social support).

METHOD

A total of 202 adult long-stay, chronic, and clinically remitted patients (166 diagnosed with schizophrenia and 36 with schizoaffective disorder) were enrolled. A cluster analysis approach was adopted to classify patients based on the five NS domains social withdrawal, emotional withdrawal, alogia, avolition and anhedonia.

RESULTS

A three-cluster solution was obtained based on unique NS profiles, and divided patients into (1) low NS (LNS; 42.6%) which characterized by the lowest mean scores in all NS domains, (2) moderate NS (MNS; 25.7%), and (3) high NS (HNS; 31.7%). Post-hoc comparisons showed that depression (state and trait), loneliness and social support could accurately distinguish the schizophrenia subgroups. Additionally, individuals in the HNS cluster had longer duration of illness, longer duration of hospitalization, and were given higher dosages of antipsychotic medication compared to those in the other clusters, but these differences did not achieve the statistical significance.

CONCLUSION

Findings provide additional support to the categorical model of schizophrenia by confirming the existence of three alternate subtypes based on NS. The determination of distinct NS subgroups within the broad heterogeneous population of people diagnosed with schizophrenia may imply that each subgroup possibly has unique underlying mechanisms and necessitates different treatment approaches.

Internalised stigma among people with mental illness in Africa, pooled effect estimates and subgroup analysis on each domain: systematic review and meta-analysis

BACKGROUND

Internalisation of stigma occurs when people with a stigmatised attribute, such as a mental illness, supress negative but accepted societal attitudes. However, as far as is known, there is no comprehensive picture of the prevalence of and factors associated with, internalised stigma among people living with mental illness in Africa. This systematic review and meta-analysis provide new knowledge by examining the evidence on the prevalence of internalised stigma and associated factors among people living with mental illness in Africa.

METHODS

Using the population, intervention, comparison, outcome, and type of study (PICOT) approach, PubMed, Scopus, MEDLINE, PsycINFO, CINAHL, ScienceDirect, and Google Scholar were searched using a structured search comprising terms associated with mental health, mental illness, internalised stigma, and a list of all African countries. To evaluate paper quality, the Joanna Briggs Institute Quality Appraisal Checklist was used. Subgroup analysis with country and diagnosis was tested using a random-effect model, and bias was checked using a funnel plot and an inspection of Egger's regression test. A p-value, OR and 95% CI was used to demonstrate an association.

RESULTS

The pooled prevalence of internalised stigma was 29.05% (25.42,32.68: I2 = 59.0%, p ≤ 0.001). In the subgroup analysis by country, Ethiopia had the highest prevalence of internalised stigma at 31.80(27.76,35.84: I2 = 25.6%, p ≤ 0.208), followed by Egypt at 31.26(13.15,49.36: I2 = 81.6%, p ≤ 0.02), and Nigeria at 24.31(17.94,30.67: I2 = 62.8%, p ≤ 0.02). Based on domains of internalised stigma, pooled prevalence was stigma resistance: 37.07%, alienation: 35.85%, experience of discrimination: 31.61%, social withdrawal: 30.81% and stereotype: 26.10%. Experiencing psychotic symptoms (1.42(0.45,2.38)), single marital status (2.78(1.49,4.06)), suicidal ideation (2.32(1.14,3.49)), drug nonadherence (1.5(-0.84,4.00)), poor social support (6.69(3.53,9.85)), being unemployed (2.68(1.71,3.65)), and being unable to read and write (3.56(2.26,4.85)) were identified as risk factors for internalised stigma.

CONCLUSIONS

Internalised stigma is common among people suffering from mental illnesses in Africa. This review determined that 29% of the sample population had elevated internalised stigma scores, and there were variations by country. People experiencing mental illness who have a single marital status, suicidal behaviours, poor social support, unemployed and have poor literacy levels were at a higher risk of internalised stigma. The finding points to populations that require support to address internalised stigma and improve the mental health outcomes.

Prevalence, risk, and protective factors of self-stigma for people living with depression: A systematic review and meta-analysis

BACKGROUND

People living with depression are subjected to widespread stigmatization worldwide. Self-stigma may negatively affect patients' treatment, recovery, and psychological well-being. This review aims to summarize and synthesize the evidence on the prevalence, risk, and protective factors of depression self-stigma.

METHODS

Four online databases, PubMed, PsycINFO, Web of Science, and Embase, were searched to identify eligible studies. Fifty-six studies involving a total of 11,549 samples were included in the final analysis. Four reviewers independently screened the literature, extracted data, and assessed the risk of bias in eligible studies. Pearson's r was chosen as the effect size metric of risk and protective factors.

RESULTS

The results showed that the global prevalence of depression self-stigma was 29 %. Levels of self-stigma varied across regions, but this difference was not significant. Two demographic factors were identified: ethnicity (r = 0.10, p < 0.05) and having a partner/married (r = -0.22, p < 0.001). Five risk factors were identified: depression severity (r = 0.33, p < 0.01), public stigma (r = 0.44, p < 0.001), treatment stigma (r = 0.46, p < 0.001), perceived stigma (r = 0.37, p < 0.001), and enacted stigma (r = 0.71, p < 0.001). Five protective factors were identified: quality of life (r = -0.38, p < 0.001), social relationship (r = -0.26, p < 0.05), self-esteem (r = -0.46, p < 0.001), extroversion (r = -0.32, p < 0.001), and social functioning (r = -0.49, p < 0.001).

LIMITATIONS

Heterogeneity was observed in some of the results. Causality cannot be inferred due to the predominance of cross-sectional designs among the included literature.

CONCLUSIONS

Risk and protective factors of depression self-stigma exist across many dimensions. Future research should examine the inner mechanisms and effectiveness of interventions to reduce stigma.

Psychometric properties of the Internalized Stigma of Mental Illness (ISMI-10) scale in a Dutch sample of employees with mental illness

BACKGROUND

Internalized stigma can have numerous negative effects on the well-being and employment of people with mental illness. Brief, valid, and reliable measures are needed to get a better understanding of self-stigmatization. The aim of this study is to translate the brief version of the Internalized Stigma of Mental Illness (ISMI-10) scale into a Dutch version and to assess the reliability and validity of this Dutch version in a sample of employees with mental illness.

METHODS

The ISMI-10 was translated into Dutch using the forward-backward translation procedure. The sample consisted of 161 employees with mental illness. Internal consistency was evaluated and the retest reliability was tested with 68 respondents. The construct validity was evaluated by testing convergent and divergent validity.

RESULTS

The Dutch ISMI-10 showed good internal consistency (α = 0.83) and good test-retest reliability (r = 0.73). The Dutch ISMI-10 demonstrated excellent convergent validity; high correlations were found between the Dutch ISMI-10 and hope (r = -0.54), anxiety and depression (r = 0.59), self-esteem (r = -0.56), and empowerment (r = - 0.59). Acceptable divergent validity was indicated; small correlations were found between the Dutch ISMI-10 and the physical functioning subscale (r = -0.27) and the role limitation due to physical problems subscale (r = -0.21), and medium correlations were found between the Dutch ISMI-10 and the general health subscale (r = -0.36).

CONCLUSION

The Dutch ISMI-10 demonstrated adequate psychometric properties for assessing internalized stigma and can be used by researchers in Dutch speaking countries to get a better understanding of self-stigmatization among people with mental illness.

Development of the Japanese Version of the Infertility Stigma Scale: Examination of Its Reliability and Validity

The stigma of infertility negatively affects health, resulting in mental distress and poor quality of life. An appropriate scale is essential to examine the stigma experienced by infertile women and provide adequate interventions. Therefore, we developed a Japanese version of the Infertility Stigma Scale (ISS). After examining the content validity of this scale, we conducted an online survey of women undergoing fertility treatment to test the scale’s structural validity, internal consistency, intra-rater reliability, known-groups validity, convergent validity, and discriminant validity. A total of 254 participants were included in the analysis. The results of confirmatory factor analysis of four factors based on the original scale revealed the optimal fit. Cronbach’s alpha was 0.95 for the total score. Concerning test−retest analysis, the total score of the ISS and subscale had a high Spearman correlation coefficient (ρ = 0.61−0.88, p < 0.001). For convergent validity, the association between the ISS and social support, self-esteem, and family functioning was significantly negatively correlated. The results of the multitrait scaling analysis scale showed that correlations of all items exceeded 0.40, and scaling errors (7/81, 8.6%) were few. The Japanese version of the ISS was confirmed to have acceptable reliability and validity.

Internalized-stigma and dissociative experiences in bipolar disorder

INTRODUCTION

Dissociative symptoms have been recently related to bipolar disorder (BD) symptomatology. Moreover, the disease burden carries on a share of perceived self-stigma that amplifies the BD impairment. Internalized stigma and dissociative symptoms often seem overlapping, leading toward common outcomes, with reduced treatment seeking and poor adherence. We hypothesize a potential relationship between dissociation and self-stigma in patients suffering from BD.

MATERIALS AND METHODS

In this cross-sectional study we enrolled a total of 120 adult clinically stable BD outpatients. All participants completed the Internalized Stigma of Mental Illness (ISMI), Dissociative Experiences Scale-II (DES-II), and Manchester Short Assessment of Quality of Life (MANSA).

RESULTS

Average age and age at BD (BD-I n = 66, 55%; BD-II n = 54, 45%) onset were 46.14 (±4.23), and 27.45 (±10.35) years, with mean disease duration of 18.56 (±13.08) years. Most participants were female (n = 71; 59.2%) and 40 (33%) of them experienced lifetime abuse, with an average of 1.05 (±0.78) suicide attempts. DES scores (mean 31.8, ±21.6) correlated with ISMI total-score, with significant association with spikes in Alienation (13.1, SD±3.1) (p < 0.001) and Stereotype (13.8, SD±3.9) (p < 0.001). Linear regression analysis has shown a significant association between DES total score and alienation (p < 0.001), stereotype (p < 0.001) and MANSA total-score (p < 0.001).

DISCUSSION

For the first time, our data suggests that self-stigma is associated to dissociative symptoms, reducing overall quality of life in BD. The early identification of at-risk patients with previous lifetime abuse and high perceived stigma could lead the way for an ever more precise tailoring of treatment management.

Exploring mental illness stigma among Asian men mobilized to become Community Mental Health Ambassadors in Toronto Canada

BACKGROUND

Stigma of mental illness contributes to silence, denial and delayed help seeking. Existing stigma reduction strategies seldom consider gender and cultural contexts.

PURPOSE

The Strengths in Unity study was a multi-site Canadian study that engaged Asian men in three stigma reduction interventions (ACT, CEE, psychoeducation) and mobilized them as Community Mental Health Ambassadors. Our participants included both men living with or affected by mental illness (LWA) as well as community leaders (CL). This paper will: (1) describe the baseline characteristics of the Toronto participants including their sociodemographic information, mental illness stigma (CAMI and ISMI), attitudes towards social change (SJS), and intervention-related process variables (AAQ-II, VLQ, FMI, Empowerment); (2) compare the differences among these variables between LWA and CL; and (3) explore factors that may correlate with socio-economic status and mental health stigma.

RESULTS

A total of 609 Asian men were recruited in Toronto, Canada. Both CL and LWA had similar scores on measures of external and internalized stigma and social change attitudes, except that LWA had more positive views about the acceptance and integration of those with mental illness into the community on the CAMI, while CL had a higher level of perceived behavioral control on the SJS. Group differences were also observed between LWA and CL in some process-related variables. Exploratory analysis suggests that younger and more educated participants had lower stigma.

CONCLUSION

Our findings underscore the importance of engaging both community leaders and people with lived experience as mental health advocates to address stigma.

Reliability and Validity of the Japanese Version of the Barriers to Access to Care Evaluation Scale Version 3 for People With Mental Disorders: an Online Survey Study

It is a serious problem when people with mental disorders avoid, delay, discontinue, or do not use treatment and support, despite the existence of evidence-based treatment and support methods. In this study, we aimed to clarify the factor structure of BACE v3, a scale to measure barriers to accessing mental health care, and to examine its reliability and validity among Japanese people with mental disorders. An online survey with 268 participants, 20 years old and over, who had received care from mental health services in the past 12 months was conducted. Exploratory and confirmatory factor analysis (EFA and CFA) were used to examine the structure of the BACE v3. Internal consistency and test-retest reliability of all subscales were examined. Convergent validity [correlation of one of the subscales of the BACE v3, the treatment stigma subscale with the Stigma Scale for Receiving Psychological Help (SSRPH) and with the Internalized Stigma of Mental Illness Scale (ISMI)] was assessed. EFA identified two factors (treatment stigma and non-stigma), and the results suggested that the factor structure of the Japanese version of BACE v3 was similar to the original 2-factor structure. Regarding the CFA result, the goodness-of-fit indices showed marginal fit (root mean square error of approximation = 0.087; Tucker–Lewis index = 0.842; standardized root mean square residual = 0.078; comparative fit index = 0.86). The internal consistency of the treatment stigma subscale was α = 0.90, and the intraclass correlation coefficient was 0.76 (confidence interval: 0.70–0.81). The internal consistency of the non-stigma subscale was α = 0.83, and the intraclass correlation coefficient was 0.64 (confidence interval: 0.56–0.71). The score of the treatment stigma subscale was significantly and positively correlated with the SSRPH and ISMI. Thus, the BACE v3 has acceptable consistency, reliability and validity for the assessment of barriers to accessing mental health care including treatment stigma among people with mental disorders in Japan.

Mediating effects of self-stigma and depression on the association between autistic symptoms and recovery in patients with schizophrenia-spectrum disorders: a cross-sectional study

BACKGROUND

Several studies have indicated that self-stigma is associated with depressive symptoms and could be a barrier to recovery in patients with schizophrenia-spectrum disorders. More recently, an association between autistic symptoms and self-stigma was found in schizophrenia-spectrum patients. This study aimed to investigate the association between self-stigma, autistic and depressive symptoms, and recovery in patients with schizophrenia.

METHODS

In total, 105 participants were evaluated using the Autism Spectrum Quotient, the Internalized Stigma of Mental Illness Scale, the Quick Inventory of Depressive Symptomatology, and the Recovery Assessment Scale to investigate autistic symptoms, self-stigma, depressive symptoms, and recovery, respectively. The relationship between self-stigma, autistic symptoms, depressive symptoms, and recovery was assessed using structural equation modeling analysis.

RESULTS

Impaired attention switching, one symptom of autism, was found to positively affect stereotype endorsement, which negatively influenced recovery through depressive symptoms. Moreover, problems with communication skills negatively affected recovery through depressive symptoms. Concerning self-stigma, stereotype endorsement and perceived discrimination had a negative effect on recovery through depressive symptoms, whereas stigma resistance had a direct negative effect on recovery.

CONCLUSIONS

This study may provide meaningful insight into the psychological structure of recovery and could inform effective interventions for patients with schizophrenia-spectrum disorders. This was a cross-sectionally designed study; therefore, further longitudinal studies are needed to identify the causal relationships between self-stigma, autistic and depressive symptoms, and recovery.

Functional Disability in Patients with Mood Disorders at St Paul's Hospital Psychiatry Clinic, Addis Ababa, Ethiopia, 2019

Background

Functional disability is defined as limitations in performing socially defined roles and tasks expected within a sociocultural and physical environment. Functionality is a result of good mental health care. This study aimed to assess the magnitude and determinants of functional disability among patients with a mood disorders treated at St Paul's Hospital outpatient psychiatry clinic, Addis Ababa, Ethiopia in 2019.

Methods

This was a cross-sectional study. We used consecutive sampling to select respondents. Data were collected through face-to-face interviews using the 12-item World Health Organization Disability Assessment Schedule version 2.0. Data were entered into EpiData 3.1 and exported to SPSS 22.0 for analysis. Linear regression analysis was used to identify significant variables associated with outcomes.

Results

This study enrolled 235 respondents with a 100% nonresponse rate, and 62.5% were diagnosed with major depressive disorder. Mean disability score was 30.2%±32.4%. Nearly a quarter of respondents had had difficulties every day with day-to-day activity for the past 30 days. Current level of improvement (no change, β=10.5, 95% CI 3.85-17.2), relapse (β=6.15, 95% CI 1.34-10.9) and self-stigma (β=4.36, 95% CI 1.39-7.33) were strong predictors of disability score (P<0.05).

Conclusion

This study found a mean disability score of 30.2%. Current level of improvement and self-stigma were variables associated with disability, so working with stakeholders to focus on patients' clinical improvement from their illness and self-stigma will be vital to enhance their functionality.

Examining Different Strategies for Stigma Reduction and Mental Health Promotion in Asian Men in Toronto

Mental illness stigma has detrimental effects on health and wellbeing. Approaches to address stigma in racialized populations in Western nations need to emphasize inclusivity, social justice, and sociocultural intersectionality of determinants of health. The current paper evaluates three intervention approaches to reduce stigma of mental illness among Asian men in Toronto, Canada. Participants received one of four group interventions: psychoeducation, Acceptance and Commitment Therapy (ACT), Contact-based Empowerment Education (CEE), and a combination of ACT+CEE. Self-report measures on stigma (CAMI, ISMI) and social change (SJS) were administered before and after the intervention. A total of 535 Asian men completed the interventions. Overall analyses found that all intervention approaches were successful in reducing stigma and promoting social change. Subscale differences suggest that CEE may be more broadly effective in reducing mental illness stigmatizing attitudes while ACT may be more specifically effective in reducing internalized stigma. More work needs to be done to elucidate mechanisms that contribute to socioculturally-informed mental illness stigma interventions for racialized communities and traditionally marginalized populations.

Effects of a multimodal physical exercise program on physical and mental health indicators in males with substance use disorder

Introduction: Substance use disorder (SUD) is seen as a serious and growing public safety and health problem worldwide. Long-term sequelae may involve permanent damage to physical fitness, body balance, and coordination skills, with a severe motor, functional, and emotional consequences. Objective: To verify the effect of 16 sessions of a multimodal physical exercise program on physical fitness, body balance, and internalized stigma of inpatients for the treatment of Substance use disorder. Methods: Forty-three males with Substance use disorder (aged 33.9 ±12.4 years) were divided into an Intervention Group (IG, n=21) and Control Group (CG, n=22). The IG was submitted to eight weeks of training with physical exercises. Participants were submitted to the evaluation of internalized stigma, body balance, agility, and flexibility, before and after the intervention period. Results: Positive results were observed in physical fitness (agility, p=0.001) and body balance variables (center of pressure path with closed eyes, p=0.050, and ellipse area with closed eyes, p=0.031). The time of substance use correlated with lower performance in agility and body balance tests. Conclusion: The data seem to support the potential benefit of physical exercise as an adjunct in Substance use disorder rehabilitation process, particularly for physical fitness and body balance variables.

Knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among people diagnosed with schizophrenia in a long-term care facility

PURPOSE

This study assessed the level of knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among patients with schizophrenia in Jordan.

DESIGN AND METHODS

A cross-sectional survey was conducted on 135 patients diagnosed with schizophrenia, who had been admitted to the largest psychiatric hospital in Jordan.

FINDINGS

The participants had a low level of knowledge, insight, and a high level of internalized stigma. No correlation was found between these variables. Meanwhile, the educational level and vacation were found to be predictors of knowledge.

PRACTICE IMPLICATIONS

This can help psychiatric nurses to identify which area needs to be improved to ensure the best service and care is provided to patients diagnosed with schizophrenia.

Stigmatization caused by hair loss - a systematic literature review

Hair loss is a symptom that can cause stigmatization and severe impairment of quality of life. The aim of this systematic review was to evaluate the literature on stigmatization of hair loss. Using predefined MeSH terms and keywords, a systematic search was performed in the databases MEDLINE (PubMed), EMBASE, PsycINFO and PsycNET. No time restriction was chosen (last update: May 07, 2019; PROSPERO registration number: CRD42019122966). A total of 98 studies were identified, of which eleven were selected for inclusion in this work. The Hairdex, a questionnaire on disease-specific quality of life, was the most frequently used instrument for the quantitative assessment of stigma. The studies were highly heterogeneous and values for stigmatization of androgenetic alopecia varied widely. However, regardless of the pathogenesis, patients with hair loss often suffer from stigmatization which limits their quality of life. Stigmatization of people with visible skin lesions has often been neglected in clinical practice and in daily contact with affected individuals. Studies that specifically address the stigma of hair loss are rare. Further studies are needed to achieve comparability within pathogeneses as well as with other visible dermatoses in order to better understand the enormous psychosocial burden of hair loss.

The impact of illness identity on recovery from severe mental illness: A review of the evidence

The "Illness Identity" model proposed that self-stigma impacts hope and self-esteem and subsequently leads to a cascade of negative effects on outcomes related to recovery among people diagnosed with severe mental illnesses. The purpose of the present review is to take stock of research support for the model. The citation index SCOPUS was reviewed for all papers published in peer-reviewed journals in English between 2010 and 2019 citing one of the initial 3 articles discussing the model: 111 studies met inclusion criteria and were reviewed. The most frequently tested, and supported, aspects of the model were relationships between self-stigma and self-esteem, hope, psychiatric symptoms and social relationships. Least frequently studied areas were relationships with suicide, avoidant coping, treatment adherence and vocational functioning, although they were supported in the majority of studies. The "insight paradox" was also tested in a relatively small number of studies, with mixed results. Findings were robust to geographic location of study, method, and subpopulation studied. Findings indicate that a large body of research has tested, and largely supported, the various components of the Illness Identity model, although some components need further investigation and there is a need for more comprehensive tests of the model.

Association Between Autistic Symptoms and Self-Stigma in Patients with Schizophrenia Spectrum Disorders

PURPOSE

Self-stigma negatively influences self-esteem, quality of life, self-efficacy, treatment adherence, and recovery in psychiatric patients. By revealing personality traits that influence self-stigma, we can gain useful knowledge for the management of self-stigma. A previous meta-analysis indicated that patients with schizophrenia have higher scores on the Autism-Spectrum Quotient (AQ) than healthy controls. However, the relationship between autistic symptoms and self-stigma in patients with schizophrenia spectrum disorders remains unclear. Therefore, the present study aimed to reveal the association between autistic symptoms and self-stigma in patients with schizophrenia spectrum disorders.

PATIENTS AND METHODS

We recruited 127 patients with schizophrenia spectrum disorders (schizophrenia, schizoaffective disorder, and delusional disorder). We assessed participants' self-stigma and autistic symptoms using the Internalized Stigma for Mental Illness (ISMI) scale and the Autism-Spectrum Quotient (AQ), respectively. The differences in the scores of ISMI and AQ according to patient characteristics were investigated. Multiple regression analysis controlling for age and gender was performed to determine the relationship between the total scores on the AQ and IMSI scale.

RESULTS

Female patients showed a higher level of self-stigma than males. Unmarried patients showed a significantly higher score on the AQ than married patients. Multiple regression analysis adjusted for age and gender indicated that the total score on AQ might be a predictor of the overall rating on ISMI in patients with schizophrenia spectrum disorders.

CONCLUSION

This study is the first to reveal the association between autistic symptoms and self-stigma in patients with schizophrenia spectrum disorders. Our results highlight the importance of considering autistic symptoms in the assessment and management of self-stigma in patients with schizophrenia spectrum disorders.

Self-stigma in patients with schizophrenia: a multicentric study from three Latin-America countries

The aim of this study was to describe the degree of self-stigma in patients with schizophrenia across three Latin-Americans countries (Bolivia, Chile and Peru). The study included 253 outpatients that were assessed using the Internalized Stigma of Mental Illness Scale (ISMI). The results show that 48.7% of patients from Bolivia report high internalized stigma compared to 38.6% from Chile and 28.6% from Peru. There were no statistically significant differences in ISMI mean total scores for country (p = 0.057), however, there were significant differences on two subscales: alienation and social withdrawal for which Bolivia had the highest scores. In conclusion, even though these countries share several common cultural characteristics, there are also some differences between them on patients' self-stigma.

Process Evaluation of a Pilot Intervention for Psychosocial Rehabilitation for Service Users with Schizophrenia in North West Province, South Africa

This study investigated a non-specialist delivered programme for psychosocial rehabilitation for service users with schizophrenia in a low-resource South African setting. Forty-four service users with schizophrenia living in the community, receiving ongoing medication through primary care, participated in a structured support group. Quantitative measures (WHODAS 12 item, Brief Psychiatric Rating Scale and Internalized Stigma of Mental Illness Inventory) were assessed at baseline and 12 months. Sixteen service users were interviewed on their experiences. WHODAS data showed a small reduction. ISMI assessment showed a statistically significant reduction. Qualitative data revealed: improved self-esteem and increased illness knowledge, reduced risk taking, reduced social isolation and improved pro-social behavior, improved financial management and engagement in income generation activities as well as improved acceptance by the community. This study provides preliminary evidence on the benefits of this programme that warrant further study incorporating experimental methods.

Development of Japanese version of King's Stigma Scale and its short version: Psychometric properties of a self-stigma measure

AIM

The study aimed to develop two Japanese versions of King's Stigma Scale, a full version (KSS-J-1) and a short version (KSS-J-2), through psychometric property testing.

METHODS

The sample included 112 people with mental illness. We tested the constructs of the scales using both confirmatory and exploratory factor analyses. Internal consistency and test-retest reliability were tested. We examined convergent validity with self-esteem or perceived stigma, and different group validity, using the Kessler Psychological Distress Scale (K6).

RESULTS

Whereas a relatively weak model fit (comparative fit index = 0.66, Tucker-Lewis index = 0.63, root mean square error of approximation = 0.097) of KSS-J-1 (full version: 28 items) was found, KSS-J-2 (short version: 17 items), produced by exploratory factor analysis, had a moderate model fit (comparative fit index = 0.90, Tucker-Lewis index = 0.89, root mean square error of approximation = 0.063). High internal consistency (KSS-J-1, ω = 0.82-0.89; KSS-J-2, ω = 0.86-0.89) and moderate test-retest reliability (KSS-J-1, interclass correlation = 0.56-0.88; KSS-J-2, interclass correlation = 0.45-0.85) were reported. Some subscales and the entire scale of KSS-J-1 were significantly correlated with self-esteem and perceived stigma. Conversely, only two subscales in KSS-J-2 were significantly correlated with self-esteem. The scores of each subscale and the entire score for both KSS-J-1 and KSS-J-2 in the high psychological distress group were higher than the low group (KSS-J-1, d = 0.61-0.83; KSS-J-2, d = 0.47-0.70), except for the Discrimination subscale in KSS-J-2.

CONCLUSION

Both Japanese versions of King's Stigma Scale can be utilized depending on their intended use.