Transcultural Validity of Concept of Internalized Stigma in Patients with Mental Illnesses (Psychometric Properties of Russian Version of Internalized Stigma of Mental Illness Scale)

Abstract

INTRODUCTION: One of the commonest methods of evaluation of internalized stigma is Internalized Stigma of Mental Illness (ISMI) scale where the differences in the prevalence and perception of mental stigma in different cultures are specified.

AIM: Validation of Russian version of ISMI scale and evaluation of peculiarities of perception of stigma by Russian-speaking patients with severe psychiatric disorders.

MATERIALS AND METHODS: Four hundred thirty nine patients with severe psychiatric disorders (F2 and F3 according to the International Statistical Classification of Diseases and Related Health Problems, 10^th revision) were examined. The psychometric properties of the Russian version of ISMI scale were evaluated using internal consistency analysis. Exploratory and confirmatory factor analysis (EFA and CFA, respectively) were performed. To check age- and gender-related invariance, MIMIC and MIFA models were used, and discriminative power and accuracy of scoring were identified using generalized partial credit model (GPCM). The results of EFA were compared with the data obtained in the Regional Clinical Hospital (n = 120) using independent alternative version of ISMI translation into Russian.

RESULTS: The internal consistency of the Russian version of ISMI questionnaire was high: Chronbach’s α — 0.90. EFA permitted to identify 4 factors. The first factor (‘Demoralization’, F1) combined elements corresponding to subscale 1 (‘Alienation’) and subscale 2 (‘Social withdrawal’) of the original version of ISMI questionnaire. The other three factors identified in this study according to the content of the items, corresponded to the remaining subscales of the original ISMI scale. In all kinds of the conducted analysis, item 14 had low factor weight. CFA confirmed the four-factor structure. In the sample, MIMIC and MIFA showed the general age- and gender-related invariance with their insufficient power. GPCM showed good characteristics of discriminative power and difficulties in choice of scoring for all factors except the fourth one (‘Resistance to stigma’). EFA performed on the data of the alternative sample, neither could reliably reproduce the five-factor structure of the original ISMI scale due to eclectic mixing of the items of the original scale within five isolated structures.

CONCLUSION: The suitability of using the internalized stigma assessment tool for the Russian-speaking population has been confirmed. The study highlights the relevance and necessity of expanding transcultural studies of psychological reactions of psychiatric patients.

Keywords

social stigma / mentalization / cultural psychiatry / psychometry / validation / ISMI

References

[1] Lutova NB, Makarevich OV, Sorokin MYu, et al. Psychiatric stigma: clinical-demographic or cultural factors. Sotsial’naya i Klinicheskaya Psikhiatriya. 2019;29(4):50–6. (In Russ).

[2] Лутова Н.Б., Макаревич О.В., Сорокин М.Ю., и др. Психиатрическая стигма: клинико-демографические или культуральные факторы // Социальная и клиническая психиатрия. 2019. Т. 29, № 4. С. 50–56.

[3] Vasilchenko KF, Drozdovsky YuV. Internalized stigma and social adaptation levels among patients with first episode schizophrenia. Siberian Herald of Psychiatry and Addiction Psychiatry. 2018;(1):30–5. (In Russ). doi: 10.26617/1810-3111-2018-1(98)-30-35

[4] Васильченко К.Ф., Дроздовский Ю.В. Самостигматизация и уровни социальной адаптации пациентов с первым психотическим эпизодом при шизофрении // Сибирский вестник психиатрии и наркологии. 2018. № 1 (98). С. 30–35. doi: 10.26617/1810-3111-2018-1(98)-30-35

[5] Perlick DA, Rosenheck RA, Clarkin JF, et al. Stigma as a barrier to recovery: adverse effects of perceived stigma on social adaptation of persons diagnosed with bipolar affective disorder. Psychiatr Serv. 2001;52(12):1627–32. doi: 10.1176/appi.ps.52.12.1627

[6] Perlick D.A., Rosenheck R.A., Clarkin J.F., et al. Stigma as a barrier to recovery: adverse effects of perceived stigma on social adaptation of persons diagnosed with bipolar affective disorder // Psychiatr. Serv. 2001. Vol. 52, No. 12. P. 1627–1632. doi: 10.1176/appi.ps.52.12.1627

[7] Shrivastava A, Bureau Y, Rewari N, et al. Clinical risk of stigma and discrimination of mental illnesses: Need for objective assessment and quantification. Indian J Psychiatry. 2013;55(2):178–82. doi: 10.4103/0019-5545.111459

[8] Shrivastava A., Bureau Y., Rewari N., et al. Clinical risk of stigma and discrimination of mental illnesses: Need for objective assessment and quantification // Indian J. Psychiatry. 2013. Vol. 55, No. 2. P. 178–182. doi: 10.4103/0019-5545.111459

[9] Corrigan PW, Druss BG, Perlick DA. The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychol Sci Public Interest. 2014;15(2):37–70. doi: 10.1177/1529100614531398

[10] Corrigan P.W., Druss B.G., Perlick D.A. The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care // Psychol. Sci. Public Interest. 2014. Vol. 15, No. 2. P. 37–70. doi: 10.1177/1529100614531398

[11] Sorokin MYu, Neznanov NG, Lutova NB, et al. Revisiting Drug Compliance: The Need for a Holistic Approach in the Treatment of Severe Mental Disorders. Consortium Psychiatricum. 2021;2(3):17–25. doi: 10.17816/CP93

[12] Sorokin M.Yu., Neznanov N.G., Lutova N.B., et al. Revisiting Drug Compliance: The Need for a Holistic Approach in the Treatment of Severe Mental Disorders // Consortium Psychiatricum. 2021. Vol. 2, No. 3. P. 17–25. doi: 10.17816/CP93

[13] Shumet S, W/Michele B, Angaw D, et al. Magnitude of internalised stigma and associated factors among people with bipolar disorder at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study. BMJ Open. 2021;11(4):e044824. doi: 10.1136/bmjopen-2020-044824

[14] Shumet S., W/Michele B., Angaw D., et al. Magnitude of internalised stigma and associated factors among people with bipolar disorder at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study // BMJ Open. 2021. Vol. 11, No. 4. P. e044824. doi: 10.1136/bmjopen-2020-044824

[15] Filimonov AP, Volodin BYu. The quality of life of patients with mental disorders. I. P. Pavlov Russian Medical Biological Herald. 2011;(2):24. (In Russ).

[16] Филимонов А.П., Володин Б.Ю. Качество жизни пациентов с психическими расстройствами // Российский медико-биологический вестник имени академика И. П. Павлова. 2011. № 2. С. 24.

[17] Ritsher JB, Otilingam PG, Grajales M. Internalized Stigma of mental illness: psychometric properties of new measure. Psychiatry Res. 2003;121(1):31–49. doi: 10.1016/j.psychres.2003.08.008

[18] Ritsher J.B., Otilingam P.G., Grajales M. Internalized Stigma of mental illness: psychometric properties of new measure // Psychiatry Res. 2003. Vol. 121, No. 1. P. 31–49. doi: 10.1016/j.psychres.2003.08.008

[19] Boyd JE, Adler EP, Otilingam PG, et al. Internalized Stigma of Mental Illness (ISMI) Scale: A multinational review. Compr Psychiatry. 2014;55(1):221–31. doi: 10.1016/j.comppsych.2013.06.005

[20] Boyd J.E., Adler E.P., Otilingam P.G., et al. Internalized Stigma of Mental Illness (ISMI) Scale: A multinational review // Compr. Psychiatry. 2014. Vol. 55, No. 1. P. 221–231. doi: 10.1016/j.comp psych.2013.06.005

[21] Lien Y–J, Kao Y–C, Liu Y–P, et al. Internalized Stigma and Stigma Resistance Among Patients with Mental Illness in Han Chinese Population. Psychiatr Q. 2015;86(2):181–97. doi: 10.1007/s11126-014-9315-5

[22] Lien Y.–J., Kao Y.–C., Liu Y.–P., et al. Internalized Stigma and Stigma Resistance Among Patients with Mental Illness in Han Chinese Population // Psychiatr. Q. 2015. Vol. 86, No. 2. P. 181–197. doi: 10.1007/s11126-014-9315-5

[23] Tanabe Y, Hayashi K, Ideno Y. The Internalized Stigma of Mental Illness (ISMI) Scale: validation of Japanese version. BMS Psychiatry. 2016;16:116. doi: 10.1186/s12888-016-0825-6

[24] Tanabe Y., Hayashi K., Ideno Y. The Internalized Stigma of Mental Illness (ISMI) Scale: validation of Japanese version // BMS Psychiatry. 2016. Vol. 16. P. 116. doi: 10.1186/s12888-016-0825-6

[25] Ocisková M, Praško J, Kamarádová D, et al. Self-stigma in psychiatric patients — standardization of the ISMI scale. Neuro Endocrinol Lett. 2014;35(7):624–32.

[26] Ocisková M., Praško J., Kamarádová D., et al. Self-stigma in psychiatric patients — standardization of the ISMI scale // Neuro Endocrinol. Lett. 2014. Vol. 35, No. 7. P. 624–632.

[27] Chang C–C, Wu T–H, Chen C–Y, et al. Psychometric evaluation of the Internalized Stigma of Mental Illness Scale for Patients with Mental Illnesses: Measurement Invariance across Time. PLoS One. 2014;9(6):e98767. doi: 10.1371/journal.pone.0098767

[28] Chang C.–C., Wu T.–H., Chen C.–Y., et al. Psychometric evaluation of the Internalized Stigma of Mental Illness Scale for Patients with Mental Illnesses: Measurement Invariance across Time // PLoS One. 2014. Vol. 9, No. 6. Р. e98767. doi: 10.1371/journal.pone.0098767

[29] Maydeu–Olivares A, McArdle JJ, editords. Contemporary Psychometrics. 1st ed. New York: Psychology Press; 2005. doi: 10.4324/9781410612977

[30] Maydeu–Olivares A., McArdle J.J., editors. Contemporary Psychometrics. 1st ed. N.–Y.: Psychology Press; 2005. doi: 10.4324/9781410612977

[31] Nabors LM, Yanos PT, Roe D, et al. Stereotype endorsement, metacognitive capacity, and self-esteem as predictors of stigma resistance in persons with schizophrenia. Compr Psychiatry. 2014;55(4):792–8. doi: 10.1016/j.comppsych.2014.01.011

[32] Nabors L.M., Yanos P.T., Roe D., et al. Stereotype endorsement, metacognitive capacity, and self-esteem as predictors of stigma resistance in persons with schizophrenia // Compr. Psychiatry. 2014. Vol. 55, No. 4. P. 792–798. doi: 10.1016/j.comppsych.2014.01.011

[33] Lutova NB, Sorokin MYu, Bocharova MO, et al. Sposob otsenki vnutrenney stigmy bol’nykh psikhicheskimi rasstroystvami. In: Diagnostika i lecheniye psikhicheskikh i narkologicheskikh rasstroystv: sovremennyye podkhody. Saint-Petersburg: KOSTA; 2022. Suppl. 5. P. 188–202. (In Russ).

[34] Лутова Н.Б., Сорокин М.Ю., Бочарова М.О., и др. Способ оценки внутренней стигмы больных психическими расстройствами. В сб.: Диагностика и лечение психических и наркологических расстройств: современные подходы. СПб.: КОСТА; 2022. Вып. 5. С. 188–202.

[35] Corrigan PW, Michaels PJ, Vega E, et al. Self-stigma of mental illness scale-short form: reliability and validity. Psychiatry Res. 2012;199(1):65–9. doi: 10.1016/j.psychres.2012.04.009

[36] Corrigan P.W., Michaels P.J., Vega E., et al. Self-stigma of mental illness scale-short form: reliability and validity // Psychiatry Res. 2012. Vol. 199, No. 1. P. 65–69. doi: 10.1016/j.psychres.2012.04.009

[37] Vasilchenko KF, Drozdovsky YuV. Dynamic variants of self-stigmatization in patients with the first psychotic episode. Siberian Herald of Psychiatry and Addiction Psychiatry. 2019;(1):37–44. (In Russ). doi: 10.26617/1810-3111-2019-1(102)-37-44

[38] Васильченко К.Ф., Дроздовский Ю.В. Динамические варианты самостигматизации у пациентов с первым психотическим эпизодом // Сибирский вестник психиатрии и наркологии. 2019. № 1 (102). С. 37–44. doi: 10.26617/1810-3111-2019-1(102)-37-44

[39] Lutova NB, Sorokin MY, Makarevich OV, et al. The subjective concept of morbidity: its assessment and connection with the motivation for treatment in person who underwent psychosis. V.M. Bekhterev Review of Psychiatry and Medical Psyhology. 2020;(2):73–9. (In Russ). doi: 10.31363/2313-7053-2020-2-73-79

[40] Лутова Н.Б., Сорокин М.Ю., Макаревич О.В., и др. Субъективная концепция морбидности: её оценка и связь с мотивацией к лечению у лиц, перенесших психоз // Обозрение психиатрии и медицинской психологии имени В.М.Бехтерева. 2020. № 2. C. 73–79. doi: 10.31363/2313-7053-2020-2-73-79

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