Abstract
BackgroundExposure to public stigma can lead to stereotype endorsement and resignation, which are constructs related to self-stigma. This latter phenomenon has well-documented deleterious consequences for people living with mental illness. Paradoxically, it can also lead to the empowering reactions of righteous anger and coming out proud.AimThe aim of this study was to develop and validate a brief tool to measure stereotype endorsement, righteous anger, and non-disclosure across different groups of stigmatized persons. This process was conducted in collaboration with users.MethodUsing focus groups with mental health professionals and people living with mental illness, 72 items were developed to measure various aspects of self-stigma. The Paradox of Self-Stigma scale (PaSS-24) containing 24 items and three subscores (stereotype endorsement, non-disclosure, and righteous anger) resulted from a calibration phase using factor analysis. This structure was cross-validated on an independent sample. Internal consistency, test–retest reliability, and convergent validity were also evaluated.Results202 patients were assessed. The PaSS-24 demonstrated good internal validity. Internal consistency, test–retest reliability, and convergent validity estimates were also good.ConclusionsThe PaSS-24 is a short but psychometrically rigorous tool designed to measure self-stigma and related constructs in French language, developed in collaboration with users. The development and validation of the PaSS-24 represent a first step towards implementing and evaluating programs aimed at reducing negative consequences of self-stigma.
Highlights
Exposure to public stigma can lead to stereotype endorsement and resignation, which are constructs related to self-stigma
The development and validation of the PaSS-24 represent a first step towards implementing and evaluating programs aimed at reducing negative consequences of self-stigma
Two psychologists trained in psychometrics and questionnaire development conducted a literature review and identified four domains related to self-stigma at four levels: awareness
Summary
Exposure to public stigma can lead to stereotype endorsement and resignation, which are constructs related to self-stigma. This latter phenomenon has well-documented deleterious consequences for people living with mental illness. Self-stigma lead people to agree to public stigma stereotypes (“People with mental illness are weak”), to apply it to themselves (“I am a weak person because of my mental illness”), and to modify their behavior in consequence (“Why try?”). Both “apply” and “harm” stages belong to the behavioral level. Internalized stigma starts with the awareness of stereotypes associated with one’s condition, followed by agreement with the stereotypes, and the ultimate adoption of the stereotypes on oneself, resulting in lowered self-esteem and self-discrimination [6]
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