Abstract
BackgroundTo date, no data have been available concerning the psychometric characteristics of the Internalized Stigma of Mental Illness scale (ISMI-29) in Latin American countries. The aim of this study was to validate a Latin American version of the ISMI in people with schizophrenia.MethodsThe study included 253 stabilized outpatients with schizophrenia from 3 Mental Health Services in three Latin American countries: Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). We analyzed the psychometric properties using item response and classical test theories. An item reduction was then performed to improve the psychometric properties of the ISMI-29. The final version of the ISMI was tested for construct validity, reliability, external validity and differential item functioning (DIF).ResultsThe five-factor structure of the ISMI-29 was not confirmed using confirmatory factor analysis (RMSEA = 0.12, CFI = 0.77, and WRMR = 2.20). Seventeen items were discarded to obtain a satisfactory psychometric version. The ISMI-12 evaluates 3 dimensions: social stigma (4 items), stigma experience (4), and self-stigma (3). The factor structure accounted for 68% of the total variance. Internal consistency was satisfactory. The scalability was satisfactory, with INFIT statistics within an acceptable range. In addition, the results confirmed the absence of DIF and supported the invariance of the item calibrations between countries.ConclusionThe ISMI-29 is not valid in our sample and should not be used in Latin American countries. The ISMI-12 is the first internalized stigma questionnaire with satisfactory psychometric properties available in Latin American countries. Its brevity could facilitate its dissemination and use in clinical settings.
Highlights
To date, no data have been available concerning the psychometric characteristics of the Internalized Stigma of Mental Illness scale (ISMI-29) in Latin American countries
The psychometric characteristics of the ISMI-29 have not been explored in Latin American countries [9]
Inclusion criteria All stabilized community-dwelling patients diagnosed with schizophrenia according to the criteria of International Classification of Diseases (ICD), 10th version [28] were included in this study
Summary
No data have been available concerning the psychometric characteristics of the Internalized Stigma of Mental Illness scale (ISMI-29) in Latin American countries. Another consequence is the increased duration of untreated psychosis has been associated with worse prognosis and with higher hospitalization, involuntary admission and suicidal behaviour [17] These last elements impact on the therapeutic effect, because, as Chang and colleagues [18] pointed out is expected to have better outcomes when health care professionals take into the symptomatology and self-stigma in persons with mental illness [16, 18, 19]. Restricted data regarding validity and reliability were provided For these reasons, the extent to which SZ patients in Latin American countries can validly self-report their internalized stigma using the ISMI-29 is a crucial issue that has not been sufficiently explored. Shortening the ISMI-29 could make the assessment on internalized stigma efficiently
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