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

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.