Background
Methods
Participants and procedures
Characteristic | Mean (S.D.) or % (n) | |
---|---|---|
Age | 49.7 years (12.0) | |
Period of mental illness | 24.3 years (12.1) | |
Gender | Male | 64.2 % (111) |
Female | 35.8 % (62) | |
Residence | Gunma Prefecture | 35.8 % (62) |
Niigata Prefecture | 64.2 % (111) | |
Education | Junior high school | 36.4 % (63) |
High school | 41.6 % (72) | |
Junior college or vocational school | 12.1 % (21) | |
University degree or higher | 9.8 % (17) | |
Marital status | Single | 75.1 % (130) |
Married | 6.4 % (11) | |
Divorced or widowed | 18.5 % (32) | |
Cohabitation | Cohabitation | 38.2 % (66) |
Living alone | 61.8 % (107) | |
Seif-reported diagnosis | Schizophrenia | 81.5 % (141) |
Bipolar disorder | 5.8 % (10) | |
Depression | 8.1 % (14) | |
Personality disorder | 1.2 % (2) | |
Adjustment disorder | 0.6 % (1) | |
Other | 2.9 % (5) | |
Period of facility use | Less than 6 months | 4.0 % (7) |
6 months to less than 1 year | 13.9 % (24) | |
1 year or more | 82.1 % (142) |
Measures
Demographic questionnaire
Internalized Stigma of Mental Illness (ISMI) scale
Item | Mean | S.D. |
---|---|---|
Alienation | ||
I feel out of place in the world because I have a mental illness. | 2.3 | 0.84 |
I am embarrassed or ashamed that I have a mental illness. | 2.3 | 0.87 |
I feel inferior to others who don’t have a mental illness. | 2.4 | 0.88 |
I am disappointed in myself for having a mental illness. | 2.3 | 0.90 |
Having a mental illness has spoiled my life. | 2.3 | 0.93 |
People without mental illness could not possibly understand me. | 2.4 | 0.89 |
Subscale mean | 2.35 | 0.63 |
Proportion above the midpoint of 2.5 | 43.1 % | |
Stereotype Endorsement | ||
Mentally ill people tend to be violent. | 2.0 | 0.80 |
Mentally ill people shouldn’t get married. | 1.9 | 0.81 |
People with mental illness cannot live a good, rewarding life. | 2.1 | 0.85 |
People can tell that I have a mental illness by the way I look. | 2.1 | 0.83 |
Because I have a mental illness, I need others to make most decisions for me. | 2.0 | 0.75 |
I can’t contribute anything to society because I have a mental illness. | 2.2 | 0.78 |
Stereotypes about the mentally ill apply to me. | 2.4 | 0.83 |
Subscale mean | 2.10 | 0.4 |
Proportion above the midpoint of 2.5 | 29.7 % | |
Discrimination Experience | ||
People discriminate against me because I have a mental illness. | 2.2 | 0.82 |
People often patronize me, or treat me like a child, just because I have a mental illness. | 2.2 | 0.79 |
People ignore me or take me less seriously just because I have a mental illness. | 2.3 | 0.82 |
Nobody would be interested in getting close to me because I have a mental illness. | 2.2 | 0.76 |
Others think that I can’t achieve much in life because I have a mental illness. | 2.4 | 0.84 |
Subscale mean | 2.25 | 0.60 |
Proportion above the midpoint of 2.5 | 34.7 % | |
Social Withdrawal | ||
I avoid getting close to people who don’t have a mental illness to avoid rejection. | 1.9 | 0.73 |
I don’t socialize as much as I used to because my mental illness might make me look or behave “weird”. | 2.3 | 0.86 |
I don’t talk about myself much because I don’t want to burden others with my mental illness. | 2.5 | 0.85 |
Negative stereotypes about mental illness keep me isolated from the “normal” world. | 2.4 | 0.83 |
Being around people who don’t have a mental illness makes me feel out of place or inadequate. | 2.3 | 0.78 |
I stay away from social situations in order to protect my family or friends from embarrassment. | 2.2 | 0.78 |
Subscale mean | 2.27 | 0.56 |
Proportion above the midpoint of 2.5 | 37.8 % | |
Stigma Resistance (reverse-coded items) | ||
People with mental illness make important contributions to society. | 2.8 | 0.80 |
I feel comfortable being seen in public with an obviously mentally ill person. | 3.1 | 0.71 |
Living with mental illness has made me a tough survivor. | 2.5 | 0.80 |
In general, I am able to live my life the way I want to. | 2.7 | 0.82 |
I can have a good, fulfilling life, despite my mental illness. | 2.7 | 0.83 |
Subscale mean | 2.75 | 0.48 |
Proportion above the midpoint of 2.5 | 63.5 % | |
Total scale mean | 2.33 | 0.43 |
Proportion above the midpoint of 2.5 | 40.8 % |
External validity
Data analysis
Results
Total ISMI scores
Mean total score | Test | ||
---|---|---|---|
Gender | Male | 2.30 |
t = −1.09 |
Female | 2.38 | (p = 0.28) | |
Residence | Gunma Prefecture | 2.28 |
t = −1.00 |
Niigata Prefecture | 2.35 | (p = 0.32) | |
Education | Junior high school | 2.33 |
F = 0.57 |
High school | 2.29 | (p = 0.97) | |
Junior college or vocational school | 2.41 | ||
University degree or higher | 2.39 | ||
Marital status | Single | 2.37 |
F = 2.06 |
Married | 2.22 | (p = 0.86) | |
Divorced or widowed | 2.21 | ||
Cohabitation | Cohabitation | 2.35 |
t = 0.42 |
Living alone | 2.32 | (p = 0.67) | |
Period of facility use | Less than 6 months | 2.42 |
F = 0.73 |
6 months to less than 1 year | 2.41 | (p = 0.79) | |
1 year or more | 2.31 | ||
Self-reported diagnosis | Schizophrenia | 2.33 | |
Bipolar disorder | 2.22 |
F = 0.22 | |
Depression | 2.34 | (p = 0.04) | |
Other | 2.38 |
Reliability
Internal consistency
Subscale | Japanese version Cronbach’s alpha | Original English version Cronbach’s alpha |
---|---|---|
Alienation | 0.81 | 0.79 |
Stereotype endorsement | 0.70 | 0.72 |
Discrimination experience | 0.80 | 0.75 |
Social withdrawal | 0.79 | 0.80 |
Stigma resistance | 0.57 | 0.58 |
Test–retest reliability
Validity
Criterion-related validity
ISMI | BDI | RSES | ES |
---|---|---|---|
Alienation | 0.59**
| −0.49**
| −0.43**
|
Stereotype endorsement | 0.50**
| −0.42**
| −0.45**
|
Discrimination experience | 0.56**
| −0.47**
| −0.47**
|
Social withdrawal | 0.45**
| −0.37**
| −0.37**
|
Stigma resistance | 0.23**
| −0.31**
| −0.31**
|
Total score | 0.61**
| −0.53**
| −0.52**
|
Construct validity
Item | Social withdrawal | Alienation | Discrimination experience | Stereotype endorsement |
---|---|---|---|---|
I am embarrassed or ashamed that I have a mental illness |
0.79
| −0.03 | −0.04 | −0.08 |
I feel inferior to others who don’t have a mental illness |
0.63
| 0.08 | 0.04 | −0.06 |
I don’t talk about myself much because I don’t want to burden others with my mental illness |
0.60
| 0.01 | −0.14 | 0.24 |
I feel out of place in the world because I have a mental illness |
0.59
| −0.11 | 0.24 | −0.06 |
Being around people who don’t have a mental illness makes me feel out of place or inadequate |
0.55
| 0.14 | 0.08 | 0.07 |
Mentally ill people tend to be violent |
0.49
| −0.06 | 0.13 | 0.07 |
I don’t socialize as much as I used to because my mental illness might make me look or behave “weird” |
0.46
| 0.22 | 0.05 | 0.07 |
I avoid getting close to people who don’t have a mental illness to avoid rejection |
0.45
| −0.08 | 0.10 | 0.09 |
I stay away from social situations in order to protect my family or friends from embarrassment | 0.32 | 0.14 | −0.04 | 0.14 |
I am disappointed in myself for having a mental illness | 0.04 |
0.75
| 0.07 | −0.01 |
People with mental illness cannot live a good, rewarding life | 0.21 |
0.68
| −0.06 | −0.21 |
I can’t contribute anything to society because I have a mental illness | −0.24 |
0.67
| 0.19 | 0.15 |
Having a mental illness has spoiled my life | −0.02 |
0.65
| 0.31 | −0.17 |
Others think that I can’t achieve much in life because I have a mental illness | 0.19 |
0.40
| 0.15 | 0.12 |
People often patronize me, or treat me like a child, just because I have a mental illness | −0.08 | 0.03 |
0.67
| 0.18 |
People discriminate against me because I have a mental illness | 0.34 | −0.12 |
0.61
| −0.10 |
People ignore me or take me less seriously just because I have a mental illness | -0.10 | 0.25 |
0.54
| 0.21 |
People without mental illness could not possibly understand me | 0.06 | 0.24 |
0.54
| −0.04 |
Negative stereotypes about mental illness keep me isolated from the “normal” world | 0.41 | 0.07 |
0.43
| −0.16 |
Mentally ill people shouldn’t get married | 0.31 | 0.31 | −0.39 | 0.15 |
Nobody would be interested in getting close to me because I have a mental illness | 0.05 | 0.24 | 0.30 | 0.18 |
People can tell that I have a mental illness by the way I look | 0.06 | −0.28 | 0.27 |
0.67
|
Because I have a mental illness, I need others to make most decisions for me | 0.01 | 0.11 | −0.08 |
0.55
|
Stereotypes about the mentally ill apply to me | 0.24 | 0.13 | 0.04 | 0.36 |
Eigenvalue | 8.739 | 1.669 | 1.458 | 1.285 |
Cumulative contribution ratio | 0.364 | 0.434 | 0.494 | 0.548 |
Discussion
Country/region | n | Alienation | Stereotype endorsement | Discrimination experience | Social withdrawal | Stigma resistance | |
---|---|---|---|---|---|---|---|
The present study | Japan | 141a
| 2.35 ± 0.88 | 2.12 ± 0.83 | 2.25 ± 0.80 | 2.28 ± 0.83 | 2.75 ± 0.83 |
Lv et al. [25] | China | 95 | 2.29 ± 0.49 | 2.07 ± 0.44 | 2.15 ± 0.45 | 2.19 ± 0.46 | 2.17 ± 0.38 |
Brohan et al. [26] | 14 European | 1220b
| 2.53 ± 0.70 | 2.19 ± 0.53 | 2.43 ± 0.61 | 2.48 ± 0.66 | 2.47 ± 0.51 |
Sibitz et al. [27] | Austria | 157 | 2.28 ± 0.86 | 1.87 ± 0.63 | 2.16 ± 0.79 | 2.13 ± 0.74 | 2.73 ± 0.76 |
Lysaker et al. [28] | US | 133 | 2.45 ± 0.68 | 2.00 ± 0.51 | 2.48 ± 0.65 | 2.37 ± 0.65 | 2.25 ± 0.51 |
Lysaker et al. [29] | US | 75 | 2.31 ± 0.65 | 1.99 ± 0.54 | 2.42 ± 0.69 | 2.30 ± 0.66 | 2.17 ± 0.52 |
Lysaker et al. [30]c
| US | 36 | 1.39 ± 0.68 | 1.14 ± 0.61 | 1.42 ± 0.70 | 1.31 ± 0.67 | 1.24 ± 0.50 |
Assefa et al. [31] | Ethiopia | 212 | 2.3 ± 0.6 | 2.5 ± 0.6 | 2.5 ± 0.7 | 2.4 ± 0.9 | - |
Botha et al. [8] | South African | 100 | 2.50 | 2.16 | 2.90 | 2.63 | - |