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“Thandi should feel embarrassed”: describing the validity and reliability of a tool to measure depression-related stigma among patients with depressive symptoms in Malawi

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Abstract

Purpose

There are no validated tools in Malawi to measure mental health stigma. Accordingly, this study evaluates the validity and reliability of a short quantitative instrument to measure depression-related stigma in patients exhibiting depressive symptoms in Malawi.

Methods

The SHARP study began depression screening in 10 NCD clinics across Malawi in April 2019; recruitment is ongoing. Eligible participants were 18–65 years, had a patient health questionnaire (PHQ-9) score ≥ 5, and were new or current diabetes or hypertension patients. Participants completed a baseline questionnaire that measured depression-related stigma, depressive symptoms, and sociodemographic information. The stigma instrument included a vignette of a depressed woman named Thandi, and participants rated their level of agreement with statements about Thandi’s situation in nine prompts on a 5-point Likert scale. Inter-item reliability was assessed with Cronbach’s alpha. Exploratory factor analysis (EFA) was used to assess structural validity, and OLS regression models were used to assess convergent and divergent validity between measured levels of depression-related stigma and covariates.

Results

The analysis of patient responses (n = 688) to the stigma tool demonstrated acceptable inter-item reliability across all scales and subsequent subscales of the instrument, with alpha values ranging from 0.70 to 0.87. The EFA demonstrated clustering around three domains: negative affect, treatment carryover, and disclosure carryover. Regression models demonstrated convergence with several covariates and demonstrated divergence as expected.

Conclusion

This study supports the reliability and validity of a short stigma questionnaire in this population. Future studies should continue to assess the validity of this stigma instrument in this population.

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Availability of data and materials

Data from this study are available via the National Institute of Mental Health Data Archive (NDA): https://nda.nih.gov/edit_collection.html?id=2822

Code availability

Code will be made available upon request.

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Funding

This work was supported by the National Institute of Mental Health (U19MH113202-01; U19MH113202-03S1). JMD was also supported by funding from the National Institute of Allergy and Infectious Diseases (T32AI070114).

Author information

Authors and Affiliations

  1. Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, USA

    Josée M. Dussault, Bradley N. Gaynes & Brian W. Pence

  2. UNC Project, Malawi, Lilongwe, Malawi

    Chifundo Zimba, Harriet Akello & Mina C. Hosseinipour

  3. Malawi Epidemiology and Intervention Research Unit, Karonga, Malawi

    Jullita Malava

  4. Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA

    Melissa A. Stockton

  5. New York State Psychiatric Institute, New York, USA

    Melissa A. Stockton

  6. NCDs and Mental Health Unit, Ministry of Health Malawi, Lilongwe, Malawi

    Michael Udedi & Jones Masiye

  7. Department of Psychiatry, UNC School of Medicine, Chapel Hill, USA

    Bradley N. Gaynes

  8. Division of Infectious Disease, UNC School of Medicine, Chapel Hill, USA

    Mina C. Hosseinipour

Authors
  1. Josée M. Dussault
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  2. Chifundo Zimba
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  3. Jullita Malava
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  4. Harriet Akello
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  5. Melissa A. Stockton
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  6. Michael Udedi
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  8. Mina C. Hosseinipour
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  9. Brian W. Pence
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  10. Jones Masiye
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Contributions

Study protocol and materials were developed by CZ, JM, HA, MU, MS, BNG, MH, BWP, and JM. Data analysis was performed by JD. The first draft of the manuscript was written by JD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Josée M. Dussault.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

This study has been approved by the University of North Carolina Biomedical Institutional Review Board (UNC IRB). It has also been approved by the Malawi National Health Science Research Committee (NHSRC). All study participants provided written informed consent and were provided with a small honorarium for participating in each research interview, as approved by the NHSRC and UNC IRB.

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Dussault, J.M., Zimba, C., Malava, J. et al. “Thandi should feel embarrassed”: describing the validity and reliability of a tool to measure depression-related stigma among patients with depressive symptoms in Malawi. Soc Psychiatry Psychiatr Epidemiol 57, 1211–1220 (2022). https://doi.org/10.1007/s00127-021-02202-w

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