Measuring Recurring Stigma in the Lives of Individuals with Mental Illness

Abstract

We present an exploratory factor analysis of the 8-item Daily Indignities of Mental Illness (DIMI) scale, created to measure the detection and perceptions of recurring stigma among individuals with recent psychiatric hospitalizations. Structured in-person interviews were conducted with individuals with recent psychiatric hospitalizations in metropolitan New York. The 8-item DIMI scale’s internal consistency for the sample (n = 65), measured by Cronbach’s alpha, was 0.869. Statistically significantly higher DIMI scale scores were observed among individuals with more than 2 psychotic episodes and those reporting seeing relatives less often after hospitalization. The DIMI scale possesses good internal consistency for research contextualizing perceptions around the occurrence or recurrence of mental illness-related stigma among individuals with recent psychiatric hospitalizations.

This is a preview of subscription content, log in to check access.

References

  1. Baghaei, P., & Yazdi, M. T. (2016). The logic of latent variable analysis as validity evidence in psychological measurement. Open Psychology Journal. 9, 168–175.

    Article  Google Scholar 

  2. Bandalos, D. L., Boehm-Kaufman, M. R., Bandalos, D. L., & Boehm-Kaufman, M. R. (2008). Four common misconceptions in exploratory factor analysis. In C. E. Lance & R. J. Vandenberg (Eds.), Statistical and methodological myths and urban legends: Doctrine, verity and fable in the organizational and social sciences. Abingdon: Taylor & Francis. pp. 61–87.

    Google Scholar 

  3. Barney, L. J., Griffiths, K. M., Jorm, A. F., & Christensen, H. (2006). Stigma about depression and its impact on help-seeking intentions. Australian & New Zealand Journal of Psychiatry, 40(1), 51–54.

    Article  Google Scholar 

  4. Carliner, H., Collins, P. Y., Cabassa, L. J., McNallen, A., Joestl, S. S., & Lewis-Fernández, R. (2014). Prevalence of cardiovascular risk factors among racial and ethnic minorities with schizophrenia spectrum and bipolar disorders: A critical literature review. Comprehensive Psychiatry, 55(2), 233–247.

    Article  Google Scholar 

  5. Cohen, P., & Cohen, J. (1984). The clinician’s illusion. Archives of General Psychiatry, 41(12), 1178–1182.

    CAS  Article  Google Scholar 

  6. Cooper, L. A., Gonzales, J. J., Gallo, J. J., Rost, K. M., Meredith, L. S., Rubenstein, L. V. … Ford, D. E. (2003). The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Medical Care, 41(4), 479–489.

    PubMed  Google Scholar 

  7. Corrigan, P., Larson, J. E., & Sells, M. (2007). Self-stigma in people with mental illness. Schizophrenia Bulletin, 33(6), 1312–1318.

    PubMed  PubMed Central  Google Scholar 

  8. Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334.

    Article  Google Scholar 

  9. Doty, M. M., & Fund, C. (2003). Hispanic patients’ double burden: Lack of health insurance and limited English. New York: Commonwealth Fund.

    Google Scholar 

  10. Gaebel, W., Zäske, H., & Baumann, A. E. (2006). The relationship between mental illness severity and stigma. Acta Psychiatrica Scandinavica Supplement. 429, 41–45.

    Article  Google Scholar 

  11. Gary, F. A. (2005). Stigma: Barrier to mental health care among ethnic minorities. Issues Mental Health Nursing, 26(10), 979–999.

    Article  Google Scholar 

  12. Gonzales, L., Davidoff, K. C., Nadal, K. L., & Yanos, P. T. (2015). Microaggressions experienced by persons with mental illnesses: An exploratory study. Psychiatric Rehabilitation Journal, 38(3), 234–241.

    Article  Google Scholar 

  13. Gonzalez, J. M., Perlick, D. A., Miklowitz, D. J., Kaczynski, R., Hernandez, M., Rosenheck, R. A. et al. (2007). Factors associated with stigma among caregivers of patients with bipolar disorder in the STEP-BD study. Psychiatric Services, 58(1), 41–48.

    Article  Google Scholar 

  14. Harris, K. M., Edlund, M. J., & Larson, S. (2005). Racial and ethnic differences in the mental health problems and use of mental health care. Medical Care, 43(8), 775–784.

    Article  Google Scholar 

  15. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structrual Equation Model, 6, 1–55.

    Article  Google Scholar 

  16. Kaufmann, C. L. (1995). The self help employment center: Some outcomes from the first year. Psychosocial Rehabilitation Journal, 18(4), 145.

    Article  Google Scholar 

  17. Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E. … Zaslavsky, A. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189.

    Article  Google Scholar 

  18. Link, B. G., & Phelan, J. (2014). Stigma power. Social Science and Medicine, 103, 24–32.

    Article  Google Scholar 

  19. Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385.

    Article  Google Scholar 

  20. Link, B. G., & Phelan, J. C. (2006). Stigma and its public health implications. Lancet, 367(9509), 528–529.

    Article  Google Scholar 

  21. Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A., & Pescosolido, B. A. (1999). Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. American Journal of Public Health, 89(9), 1328–1333.

    CAS  Article  Google Scholar 

  22. Link, B. G., Struening, E. L., Rahav, M., Phelan, J. C., & Nuttbrock, L. (1997). On stigma and its consequences: Evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. Journal of Health and Social Behavior, 38(2), 177–190.

    CAS  Article  Google Scholar 

  23. Manderscheid, R., Delvecchio, P., Marshall, C., Palpant, R., Bigham, J., Bornemann, T. … Lubar, D. (2010). Attitudes toward mental illness: 35 states, District of Columbia, and Puerto Rico, 2007. Morbidity and Mortality Weekly Report. 59(20), 619–625.

    Google Scholar 

  24. Markowitz, F. E. (1998). The effects of stigma on the psychological well-being and life satisfaction of persons with mental illness. Journal of Health and Social Behavior, 39(4), 335–347.

    CAS  Article  Google Scholar 

  25. Parcesepe, A. M., & Cabassa, L. J. (2013). Public stigma of mental illness in the United States: A systematic literature review. Administration and Policy in Mental Health and Mental Health Services Research, 40(5), 384–399.

    Article  Google Scholar 

  26. Parks, J., Svendsen, D., Singer, P., Foti, M. E., & Mauer, B. (2006). Morbidity and mortality in people with serious mental illness. Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council.

    Google Scholar 

  27. Perlick, D. A., Rosenheck, R. A., Clarkin, J. F., Sirey, J. A., Salahi, J., Struening, E. L., & Link, B. G. (2001). Stigma as a barrier to recovery: Adverse effects of perceived stigma on social adaptation of persons diagnosed with bipolar affective disorder. Psychiatric Services, 52(12), 1627–1632.

    CAS  Article  Google Scholar 

  28. Pierce, C. M., Carew, J. V., Pierce-Gonzalez, D., & Wills, D. (1977). An experiment in racism: TV commercials. Education and Urban Society, 10(1), 61–87.

    Article  Google Scholar 

  29. Rüsch, N., Angermeyer, M. C., & Corrigan, P. W. (2005). Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20(8), 529–539.

    Article  Google Scholar 

  30. Schulze, B., & Angermeyer, M. C. (2003). A focus group study of schizophrenic patients, their relatives and mental health professionals. Social Science and Medicine, 56(2), 299–312.

    Article  Google Scholar 

  31. Sirey, J. A., Bruce, M. L., Alexopoulos, G. S., Perlick, D. A., Friedman, S. J., & Meyers, B. S. (2001). Stigma as a barrier to recovery: Perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatric Services, 52(12), 1615–1620.

    CAS  Article  Google Scholar 

  32. Solorzano, D., Ceja, M., & Yosso, T. (2000). Critical race theory, racial microaggressions, and campus racial climate: The experiences of African American college students. Journal of Negro Education, 79(4), 60–73.

    Google Scholar 

  33. Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychology, 62(4), 271–286.

    Article  Google Scholar 

  34. Thornicroft, G., Leff, J., Warner, R., Sartorius, N., & Schulze, H. (2009). Shunned: Discrimination against people with mental illness. Journal of Occupational Psychology, Employment and Disability, 11, 56–58.

    Google Scholar 

  35. Wahl, O. F. (1999). Mental health consumers’ experience of stigma. Schizophrenia Bulletin, 25(3), 467–478.

    CAS  Article  Google Scholar 

  36. Wahl, O. F. (2012). Stigma as a barrier to recovery from mental illness. Trends in Cognitive Sciences, 16(1), 9–10.

    Article  Google Scholar 

  37. West, M. L., Yanos, P. T., Smith, S. M., Roe, D., & Lysaker, P. H. (2011). Prevalence of internalized stigma among persons with severe mental illness. Stigma Research Action, 1(1), 3–10.

    Article  Google Scholar 

Download references

Acknowledgements

We wish to thank the study participants and their mental healthcare providers for their commitment to this study. We also wish to thank the field and study staff for their hard work and dedication to the research being undertaken in this study.

Funding

The data collection and research carried out for this manuscript was funded by a grant from the National Institute of Mental Health (MH74996) and by funding from the Robert Wood Johnson Foundation Health and Society Scholars Program at Columbia University.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Jerel M. Ezell.

Ethics declarations

Conflict of interest

The authors have no conflict to report.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCx 30 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ezell, J.M., Choi, CW.J., Wall, M.M. et al. Measuring Recurring Stigma in the Lives of Individuals with Mental Illness. Community Ment Health J 54, 27–32 (2018). https://doi.org/10.1007/s10597-017-0156-1

Download citation

Keywords

  • Stigma
  • Micro-aggression
  • Mental illness
  • Self esteem
  • Exploratory factor analysis