Keywords

2.1 Mental Health Scales

“Mental health problems are a growing public health concern.” (Mental Health Foundation, 2016) “Nearly one billion people worldwide suffer from some form of mental disorder, according to latest UN data–a staggering figure that is even more worrying, if you consider that it includes around one in seven teenagers.” (UN News, 2022) A recent index of 301 diseases discovered that mental health issues ranked among the major causes of the global overall disease burden (Vos et al., 2013). It has been estimated that 35–50% of individuals living with severe mental health issues in developed countries, and 76–85% in developing countries, receive no treatment (Demyttenaere et al., 2004).

Given the worldwide prevalence of mental health issues and the imbalance between the global disease burden caused by mental health issues and attention paid to these conditions, various types of mental health-related scales have been developed and validated to serve different purposes. These scales can roughly be grouped under four broad headings: (1) mental health locus of control scales; (2) attitude assessment tools; (3) knowledge and literacy scales; and (4) psychiatric rating scales. In the following sections, we will focus on and exemplify the first two categories.

2.2 Mental Health Locus of Control Scales

Since their advent in the mid-late 1970’s, the Multidimensional Health Locus of Control (MHLC) Scales Forms A and B have been in use as the “general” health locus of control scales (Wallston, 2023) and remained “one of the most frequently used measures of health-related beliefs” (Wallston et al., 1994). Both forms comprise three 6-item subscales: internality; powerful others externality; and chance externality. They have been used in more than a thousand studies and cited in literature hundreds of times in the past 30 years (Wallston, 2023).

Health locus of control refers to a person’s belief regarding where control over his/her health lies (Wallston et al., 1994). “It the person believes that his/her own behavior influences his/her health status, the person is said to possess an internal locus of control orientation with regard to his/her health. If, on the other hand, the person believes that his/her health status is influenced by the actions of other people or is due to fate, luck, or chance, the person is said to have an external health locus of control orientation.” (Wallston et al., 1994: 534) A person’s health locus of control orientation is one of several factors that determine his/her health-related behaviors, which, in turn, partially determine his/her health condition (Wallston et al., 1994).

Drawing on Wallston et al. (1994), we can say that mental health locus of control means a person’s beliefs about an existing mental condition, and that mental health locus of control scales refer to instruments that measure a person’ beliefs about an existing mental condition. To our knowledge, there are no scales exclusively designed for measuring people’s mental health locus of control. However, the Multidimensional Health Locus of Control (MHLC) Form C (Wallston et al., 1994) could be a helpful alternative. As Wallston et al. (1994) claim, the MHLC Form C, designed to be “condition-specific,” can be used to study individuals with an existing health/medical condition by substituting whatever condition (e.g., arthritis, diabetes, pain, etc.) the subjects have for the word “condition” in each item with. As thus, we adapted it to a depression-specific instrument, as shown in Table 2.1, in which each item is a belief statement about depression with which a person may agree or disagree.

Table 2.1 Multidimensional health locus of control scale for depression
Full size table

The construct above contains three subscales of depression locus of control: Internal (Items1, 6, 8, 12, 13, and 17), Powerful Others (Items 3, 7, 5, 10, 14, and 18), and Chance (Items 2, 4, 9, 11, 15, and 16). Drawing on Wallston et al. (1994), we can propose that the Internal depression locus of control refers to the extent to which one believes his/her depression status is a function of his/her own behaviors; the Powerful Others depression locus of control refers to the belief that a person’s depression status is determined by the actions of “powerful” doctors, family members, friends, etc.; and the Chance depression locus of control refers to the belief that chance, fate, or luck determines one’s depression status.

The MHLC Form C can be used to measure a person’s belief about where control over any of his/her specific mental conditions lies when we replace “condition” in all the items on the scale with a specific mental condition, like anxiety, personality disorder, etc. As argued by Wallston et al. (1994: 535), “in predicting behaviors or outcomes in specific psychological situations, expectancies specific to that situation would perform better than more generalized expectancies.”

We will discuss how to translate and adapt the MHLC Form C to Chinese and validate the reliability and validity of the translated and adapted Chinese measure in Chap. 3.

2.3 Attitude Assessment Scales

People living with mental disorders are far more stigmatized than individuals living with other medical conditions, leading to unfavorable individual, social, political, economic, and psychological consequences (Baumann, 2007; El-Badri & Mellsop, 2007; Marwaha & Johnson, 2005). It is, therefore, imperative to measure stigma attached to mental disorders and those living with these conditions to launch targeted stigma reduction initiatives. To this end, various instruments have been designed to capture various, mental illness-related stigma, including Day’s Mental Illness Stigma Scale (Day et al., 2007), the Dementia Attitudes Scale (O’Connor & McFadden, 2010), Stigma questionnaire (Cheng et al., 2011), the Family Stigma in Alzheimer’s Disease Scale (Werner et al., 2011), STIG-MA (Piver et al., 2013), Dementia Stigma Questionnaire (Woo & Chung, 2013), the Prejudice towards People with Mental Illness (PPMI) scale (Kenny et al., 2018), the Stigma-9 Questionnaire (STIG-9) (Gierka et al., 2018), the Dementia Public Stigma Scale (DPSS) (Kim et al., 2022), among many others.

Stigma, “generated in social contexts” (Goffman, 1986: 138), mainly comprises public stigma (a negative reaction to a stigmatized individual or group from non-stigmatized others), affiliated stigma (the experience of stigma in individuals associated with a stigmatized person), and self-stigma (the negative attitudes that a stigmatized person perceives from society and internalizes in himself or herself) (Corrigan & Watson, 2002). Public stigma underpins affiliated stigma and self-stigma, as found by Jones and Corrigan (2014). Based on this finding, we think it imperative to examine public stigma before studying affiliated and self-stigma. We, therefore, exemplify mental disorders-related attitude assessment tools with the Dementia Public Stigma Scale (DPSS) (Kim et al., 2022), as shown in Table 2.2.

Table 2.2 The Dementia Public Stigma Scale (DPSS)
Full size table

In the DPSS, five distinct dementia‐related stigma factors have been identified: “Fear and discomfort,” “Incapability and loss,” “Acknowledgement of personhood,” “Burden,” and “Exclusion.” The “Fear and discomfort” factor reflects the emotional domain of stigma and discomfort around people living with dementia; the “Incapability and loss” factor reflects the cognitive domain of stigma especially lack of capability and loss of personhood; the “Acknowledgement of personhood” factor reflects the cognitive domain of stigma and understanding of people living with dementia; the “Burden” factor reflects the cognitive domain of stigma and perceptions that people living with dementia are a burden to family and society; and the “Exclusion” factor reflects the behavioral domain of stigma and the display of discriminatory behaviors (Kim et al., 2022).

We will discuss how to translate and adapt the DPSS to Chinese and validate the reliability and validity of the translated and adapted Chinese instrument in Chap. 4.

2.4 Summary

In this chapter, we present two main categories of mental health scales: (1) mental health locus of control scales and (2) attitude assessment tools. The mental health locus of control scales measures a person’ beliefs about an existing mental condition, like the Multidimensional Depression Locus of Control Scale Form C. The attitude assessment tools are designed to measure people’s attitudes towards mental disorders, as illustrated by the Dementia Public Stigma Scale (DPSS). The translation and adaptation of these two types of scales will be discussed in Chaps. 3 and 4 respectively.