Development of self-stigma inventory for patients with schizophrenia (SSI-P): reliability and validity study

OBJECTIVES: Internalizing the public stigma in patients with schizophrenia leads to self-stigmatization associated with a number of negative consequences such as depression, low self-esteem, hopelessness, impairment of social adaptation, unemployment, and treatment non-adherence. No instruments have been developed to assess the self-stigmatization for patients with schizophrenia living in Turkey. The purpose of this study was to develop a culturally-sensitive and easy-to-use instrument to measure self-stigma of the patients with schizophrenia and schizoaffective disorder. METHODS: After examining the existing stigma and self-stigma scales for people with mental illnesses, a 19-item self-stigma inventory was formed. Focus group interviews were conducted with patients with schizophrenia and the items were reviewed and rephrased into more comprehensible statements for the patients. The pilot study was conducted with a sample of 15 patients with schizophrenia, and the inventory was given its final form, self-stigma inventory for patients (SSI-P). Outpatients with schizophrenia and schizoaffective disorder were given sociodemographic form, SSI-P, Beck Depression Inventory (BDI), Internalized Stigma of Mental Illness (ISMI), Rosenberg Self-Esteem Scale (RSES), Beck Hopelessness Scale (BHS), Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), and Global Assessment of Functioning (GAF). For reliability analyses; internal consistency, item-total correlation, and test-retest reliability were assessed. Validity analyses were conducted with Explanatory Factor Analysis and convergent validity. RESULTS: The sample of the study was 162 patients with schizophrenia and schizoaffective disorder of which 77% were males, 70% were single, mean age was 37, and level of education was 10 years. Cronbach’s alpha coefficient of the scale was 0.93 ranging among the subscales between 0.60 and 0.91. Kaiser-Meyer-Olkin value was 0.91, and the Barlett test was significant (p < 0.001) for explanatory factor analysis and three factors were found (perceived devaluation, internalized stereotypes and social withdrawal, concealment of the illness) that can explain 63.5% of the total variance. Two items were removed because of their low factor value, and the final form consisted of 17 items. SSI-P was highly correlated with commonly-used stigma scale ISMI (r = 0.73), and moderately correlated with BDI (r = 0.53), BHS (r = 0.40), and RSES (r = −0.59). It also showed low correlation with PANSS negative score (r = 0.19). The test-retest reliability coefficient of the scale was 0.83. CONCLUSION: SSI-P is a reliable and valid instrument for assessing the self-stigmatization of patients with schizophrenia and schizoaffective disorder. The scale is an easy-to-comprehend, user-friendly, and culturally-sensitive tool with its 17 items

Development of Self-Stigma Inventory for Families of the patients with schizophrenia (SSI-F): validity and reliability study

OBJECTIVE: It is known that relatives of the patients with schizophrenia tend to hide the illness from other people, are ashamed of their patients, and feel excluded from society. This situation is referred as self-stigmatization of families, and it may negatively affect the family functioning and therapeutic alliance. Assessing and evaluating the self-stigma of families are essential concerning family therapies and treatment of their patients. The purpose of this study is to develop a culturally sensitive inventory for the assessment of self-stigmatization for families of patients with schizophrenia in Turkey. METHODS: After examining the studies in the related field and conducting a focus group interview with the families of the patients with schizophrenia, a 19-item inventory was formed. One hundred and six relatives of the patients with schizophrenia and schizoaffective disorder were given a sociodemographic form, Self-Stigma Inventory for Families (SSI-F), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Rosenberg Self-Esteem Scale (RSES), and Zarit Caregiver Burden Scale (ZCBS). Explanatory factor analysis and convergent validity were assessed as validity analysis, and internal consistency coefficient, item–total correlation, and test–retest reliability were calculated for reliability analysis. RESULTS: The sample consisted of 106 relatives whose 52% were female, 77% were married, mean age was 51 years, and level of education was 9 years. In explanatory factor analysis, three factors (social withdrawal, concealment of the illness, and perceived devaluation) with 14 items were detected, and the factors could explain 66.8% of the total variance. SSI-F was significantly correlated with Beck Depression Inventory (r = 0.48, P < 0.01), Beck Hopelessness Scale (r = 0.27, P < 0.01), Zarit Caregiver Burden Scale (r = 0.54, P < 0.01), and Rosenberg Self-Esteem Scale (r = −0.35, P < 0.01). Cronbach’s alpha coefficient for SSI-F total score was calculated as 0.88, and test–retest reliability coefficient of SSI-F was 0.93. CONCLUSIONS: This study shows that the SSI-F is a valid and reliable instrument for assessing self-stigmatization in the families of patients with schizophrenia. It can be considered as a valuable instrument to use for research and therapeutic purposes

Development and validation of the Subjective Recovery Assessment Scale for patients with schizophrenia

OBJECTIVE Studies investigating the recovery from schizophrenia revealed two concepts of recovery; one is clinical recovery, and the other is personal or subjective recovery. Both states of recovery require specific assessment tools and therapeutic approaches. While current measures of clinical recovery can be used upon consensus all over the world, measures of subjective recovery which are based on cultural and individual values are yet to be investigated. The aim of this study was to develop and validate the Subjective Recovery Assessment Scale (SubRAS) for patients with schizophrenia. METHODS The SubRAS consisting of 17-item was prepared using related literature with focus group interviews. Internal consistency reliability was assessed by Cronbach’s alpha coefficients, and test–retest reliability was assessed. Exploratory factor analyses and correlations with Global Assessment of Functioning (GAF), The Heinrichs-Carpenter Quality of Life Scale (QLS), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression – Severity (CGI-S) were used to examine the factor-based validity and construct validity of the SubRAS. RESULTS The participants consisted of 127 patients with schizophrenia (n = 110) and schizoaffective disorder (n = 17), with 63.6% being male and a mean age of 41.2 years. Cronbach’s alpha coefficient of the scale was calculated as 0.98 while item-total score correlation coefficients were measured between 0.83 and 0.94. Test–retest reliability (r = .98) was very satisfactory. As for construct validity, a one-factor solution was obtained that could explain 83.0% of the variance. The scale showed a high correlation with the GAF (r = .82), the QLS (r = .76), PANSS (r = −.74), and CGI-S (r = −.74). CONCLUSIONS SubRAS is a valid and reliable instrument that can be utilized for patients with schizophrenia to assess their subjective recovery states. It is a culture-sensitive self-assessment instrument and easy to use for Turkish patients with schizophrenia

Development of Social Functioning Assessment Scale for People with Schizophrenia: validity and reliability study

Objective: Assessment of the level of social functioning is important especially for people with schizophrenia that has a chronic course of illness. The purpose of this study was to develop a culturally sensitive, user-friendly scale that could assess the social functioning of the people with schizophrenia living in Turkey. Methods: After examining the studies that assessed social functioning in people with mental illnesses and social habits of people living in the community, a 28-item scale was formed. The items of the form were discussed with patients with schizophrenia and their family members. Items, which were difficult to comprehend, were reevaluated and the form was finalized as Social Functioning Assessment Scale (SFAS). One hundred and forty-eight outpatients with schizophrenia or schizoaffective disorder were given the SFAS, Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression-Severity (CGI-S), and Global Assessment of Functioning (GAF). At the same time, Social Functioning Scale (SFS) and SFAS were filled out by the relatives of the patients living together. SFAS was also given to 161 healthy subjects living in the community. For reliability analyses; internal consistency coefficient, item-total correlation, and test-retest reliability were assessed. For validity analyses; explanatory factor analysis, convergent, divergent, and discriminant validity were examined. Results: The data from 120 patients with schizophrenia and 28 with schizoaffective disorder was examined. Cronbach's alpha coefficient for SFAS total score was 0.842. Kaiser-Meyer-Olkin value was 0.813, and Bartlett test was significant for factor analysis. In explanatory factor analysis, SFAS comprised of three factors (interpersonal relations and recreation, self-care, independent living) and they can explain 47% of the total variance. Occupational life could not get in any of the factors; however, since it was important for social functioning, it was added to the scale as the fourth factor. Total score of the SFAS filled out by the patients was significantly correlated with PANSS, CGI-S, GAF and SFS total score. There was a satisfactory correlation between the total score of SFAS filled out by the patients and relatives. There was a statistically significant difference between the SFAS scores of the patients and SFAS scores of the controls. Test-retest reliability of the SFAS-P was 0.874. Conclusion: Regarding the findings of the study, SFAS was considered a culturally sensitive, easy-to-use, valid and reliable instrument that objectively assesses the social functioning of the patients with schizophrenia