Psychometric Evaluation of the HIV Stigma Scale in a Swedish Context

Background HIV-related stigma has negative consequences for infected people's lives and is a barrier to HIV prevention. Therefore valid and reliable instruments to measure stigma are needed to enable mapping of HIV stigma. This study aimed to evaluate the psychometric properties of the HIV stigma scale in a Swedish context with regard to construct validity, data quality, and reliability. Methods The HIV stigma scale, developed by Berger, Ferrans, and Lashley (2001), was distributed to a cross-sectional sample of people living with HIV in Sweden (n = 194). The psychometric evaluation included exploratory factor analysis together with an analysis of the distribution of scores, convergent validity by correlations between the HIV stigma scale and measures of emotional well-being, and an analysis of missing items and floor and ceiling effects. Reliability was assessed using Cronbach's α. Results The exploratory factor analysis suggested a four-factor solution, similar to the original scale, with the dimensions personalised stigma, disclosure concerns, negative self-image, and concerns with public attitudes. One item had unacceptably low loadings and was excluded. Correlations between stigma dimensions and emotional well-being were all in the expected direction and ranged between −0.494 and −0.210. The instrument generated data of acceptable quality except for participants who had not disclosed their HIV status to anybody. In line with the original scale, all subscales demonstrated acceptable internal consistency with Cronbach's α 0.87–0.96. Conclusion A 39-item version of the HIV stigma scale used in a Swedish context showed satisfactory construct validity and reliability. Response alternatives are suggested to be slightly revised for items assuming the disclosure of diagnosis to another person. We recommend that people that have not disclosed should skip all questions belonging to the dimension personalised stigma. Our analysis confirmed construct validity of the instrument even without this dimension

Cultural adaptation and psychometric evaluation of the Swedish version of the Reproductive Concerns After Cancer (RCAC) scale

BACKGROUND: Reproductive concerns are common among young cancer survivors and include worries related to different aspects of fertility and parenthood. The Reproductive Concerns After Cancer (RCAC) scale is an 18-item scale with six dimensions, developed to capture a variety of such concerns. The aim of the present study was to describe the cultural adaptation of the RCAC scale into Swedish and evaluate its psychometric properties among young women who have undergone treatment for cancer. METHODS: The RCAC was forward translated from English into Swedish and assessed for cultural adaptation based on a two-panel approach followed by cognitive interviews with the target group. For the psychometric evaluation, a Swedish cohort of 181 female young adult breast cancer survivors completed a survey including the RCAC scale approximately 1.5 years post-diagnosis. Psychometric properties were examined by analyses of construct validity (confirmatory factor analysis and convergent validity), data quality (score distribution, floor and ceiling effects), reliability and known-groups validity. RESULTS: The confirmatory factor analysis yielded an acceptable fit (RMSEA 0.08, SRMR 0.09, CFI 0.92). Convergent validity was demonstrated by a negative correlation of moderate size (- 0.36) between the RCAC total score and the emotional function scale of the EORTC QLQ-C30. Reliability measured with Revelle Ω total was satisfactory (0.73-0.92) for five of the dimensions, and poor for the dimension Becoming pregnant (Revelle Ω total = 0.60); Cronbach's alpha showed a similar pattern. Known-groups validity was indicated by significant RCAC mean score differences (MD), reflecting more concerns among women with a certain (MD 4.56 [95% CI 3.13 to 5.99]) or uncertain (MD 3.41 [95% CI 1.68 to 5.14]) child wish compared to those with no wish for (additional) children. CONCLUSION: The translation and cultural adaptation of the Swedish RCAC has resulted in a scale demonstrating construct and known-groups validity, and satisfactory reliability for five of six dimensions. The dimension Becoming pregnant showed non-optimal internal consistency and should undergo further evaluation. The Swedish RCAC is recommended to be used in research settings for measurement of concerns related to fertility and parenthood in young women with cancer

The Relationship Between Stigma and Health-Related Quality of Life in People Living with HIV Who Have Full Access to Antiretroviral Treatment: An Assessment of Earnshaw and Chaudoir's HIV Stigma Framework Using Empirical Data.

The aim was to empirically test the tenets of Earnshaw and Chaudoir's HIV stigma framework and its potential covariates for persons living with HIV in Sweden. Partial least squares structural equation modelling was used on survey data from 173 persons living with HIV in Sweden. Experiencing stigma was reported to a higher extent by younger persons and by women who had migrated to Sweden. As expected, anticipated stigma was related to lower Physical functioning, and internalized stigma to lower Emotional wellbeing. In contrast to that hypothesized by the HIV stigma framework, enacted stigma was not related to Physical functioning and no relationships were found between HIV-related stigma and antiretroviral adherence. These results indicate that the HIV stigma framework may need to be revised for contexts where a very high proportion of persons living with HIV are diagnosed and under efficient treatment

Varför har den psykiska ohälsan ökat bland barn och unga i Sverige under perioden 1985–2014?

SammanfattningDenna artikel redovisar huvudresultaten från Folkhälsomyndighetens undersökning av faktorer som skulle kunna förklara den ökade förekomsten av psykosomatiska symtom bland barn och unga i Sverige. Rapporten bygger på analyser av svenska data från studien Skolbarns hälsovanor (1985/86−2013/14), trenddata från olika källor och vetenskaplig litteratur.Sammanfattningsvis tycks brister i skolans funktion, indikerat av de sjunkande skolprestationerna och den utbredda skolstressen, tillsammans med förändringar på arbetsmarknaden troligen ha bidragit till utvecklingen av psykosomatiska symtom bland unga. Däremot tycks inte faktorer inom familjen eller ekonomisk utsatthet i absoluta termer hos barnfamiljer, ha påverkat utvecklingen av psykosomatiska symtom bland barn och unga.På grund av ämnenas komplexitet och begränsat vetenskapligt underlag är det osäkert i vilken utsträckning faktorer som ökad individualisering, ökad öppenhet kring psykisk ohälsa, lägre krav på barnen, medikalisering av barndomen och digital medieanvändning har påverkat utvecklingen.AbstractThis article presents the main findings from the Swedish Public Health Agency's study of factors that could explain the increase of psychosomatic symptoms among children and young people in Sweden. The report is based on analyses of Swedish data from the international study Health Behaviour in School-aged Children, HBSC (1985/86−2013/14), trend data from various sources and scientific literature.In summary, deteriorated school functioning indicated by declining school performance and widespread school stress, together with the changes in the labour market, have probably contributed to the development of psychosomatic symptoms among young people. Factors within the family do not appear to have influenced the development of psychosomatic symptoms among children and adolescents, neither financial vulnerability in absolute terms among families.Due to the complexity of the subjects and limited scientific evidence, it is uncertain to what extent factors such as increased individualization, increased openness about mental ill health, lower demands on children, medicalisation of childhood and digital media use have affected the development.Key words:Psychosomatic symptoms, psychosomatic problems, mental ill health, children, adolescents, Sweden, school, labour marke

Shame-proneness in attempted suicide patients

<p>Abstract</p> <p>Background</p> <p>It has been suggested that shame may be an important feature in suicidal behaviors. The disposition to react with shame, “shame-proneness”, has previously not been investigated in groups of attempted suicide patients. We examined shame-proneness in two groups of attempted suicide patients, one group of non-suicidal patients and one group of healthy controls. We hypothesized that the attempted suicide patients would be more shame-prone than non-suicidal patients and healthy controls.</p> <p>Methods</p> <p>The Test of Self-Conscious Affect (TOSCA), which is the most used measure of shame-proneness, was completed by attempted suicide patients (n = 175: 105 women and 3 men with borderline personality disorder [BPD], 45 women and 22 men without BPD), non-suicidal psychiatric patients (n = 162), and healthy controls (n = 161). The participants were convenience samples, with patients from three clinical research projects and healthy controls from a fourth research project. The relationship between shame-proneness and attempted suicide was studied with group comparisons and multiple regressions. Men and women were analyzed separately.</p> <p>Results</p> <p>Women were generally more shame-prone than men of the same participant group. Female suicide attempters with BPD were significantly more shame-prone than both female suicide attempters without BPD and female non-suicidal patients and controls. Male suicide attempters without BPD were significantly less shame-prone than non-suicidal male patients. In multiple regressions, shame-proneness was predicted by level of depression and BPD (but not by attempted suicide) in female patients, and level of depression and non-suicidality in male patients.</p> <p>Conclusions</p> <p>Contrary to our hypothesis and related previous research, there was no general relationship between shame-proneness and attempted suicide. Shame-proneness was differentially related to attempted suicide in different groups of suicide attempters, with significantly high shame-proneness among female suicide attempters with BPD and a negative relationship between shame-proneness and attempted suicide among male patients. More research on state and trait shame in different groups of suicidal individuals seems clinically relevant.</p

Descriptive statistics for the subscales of the HIV stigma scale.

<p>Descriptive statistics for the subscales of the HIV stigma scale.</p

Descriptive statistics for all 39 items in the Swedish version of the HIV stigma scale.

<p>(R) indicates that the item is reversely scored.</p><p>Descriptive statistics for all 39 items in the Swedish version of the HIV stigma scale.</p

Factor loadings for all 40 items in the HIV stigma scale.^a

a<p>Factor loadings based on alpha factoring with oblimin rotation. Pattern matrix. Factor loadings <0.32 not shown.</p>b<p>in the Swedish version (factor assignment in original English version).</p><p>(R) indicates that the item is reversely scored.</p><p>Factor loadings for all 40 items in the HIV stigma scale.^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0114867#nt102" target="_blank">a</a>}</p