What question did this study set out to answer?

The aim is to develop and psychometrically evaluate the Liver Disease Stigma Scale (LDSS) for measuring stigma in chronic liver disease patients.

May 8, 2026Open Access

Development and Psychometric Evaluation of the Liver Disease Stigma Scale (LDSS)

Key Points

The aim is to develop and psychometrically evaluate the Liver Disease Stigma Scale (LDSS) for measuring stigma in chronic liver disease patients.
Conducted a cross-sectional study of 211 patients from hepatology services, categorized as alcohol-associated liver disease (ALD) or non-ALD.
Assessed stigma using the LDSS and evaluated psychometric properties including exploratory factor analysis (EFA) and internal consistency (Cronbach's alpha).
Evaluated convergent validity with the Substance Use Stigma Mechanisms Scale and mental health symptoms using statistical tests.
Five-factor structure of LDSS accounted for 73.7% of variance with excellent subscale reliability (0.90-0.97).
Demonstrated strong convergent validity with SU-SMS subscales (correlation r = 0.43-0.80).
Participants with ALD had significantly higher stigma scores (internalized stigma: 2.34 vs 1.50, p < 0.001, d = 0.85).

Abstract

Background n=128) or non-ALD (n=83).The LDSS assessed internalized, anticipated (family and healthcare), and experienced (family and healthcare) stigma.Psychometric evaluation included exploratory factor analysis (EFA), internal consistency (Cronbach's alpha), and convergent validity with the Substance Use Stigma Mechanisms Scale (SU-SMS) and mental health symptoms.Known-groups validity was assessed using t-tests and adjusted linear regression.Results: EFA supported a five-factor structure accounting for 73.7% of variance.Subscale reliability was excellent ( = 0.90-0.97).LDSS subscales showed strong convergent validity with corresponding SU-SMS subscales (r = 0.43-0.80)and moderate correlations with mental health (r = 0.18-0.60).Known-groups validity was demonstrated by higher stigma scores among participants with ALD, particularly for internalized stigma (2.34 vs 1.50, p < 0.001, d = 0.85) and family-experienced stigma (1.80 vs 1.18, p < 0.001, d = 0.77).After adjustment, differences in internalized and family-experienced stigma remained significant. J o u r n a l P r e -p r o o fConclusions: The LDSS demonstrated a stable five-factor structure, strong reliability, and good convergent validity, supporting its use as a psychometrically sound measure of liver disease-specific stigma.Patients with ALD showed higher stigma levels, underscoring the scale's clinical relevance and the need for further research on stigma and outcomes in liver disease.Findings require validation in larger, more diverse, and independent samples.

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