Measuring the paradox of self-stigma: psychometric properties of a brief scale

BACKGROUND: Exposure to public stigma can lead to stereotype endorsement and resignation, which are constructs related to self-stigma. This latter phenomenon has well-documented deleterious consequences for people living with mental illness. Paradoxically, it can also lead to the empowering reactions of righteous anger and coming out proud. AIM: The aim of this study was to develop and validate a brief tool to measure stereotype endorsement, righteous anger, and non-disclosure across different groups of stigmatized persons. This process was conducted in collaboration with users. METHOD: Using focus groups with mental health professionals and people living with mental illness, 72 items were developed to measure various aspects of self-stigma. The Paradox of Self-Stigma scale (PaSS-24) containing 24 items and three subscores (stereotype endorsement, non-disclosure, and righteous anger) resulted from a calibration phase using factor analysis. This structure was cross-validated on an independent sample. Internal consistency, test-retest reliability, and convergent validity were also evaluated. RESULTS: 202 patients were assessed. The PaSS-24 demonstrated good internal validity. Internal consistency, test-retest reliability, and convergent validity estimates were also good. CONCLUSIONS: The PaSS-24 is a short but psychometrically rigorous tool designed to measure self-stigma and related constructs in French language, developed in collaboration with users. The development and validation of the PaSS-24 represent a first step towards implementing and evaluating programs aimed at reducing negative consequences of self-stigma.