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.

Feeling coerced during psychiatric hospitalization: Impact of perceived status of admission and perceived usefulness of hospitalization.

INTRODUCTION: Perceived coercion is not exclusively related to the patient's legal status at admission. Patients are not always aware of their correct status and voluntary patients often report having felt coerced. Moreover, involuntary patients commonly report that their hospitalization was justified. The first goal was to disentangle the contribution of the legal and of the perceived status of admission in predicting perceived coercion. The second goal of this study was to investigate to which extent perception of the usefulness of the hospitalization affected perceived coercion. MATERIAL AND METHODS: 152 inpatients were interviewed about their knowledge of their legal status of admission, perceived need for hospitalization and subjective improvement. They completed the MacArthur's Admission Experience Survey and the Coercion Experience Scale. RESULTS: 6.6% of voluntarily admitted patients and 30.4% of involuntarily admitted patients reported an erroneous status of admission. 88.2% of voluntarily admitted patients and 44.7% of involuntarily admitted patients felt that they needed hospitalization during their stay. Levels of perceived coercion at admission and during hospitalization were mostly predicted by their perceived legal status. While involuntary patients frequently perceived the need for hospitalization and reported subjective improvement after admission, their perception of coercion markedly differed from voluntary patients. CONCLUSIONS: Perceived coercion was marginally related to the legal admission status, which leaves room for interventions that reduce the patients' feeling of being coerced and avoid its negative effects. If many patients revised their belief on the need for and benefits of hospitalization during their stay, their perception of coercion was left partially unchanged.