Toward an understanding of the quality of life construct: Validity and reliability of the WHOQOL-Bref in a psychiatric sample.

This study tested the psychometric properties of the WHOQOL-Bref by examining its construct validity, predictive validity and reliability in a psychiatric sample. The sample consisted of 403 participants recruited from mental health care facilities. Construct validity was assessed through confirmatory factor analysis (CFA) and item-domains correlations. Predictive validity was evaluated via multiple regressions. Internal consistency was analyzed by using Cronbach's alpha. Results from CFA second-order hierarchical model and item-domain correlational analyses supported the construct validity of the WHOQOL-Bref. A 5-domain model (psychological, physical, social relationships, environment and level of independence) demonstrated good-fit and adequate internal consistency. Multiple regression analyses of the domains with overall quality of life (QOL), general health and general QOL were supportive of predictive validity. This study found support for the multidimensionality of the WHOQOL-Bref which demonstrated appropriate properties for the assessment of QOL in psychiatric inpatients and outpatients. Thus, a valuable tool to be incorporated as part of the routine clinical evaluation, monitoring and an important indicator of treatment outcome and research. Our findings suggest a conceptual distinction between the physical domain and level of independence domain in this short version of the WHOQOL, as proposed by the WHOQOL-100.

Internalized stigma and quality of life domains among people with mental illness: the mediating role of self-esteem.

BACKGROUND: People with mental illness who internalize stigma often experience reduced self-esteem and impaired quality of life (QOL). AIMS: To propose a theoretical model in which self-esteem mediates the effects of internalized stigma on the multidimensional domains comprising QOL. METHOD: In 403 inpatients and outpatients (DSM-IV, American Psychiatric Association, 1994), from hospital-based and community mental health facilities, self-report measures of internalized stigma (ISMI), self-esteem (RSES) and QOL (WHOQOL-Bref) were administrated. RESULTS: Structural equation modeling results supported the proposed model. Self-esteem fully mediated the relation between internalized stigma and the physical and the social relationships domains, and partially mediated the relationship between internalized stigma and psychological, environment and level of independence QOL domains. Such results provided empirical support and shed light upon previous research. Specifically the results emphasize the mediating role that self-esteem plays in the degree to which internalized stigma exerts a negative effect on specific QOL domains. CONCLUSIONS: Self-esteem appears to be a core element in reducing the negative effects of internalized stigma on aspects of QOL among people with mental illness. These findings suggest there is a crucial impact regarding clinical mental health interventions along with important theoretical implications.

Clinical profiles of stigma experiences, self-esteem and social relationships among people with schizophrenia, depressive, and bipolar disorders.

Some mental illnesses and certain mental health care environments can be severely stigmatizing, which seems to be related to decreased self-esteem and a deterioration of the quality of social relationships for people with mental illness. This study aims to identify clinical profiles characterized by clinical diagnoses more strongly associated with the treatment settings and related to internalized stigma, self-esteem and satisfaction with social relationships. It also aimed to analyze associations between clinical profiles and socio-demographic indicators. Multiple correspondence analysis and cluster analysis were performed on a sample of 261 individuals with schizophrenia and mood disorders, from hospital-based and community-based facilities. MCA showed four distinct clinical profiles allowing a differentiation among levels of: internalized stigma, social relationship satisfaction and self-esteem. Overall, results revealed that internalized stigma remains a pervasive problem for some people with schizophrenia and mood disorders. Particularly, internalized stigma and social relationships dissatisfaction and associated socio-demographic indicators appear to be a risk factor for social isolation for individuals with schizophrenia, which may worsen the course of the disorder. Our findings highlight the importance to develop structured interventions aimed to reduce internalized stigma, and exclusion of those who suffer the loss of their social roles and networks.

The Internalized Stigma of Mental Illness: Cross-Cultural Adaptation and Psychometric Properties of the Portuguese Version of the ISMI Scale.

This study examined the psychometric properties of the Portuguese version of the ISMI scale in a sample of 253 adult psychiatric outpatients. The exploratory factor analysis replicated the five factor structure of the scale. The results revealed good internal consistency. Criterion-related validity supported the variability in response to stigma across clinical diagnoses. Thus, the Portuguese version of the ISMI scale can be considered appropriate to measure and differentiate between stigmatization experiences. Also, in order to design more focused approaches aimed to reduce the negative effects of internalized stigma, its use in institutional and in community-based mental health services is recommended.