Skip to main content
Top
Published in: Health and Quality of Life Outcomes 1/2022

Open Access 01-12-2022 | Mood Disorders | Research

Psychometric properties of the Depression Stigma Scale in the Portuguese population and its association with gender and depressive symptomatology

Authors: Virgínia Conceição, Inês Rothes, Milton Severo, Kathleen Griffiths, Ulrich Hegerl, Ricardo Gusmão

Published in: Health and Quality of Life Outcomes | Issue 1/2022

Login to get access

Abstract

Background

Stigma is one of the most significant constraints on people living with depression. There is a lack of validated scales in Portugal to measure depression stigma; therefore, the Depression Stigma Scale (DSS) is essential to the depression stigma research in Portugal.

Methods

We developed the adaptation process with the ITC Guidelines for Translation and Adapting Tests taken into consideration. We collected the sample as part of the OSPI program—Optimizing suicide prevention programs and their implementation in Europe, specifically within the application in Portugal, and included 1693 participants. Floor-ceiling effects and response ranges were analyzed, and we calculated Cronbach alphas, and Confirmatory Analysis. Validity evidence was tested with two well-documented hypotheses, using data on gender and depression symptoms.

Results

The sample was well comparable with the general Portuguese population, indicating its representativeness. We identified a three-factor structure in each subscale (personal and perceived stigma): weak-not-sick, discrimination, and dangerous/unpredictable, with good model fit results. The Cronbach's alphas were satisfactory, and validity was confirmed.

Conclusions

This study established the validity and demonstrated good psychometric properties of the DSS in the Portuguese population. The validation of the DSS can be beneficial in exploring stigma predictors and evaluating the effectiveness of stigma reduction interventions.
Appendix
Available only for authorised users
Literature
1.
go back to reference Shahwan S, Lau JH, Goh CMJ, Ong WJ, Tan GTH, Kwok KW, et al. The potential impact of an anti-stigma intervention on mental health help-seeking attitudes among university students. BMC Psychiatry. 2020;20(1):562.CrossRef Shahwan S, Lau JH, Goh CMJ, Ong WJ, Tan GTH, Kwok KW, et al. The potential impact of an anti-stigma intervention on mental health help-seeking attitudes among university students. BMC Psychiatry. 2020;20(1):562.CrossRef
2.
go back to reference Yang F, Yang BX, Stone TE, Wang XQ, Zhou Y, Zhang J, et al. Stigma towards depression in a community-based sample in China. Compr Psychiatry. 2020;97:152152.CrossRef Yang F, Yang BX, Stone TE, Wang XQ, Zhou Y, Zhang J, et al. Stigma towards depression in a community-based sample in China. Compr Psychiatry. 2020;97:152152.CrossRef
3.
go back to reference Kosyluk K, Marshall J, Conner K, Macias DR, Macias S, Michelle Beekman B, et al. Challenging the stigma of mental illness through creative storytelling: a randomized controlled trial of this is my brave. Commun Ment Health J. 2021;57(1):144–52.CrossRef Kosyluk K, Marshall J, Conner K, Macias DR, Macias S, Michelle Beekman B, et al. Challenging the stigma of mental illness through creative storytelling: a randomized controlled trial of this is my brave. Commun Ment Health J. 2021;57(1):144–52.CrossRef
4.
go back to reference Walsh DAB, Foster JLH. A call to action. A critical review of mental health related anti-stigma campaigns. Front Public Health. 2021;8:990.CrossRef Walsh DAB, Foster JLH. A call to action. A critical review of mental health related anti-stigma campaigns. Front Public Health. 2021;8:990.CrossRef
5.
go back to reference Corrigan PW. Mental health stigma as social attribution: Implications for research methods and attitude change. Clin Psychol Sci Pract. 2006;7(1):48–67.CrossRef Corrigan PW. Mental health stigma as social attribution: Implications for research methods and attitude change. Clin Psychol Sci Pract. 2006;7(1):48–67.CrossRef
6.
go back to reference Rusch N, Angermeyer MC, Corrigan PW. Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry. 2005;20(8):529–39.CrossRef Rusch N, Angermeyer MC, Corrigan PW. Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry. 2005;20(8):529–39.CrossRef
7.
go back to reference Griffiths KM, Christensen H, Jorm AF. Predictors of depression stigma. BMC Psychiatry. 2008;8:25.CrossRef Griffiths KM, Christensen H, Jorm AF. Predictors of depression stigma. BMC Psychiatry. 2008;8:25.CrossRef
8.
go back to reference Lasalvia A, Zoppei S, Van Bortel T, Bonetto C, Cristofalo D, Wahlbeck K, et al. Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet. 2013;381(9860):55–62.CrossRef Lasalvia A, Zoppei S, Van Bortel T, Bonetto C, Cristofalo D, Wahlbeck K, et al. Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet. 2013;381(9860):55–62.CrossRef
9.
go back to reference Kashihara J. Examination of stigmatizing beliefs about depression and stigma-reduction effects of education by using implicit measures. (0033–2941 (Print)) Kashihara J. Examination of stigmatizing beliefs about depression and stigma-reduction effects of education by using implicit measures. (0033–2941 (Print))
10.
go back to reference McNair BG, Highet NJ, Hickie IB, Davenport TA. Exploring the perspectives of people whose lives have been affected by depression. Med J Aust. 2002;196(10):69–76. McNair BG, Highet NJ, Hickie IB, Davenport TA. Exploring the perspectives of people whose lives have been affected by depression. Med J Aust. 2002;196(10):69–76.
11.
go back to reference Alonso J, Buron A, Rojas-Farreras S, de Graaf R, Haro JM, de Girolamo G, et al. Perceived stigma among individuals with common mental disorders. J Affect Disord. 2009;118(1–3):180–6.CrossRef Alonso J, Buron A, Rojas-Farreras S, de Graaf R, Haro JM, de Girolamo G, et al. Perceived stigma among individuals with common mental disorders. J Affect Disord. 2009;118(1–3):180–6.CrossRef
12.
go back to reference World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates, Geneva; 2017. World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates, Geneva; 2017.
13.
go back to reference Martínez V, Crockett MA, Jiménez-Molina Á, Espinosa-Duque HD, Barrientos E, Ordóñez-Carrasco JL. Stigmatizing beliefs and attitudes to depression in adolescent School Students in Chile and Colombia. Front Psychol. 2020;11:577177.CrossRef Martínez V, Crockett MA, Jiménez-Molina Á, Espinosa-Duque HD, Barrientos E, Ordóñez-Carrasco JL. Stigmatizing beliefs and attitudes to depression in adolescent School Students in Chile and Colombia. Front Psychol. 2020;11:577177.CrossRef
14.
go back to reference Kaushik A, Kostaki E, Kyriakopoulos M. The stigma of mental illness in children and adolescents: a systematic review. Psychiatry Res. 2016;243:469–94.CrossRef Kaushik A, Kostaki E, Kyriakopoulos M. The stigma of mental illness in children and adolescents: a systematic review. Psychiatry Res. 2016;243:469–94.CrossRef
15.
go back to reference Oliveira SE, Esteves FG, Pereira EG, Carvalho M, Boyd JE. The internalized stigma of mental illness: cross-cultural adaptation and psychometric properties of the Portuguese version of the ISMI scale. Commun Ment Health J. 2015;51(5):606–12.CrossRef Oliveira SE, Esteves FG, Pereira EG, Carvalho M, Boyd JE. The internalized stigma of mental illness: cross-cultural adaptation and psychometric properties of the Portuguese version of the ISMI scale. Commun Ment Health J. 2015;51(5):606–12.CrossRef
16.
go back to reference Sousa S, Marques A, Rosário C, Queirós C. Stigmatizing attitudes in relatives of people with schizophrenia: a study using the attribution questionnaire AQ-27. Trends Psychiatry Psychother. 2012;34(4):186–97.CrossRef Sousa S, Marques A, Rosário C, Queirós C. Stigmatizing attitudes in relatives of people with schizophrenia: a study using the attribution questionnaire AQ-27. Trends Psychiatry Psychother. 2012;34(4):186–97.CrossRef
17.
go back to reference Oliveira ARF, Azevedo SM. Estigma na doença mental: estudo observacional. Revista Portuguesa de Medicina Geral e Familiar; v 30, n 4 (2014): Revista Portuguesa de Medicina Geral e Familiar. 2014. Oliveira ARF, Azevedo SM. Estigma na doença mental: estudo observacional. Revista Portuguesa de Medicina Geral e Familiar; v 30, n 4 (2014): Revista Portuguesa de Medicina Geral e Familiar. 2014.
18.
go back to reference Loureiro L, Dias C, Ferreira P. Um Inventário de Crenças acerca da Doença Mental. Revista de Investigação em Enfermagem. 2006;14:36–44. Loureiro L, Dias C, Ferreira P. Um Inventário de Crenças acerca da Doença Mental. Revista de Investigação em Enfermagem. 2006;14:36–44.
19.
go back to reference Oliveira S. A loucura no outro: um contributo para o estudo do impacto da loucura no profissional de Saúde Mental. Coimbra: Universidade de Coimbra; 2005. Oliveira S. A loucura no outro: um contributo para o estudo do impacto da loucura no profissional de Saúde Mental. Coimbra: Universidade de Coimbra; 2005.
20.
go back to reference Hegerl U, Wittenburg L, Arensman E, Van Audenhove C, Coyne JC, McDaid D, et al. Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): an evidence-based multi-level approach. BMC Public Health. 2009;9:428.CrossRef Hegerl U, Wittenburg L, Arensman E, Van Audenhove C, Coyne JC, McDaid D, et al. Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): an evidence-based multi-level approach. BMC Public Health. 2009;9:428.CrossRef
21.
go back to reference Coppens E, Van Audenhove C, Scheerder G, Arensman E, Coffey C, Costa S, et al. Public attitudes toward depression and help-seeking in four European countries baseline survey prior to the OSPI-Europe intervention. J Affect Disord. 2013;150(2):320–9.CrossRef Coppens E, Van Audenhove C, Scheerder G, Arensman E, Coffey C, Costa S, et al. Public attitudes toward depression and help-seeking in four European countries baseline survey prior to the OSPI-Europe intervention. J Affect Disord. 2013;150(2):320–9.CrossRef
22.
go back to reference Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. Br J Psychiatry. 2004;185:342–9.CrossRef Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. Br J Psychiatry. 2004;185:342–9.CrossRef
23.
go back to reference Fusar-Poli P, de Pablo GS, De Micheli A, Nieman DH, Correll CU, Kessing LV, et al. What is good mental health? A scoping review. Eur Neuropsychopharmacol. 2020;31:33–46.CrossRef Fusar-Poli P, de Pablo GS, De Micheli A, Nieman DH, Correll CU, Kessing LV, et al. What is good mental health? A scoping review. Eur Neuropsychopharmacol. 2020;31:33–46.CrossRef
24.
go back to reference Yuan Q, Seow E, Abdin E, Chua BY, Ong HL, Samari E, et al. Direct and moderating effects of personality on stigma towards mental illness. BMC Psychiatry. 2018;18(1):358.CrossRef Yuan Q, Seow E, Abdin E, Chua BY, Ong HL, Samari E, et al. Direct and moderating effects of personality on stigma towards mental illness. BMC Psychiatry. 2018;18(1):358.CrossRef
25.
go back to reference Singh S, Zaki RA, Farid NDN. A systematic review of depression literacy: knowledge, help-seeking and stigmatising attitudes among adolescents. J Adolesc. 2019;74:154–72.CrossRef Singh S, Zaki RA, Farid NDN. A systematic review of depression literacy: knowledge, help-seeking and stigmatising attitudes among adolescents. J Adolesc. 2019;74:154–72.CrossRef
26.
go back to reference Hanlon HR, Swords L. Adolescent endorsement of the “weak-not-sick” stereotype for generalised anxiety disorder: associations with prejudice, discrimination, and help-giving intentions toward peers. Int J Environ Res Public Health. 2020;17(15):5415.CrossRef Hanlon HR, Swords L. Adolescent endorsement of the “weak-not-sick” stereotype for generalised anxiety disorder: associations with prejudice, discrimination, and help-giving intentions toward peers. Int J Environ Res Public Health. 2020;17(15):5415.CrossRef
27.
go back to reference Hambleton RK. The next generation of the ITC test translation and adaptation guidelines. Eur J Psychol Assess. 2001;17(3):164–72.CrossRef Hambleton RK. The next generation of the ITC test translation and adaptation guidelines. Eur J Psychol Assess. 2001;17(3):164–72.CrossRef
28.
go back to reference ITC Guidelines for Translating and Adapting Tests (Second Edition). Int J Test 2017;18(2):101–34. ITC Guidelines for Translating and Adapting Tests (Second Edition). Int J Test 2017;18(2):101–34.
29.
go back to reference Kohls E, Coppens E, Hug J, Wittevrongel E, Van Audenhove C, Koburger N, et al. Public attitudes toward depression and help-seeking: impact of the OSPI-Europe depression awareness campaign in four European regions. J Affect Disord. 2017;217:252–9.CrossRef Kohls E, Coppens E, Hug J, Wittevrongel E, Van Audenhove C, Koburger N, et al. Public attitudes toward depression and help-seeking: impact of the OSPI-Europe depression awareness campaign in four European regions. J Affect Disord. 2017;217:252–9.CrossRef
30.
go back to reference Beullens K, Loosveldt G, Vandenplas C, Stoop I. Response rates in the European Social Survey: Increasing, decreasing, or a matter of fieldwork efforts? Survey Methods: Insights from the Field. 2018. Beullens K, Loosveldt G, Vandenplas C, Stoop I. Response rates in the European Social Survey: Increasing, decreasing, or a matter of fieldwork efforts? Survey Methods: Insights from the Field. 2018.
31.
go back to reference Berwick DM, Murphy JM, Goldman PA, Ware JE Jr, Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991;29(2):169–76.CrossRef Berwick DM, Murphy JM, Goldman PA, Ware JE Jr, Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991;29(2):169–76.CrossRef
32.
go back to reference Pais-Ribeiro J. Mental health inventory: Um estudo de adaptação à população portuguesa. Psicologia Saúde & Doenças. 2001;2:77–99. Pais-Ribeiro J. Mental health inventory: Um estudo de adaptação à população portuguesa. Psicologia Saúde & Doenças. 2001;2:77–99.
33.
go back to reference Rivera-Riquelme M, Piqueras JA, Cuijpers P. The Revised Mental Health Inventory-5 (MHI-5) as an ultra-brief screening measure of bidimensional mental health in children and adolescents. Rivera-Riquelme M, Piqueras JA, Cuijpers P. The Revised Mental Health Inventory-5 (MHI-5) as an ultra-brief screening measure of bidimensional mental health in children and adolescents.
34.
go back to reference Boerema AM, Zoonen K, Cuijpers P, Holtmaat CJ, Mokkink LB, Griffiths KM, et al. Psychometric properties of the Dutch Depression Stigma Scale (DSS) and associations with personal and perceived stigma in a depressed and community sample. PLOS ONE. 2016;11(8):e0160740.CrossRef Boerema AM, Zoonen K, Cuijpers P, Holtmaat CJ, Mokkink LB, Griffiths KM, et al. Psychometric properties of the Dutch Depression Stigma Scale (DSS) and associations with personal and perceived stigma in a depressed and community sample. PLOS ONE. 2016;11(8):e0160740.CrossRef
35.
go back to reference Zhu L, Yao J, Wu L, Wang J, Qiu M, Zhang C, et al. Psychometric properties of the Depression Stigma Scale (DSS) in Chinese cancer patients: a cross-sectional study. BMJ Open. 2019;9(7):e028429.CrossRef Zhu L, Yao J, Wu L, Wang J, Qiu M, Zhang C, et al. Psychometric properties of the Depression Stigma Scale (DSS) in Chinese cancer patients: a cross-sectional study. BMJ Open. 2019;9(7):e028429.CrossRef
36.
go back to reference Hu L-T, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6(1):1–55.CrossRef Hu L-T, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model. 1999;6(1):1–55.CrossRef
37.
go back to reference Busby Grant J, Bruce CP, Batterham PJ. Predictors of personal, perceived and self-stigma towards anxiety and depression. Epidemiol Psychiatr Sci. 2016;25(3):247–54.CrossRef Busby Grant J, Bruce CP, Batterham PJ. Predictors of personal, perceived and self-stigma towards anxiety and depression. Epidemiol Psychiatr Sci. 2016;25(3):247–54.CrossRef
38.
go back to reference Dardas LA, Silva S, Noonan D, Simmons LA. Studying depression among Arab adolescents: methodological considerations, challenges, and lessons learned from Jordan. Stigma and Health. 2018;4:296–304.CrossRef Dardas LA, Silva S, Noonan D, Simmons LA. Studying depression among Arab adolescents: methodological considerations, challenges, and lessons learned from Jordan. Stigma and Health. 2018;4:296–304.CrossRef
39.
go back to reference Pyne JM, Kuc EJ, Schroeder PJ, Fortney JC, Edlund M, Sullivan G. Relationship between perceived stigma and depression severity. J Nerv Ment Dis. 2004;192(4):278–83.CrossRef Pyne JM, Kuc EJ, Schroeder PJ, Fortney JC, Edlund M, Sullivan G. Relationship between perceived stigma and depression severity. J Nerv Ment Dis. 2004;192(4):278–83.CrossRef
40.
go back to reference Jennings KS, Cheung JH, Britt TW, Goguen KN, Jeffirs SM, Peasley AL, et al. How are perceived stigma, self-stigma, and self-reliance related to treatment-seeking? A three-path model. Psychiatr Rehabil J. 2015;38(2):109–16.CrossRef Jennings KS, Cheung JH, Britt TW, Goguen KN, Jeffirs SM, Peasley AL, et al. How are perceived stigma, self-stigma, and self-reliance related to treatment-seeking? A three-path model. Psychiatr Rehabil J. 2015;38(2):109–16.CrossRef
41.
go back to reference Cornally N, McCarthy G. Help-seeking behaviour: a concept analysis. Int J Nurs Pract. 2011;17(3):280–8.CrossRef Cornally N, McCarthy G. Help-seeking behaviour: a concept analysis. Int J Nurs Pract. 2011;17(3):280–8.CrossRef
Metadata
Title
Psychometric properties of the Depression Stigma Scale in the Portuguese population and its association with gender and depressive symptomatology
Authors
Virgínia Conceição
Inês Rothes
Milton Severo
Kathleen Griffiths
Ulrich Hegerl
Ricardo Gusmão
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2022
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-022-01945-7

Other articles of this Issue 1/2022

Health and Quality of Life Outcomes 1/2022 Go to the issue