Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Internalised stigma in people with rheumatoid arthritis: a cross sectional study to establish the psychometric properties of the ISMI-RA

Authors: Elizabeth Corker, R. Claire Henderson, Heidi Lempp, June S. L. Brown

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

Login to get access

Abstract

Background

Internalised stigma is theorized to be the internalisation and legitimisation of stereotypes of the diagnosis held in society and has not been quantified within patients with Rheumatoid Arthritis. This study aimed to: validate a modified version of a measure of internalised stigma, (the Internalised Stigma of Mental Illness scale, ISMI) for use in a group of patients diagnosed with rheumatoid arthritis; establish the consistency of the construct being measured, and to explore the levels of internalised stigma within this group.

Methods

A cross-sectional survey was conducted in London, UK with participants receiving out-patient treatment for Rheumatoid Arthritis. Participants completed the ISMI-Rheumatoid Arthritis (ISMI-RA) and a measure of self-esteem.

Results

One hundred respondents were interviewed by phone. The ISMI-RA was found to be reliable using a measure of internal consistency (α = 0.85) showed concurrent validity with the Index of Self Esteem (r = 0.58, p < 0.01) and discriminant validity with no association with gender (t = 1.43, p = 0.61). A quarter of respondents reported internalised stigma to a ‘severe’ level. Acceptability and feasibility were established. A confirmatory factor analysis provided some support for the model of internalised stigma.

Conclusions

The application of the ISMI-RA among the Rheumatoid Arthritis population looks promising. Internalised stigma was found to be present within this group. More research is needed to generalize these results and to explore the effects of internalised stigma on treatment adherence and quality of life.
Literature
1.
2.
Symmons D, Turner G, Webb R, Asten P, Barrett E, Lunt M, et al. The prevalence of rheumatoid arthritis in the United Kingdom: new estimates for a new century. Rheumatology (Oxford). 2002;41:793–800.CrossRef
3.
4.
Lempp H, Scott D, Kingsley G. The personal impact of rheumatoid arthritis on patients’ identity: a qualitative study. Chronic Illn. 2006;2:109–20.CrossRefPubMed
5.
Humphreys JH, Verstappen SMM, Hyrich KL, Chipping JR, Marshall T, Symmons DPM. The incidence of rheumatoid arthritis in the UK: comparisons using the 2010 ACR/EULAR classification criteria and the 1987 ACR classification criteria. Results from the Norfolk Arthritis Register. Ann Rheum Dis. 2013;72:1315–20.CrossRefPubMed
6.
Abdel-Nasser AM, Rasker JJ, Valkenburg HA. Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis. Semin Arthritis Rheum. 1997;27:123–40.CrossRefPubMed
7.
Doran MF, Pond GR, Crowson CS, O’Fallon WM, Gabriel SE. Trends in incidence and mortality in rheumatoid arthritis in Rochester, Minnesota, over a forty-year period. Arthritis Rheum. 2002;46:625–31.CrossRefPubMed
8.
Gabriel SE, Crowson CS, Kremers HM, Doran MF, Turesson C, O’Fallon WM, et al. Survival in rheumatoid arthritis: A population-based analysis of trends over 40 years. Arthritis Rheum. 2003;48:54–8.CrossRefPubMed
9.
Wolfe F, Mitchell DM, Sibley JT, Fries JF, Bloch DA, Williams CA, et al. The mortality of rheumatoid arthritis. Arthritis Rheum. 1994;37:481–94.CrossRefPubMed
10.
Looper KJ, Kirmayer LJ. Perceived stigma in functional somatic syndromes and comparable medical conditions. J Psychosom Res. 2004;57:373–8.CrossRefPubMed
11.
Thornicroft G. Shunned: Discrimination against People with Mental Illness. Oxford: Oxford University Press; 2006.
12.
Corrigan PW, Watson AC, Barr L. The self-stigma of mental illness: Implications for self-esteem and self-efficacy. J Soc Clin Psychol. 2006;25:875–84.CrossRef
13.
Heijnders M, Van Der Meij S. The fight against stigma: an overview of stigma-reduction strategies and interventions. Psychol Health Med. 2006;11:353–63.CrossRefPubMed
14.
Earnshaw VA, Quinn DM. The impact of stigma in healthcare on people living with chronic illnesses. J Health Psychol. 2012;17:157–68.CrossRefPubMed
15.
Quinn DM, Earnshaw VA. Understanding Concealable Stigmatized Identities: The Role of Identity in Psychological, Physical, and Behavioral Outcomes. Soc Issues Policy Rev. 2011;5:160–90.CrossRef
16.
Mak WWS, Poon CYM, Pun LYK, Cheung SF. Meta-analysis of stigma and mental health. Soc Sci Med. 2007;65:245–61.CrossRefPubMed
17.
Shiloh S, Heruti I, Berkovitz T. Attitudes toward people with disabilities caused by illness or injury: beyond physical impairment. Int J Rehabil Res. 2011;34:321–9.CrossRefPubMed
18.
Mak WWS, Mo PKH, Cheung RYM, Woo J, Cheung FM, Lee D. Comparative stigma of HIV/AIDS, SARS, and Tuberculosis in Hong Kong. Soc Sci Med. 2006;63:1912–22.CrossRefPubMed
19.
Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res. 2003;121:31–49.CrossRefPubMed
20.
Boyd JE, Adler EP, Otilingam PG, Peters T. Internalized Stigma of Mental Illness (ISMI) scale: a multinational review. Compr Psychiatry. 2014;55:221–31.CrossRefPubMed
21.
Rensen C, Bandyopadhyay S, Gopal PK, Van Brakel WH. Measuring leprosy-related stigma - a pilot study to validate a toolkit of instruments. Disabil Rehabil. 2011;33:711–9.CrossRefPubMed
22.
Stevelink SAM, van Brakel WH, Augustine V. Stigma and social participation in Southern India: Differences and commonalities among persons affected by leprosy and persons living with HIV/AIDS. Psychol Heal Med. 2011;16:695–707.CrossRef
23.
Taft T, Ballou S, Keefer L. A Preliminary Evaluation of Internalized Stigma and Stigma Resistance in Inflammatory Bowel Disease. J Health Psychol. 2012;4:541–60.
24.
McGlone J, Gillespie J, Lee K, Pohlmann-Eden B, Sadler RM. Measuring perceived stigma in adults with epilepsy: Where does resilience fit? Epilepsia. (C) International League Against Epilepsy. Boston, MA: Blackwell Publishing Inc, vol. 50; 2009. p. 267–8.
25.
West ML, Yanos PT, Smith SM, Roe D, Lysaker PH. Prevalence of Internalized Stigma among Persons with Severe Mental Illness. Stigma Res Action. 2011.
26.
Barney LJ, Griffiths KM, Jorm AF, Christensen H. Stigma about depression and its impact on help-seeking intentions. Aust N Z J Psychiatry. 2006;40:51–4.CrossRefPubMed
27.
Fung KMT, Tsang HWH, Corrigan PW. Self-stigma of people with schizophrenia as predictor of their adherence to psychosocial treatment. Psychiatr Rehabil J. 2008;32:95–104.CrossRefPubMed
28.
Chang C-C, Wu T-H, Chen C-Y, Wang J-D, Lin C-Y. Psychometric evaluation of the internalized stigma of mental illness scale for patients with mental illnesses: measurement invariance across time. PLoS One. 2014;9:e98767.CrossRefPubMedPubMedCentral
29.
Lysaker PH, Roe D, Yanos PT. Toward understanding the insight paradox: Internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bull. 2007;33:192–9.CrossRefPubMed
30.
Arnett FC, Edworthy SM, Bloch DA, Mcshane DJ, Fries JF, Cooper NS, et al. The american rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–24.CrossRefPubMed
31.
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, et al. Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62:2569–81.CrossRefPubMed
32.
Brohan E, Slade M, Clement S, Thornicroft G. Experiences of mental illness stigma, prejudice and discrimination: a review of measures. BMC Health Serv. Res. 2010;10:80
33.
Abell N, Jones BL, Hudson WW. Revalidation of the Index of Self-Esteem. Soc Work Res Abstr. 1984;20:11–6.CrossRef
34.
Brohan E, Clement S, Rose D, Sartorius N, Slade M, Thornicroft G. Development and psychometric evaluation of the Discrimination and Stigma Scale (DISC). Psychiatry Res. 2013;208:33–40.CrossRefPubMed
35.
Lamping D, Schroter S. The Community-Acquired Pneumonia Symptom QuestionnaireA New, Patient-Based Outcome Measure To Evaluate Symptoms in Patients With Community-Acquired. Chest. 2002;122:920–9.CrossRefPubMed
36.
Albright JJ, Park HM. Confirmatory Factor Analysis using Amos, LISREL, Mplus, SAS/STAT CALIS. 2009. Working paper. Univ. Inf. Technol. Serv. Cent. Stat. Math. Coumputing, Indiana Univ.
37.
DeVellis RF. Scale Development: Theory and Applications. Appl Soc Res Methods Ser. Los Angeles: Sage Publications Inc; 2003.
38.
Kline P. The handbook of psychological testing (2nd ed.). Handb Psychol Test (2nd ed). London: Routledge; 1993.
39.
Boyd JE, Otilingam PG, Deforge BR. Brief version of the Internalized Stigma of Mental Illness (ISMI) scale: psychometric properties and relationship to depression, self esteem, recovery orientation, empowerment, and perceived devaluation and discrimination. Psychiatr Rehabil J. 2014;37:17–23.CrossRefPubMed
40.
Brohan E, Elgie R, Sartorius N, Thornicroft G, Grp GA-ES. Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: The GAMIAN-Europe study. Schizophr Res. 2010;122:232–8.CrossRefPubMed
41.
Corrigan PW, Rafacz J, Ruesch N. Examining a progressive model of self-stigma and its impact on people with serious mental illness. Psychiatry Res. 2011;189:339–43.CrossRefPubMedPubMedCentral
42.
Corrigan PW, Watson AC. The paradox of self-stigma and mental illness. Clin Psychol Pract. 2002;9:35–53.CrossRef
43.
Drapalski AL, Lucksted A, Perrin P, Aakre J, Brown H, DeForge B, et al. A Model of Internalized Stigma and Its Effects on People With Mental Illness. Psychiatr Serv. 2013;64:264–9.CrossRefPubMed
44.
Brohan E, Gauci D, Sartorius N, Thornicroft G, Grp GA-ES. Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: The GAMIAN-Europe study. J Affect Disord. 2011;129:56–63.CrossRefPubMed
45.
Myers ND, Ahn S, Jin Y. Sample Size and Power Estimates for a Confirmatory Factor Analytic Model in Exercise and Sport : A Monte Carlo Approach. Res Q Exerc Sport. 2011;82:412–23.CrossRefPubMed
46.
Whitley E, Ball J. Statistics review 4 : Sample size calculations. Crit Care. 2002;4:335–41.
47.
Boyd Ritsher J, Phelan JC, Ritsher JB. Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Res. 2004;129:257–65.CrossRef
48.
Drapalski A, Murray-Swank A, Lucksted A, Goldberg R, Ritsher JB, Forbes C, et al. Internalized stigma and discrimination among individuals with serious mental illness. Schizophr Bull. 2007;33:587.
49.
Yanos PT, Lysaker PH, Roe D. Internalized stigma as a barrier to improvement in vocational functioning among people with schizophrenia-spectrum disorders. Psychiatry Res. 2010;178:211–3.CrossRefPubMedPubMedCentral
Metadata
Title
Internalised stigma in people with rheumatoid arthritis: a cross sectional study to establish the psychometric properties of the ISMI-RA
Authors
Elizabeth Corker
R. Claire Henderson
Heidi Lempp
June S. L. Brown
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-1089-5

Other articles of this Issue 1/2016

BMC Musculoskeletal Disorders 1/2016 Go to the issue

Research article

A functional movement screen profile of an Australian state police force: a retrospective cohort study

Study protocol

Does occupational therapy reduce the need for surgery in carpometacarpal osteoarthritis? Protocol for a randomized controlled trial

Research article

Body size from birth to middle age and the risk of hip and knee replacement

Research article

Multidisciplinary approaches to managing osteoarthritis in multiple joint sites: a systematic review

Case report

A case of epidemic myalgia with symptoms resembling acute purulent spondylitis and discitis

Research article

Can anti-osteoporotic therapy reduce adjacent fracture in magnetic resonance imaging-proven acute osteoporotic vertebral fractures?