Open Access Research article

The Maristán stigma scale: a standardized international measure of the stigma of schizophrenia and other psychoses

Sandra Saldivia1*, Ariadne Runte-Geidel2, Pamela Grandón3, Francisco Torres-González4, Miguel Xavier5, Claudio Antonioli6, Dinarte A Ballester7, Roberto Melipillán1, Emiliano Galende6, Benjamín Vicente1, José Miguel Caldas5, Helen Killaspy8, Rachel Gibbons9 and Michael King8

Author Affiliations

1 Department of Psychiatry and Mental Health, Faculty of Medicine, University of Concepcion, Concepcion, Chile

2 Department of Pedagogy, University of Jaen, Jaen, Spain

3 Department of Psychology, Faculty of Social Sciences, University of Concepcion, Concepcion, Chile

4 Centre of Bio-Medical Research in Network of Mental Health (CIBERSAM), Section of Psychiatry and Medical Psychology, University of Granada, Granada, Spain

5 Faculty of Medical Sciences, University Nova of Lisbon, Lisbon, Portugal

6 Department of Community Health, University National of Lanus, Buenos Aires, Argentina

7 University State of Londrina, Londrina, Brazil

8 Division of Psychiatry, Faculty of Brain Sciences, UCL Medical School, London, UK

9 Camden and Islington NHS Foundation Trust, London, UK

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BMC Psychiatry 2014, 14:182  doi:10.1186/1471-244X-14-182

Published: 18 June 2014

Abstract

Background

People with schizophrenia face prejudice and discrimination from a number of sources including professionals and families. The degree of stigma perceived and experienced varies across cultures and communities. We aimed to develop a cross-cultural measure of the stigma perceived by people with schizophrenia.

Method

Items for the scale were developed from qualitative group interviews with people with schizophrenia in six countries. The scale was then applied in face-to-face interviews with 164 participants, 103 of which were repeated after 30 days. Principal Axis Factoring and Promax rotation evaluated the structure of the scale; Horn’s parallel combined with bootstrapping determined the number of factors; and intra-class correlation assessed test-retest reliability.

Results

The final scale has 31 items and four factors: informal social networks, socio-institutional, health professionals and self-stigma. Cronbach’s alpha was 0.84 for the Factor 1; 0.81 for Factor 2; 0.74 for Factor 3, and 0.75 for Factor 4. Correlation matrix among factors revealed that most were in the moderate range [0.31-0.49], with the strongest occurring between perception of stigma in the informal network and self-stigma and there was also a weaker correlation between stigma from health professionals and self-stigma. Test-retest reliability was highest for informal networks [ICC 0.76 [0.67 -0.83]] and self-stigma [ICC 0.74 [0.64-0.81]]. There were no significant differences in the scoring due to sex or age. Service users in Argentina had the highest scores in almost all dimensions.

Conclusions

The MARISTAN stigma scale is a reliable measure of the stigma of schizophrenia and related psychoses across several cultures. A confirmatory factor analysis is needed to assess the stability of its factor structure.

Keywords:
Stigma; Questionnaire; Psychometrics; Rating scale schizophrenia