Peer Mental Health Stigmatization Scale: psychometric properties of a questionnaire for children and adolescents

Abstract

Background: The nature of stigmatizing attitudes towards children and adolescents with mental health problems has received little empirical attention, despite consensus that such attitudes are widespread. As a consequence, much less is known about stigma in childhood and adolescence and methods of stigma measurement are frequently borrowed from the adult literature. For research on this topic to develop, a theoretically based and developmentally appropriate measure is needed. This study aimed to develop a theory-based peer stigma questionnaire suitable for children and adolescents. Method: Participants were 562 children and adolescents aged 9-16 years (M = 12.99 years; SD = 1.6 years) in the Republic of Ireland, 316 female, all were White. The Peer Mental Health Stigmatization Scale (PMHSS) contains 24 statements (negative and positive) about peers with mental health problems that are rated on a 5-point scale. Participants also completed the Strengths and Difficulties Questionnaire. Re-test data was collected after 2 weeks from 109 participants. Results: Principal Components Analysis on the negative statements indicate the presence of two components: Stigma Agreement, personal endorsement of stigmatising statements and Stigma Awareness: awareness of prevailing societal stigma towards youth with mental health problems. The positive statements include three components: Intellectual Ability, Recovery and Friendship. Conclusions: The PMHSS is a psychometrically sound instrument with good retest reliability suitable for use with older children and teenagers. Initial use of the scale suggests that personal endorsement of stigma is lower than perceptions of public stigma. Key Practitioner Message• The measurement of mental health stigma in children and adolescents has received little attention and most studies have used adapted questionnaires developed for adults without presenting evidence on their appropriateness or psychometric properties.• The stigma construct used to develop the Peer Mental Health Stigmatization Scale (PMHSS) comprises stereotypes, prejudice, discrimination and lower status.• The PMHSS can be administered to children as young as 9 years and yields a total stigma score, a total score for endorsement of positive statements as well as scores on separate subscales.• The findings demonstrate that children and adolescents distinguish between societal stigma (what most people think) and personal stigma (what I think) in relation to mental health problems.

The stigma of mental illness in children and adolescents: A systematic review

“…Unfortunately, stigmatization of YP-MHD is under-researched and not well understood (Hinshaw, 2005;McKeague et al, 2015), yet children are not necessarily stigmatized as their adult counterparts, and stigma is likely to have different long-term implications based on a child s development. This lack of a more specific understanding has resulted in expensive large scale national initiatives with predominantly disappointing results (Rickwood et al, 2004).…”

“…However, knowledge did not equate to acceptance. A number of high quality studies, predominantly comparing primary school children of 2 different ages, identified younger children to be more accepting than older children (Peterson et al, 1985;Swaim et al, 2001;Campbell et al, 2004;Bellanca and Pote, 2013;McKeague et al, 2015). This contrasted with the carefully considered work of Swords et al (2011), who found that adolescents aged 14-18 were more positive than children aged under 12, towards peers with ADHD and depression.…”

“…Whilst this review represents a promising start to our understanding of stigma towards YP-MHD, it has some limitations.Firstly, although 42 papers were identified, the rich variation in methodology, sample size and subsequent quality presented a challenge in comparing the data, as the concepts being investigated were not always like-for-like. This is in part due to the absence of standardized, validated tools, to compare experiences of stigma in YP-MHD, until recently (McKeague et al, 2015). Hence, this made it difficult to both draw comparisons between groups, and also investigate change over time.…”

Questionnaires on stigmatizing attitudes among healthcare students in Taiwan: development and validation

“…For mental illness, we included 30 items that were adapted from the Community Attitudes Toward the Mentally Ill (CAMI) [17] and the Community Attitude Survey to Mental Illness [18]. For children with EBD, we included 20 items that were adapted from the Attitudes About Child Mental Health Questionnaire (ACMHQ) [19] and the Peer Mental Health Stigmatization Scale (PMHSS) [20]. For people with disabilities, we included 16 items adapted from the Attitudes to Disability Scale (ADS) [21].…”

Adolescents with personality disorders suffer from severe psychiatric stigma: evidence from a sample of 131 patients

“… 20 Recent literature emphasizes the importance of the awareness of societal stigma as conceptually distinct from personal beliefs or from self-stigma in adults as well as in children and adolescents. 21 It is important to bear in mind that perceptions of others’ beliefs are antecedents of behavior 22 and that there is evidence for the direct connection between perceived societal stigma and help-seeking. 23 …”