Development of Self-Stigma Inventory for Families of the patients with schizophrenia (SSI-F): validity and reliability study

OBJECTIVE: It is known that relatives of the patients with schizophrenia tend to hide the illness from other people, are ashamed of their patients, and feel excluded from society. This situation is referred as self-stigmatization of families, and it may negatively affect the family functioning and therapeutic alliance. Assessing and evaluating the self-stigma of families are essential concerning family therapies and treatment of their patients. The purpose of this study is to develop a culturally sensitive inventory for the assessment of self-stigmatization for families of patients with schizophrenia in Turkey.

METHODS: After examining the studies in the related field and conducting a focus group interview with the families of the patients with schizophrenia, a 19-item inventory was formed. One hundred and six relatives of the patients with schizophrenia and schizoaffective disorder were given a sociodemographic form, Self-Stigma Inventory for Families (SSI-F), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Rosenberg Self-Esteem Scale (RSES), and Zarit Caregiver Burden Scale (ZCBS). Explanatory factor analysis and convergent validity were assessed as validity analysis, and internal consistency coefficient, item–total correlation, and test–retest reliability were calculated for reliability analysis.

RESULTS: The sample consisted of 106 relatives whose 52% were female, 77% were married, mean age was 51 years, and level of education was 9 years. In explanatory factor analysis, three factors (social withdrawal, concealment of the illness, and perceived devaluation) with 14 items were detected, and the factors could explain 66.8% of the total variance. SSI-F was significantly correlated with Beck Depression Inventory (r = 0.48, P < 0.01), Beck Hopelessness Scale (r = 0.27, P < 0.01), Zarit Caregiver Burden Scale (r = 0.54, P < 0.01), and Rosenberg SelfEsteem Scale (r = −0.35, P < 0.01). Cronbach’s alpha coefficient for SSI-F total score was calculated as 0.88, and test–retest reliability coefficient of SSI-F was 0.93.

CONCLUSIONS: This study shows that the SSI-F is a valid and reliable instrument for assessing self-stigmatization in the families of patients with schizophrenia. It can be considered as a valuable instrument to use for research and therapeutic purposes.