Measuring Mental Illness Stigma Among Hispanics: A Systematic Review

Background: Stigma towards mental illness is a complex construct that impedes people’s desire to seek mental health care and engage in treatment. The impact of stigma on mental health help-seeking disproportionately impacts certain groups including ethnic minorities. Among Hispanics, stigma has been found to be negatively associated with the desire to engage in mental health care, management of depression symptoms, disclosure of mental illness to family and friends, and adherence to antidepressant medications. Thus, given that stigma is a multifaceted construct potentially with unique cultural factors among Hispanics, the purpose of this systematic review was to gather and synthesize the psychometric research on measures of mental illness stigma used with Hispanic populations.

Method: A systematic search was conducted across eight databases (Social Work Abstracts, Academic Search Complete, CINAHL Complete, Health Source: Nursing/Academic Edition, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycINFO). The keywords for the search were “Hispanic* or latin* or Spanish*”, and “stigma* or self-stigma* or prejudic* or discriminat*”, and “mental or psychiatr* or depression* or schizo* or bipolar” and “index or inventory or instrument or measur* or scale”. The search yielded 1381 publications that were uploaded into Covidence, web-based systematic review software, for screening and review. Two reviewers independently assessed each study for inclusion. A total of 1271 studies were removed during title and abstract screening. Full-text review excluded an additional 95 studies, to arrive at a final sample of 15 studies. 

Results: The 15 studies included utilized 13 unique mental illness stigma measures that assessed constructs including self-stigma, perceived stigmatization, stigma tolerance, indifference to stigma, and stigma towards treatment and antidepressant medications. Four of the 15 studies were intervention studies, while the remaining studies utilized survey methodology. Eight of the 15 studies reported offering the scales in Spanish. Sample sizes of the studies ranged from 80 to 267 Hispanic adults, with a majority (63%) of the 2299 total participants being college/adult school students. Internal consistency reliability was available for all scales and subscales ranging from .58 to .91 for full scales and .37 to .95 for subscales. Ten of the 13 measures demonstrated construct validity in terms of relationship between measure scores and help-seeking attitudes, beliefs, ability, preferences, and experience variables. Six of the 13 measures also demonstrated significant relationships between stigma and acculturation, enculturation, and ethnic identity variables. Few measures found associations between stigma and age, generation level, gender, education level, and mental health status. 

Conclusions: This systematic review demonstrates the limited reporting of psychometric properties of mental illness stigma measures among Hispanic populations, particularly those who are not college students. Among the studies included, stigma measurement varied greatly and given the limited use of the measures, indicates a greater need for psychometric development of culturally relevant measures. Assessment of barriers to mental health care, including stigma, are critical in eliminating disparities experienced by Hispanics. Therefore, future studies should continue to examine the impact of different types of mental illness stigma and their associated measures on mental health treatment engagement and retention in Hispanic populations.