Stigma and Mental Health: Confirmatory Factor Analyses of Three Depression Stigma Measures of Treatment, Antidepressant Medication, and Social Distance in a Sample of Hispanics

Purpose

Hispanics demonstrate similar rates of psychiatric disorders compared to their non-Hispanic, White counterparts, but are less likely to utilize mental health services, including the use of prescription medications, and are more likely to discontinue treatment prematurely. These disparities in mental health treatment result from a complex set of sociodemographic, structural and cultural factors including lack of insurance, geographic inaccessibility, limited number of mental health specialists, language barriers, low mental health literacy, and stigma. Among Hispanics, stigma is related to willingness to engage in mental health care, management of depression symptoms, disclosure of mental illness to family and friends, and adherence to medications. While measures of mental health treatment stigma have been developed, few have been validated in depressed, Hispanic populations. The purpose of this analysis was to examine the psychometric properties of three measures developed to assess stigma towards depression and depression treatment among Hispanics: Stigma Concerns about Mental Health Care (SCMHC), Social Distance Scale (SDS), and Latino Scale for Antidepressant Stigma (LSAS).

Methods

Data on the three stigma measures were collected during the baseline assessments for two studies taking place in integrated health care settings to improve depression treatment engagement and outcomes. Hispanic adult patients were recruited from a community health center and met diagnostic criteria for depression. The total sample size was 500 patients. Psychometric and factor validity were tested for each measure. Confirmatory factor analyses were completed on each stigma measure using weighted least squares means and variance adjusted (WLSMV) estimation in Mplus 8.0 to account for the distributional nature of the data. Additional analyses examined associations between the stigma measure scores and patient demographic characteristics and reported depression, anxiety, and depression knowledge scores.

Results

Confirmatory factor analyses for SCMHC indicated excellent fit with higher loadings between .836 and .989 (all p<.001, r²=.699 to .979). The SDS had similarly good fit to the data (𝜒²=24.29, df=9, p=.004; RMSEA=.059; CFI=.991; TLI=.985; WRMR=.651) with loadings between .672 and .895 (all p<.001, r²=.452 to .802). Lastly, LSAS demonstrated adequate fit (𝜒²=39.86, df=14, p<.001; RMSEA=.062; CFI=.987; TLI=.980; WRMR=.807) and factor loadings were all significant (ranged from .686 to .782, p<.001, r²=.471 to .612). All Cronbach alpha scores for the measures indicated adequate internal consistency (𝛼 > .74). Stigma scores significantly differed by education level with less education associated with increased stigma towards mental health care. Women reported greater need for social distance from those with mental health issues (greater stigma). Depression symptom severity, anxiety severity, and depression knowledge was not significantly correlated with scores on the three stigma measures.

Conclusion

Findings from this analysis provide support for the use of the SCMHC, SDS, and LSAS in a Hispanic population for assessing barriers to depression treatment, including stigma, are critical in engaging Hispanics in care and eliminating disparities in this population. Future studies should continue to use validated stigma measures to investigate the impact of stigma on mental health care engagement and ways in which interventions can be developed and implemented to reduce stigma and increase treatment uptake among Hispanics.