Stigma assessment: Scales review

María Teófila Vicente-Herrero; Miguel Ruiz-Flores Bistuer; María Victoria Ramírez Iñiguez de la Torre; Carmen Muñoz Ruipérez; Ángel Arturo López González

doi:10.5281/zenodo.15571012

Authors

María Teófila Vicente-Herrero ADEMA Health Group, University Institute for Health Sciences Research (IUNICS), Palma, Balearic Islands, Spain https://orcid.org/0000-0002-0796-9194
Miguel Ruiz-Flores Bistuer Mental Health Unit, Ibsalut, Ibiza (Balearic Islands), Spain https://orcid.org/0009-0008-2141-222X
María Victoria Ramírez Iñiguez de la Torre Specialist in Occupational Medicine, Occupational Health Service, Correos Group, Albacete, Spain https://orcid.org/0000-0002-7772-5689
Carmen Muñoz Ruipérez Occupational Medicine and Occupational Risk Prevention Service, 12 de Octubre University Hospital, Madrid, Spain. https://orcid.org/0000-0003-3976-1686
Ángel Arturo López González ADEMA Health Group, University Institute for Health Sciences Research (IUNICS), Palma, Balearic Islands, Spain. https://orcid.org/0000-0002-7439-8117

DOI:

https://doi.org/10.5281/zenodo.15571012

Keywords:

Stigma assessment, mental illness, infectious diseases, obesity, gender, sexual minorities

Abstract

Objective: The assessment of stigma is a multifaceted process requiring a comprehensive understanding of stigma itself, quantification of its degree, evaluation of changes over time, and assessment of the effectiveness of interventions aimed at reducing or preventing it. This study aims to review some of the most widely used scales in health-related stigma assessment and to compare them in terms of their specific characteristics, strengths, and limitations.

Materials and methods: In January 2025, a review was conducted using the PubMed database to analyze publications addressing the assessment of stigma through scales or questionnaires. Specific descriptors were employed, focusing on mental illnesses, infectious diseases, overweight and obesity, and sexual and gender minorities. Comparative reviews and studies detailing the application and performance of these scales were included in the analysis.

Results: The review identified and compared 20 scales for assessing mental health stigma, 12 scales for stigma related to infectious diseases and symptoms, 17 scales for weight stigma, and 17 scales for stigma affecting sexual and gender minorities.

Conclusion: Stigma limits the life opportunities of individuals experiencing discrimination due to illness or personal and social circumstances. Most stigma assessment scales and questionnaires lack specificity, methodological rigor, and clear definitions tailored to the particular stigma being evaluated. Future research should prioritize the development of robust conceptual frameworks, enhance methodological validity, and promote early-stage interventions to mitigate harm caused by stigma.

References

Weiss MG, Ramakrishna J. Stigma interventions and research for international health. Lancet. 2006;367(9509):536–8.

Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol. 2001;27(1):363–85.

Stevelink SAM, Wu I, Voorend C, Van Brakel W. The psychometric assessment of internalized stigma instruments: A systematic review. Stigma Res Action. 2012;2(2):100-18.

Heijnders ML, Meij SVD. The fight against stigma: An overview of stigma-reduction strategies and interventions. Psychol Health Med. 2006;11(3):353–63.

Van Brakel WH. Measuring health-related stigma: A literature review. Psychol Health Med. 2006;11(3):307–34.

Evans-Lacko S, Rose D, Little K, Flach C, Rhydderch D, Henderson C, et al. Development and psychometric properties of the reported and intended behaviour scale (RIBS): a stigma-related behaviour measure. Epidemiol Psychiatr Sci. 2011;20(3):263-71.

Evans-Lacko S, Little K, Meltzer H, Rose D, Rhydderch D, Henderson C, et al. Development and psychometric properties of the Mental Health Knowledge Schedule. Can J Psychiatry. 2010;55(7):440-8.

Luty J, Fekadu D, Umoh O, Gallagher J. Validation of a short instrument to measure stigmatised attitudes towards mental illness. Psychiatr. 2006;30:257-60.

Taylor SM, Dear MJ. Scaling Community Attitudes Toward the Mentally Ill. Schizophr Bull. 1981;7(2):225–40.

Ochoa S, Martínez-Zambrano F, Vila-Badia R, Arenas O, Casas-Anguera E, García-Morales E, et al. Spanish validation of the social stigma scale: Community Attitudes towards Mental Illness. Rev Psiquiatr Salud Ment. 2016;9(3):150-7.

Day EN, Edgren K, Eshleman A. Measuring stigma toward mental illness: Development and application of the mental illness stigma scale. J Appl Soc Psychol. 2007;37(10):2191–219.

Corrigan P, Markowitz FE, Watson A, Rowan D, Kubiak MA. An attribution model of public discrimination towards persons with mental illness. J Health Soc Behav. 2003;44(2):162-79.

Munoz M, Guillen AI, Perez-Santos E, Corrigan PW. A structural equation modeling study of the Spanish Mental Illness Stigma Attribution Questionnaire (AQ-27-E). Am J Orthopsychiatry. 2015;85(3):243–9.

Bogardus ES. Measuring social distances. J Appl Sociol. 1925;9:299–308.

Link BG, Cullen FT, Struening E, Shrout PE, Dohrenwend BP. A modified labeling theory approach to mental disorders: An empirical assessment. Am Sociol Rev. 1989;54(3):400-23.

McKeague L, Hennessy E, O'Driscoll C, Heary C. Peer Mental Health Stigmatization Scale: Psychometric properties of a questionnaire for children and adolescents. Child Adolesc Ment Health. 2015;20(3):163–70.

de la Higuera-Romero J, Candelas-Muñoz A, Jiménez-González A, Castañeda-Jiménez C, Fuica-Pereg P, Zurita-Carrasco M, et al. Spanish adaptation and validation of the Peer Mental Health Stigmatization Scale (PMHSS-24). Rev Psiquiatr Salud Ment (Engl Ed). 2022;15(3):176-84.

Boyd JE, Adler EP, Otilingam PG, Peters T. Internalized Stigma of Mental Illness (ISMI) scale: A multinational review. Compr Psychiatry. 2014;55(1):221–31.

Bengochea-Seco R, Arrieta-Rodríguez M, Fernández-Modamio M, Santacoloma-Cabero I, Gómez de Tojeiro-Roce J, García-Polavieja B, et al. Adaptation into Spanish of the Internalised Stigma of Mental Illness scale to assess personal stigma. Rev Psiquiatr Salud Ment (Engl Ed). 2018;11(4):244-54.

Komiya N, Good GE, Sherrod NB. Emotional openness as a predictor of college students' attitudes toward seeking psychological help. J Couns Psychol. 2000;47(1):138-43.

Corrigan PW, Watson AC, Barr L. The Self–Stigma of Mental Illness Scale: An initial study of its structure and internal consistency. Schizophr Res. 2006;89(1-3):59–65.

Pinel EC. Stigma consciousness: The psychological legacy of social stereotypes. J Pers Soc Psychol. 1999;76(1):114–28.

Brohan E, Slade M, Clement S, Thornicroft G. Development and psychometric evaluation of the Discrimination and Stigma Scale (DISC). Psychiatry Res. 2010;190(2-3):229–34.

King M, Dinos S, Shaw J, Watson R, Stevens S, Passetti F, et al. The Stigma Scale: development of a standardised measure of the stigma of mental illness. Br J Psychiatry. 2007;190:248-54.

Mendoza-Núñez VM. Estudio de traducción al español y evaluación psicométrica de una escala de estigma internalizado en pacientes psiquiátricos. Salud Ment. 2011;34(6):505–12.

Morris E, Hippman C, Murray G, Michalak EE, Boyd JE, Livingston J, et al. Self-Stigma in Relatives of people with Mental Illness scale: development and validation. Br J Psychiatry. 2018;212(3):169-74.

Trigueros R, Navarro Gómez N, Aguilar-Parra JM. Adaptation and validation of the Scale of Self Stigma in Relatives of People with Mental Illness to the Spanish Context. Anales de Psicologia. 2019;35:371-7.

Moore D, Ayers S, Drey N. The City MISS: Development of a scale to measure stigma of perinatal mental illness. J Reprod Infant Psychol. 2017;35(3):273–85.

Szeto ACH, Luong D, Dobson KS. Development of a scale to measure workplace stigma toward mental illness. Int J Occup Environ Med. 2013;4(3):125–37.

Kassam A, Papish A, Modgill G, Patten SB. The development and psychometric properties of a new scale to measure mental illness related stigma by health care providers: The Opening Minds Scale for Health Care Providers (OMS-HC). BMC Psychiatry. 2012;12:62.

Smith NA. Development and Validation of the Workplace Mental Illness Stigma Scale (WMISS) [dissertation]. 2019. Available from: https://doi.org/10.15760/etd.6887.

Elgohari HM, Bassiony MM, Sehlo MG, Youssef UM, Ali HM, Shahin I, et al. COVID-19 Infection Stigma Scale: psychometric properties. Egypt J Neurol Psychiatr Neurosurg. 2021;57(1):61.

Nair S, Joshi A, Aggarwal S, Adhikari T, Mahajan N, Diwan V, et al. Development & validation of scales to assess stigma related to COVID-19 in India. Indian J Med Res. 2022;155(1):156-64.

Tsukuda M, Ito Y, Nojima K, Kayano T, Honda J. Development and Validation of the COVID-19-Related Stigma Scale for Healthcare Workers (CSS-HCWs). Int J Environ Res Public Health. 2022;19(15):9641.

Bonetto C, Pace D, Bodini L, Colombi M, Van Bortel T, Lasalvia A. Development and psychometric validation of new questionnaires assessing experienced discrimination and internalised stigma among people with Covid-19. Epidemiol Psychiatr Sci. 2022;31:e37.

Kantor BN, Kantor J. Development and validation of the Oxford Pandemic Attitude Scale-COVID-19 (OPAS-C): an internet-based cross-sectional study in the UK and USA. BMJ Open. 2021;11(7):e043758.

Pantelic M, Ziauddeen N, Boyes M, O'Hara ME, Hastie C, Alwan NA. Long Covid stigma: Estimating burden and validating scale in a UK-based sample. PLoS One. 2022;17(11):e0277317.

Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–29.

Yu CH, Huang CY, Lee YT, Cheng SF. Development of an 18-item abbreviated Chinese version of Berger's HIV Stigma Scale. Int J Nurs Pract. 2019;25(2):e12708.

Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77.

Overholt L, Wohl DA, Fischer WA 2nd, Westreich D, Tozay S, Reeves E, et al. Stigma and Ebola survivorship in Liberia: Results from a longitudinal cohort study. PLoS One. 2018;13(11):e0206595.

McGhie-Fraser B, Ballering A, Lucassen P, McLoughlin C, Brouwers E, Stone J, et al. Validation of the Persistent Somatic Symptom Stigma Scale for Healthcare Professionals. J Clin Epidemiol. 2024;174:111505.

Delgado JB, Castro MC. Construction and Validation of a Subjective Scale of Stigma and Discrimination (SISD) for the Gay Men and Transgender Women Population in Chile. Sex Res Soc Policy. 2014;11:187–98.

Shangani S, Naanyu V, Operario D, Genberg B. Stigma and Healthcare-Seeking Practices of Men Who Have Sex with Men in Western Kenya: A Mixed-Methods Approach for Scale Validation. AIDS Patient Care STDS. 2018;32(11):477–86.

Strizzi J, Fernández-Agis I, Parrón-Carreño T, Alarcón-Rodríguez R. Enacted Sexual Stigma, Stigma Consciousness, and Subjective Happiness Scale Adaptation: A Two-Country Study. J Interpers Violence. 2016;31(2):316–38.

Pala AN, Dell'Amore F, Steca P, Clinton L, Sandfort T, Rael C. Validation of the Minority Stress Scale Among Italian Gay and Bisexual Men. Psychol Sex Orientat Gend Divers. 2017;4(4):451-9.

Logie CH, Earnshaw V. Adapting and validating a scale to measure sexual stigma among lesbian, bisexual and queer women. PLoS One. 2015;10(2):e0116198.

Reisner SL, Moore CS, Asquith A, Pardee DJ, Mayer KH. Gender Non-affirmation from Cisgender Male Partners: Development and Validation of a Brief Stigma Scale for HIV Research with Transgender Men Who Have Sex with Men (Trans MSM). AIDS Behav. 2020;24(1):331-43.

Ng CG, Gill JS, Koh OH. Confiabilidad y validez de la versión malaya de la escala de actitud hacia la homosexualidad (MVHAS): un estudio sobre un grupo de estudiantes de medicina en Malasia. Rev Med Interna. 2015;22:246–249.

Jackson SD, Mohr JJ. Conceptualizing the closet: Differentiating stigma concealment and nondisclosure processes. Psychol Sex Orient Gend Divers. 2016;3:80–92.

Puckett JA, Newcomb ME, Ryan DT, Swann G, Garofalo R, Mustanski B. Internalized Homophobia and Perceived Stigma: A Validation Study of Stigma Measures in a Sample of Young Men who Have Sex with Men. Sex Res Social Policy. 2017;14(1):1-16.

Bockting WO, Miner MH, Swinburne Romine RE, Dolezal C, Robinson BBE, Rosser BRS, et al. The Transgender Identity Survey: A Measure of Internalized Transphobia. LGBT Health. 2020;7(1):15-27.

Lingiardi V, Baiocco R, Nardelli N. Measure of internalized sexual stigma for lesbians and gay men: A new scale. J Homosex. 2012;59(8):1191–210.

Nguyen TQ, Poteat T, Bandeen-Roche K, German D, Nguyen YH, Vu LK, et al. The Internalized Homophobia Scale for Vietnamese Sexual Minority Women: Conceptualization, Factor Structure, Reliability, and Associations With Hypothesized Correlates. Arch Sex Behav. 2016;45(6):1329-46.

Kalichman SC, Shkembi B, Eaton LA. A novel psychometric approach to assessing intersectional HIV stigma: The geometric intersectional stigma scales. J Behav Med. 2022;45(5):804–11.

Del Pino HE, Steers WN, Lee M, McCuller J, Hays RD, Harawa NT. Measuring Gender Role Conflict, Internalized Stigma, and Racial and Sexual Identity in Behaviorally Bisexual Black Men. Arch Sex Behav. 2022;51(2):1019-30.

Puckett JA, Feinstein BA, Newcomb ME, Mustanski B. Trajectories of Internalized Heterosexism among Young Men Who have Sex with Men. J Youth Adolesc. 2018;47(4):872-89.

Williams MT, Wetterneck C, Tellawi G, Duque G. Domains of distress among people with sexual orientation obsessions. Arch Sex Behav. 2015;44(3):783–9.

Lin CY, Huang YT, Lee CH, Fan CW, Yen CF. Gay Community Stress Scale with Its Cultural Translation and Adaptions in Taiwan. Int J Environ Res Public Health. 2022;19(18):11649.

Lillis J, Luoma JB, Levin ME, Hayes SC. Measuring weight self-stigma: The weight self-stigma questionnaire. Obesity (Silver Spring). 2010;18(5):971–6.

Duarte C, Matos M, Stubbs RJ, Gale C, Morris L, Gouveia JP, et al. The Impact of Shame, Self-Criticism and Social Rank on Eating Behaviours in Overweight and Obese Women Participating in a Weight Management Programme. PLoS One. 2017;12(1):e0167571.

Durso LE, Latner JD. Understanding self-directed stigma: Development of the weight bias internalization scale. Obesity (Silver Spring). 2008;16(2):S80–S86.

McClure Brenchley KJ, Quinn DM. Weight-based rejection sensitivity: Scale development and implications for well-being. Body Image. 2016;16:79–92.

Conradt M, Dierk JM, Schlumberger P, Rauh E, Hebebrand J, Rief W. Development of the Weight- and Body-Related Shame and Guilt scale (WEB-SG) in a nonclinical sample of obese individuals. J Pers Assess. 2007;88(3):317-27.

Myers A, Rosen JC. Obesity stigmatization and coping: Relation to mental health symptoms, body image, and self-esteem. Int J Obes Relat Metab Disord. 1999;23(3):221–30.

Müller A, Crosby RD, Selle J, Osterhus A, Köhler H, Mall JW, wet al. Development and Evaluation of the Quality of Life for Obesity Surgery (QOLOS) Questionnaire. Obes Surg. 2018;28(2):451-63.

Thompson JK, Fabian LJ, Moulton DO, Dunn ME, Altabe MN. Development and validation of the Physical Appearance Related Teasing Scale. J Pers Assess. 1991;56(3):513-21.

Thompson JK, Cattarin J, Fowler B, Fisher E. The Perception of Teasing Scale (POTS): A revision and extension of the Physical Appearance Related Teasing Scale (PARTS). J Pers Assess. 1995;65(1):146–57.

Rafeh A, Hanif R. Understanding Perception of Weight Stigma: Development and Validation of the Perceived Weight Stigmatization Scale. Pak J Psychol Res. 2019;34(4):869–97.

Scott-Johnson PE, Gross SM, Gray LM, Zhu S, Browne DC. Sex differences in perceived weight-based stigmatization among African Americans. Ethn Dis. 2010;20(1):S1-196-200.

Schafer MH, Ferraro KF. The Stigma of Obesity: Does Perceived Weight Discrimination Affect Identity and Physical Health? Soc Psychol Q. 2011;74(1):76–97.

Niero M, Martin M, Finger T, Lucas R, Mear I, Wild D, et al. A new approach to multicultural item generation in the development of two obesity-specific measures: the Obesity and Weight Loss Quality of Life (OWLQOL) questionnaire and the Weight-Related Symptom Measure (WRSM). Clin Ther. 2002;24(4):690-700.

Kolotkin RL, Crosby RD, Kosloski KD, Williams GR. Development of a brief measure to assess quality of life in obesity. Obes Res. 2001;9(2):102–11.

Kolotkin RL, Head S, Hamilton M, Tse CK. Assessing Impact of Weight on Quality of Life. Obes Res. 1995;3(1):49–56.

Wadden TA, Anderson DA, Foster GD, Bennett A, Steinberg C, Sarwer DB. Obese women's perceptions of their physicians' weight management attitudes and practices. Arch Fam Med. 2000;9(9):854-60.

Farrow CV, Tarrant M. Weight-based discrimination, body dissatisfaction and emotional eating: The role of perceived social consensus. Psychol Health. 2009;24(9):1021–34.

Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health. 2013;103(5):813–21.

Stangl AL, Earnshaw VA, Logie CH, van Brakel W, C Simbayi L, Barré I, et al. The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019;17(1):31.

Mol MM, Visser MJ, Rai SS, Peters RMH. Measuring health-related stigma: Exploring challenges and research priorities to improve assessment. Glob Public Health. 2023;18(1):2264960.

Brenner RE, Colvin KF, Hammer JH, Vogel DL. Using Item Response Theory to Develop Revised (SSOSH-7) and Ultra-Brief (SSOSH-3) Self-Stigma of Seeking Help Scales. Assessment. 2021;28(5):1488–99.

Friedman SR, Williams LD, Guarino H, Mateu-Gelabert P, Krawczyk N, Hamilton L, et al. The stigma system: How sociopolitical domination, scapegoating, and stigma shape public health. J Community Psychol. 2022;50(1):385-408.

Earnshaw VA, Quinn DM, Kalichman SC, Park CL. Development and psychometric evaluation of the Chronic Illness Anticipated Stigma Scale. J Behav Med. 2013;36(3):270-82.

Weiss MG, Ramakrishna J, Somma D. Health-related stigma: Rethinking concepts and interventions. Psychol Health Med. 2006;11(3):277–87.

Bos AE, Pryor JB, Reeder GD, Stutterheim SE. Stigma: Advances in Theory and Research. Basic Appl Soc Psychol. 2013;35(1):1–9.

Boyd JE, Otilingam PG, Deforge BR. Brief version of the Internalized Stigma of Mental Illness (ISMI) scale: psychometric properties and relationship to depression, self esteem, recovery orientation, empowerment, and perceived devaluation and discrimination. Psychiatr Rehabil J. 2014;37(1):17-23.

Paterson A, Cheyne A, Jones B, Schilling S, Sigfrid L, Stolow J, et al Systematic Review of Scales for Measuring Infectious Disease-Related Stigma. Emerg Infect Dis. 2024;30(3):519-29.

Papadopoulos S, de la Piedad Garcia X, Brennan L. Evaluation of the psychometric properties of self-reported weight stigma measures: A systematic literature review. Obes Rev. 2021;22(8):e13267.

Aggarwal A, Qiao S, O'Leary SD, Schlekat KN, Li X. Measurement Instruments Assessing Multi-Faceted Stigma Regarding Sexual and Gender Minorities: A Systematic Review of Psychometric Properties. AIDS Behav. 2024;28(6):2054-77.