Internalisiertes Stigma bei Schizophrenie: Validierung der deutschen Version der Internalized Stigma of Mental Illness-Skala (ISMI)

Zusammenfassung

Anliegen: Die Diagnose Schizophrenie ist in besonderem Ausmaß mit Stigma verbunden. Vor allem internalisiertes Stigma, die Übernahme von negativen Vorstellungen ins Selbstbild, stellt eine wesentliche Barriere im Recovery-Prozess dar. Mit der von Jennifer Boyd Ritsher und KollegInnen entwickelten Internalized Stigma of Mental Illness-Skala (ISMI) lässt sich internalisiertes Stigma valide erfassen. Ziel der Studie war es, die psychometrischen Eigenschaften der deutschen Version der ISMI bei Personen mit einer Psychose aus dem schizophrenen Formenkreis zu prüfen.

Methode: Die ISMI wurde ins Deutsche übersetzt und Reliabilität und Validität sowie Prädiktoren für internalisiertes Stigma wurden geprüft. Dazu füllten 157 Personen die ISMI selbstständig aus. Weiterhin wurden soziodemografische und klinische Daten sowie zur Überprüfung der Konstruktvalidität Daten zu Devaluation-Discrimination, Depression, Selbstwert, Empowerment, Kontrollüberzeugungen und Lebensqualität erfasst.

Ergebnisse: Die deutsche Version der ISMI zeigte bei Personen mit einer Psychose aus dem schizophrenen Formenkreis gute psychometrische Eigenschaften mit einer hohen internen Konsistenz, guten Test-Retest-Reliabilität und guten Konstruktvalidität. Insgesamt zeigte etwa ein Drittel eine hohe Ausprägung an internalisiertem Stigma. Als Prädiktoren für ein höheres Ausmaß an internalisiertem Stigma fanden sich ein Mangel an sozialen Kontakten, eine Schulbildung unterhalb des Abiturniveaus und eine stationäre bzw. tagesklinische Behandlung (versus ambulante Behandlung).

Schlussfolgerungen: Die Ergebnisse sprechen für eine Vergleichbarkeit der deutschen Version der ISMI mit der Originalversion und verweisen darauf, dass mit der deutschen Version der ISMI internalisiertes Stigma bei Personen mit einer Psychose aus dem schizophrenen Formenkreis valide und reliabel erfasst werden kann. Dies ermöglicht, die Reduktion von internalisiertem Stigma als Behandlungsziel zu definieren und zu überprüfen.

Abstract

Objectives: Schizophrenia is particularly associated with stigma. Especially internalized stigma, the inner subjective experience of stigma and its psychological effects resulting from applying negative stereotypes and stigmatising attitudes to oneself, is a barrier to recovery. The Internalized Stigma of Mental Illness-scale (ISMI) developed by Jennifer Boyd Ritsher and colleagues is a valid instrument for self-rated assessment of the subjective experience of stigma. The aim of the study was to examine the psychometric properties of the German Version of the ISMI among people with schizophrenia spectrum disorder.

Methods: The ISMI was translated into German. Reliability and validity of the instrument were tested and predictors of internalized stigma were explored. Data of 157 people were collected on the ISMI and demographic and clinical variables. Construct validity was tested by comparing results with already established constructs such as perceived devaluation and discrimination, depression, self-esteem, empowerment, control convictions and quality of life.

Results: The German Version of the ISMI showed good psychometric properties with high internal consistency, good test-retest reliability and good construct validity among people with schizophrenia spectrum disorder. About one third had a mean above the midpoint of the scale indicating a high level of internalized stigma. Internalized stigma was predicted by insufficient social network, level of education less than high school and inpatient or day clinic treatment compared to outpatient treatment.

Conclusion: Results suggest that the German version of the ISMI is comparable to its original version. With the German version of the ISMI internalized stigma can be measured reliably and validly among people with schizophrenia spectrum disorder. Future studies may use the ISMI to record changes in internalized stigma pertinent to the achievement of therapeutic goals.

Schlüsselwörter

internalisiertes Stigma - Schizophrenie - Validierung

Keywords

internalized stigma - schizophrenia - validation

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