Validating the Arabic Coming Out with Mental Illness Scale (COMIS-Ar)

In Arab cultures, significant social stigma impedes the disclosure of mental illness and seeking professional help. To date, no validated Arabic tool exists to assess these perceived barriers. Therefore, we aimed to translate the Coming Out with Mental Illness Scale (COMIS) into Arabic and validate it for Arabic-speaking populations.

We generated an Arabic translation of COMIS (COMIS-Ar) using standard forward-backward translation procedures. The instrument was tested via a cross-sectional online survey among Arabic-speaking participants. Internal consistency, confirmatory factor analysis (CFA), and model fit indices were assessed.

A total of 420 Arabic-speaking adults of median age of 23 years (range 18-60) completed the survey; 73.3% were female. The COMIS-Ar showed overall good internal reliability; Cronbach's alpha (α) = 0.89; McDonald's omega (ω) = 0.90. Factor 1 on 'Benefits of being out' showed good reliability (α = 0.88; ω = 0.88), while Factor 2 on 'Benefits of remaining in' achieved 'excellent' reliability (α = 0.94; ω = 0.94). The overall CFA indicated a structural validity of comparative fit index = 0.83 with a root mean square error of approximation of 0.11, suggesting scope for further refinement.

The COMIS-Ar is a reliable and potentially valid instrument, albeit with limitations, to assess mental health disclosure-related barriers among Arabic speakers. As a preliminary model with limited testing, its cautious use may aid clinicians to identify the obstacles, including self-stigma in this population and plan targeted interventions, in addition to enhancing public awareness of mental health stigma. Additional psychometric studies are required to enhance the scale.