Beyond the Label: Psychometric Validation of the Persian Stigma and Self-Stigma Scales: A Methodological Study

Mental health disorders are becoming increasingly prevalent, making early detection and intervention crucial. However, stigma remains a significant barrier to accessing mental healthcare services. This study aimed to translate and culturally adapt the Persian version of the Stigma and Self-Stigma Scales (SASS) to assess public attitudes toward mental health issues.

This methodological study was conducted from August to December 2023 with a sample of 962 Iranian participants. The research evaluated the psychometric properties of the SASS. The assessment included content validity, face validity, and construct validity (confirmatory factor analysis (CFA)) and reliability indices.

The Scale-Content Validity Index (S-CVI/Ave) for all SASS items was excellent at 0.963. Following psychometric evaluation, seven items were eliminated. Confirmatory factor analysis demonstrated adequate model fit, with key indices including: χ²/df = 3.325, RMSEA = 0.049, CFI = 0.912, GFI = 0.920, IFI = 0.912, PNFI = 0.777, PGFI = 0.759, TLI = 0.901, and AGFI = 0.903. The final validated scale comprised 29 items organized into six distinct factors: Stigma toward others (4 items), Social distance (6 items), Anticipated stigma (6 items), Self-stigma (6 items), Avoidant coping (3 items), Help-seeking behaviors (4 items). The Persian SASS demonstrated overall acceptable reliability across its subscales (Cronbach's α = 0.911, McDonald's ω = 0.925) and acceptable test-retest reliability (ICC = 0.677) except one of the subscales (help-seeking behaviours), which had inadequate reliability and is recommended not to be used.

The Persian adaptation of the SASS was successfully validated as a 29-item instrument comprising six clinically relevant dimensions. This culturally adapted tool demonstrates acceptable psychometric properties for comprehensive stigma assessment in Persian-speaking populations. Its multidimensional structure makes it particularly valuable for: Baseline evaluation prior to anti-stigma interventions, Measuring specific stigma components in clinical and research settings and Tracking changes in public attitudes toward mental health.