Attitude Toward Persons With Mental Illness in Bangladesh: Scale Validation and Status Assessment

Stigma toward persons with mental illness remains a major barrier to mental health care. No validated Bangla instrument is available to assess attitudes toward persons with mental illness in Bangladesh.

This study aimed to adapt and validate the culturally adapted Bangla version of the Attitudes Toward Persons with Mental Illness (APMI) scale and to assess attitudes among undergraduate medical students and Islamic religious leaders in Bangladesh.

A psychometric validation study was conducted from July 2025 to June 2026 among 489 participants (249 medical students and 240 Imams). The original 16-item APMI scale was translated and culturally adapted following standard guidelines. The sample was independently divided into exploratory factor analysis (EFA; n = 245) and confirmatory factor analysis (CFA; n = 244) subsamples. EFA used polychoric correlations, minimum residual extraction, oblimin rotation, and parallel analysis. CFA compared one- and two-factor models using the WLSMV estimator. Reliability, measurement invariance, group differences, and multivariable associations were also evaluated.

EFA supported a two-factor structure comprising Fear/Social Avoidance and Interpersonal Acceptance. The correlated two-factor CFA model showed substantially better fit than the one-factor model (scaled CFI = 0.967, TLI = 0.956, RMSEA = 0.071, 90% CI 0.049-0.092, SRMR = 0.046). Ordinal alpha was 0.83 and 0.78. Measurement invariance was supported at the configural, partial metric, and partial threshold/scalar levels. Medical students had lower scores than Imams. After adjustment, the difference remained significant (β = 5.02, 95% CI 2.89-7.15; p < 0.001).

The 10-item culturally adapted Bangla APMI scale demonstrates acceptable structural validity and internal consistency for assessing attitudes toward persons with mental illness for Bangla-speaking populations.