A Scoping Review of Questionnaires on Stigma of Mental Illness in Persian

Background: Patients with mental illness generally face two major issues related to their disorder. They should deal with not only different signs and symptoms of their disorder (including anxiety, delusion, hallucination etc.), but also with the concomitant social stigma of mental illness. Families of the patients with mental illness usually feel embarrassed and guilty about the disorder of their relative and would also experience a similar social isolation and stigma. Despite the progress in the treatment of mental disorders in the recent decades, social stigma of mental illness still exists and affects the patients with mental illness and their families as well as mental health personnel. For an appropriate planning for the needs of the patients with mental illness, it is necessary to study different aspects of stigma in various sub-populations. To adequately address the need for precise assessment of social stigma of mental illness, we need valid and reliable assessment tools. Because of the limited accessibility to questionnaires for assessment of social stigma of mental illness in Persian, we intended to review all of the assessment tools related to social stigma of mental illness, which have been designed in Iran or have been translated to Persian.   Methods: we searched English databases including PubMed, Google Scholar, Scopus, and PsycINFO and Persian databases including IranMedex, Scientific Information Database, Irandoc, and Magiran. We did not limit our searches for a specific time period. We searched for both Persian and English sources. For English databases we combined three keywords of “Stigma” OR its related words, “Mental Health” OR its related words, and “Iran” OR its related words using AND operator. For Persian databases we only used the Persian equivalent terms for “stigma” and no Boolean search was used. Our search yielded 289 articles and 248 thesis. Only 25 articles and 7 thesis met our inclusion criteria of studying stigma, using a questionnaire, and Persian language of the questionnaire. After removing shared questionnaires, we found 21 distinct stigma questionnaires. Then, we sent an email to the corresponding author of all of the articles and told them about the study and asked them to send us a copy of the questionnaire and surveys that they used in their study. We also asked for their permission to publish the full text of their questionnaire as an appendix to our article. Finally we gathered the full data on 19 questionnaires. Findings: Twenty  - One questionnaires and surveys were used to assess stigma in Persian language that include: Social Distance Item, Perceived Dangerousness of Mental Patients Item, The Attribution Questionnaire, The Level of Familiarity Scale, Attitudes toward Seeking Professional Psychological Help, Knowledge and Attitude about Patients with Mental Disorders and Epilepsy, Experience of Caregiving Inventory, Internalization of Stigma for Mothers of Children with Disability, Opening Minds Scale for Health Care Providers, Perceived Stigma of Mental Illness in Nurses, Opinion about Mental Illness, Depression Stigma Scale, Stigma Scale, The Parents Internalized Stigma of Mental Illness Scale, Family Caregiver’s Stigma toward Patients with Mental Illness, Opening Minds Scale for Health Care Providers, Stigma in Patients with Mental Disorders, Perceived Stigma Questionnaire, Cognitive Appraisal of Stigma-related Stress, Rejection Sensitivity Questionnaire and  Perceived Stigma Scale – Revised. We could not find the Persian version of Rejection Sensitivity Questionnaire and Perceived Stigma Scale. Conclusion: Most of the questionnaires and surveys of social stigma of mental illness in Persian are translation from other languages and only four questionnaires have been originally developed and validated in Persian. These four questionnaires include: Internalization of Stigma for Mothers of Children with Disability, Family Caregiver’s Stigma toward Patients with Mental Illness, Perceived Stigma Questionnaire, and Perceived Stigma of Mental Illness in Nurses. Only two questionnaires assess stigma of mental illness in general population (Knowledge and Attitude about Patients with Mental Disorders and Epilepsy, Opinion about Mental Illness). However, eight questionnaires are available to assess stigma of mental illness in caregivers or family members of the patients with mental disorders. There are ten questionnaires for assessment of stigma of mental illness in health care providers, and medical and nursing students as future care providers. Few questionnaires and surveys are available in Persian for assessment of stigma in patients themselves. In the world literature most of the questionnaires have been developed to assess stigma in general population and then in patient. However, most of the questionnaires and surveys studied in Iran are related to care providers and students and then related to caregivers or family members of the patients. Limited questionnaires are available for assessment of stigma in general population and patients.   Furthermore, we did not find any questionnaires for assessment of stigma in children and adolescents. Most of the questionnaires and surveys that are being used in Persian are translations from an English questionnaire. Interestingly, some of the questionnaires are used for a different target population than the original questionnaire without clear justifications.