Attitudes Towards Mental Health Problems

Abstract

The Attitudes Towards Mental Health Problems (ATMHP) is a 35-item psychological scale developed by Gilbert et al. (2007) to assess various dimensions of shame associated with experiencing a mental health problem, such as depression or anxiety. The scale was initially informed by research highlighting specific shame concerns in Asian women, particularly those relating to community, family, and self-attitudes. The ATMHP distinguishes between different forms of shame, including external shame (fear of others’ views), internal shame (negative self-evaluation), and the culturally salient concept of reflected shame, which encompasses the fear of bringing shame to one’s family (known as Izzat) or having shame reflected back onto oneself due to a relative’s condition. All items are scored on a 4-point Likert scale.

Keywords

Attitudes, Mental health, Shame, Stigma, External Shame, Internal Shame, Reflected Shame, Cultural differences, Depression, Anxiety.

Authors

P. Gilbert, R. Bhundia, R. Mitra, K. McEwan, C. Irons, J. Sanghera.

Purpose

The primary purpose of the ATMHP scale is to quantitatively measure the degree to which individuals hold shame-focused attitudes regarding mental health difficulties, both concerning their own potential illness and the illness of close relatives. It aims to capture the complex interplay between individual psychological distress and societal/familial reactions, which is particularly relevant in cross-cultural contexts where concepts like honor and family reputation are paramount.

Specifically, the scale was designed to differentiate culturally specific shame concerns, drawing on prior research (Gilbert et al., 2004) that identified unique concerns among Asian women regarding community and family attitudes toward mental illness. By segmenting shame into distinct factors, researchers can better understand barriers to seeking help and the psychological burden imposed by stigma.

Construct

The ATMHP measures five primary dimensions of shame and perceived stigma related to mental health issues, all centered around a hypothetical or actual experience of conditions like depression or anxiety. These dimensions move beyond simple self-stigma to encompass the perceived and actual social environment.

The five core constructs explored are:

• Perceived Community and Family Attitudes (Items 1–8): Measures the respondent’s belief regarding how their community (Items 1–4) and family (Items 5–8) view mental health problems (e.g., seeing them as a personal weakness or something to keep secret).
• External Shame/Stigma Awareness (Items 9–18): Assesses the individual’s perception of how their community (Items 9–13) and family (Items 14–18) would view them specifically if they had a mental health problem (e.g., viewing them as inferior or inadequate).
• Internal Shame (Items 19–23): Focuses on the negative self-evaluation and self-blame experienced by the individual if they suffered from a mental health problem (e.g., seeing oneself as a failure or weak person).
• Reflected Shame 1 (Impact on Family) (Items 24–30): Measures worry about the impact of one’s own mental health problem on the family’s reputation, status, and honor (related to the concept of Izzat).
• Reflected Shame 2 (Impact on Self) (Items 31–35): Assesses the fear that having a close relative with a mental health problem could cause shame, loss of status, or harm to the respondent’s own reputation within the community.

Validity

While specific psychometric data detailing concurrent or predictive validity is not included in the scale description, the structural validity of the ATMHP is supported by its clear theoretical foundation. The scale items were constructed based on qualitative research (Gilbert et al., 2004) that identified specific shame concerns in minority populations, ensuring strong face validity and content validity, particularly regarding culturally sensitive concepts like reflected shame and family honor.

The scale’s design, which meticulously separates perceived attitudes (community/family views) from experienced shame (internal/external/reflected), suggests an effort to establish discriminant validity between these related but distinct psychological constructs. Subsequent research utilizing the ATMHP would typically be required to confirm its relationship with established measures of stigma, depression severity, and help-seeking behaviors.

Reliability

Formal reports detailing the internal consistency (e.g., Cronbach’s alpha) or test-retest reliability of the ATMHP subscales were not provided in the original instrument description. However, given its publication in a peer-reviewed journal and its use in cross-cultural research, it is assumed that the scale demonstrates acceptable levels of internal consistency reliability across its five defined sections. High internal consistency is particularly crucial for multi-faceted constructs like reflected shame, where multiple items must accurately converge on a single underlying concern.

Factor Analysis

The ATMHP is structured into five distinct factors or sections, strongly suggesting that an initial exploratory or confirmatory factor analysis was utilized during development to confirm the hypothesized structure. This structure ensures that the 35 items load onto five conceptually unique factors: Perceived Attitudes (Community/Family), External Shame Awareness (Community/Family), Internal Shame, Reflected Shame 1 (Impact on Family), and Reflected Shame 2 (Impact on Self).

This multi-factorial approach is necessary because the experience of shame regarding mental health is not unitary, but varies depending on whether the source of the judgment is internal, external, or reflected through family relations. The specific differentiation of reflected shame subtypes highlights the cultural sensitivity of the instrument.

Instrument

Test Type: Self-report psychometric scale (Attitudes and Shame).

Format: 35 items scored on a 4-point Likert scale.

Language Available: English (Original research utilized this version).

Population Group: General population, specifically validated for use in studies involving participants where cultural differences in shame sensitivity (e.g., Asian vs. non-Asian samples) are relevant.

Age Group: Adults (specifically used on student women in the validating study).

Population Details: The initial validation study focused on Asian and non-Asian student women, indicating its utility in academic or young adult populations, particularly where family and community honor norms are pronounced.

Test Methodology: Respondents are asked to read a series of statements and indicate their level of agreement using the 4-point Likert scale: 0 = Do not agree at all; 1 = Agree a little; 2 = Mostly agree; 3 = Completely Agree. Scoring involves summing or averaging scores across the five subscales.

Keywords

Psychological assessment, Stigma awareness, Family honor, Izzat, Self-evaluation, Cross-cultural psychology, Depression stigma, Anxiety stigma.

Authors

Author ORCID Identifier: N/A (Not provided in source).

Affiliation Email addresses: N/A (Not provided in source).

Correspondence Address: N/A (Not provided in source).

Permissions & Fee and Test Year

Test Year: 2007 (Publication date of the primary reference).

Permissions and Fee: Information regarding formal licensing fees is not specified. The scale is associated with the Compassionate Mind Foundation.

The original PDF of the scale can be downloaded here: http://www.compassionatemind.co.uk/downloads/scales/Attitudes_Towards_Mental_Health_Problems.pdf

Reference’s

• Gilbert, P., Bhundia, R Mitra, R., McEwan, K., Irons, C. & Sanghera, J. (2007). Cultural differences in shame-focused attitudes towards mental health problems in Asian and non-Asian student women. Mental Health, Religion & Culture, 10, 127-141.

Items of the Attitudes Towards Mental Health Problems

Attitudes towards Mental Health Problems

For this first set of questions please think about how your community and family view mental health problems such as depression and anxiety with a difficulty to cope in everyday life.

External Shame/Stigma Awareness

For the next set of question please think about how you might feel if you suffered from mental health problems such as depression and anxiety with a difficulty to cope in everyday life.

Internal Shame

For the next set of questions please think about how you might feel about yourself if you suffered from mental health problems such as depression and anxiety with a difficulty to cope in everyday life.

Reflected Shame 1

For the next set of questions we would like you to think about how you might feel if you suffered from mental health problems such as depression and anxiety with a difficulty to cope in everyday life. This time consider how worried or concerned you would be on the impact on your family.

Reflected Shame 2

For the next set of questions we would like you to think about how you might feel if one of your close relatives suffers from mental health problems such as depression and anxiety with a difficulty to cope in everyday life. This time consider how worried or concerned you would be on the impact on you.