Over 40 years (1981–2023) assessing stigma with the Community Attitudes to Mental Illness (CAMI) scale: a systematic review of its psychometric properties

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Abstract

Background

The Community Attitudes to Mental Illness (CAMI) scale measures social stigma towards people with mental illness. Although it has been used worldwide, the psychometric properties of the CAMI have not been systematically reviewed. The main aim of this study was to systematically review the psychometric properties of the different versions of the CAMI more than 40 years after of its publication.

Methods

A systematic search was conducted in MEDLINE, PsycINFO, Web of Science, and EMBASE from 1981 (year of publication) to 2023 (present). A double review was performed for eligibility, data extraction, and quality assessment.

Results

A total of 15 studies enrolling 10,841 participants were included. The most frequently reported factor structure comprises 3 or 4 factors. Overall, the internal consistency seems adequate for the global scale ( α ≥ 0.80), except for CAMI-10 ( α = 0.69). Internal consistency of the subscales are not supported, with authoritarianism being the weakest factor ( α = 0.27 to 0.68). The stability over time of the total scale has been assessed in the CAMI-40, CAMI-BR, and CAMI-10 ( r ≥ 0.39). Few studies have assessed the temporal stability of the CAMI subscales. Most of the correlations with potentially related measures are significant and in the expected direction.

Conclusions

The 3 and 4 factor structure are the most widely reported in the different versions of the CAMI. Even though reliability and construct validity are acceptable, further item refinement by international consensus seems warranted more than 40 years after the original publication.

Systematic review registration

PROSPERO identification number: CRD42018098956.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13643-023-02230-4.

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Most cited references 41

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The PRISMA 2020 statement: An updated guideline for reporting systematic reviews

Matthew J L Page, Joanne E. Mckenzie, Patrick Bossuyt … (2021)

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

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Quality criteria were proposed for measurement properties of health status questionnaires.

Caroline Terwee, Sandra D M Bot, Michael de Boer … (2007)

Recently, an increasing number of systematic reviews have been published in which the measurement properties of health status questionnaires are compared. For a meaningful comparison, quality criteria for measurement properties are needed. Our aim was to develop quality criteria for design, methods, and outcomes of studies on the development and evaluation of health status questionnaires. Quality criteria for content validity, internal consistency, criterion validity, construct validity, reproducibility, longitudinal validity, responsiveness, floor and ceiling effects, and interpretability were derived from existing guidelines and consensus within our research group. For each measurement property a criterion was defined for a positive, negative, or indeterminate rating, depending on the design, methods, and outcomes of the validation study. Our criteria make a substantial contribution toward defining explicit quality criteria for measurement properties of health status questionnaires. Our criteria can be used in systematic reviews of health status questionnaires, to detect shortcomings and gaps in knowledge of measurement properties, and to design validation studies. The future challenge will be to refine and complete the criteria and to reach broad consensus, especially on quality criteria for good measurement properties.

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The size and burden of mental disorders and other disorders of the brain in Europe 2010.

H.U. Wittchen, F. Jacobi, J. Rehm … (2011)

To provide 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union (EU) and to compare these findings to previous estimates. Referring to our previous 2005 review, improved up-to-date data for the enlarged EU on a broader range of disorders than previously covered are needed for basic, clinical and public health research and policy decisions and to inform about the estimated number of persons affected in the EU. Stepwise multi-method approach, consisting of systematic literature reviews, reanalyses of existing data sets, national surveys and expert consultations. Studies and data from all member states of the European Union (EU-27) plus Switzerland, Iceland and Norway were included. Supplementary information about neurological disorders is provided, although methodological constraints prohibited the derivation of overall prevalence estimates for mental and neurological disorders. Disease burden was measured by disability adjusted life years (DALY). Prevalence: It is estimated that each year 38.2% of the EU population suffers from a mental disorder. Adjusted for age and comorbidity, this corresponds to 164.8million persons affected. Compared to 2005 (27.4%) this higher estimate is entirely due to the inclusion of 14 new disorders also covering childhood/adolescence as well as the elderly. The estimated higher number of persons affected (2011: 165m vs. 2005: 82m) is due to coverage of childhood and old age populations, new disorders and of new EU membership states. The most frequent disorders are anxiety disorders (14.0%), insomnia (7.0%), major depression (6.9%), somatoform (6.3%), alcohol and drug dependence (>4%), ADHD (5%) in the young, and dementia (1-30%, depending on age). Except for substance use disorders and mental retardation, there were no substantial cultural or country variations. Although many sources, including national health insurance programs, reveal increases in sick leave, early retirement and treatment rates due to mental disorders, rates in the community have not increased with a few exceptions (i.e. dementia). There were also no consistent indications of improvements with regard to low treatment rates, delayed treatment provision and grossly inadequate treatment. Disability: Disorders of the brain and mental disorders in particular, contribute 26.6% of the total all cause burden, thus a greater proportion as compared to other regions of the world. The rank order of the most disabling diseases differs markedly by gender and age group; overall, the four most disabling single conditions were: depression, dementias, alcohol use disorders and stroke. In every year over a third of the total EU population suffers from mental disorders. The true size of "disorders of the brain" including neurological disorders is even considerably larger. Disorders of the brain are the largest contributor to the all cause morbidity burden as measured by DALY in the EU. No indications for increasing overall rates of mental disorders were found nor of improved care and treatment since 2005; less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs. We conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century. Copyright © 2011. Published by Elsevier B.V.

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Author and article information

Contributors

Juan V. Luciano:

ORCID: http://orcid.org/0000-0003-0750-1599

juanvicente.luciano@uab.cat

Journal

Journal ID (nlm-ta): Syst Rev

Journal ID (iso-abbrev): Syst Rev

Title: Systematic Reviews

Publisher: BioMed Central (London )

ISSN (Electronic): 2046-4053

Publication date (Electronic): 14 April 2023

Publication date PMC-release: 14 April 2023

Publication date Collection: 2023

Volume: 12

Electronic Location Identifier: 66

Affiliations

[1 ]GRID grid.466982.7, ISNI 0000 0004 1771 0789, Teaching, Research & Innovation Unit, , Parc Sanitari Sant Joan de Déu, ; Catalonia, Spain

[2 ]GRID grid.466571.7, ISNI 0000 0004 1756 6246, Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), ; Madrid, Spain

[3 ]GRID grid.7080.f, ISNI 0000 0001 2296 0625, Department of Basics, Developmental and Educational Psychology, , Autonomous University of Barcelona, ; Barcelona, Spain

[4 ]GRID grid.7080.f, ISNI 0000 0001 2296 0625, Department of Psychobiology and Methodology of Health Sciences, , Autonomous University of Barcelona, ; Barcelona, Spain

[5 ]GRID grid.20522.37, ISNI 0000 0004 1767 9005, Mental Health Research Group, , Hospital del Mar Medical Research Institute (IMIM), ; Barcelona, Spain

[6 ]GRID grid.13063.37, ISNI 0000 0001 0789 5319, Care Policy and Evaluation Centre, London School of Economics and Political Science, ; London, UK

[7 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, , Kin’s College London, ; London, UK

[8 ]GRID grid.7080.f, ISNI 0000 0001 2296 0625, Department of Clinical and Health Psychology, , Autonomous University of Barcelona, ; Barcelona, Spain

Author information

Juan V. Luciano http://orcid.org/0000-0003-0750-1599

Article

Publisher ID: 2230

DOI: 10.1186/s13643-023-02230-4

PMC ID: 10103533

PubMed ID: 37060031

SO-VID: fd975fe3-bac0-431e-a701-3ed938f31efa

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 1 June 2022

Date accepted : 4 April 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004587, Instituto de Salud Carlos III;

Award ID: FI20/00034

Award ID: CB22/02/00052

Award ID: CB16/02/00322

Award Recipient : Juan P. Sanabria-Mazo Juan V. Luciano María Rubio-Valera

Funded by: Generalitat de Catalunya

Award ID: FI_B/00216

Award Recipient : Ariadna Colomer-Carbonell

Funded by: National Institute for Health Research (NIHR)

Funded by: NIHR Asset Global Health Unit

Funded by: FundRef http://dx.doi.org/10.13039/501100000380, Guy's and St Thomas' Charity;

Award ID: EFT151101

Award Recipient : Graham Thornicroft

Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;

Award ID: MR/S001255/1

Award ID: MR/R023697/1

Award Recipient : Graham Thornicroft

Funded by: Medical Research Council UK

Funded by: National Institute for Health Research

Custom metadata

ScienceOpen disciplines: Public health

Keywords: stigma,mental health,community attitudes to mental illness,psychometric properties,systematic review

Data availability:

ScienceOpen disciplines: Public health

Keywords: stigma, mental health, community attitudes to mental illness, psychometric properties, systematic review

Over 40 years (1981–2023) assessing stigma with the Community Attitudes to Mental Illness (CAMI) scale: a systematic review of its psychometric properties

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Abstract

Background

Methods

Results

Conclusions

Systematic review registration

Supplementary Information

Related collections

REPO4EU WP2 Systematic Reviews

Most cited references 41

The PRISMA 2020 statement: An updated guideline for reporting systematic reviews

Quality criteria were proposed for measurement properties of health status questionnaires.

The size and burden of mental disorders and other disorders of the brain in Europe 2010.

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