title: Internalised stigma in people with rheumatoid arthritis: a cross sectional study to establish the psychometric properties of the ISMI-RA.
abstract: Internalised stigma is theorized to be the internalisation and legitimisation of stereotypes of the diagnosis held in society and has not been quantified within patients with Rheumatoid Arthritis. This study aimed to: validate a modified version of a measure of internalised stigma, (the Internalised Stigma of Mental Illness scale, ISMI) for use in a group of patients diagnosed with rheumatoid arthritis; establish the consistency of the construct being measured, and to explore the levels of internalised stigma within this group.
  
  
  
  A cross-sectional survey was conducted in London, UK with participants receiving out-patient treatment for Rheumatoid Arthritis. Participants completed the ISMI-Rheumatoid Arthritis (ISMI-RA) and a measure of self-esteem.
  
  
  
  One hundred respondents were interviewed by phone. The ISMI-RA was found to be reliable using a measure of internal consistency (α = 0.85) showed concurrent validity with the Index of Self Esteem (r = 0.58, p < 0.01) and discriminant validity with no association with gender (t = 1.43, p = 0.61). A quarter of respondents reported internalised stigma to a 'severe' level. Acceptability and feasibility were established. A confirmatory factor analysis provided some support for the model of internalised stigma.
  
  
  
  The application of the ISMI-RA among the Rheumatoid Arthritis population looks promising. Internalised stigma was found to be present within this group. More research is needed to generalize these results and to explore the effects of internalised stigma on treatment adherence and quality of life.
authors.affiliation: Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK. elizabeth.a.corker@kcl.ac.uk.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Corker
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors.forename: R Claire
authors.initials: RC
authors.lastname: Henderson
authors.affiliation: Academic Rheumatology, Faculty of Life Sciences & Medicine, King's College London, London, UK.
authors.forename: Heidi
authors.initials: H
authors.lastname: Lempp
authors.affiliation: Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
authors.forename: June S L
authors.initials: JS
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D012649:Self Concept; D055815:Young Adult
keywords: Internalised stigma; Methodology; Rheumatoid Arthritis