Validation of an adapted mental illness stigma scale in Bangladesh, utilizing data from the National Mental Health Survey

Background: In low- and middle-income countries like Bangladesh, stigma surrounding mental illness hampers public health by fostering social isolation and discouraging treatment adherence. To better understand cultural perceptions of mental illness, a multidimensional, theory-based scale is required. This study aims to assess the validity and reliability of Day’s Mental Illness Stigma Scale (DMISS) in the Bangladeshi context using National Mental Health Survey data.Methods: The cross-sectional, national mental health survey (2019) used multistage, stratified, cluster random sampling (496 clusters from updated census data). Data were collected via Android software with GPRS monitoring. Psychometric validation included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling (SEM).Results: The study utilized Exploratory Factor Analysis (EFA) to refine a measurement scale to 13 items distributed across four factors: relationship disruption, anxiety, hygiene, hesitancy, and fear. Confirmatory Factor Analysis (CFA) was conducted to assess the theoretical validity of the scale, yielding an excellent model fit with the following indices: Root Mean Square Error of Approximation (RMSEA) = 0.05, Goodness of Fit Index (GFI) = 0.97, Comparative Fit Index (CFI) = 0.96, Tucker-Lewis Index (TLI) = 0.95, and Standardized Root Mean Square Residual (SRMR) = 0.03. Furthermore, the scale demonstrated strong convergent validity, with an Average Variance Extracted (AVE) greater than 0.50, and strong discriminant validity, reflected by a Composite Reliability (CR) greater than 0.70. The reliability of the scale was high, evidenced by a Cronbach’s alpha (α) of 0.88 and an Omega coefficient of 0.88.Conclusions: The culturally adapted Day’s Stigma Scale demonstrated strong validity and reliability, supporting its suitability for measuring mental illness stigma and informing stigma-reduction initiatives in Bangladesh. Future research should extend validation across diverse LMIC contexts using COSMIN guidelines and adopt mixed-methods, multi-source approaches to strengthen stigma surveillance and deepen understanding of sociocultural determinants.