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    Interdependent Stigma of Seeking Mental Health Services: Examining a New Scale Across Eight Countries/Regions
    (Amer Psychological Assoc, 2024) Vogel, David L.; Zhao, Nan; Vidales, Carlos A.; Al-Darmaki, Fatima R.; Baptista, Makilim N.; Brenner, Rachel E.; Ertl, Melissa M.
    Although the presence of mental health stigma associated with seeking help has been demonstrated in many parts of the world, this work has largely been from an independent perspective (i.e., I will be perceived as crazy) rather than from an interdependent perspective (i.e., My family will be viewed negatively). Interdependent stigma of seeking help (i.e., the extent to which people believe their family would be devalued and shamed if they seek psychological help) may be an important type of stigma that has not been assessed. Based on self-construal theory, the present study sought to develop and evaluate the psychometric properties of an Interdependent Stigma of Seeking Help (ISSH) scale in eight different countries and regions (i.e., Australia, Brazil, Germany, Hong Kong, Taiwan, T & uuml;rkiye, the UAE, the United States). Findings suggest that the psychometric properties of the eight-item ISSH are adequate for research purposes (a unidimensional scale with full invariance and internal consistency estimates from .84 to .94). The ISSH was moderately related to other measures of stigma and psychological distress. Some differences in the relationship with specific outcomes by country and region were found, and there were notable country differences in the latent mean levels of ISSH, with Hong Kong and Taiwan having the highest means, and Australia, the United States, and Brazil having the lowest levels. Results suggest that the ISSH could be used to help clarify the complex relationships between stigma and other variables of interest and might be useful in developing culturally relevant interventions. Public Significance Statement Stigma remains an obstacle to mental health care. This study examined the reliability and validity of a new scale of interdependent stigma associated with seeking mental health services across eight countries and regions (i.e., Australia, Brazil, Germany, Hong Kong, Taiwan, T & uuml;rkiye, the UAE, and the United States) that expands on the theoretical assertions of self-construal theory and will assist in the development of culturally responsive interventions to combat stigma around the world.
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    Psychometric properties of the Depression, Anxiety, and Stress Scale-21 (DASS-21) across nine countries/regions
    (Routledge Journals, Taylor & Francis Ltd, 2025) Zanon, Cristian; Zhao, Nan; Topkaya, Nursel; Sahin, Ertugrul; Vogel, David L.; Ertl, Melissa M.; Sanatkar, Samineh
    Examinations of the internal structure of the Depression, Anxiety, and Stress Scale-21 (DASS-21) have yielded inconsistent conclusions within and across cultural contexts. This study examined the dimensionality and reliability of the DASS-21 across three theoretically plausible factor structures (i.e., unidimensional, oblique three-factor, and bifactor) as well as measurement equivalence/invariance of the DASS-21 using two different approaches (i.e., multigroup confirmatory factor analysis and the alignment approach) with a large, diverse sample of 2,920 young adult college student participants from nine countries/regions (i.e., Australia, Brazil, Germany, Hong Kong, Lithuania, Taiwan, T & uuml;rkiye, United Arab Emirates, and the United States). Results showed an excellent fit of the bifactor model in all countries/regions except the UAE and the US in which the model did not converge. Regarding parameter equivalence, we found configural, threshold, and loading invariance for the oblique three-factor model (across the nine studied countries/regions) and for the bifactor model (across seven countries/regions). Results indicate that DASS-21 scores measure a general psychological distress factor with more validity and reliability than depression, anxiety, or stress constructs independently. Findings supported the bifactor structure of DASS-21 and demonstrated that cross-cultural comparisons using this scale should be conducted using proper procedures, such as the alignment approach.