Forty years (1981-2021) assessing stigma with the Community Attitudes to Mental Illness (CAMI) scale: systematic review of psychometric properties

Abstract

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 the present work was to systematically review the psychometric properties (dimensionality, reliability, and construct validity) of the different versions of the CAMI 40 years after of its publication. Methods. A systematic search was conducted in PubMed, PsycINFO, Web of Science, and EMBASE from January 1981 to June 2021. A double review was performed for eligibility, data extraction, and quality assessment. Results. A total of 13 studies enrolling 10,095 participants were included. The most frequently reported factor structure comprises 3 or 4 factors. The internal consistency seems adequate for the global scale (a ≥ 0.80), except for CAMI-10 (a = 0.69). Overall, internal consistency of the sub-scales is not supported, with authoritarianism being the weakest factor (a = 0.27 to 0.68). The stability over time of the total scale has been assessed in the CAMI-BR and CAMI-10 (r > 0.65). 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 3-4 factor structure is the most widely reported in the different versions of the CAMI. Although the reliability and construct validity are acceptable, further item refinement by international consensus seems warranted 40 years after the original publication. PROSPERO registration number: CRD42018098956