Combined Self-Stigma of Justice System Involvement, Opioid Use, and Mental Health Disorder

Self-stigma is pervasive among adults with mental health, drug use, and carceral histories. Yet, existing instruments are limited because they are lengthy and capture a single type of self-stigma, imposing significant respondent burden and resulting in incomplete assessment. This study describes the development and psychometric evaluation of a brief instrument of criminal justice (CJ), opioid use disorder (OUD), and mental health disorder (MHD) combined self-stigma. Participants (N = 213) were justice-involved adults with OUD and MHD who completed a survey from August 2023 to January 2024 on sociodemographic characteristics; three validated measures of self-stigma; psychological distress; active concealment of CJ, OUD, and MHD; and health-related quality of life (QOL). Analyses included exploratory factor analysis, confirmatory factor analysis, and structural equation modeling. Four exploratory factor analysis models were compared. Fit indices, factor loadings, and the meaning of factor indicators were examined. MHD self-stigma was associated with greater psychological distress (p <.001), more active concealment (p <.001), and poorer mental health QOL (p =.001). CJ self-stigma was associated with more active concealment (p =.007) but also better mental health QOL (p <.001). While correlated with MHD and CJ self-stigma, OUD self-stigma was not related to the health outcomes (p >.05 for all outcomes). OUD, MHD, and CJ self-stigma are correlated yet distinct and can be measured with a single, brief 12-item instrument. Preliminary construct validity was supported through associations with poorer health, but further evaluation of the validity and reliability of the brief instrument is needed.