Psychometric Properties of the 12 Items Community Attitudes Toward Mental Illness Scale (CAMI) in a Representative Sample of Spain: The CAMI-12-ES

Stigma toward mental health problems (MHPs) is defined as a mark or attribute associating a person with undesirable characteristics. Stigma's consequences for individuals with MHPs include reduced quality of life, limited rights, and restricted access to opportunities. The Community Attitudes toward Mental Illness (CAMI) scale is a widely used instrument to measure public attitudes toward MHPs, with versions in multiple languages. The aim of the present study was to examine the psychometric properties of the CAMI in a representative Spanish sample. We analyzed data from a representative sample of adult Spanish population, using a 12-item version, the CAMI-12-ES. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to assess the quality of the study. Three factors emerged from exploratory factor analysis: Exclusion, Tolerance and Community Support, and Social Restriction, which accounted for 38.8% of the scale's variance. Exploratory factor analysis yielded a good fit, root-mean-square of the residuals = 0.02, Tucker-Lewis index = 0.959, root-mean-square error of approximation = 0.04, 90% confidence interval [0.034, 0.046], and better fit than a rival two-factor model. The scale showed adequate reliability, omega = .786, 95% confidence interval [.771, .797], R-xx = .78. Scores converged with other psychometric instruments measuring stigma on MHPs: Attribution Questionnaire-9 and Reported and Intended Behaviour Scale, both r = .51, p < .001. We provided a ready-to-use version, scoring instruction, and percentile ranks to use CAMI-12-ES as a brief measure for evaluating community stigma toward persons with MHPs. Identifying and assessing stigma is necessary in order to combat it, and it is a priority line of action for several international institutions.