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Table 1 Characteristics of the studies included in the systematic review (n = 13)

From: Over 40 years (1981–2023) assessing stigma with the Community Attitudes to Mental Illness (CAMI) scale: a systematic review of its psychometric properties

Author (year). Country

CAMI version (items)

Target population and study design (sample type)

Sample size. Mean age (SD). % female

Results depending on sociodemographic variables

Psychometric results about CAMI

Taylor and Dear (1981) [23]. Canada

CAMI-40

(40 items)

• General population from Toronto with separate samples from areas with and without mental health facilities

• Observational (non-probabilistic sample)

• 1090 participants

• Mean age: NA (NA). Female: NA

• Less considerate attitudes toward the mentally ill: elder people, divorced people, users with children (not including the ones with children older than 18 years old), regular church attenders (depending on the religious determination). The Pentecostal and Greek Orthodox groups showed more authoritarian attitudes and the Pentecostal and Greek Orthodox had the least benevolent attitudes

• More considerate attitudes toward the mentally ill: female respondents, higher sociodemographic status, and higher education. The users that had used mental health facilities or are related with friends that had used those facilities. The Baptists and Salvation Army showed fewer authoritarian attitudes and the Baptists with the United Church, showed more benevolent attitudes

Factor structure

• Benevolence (10 items)

• CMHI (10 items)

• Social restrictiveness (10 items)

• Authoritarianism (10 items)

Internal consistency

• Global (NA)

• Subscales: benevolence (α = 0.76), CMHI (α = 0.88), social restrictiveness (α = 0.80), and authoritarianism (α = 0.68)

Test–retest reliability

• Global (NA)

• Subscales (NA)

Validity

• A strong degree of correspondence between the factor scales and the theoretically ones. It is important to emphasize that the authoritarianism and social restrictiveness scales equally correlated with the first factor, ad to a lesser extent, with the fourth factor

Brockington et al. (1993) [31]. United Kingdom

CAMI-31

(31 items)

• General population from the Malvern and Bromsgrove area

• Observational (non-probabilistic sample)

• 2000 participants

• Bromsgrove mean age: NA (NA). Female: 51%

• Malvern mean age: NA (NA). Female: 58%

• CMHI: (factor 1). Higher education and professional experience with people with mental health problems

• Authoritarianism (factor 2). Lower scores are related with higher education

• Benevolence (factor 3). Highest scores were found within the groups with higher education, knowledge of mental illness, and an age between 55 and 64

Factor structure

• Benevolence (NA)

• CMHI (NA)

• Authoritarianism (NA)

Internal consistency

• Global (NA)

• Subscales (NA)

Test–retest reliability

• Global (NA)

• Subscales (NA)

Validity

• NA

Wolff et al. (1996) [37]. United Kingdom

CAMI-W

(20 items)

• General population from London

• Observational (non-probabilistic sample)

• 215 participants

• Mean age: 37 (13). Female: 55%

• Fear and exclusion were associated with having children in the domestic establishment (< 18), higher age, and a lower occupational status

• Social control was associated with a higher age; sociodemographic lower class; Asian, African, or Caribbean descendant; lower educational level; with children in the household; lower occupational status; being divorced, widowed, or separated; and be aware of somebody with a mental health problem

• Goodwill was associated with lower age, higher educational level, and people from ethnical origin

Factor structure

• Fear and exclusion (11 items)

• Social control (6 items)

• Goodwill (3 items)

Internal consistency

• Global (NA)

• Subscales (NA)

Test–retest reliability

• Global (NA)

• Subscales (NA)

Validity

• Predictive validity. Significant correlation between fear and exclusion, social control and goodwill, and behavioural intention items

Song et al. (2005) [42]. China

CAMI-22

(22 items)

• General population from Taiwan

• Observational (stratified proportional sample)

• 1203 participants

• Mean age: 42 (14). Female: 51%

• NA

Factor structure

• Benevolence (6 items)

• Rehabilitation in the community (6 items)

• Non-authoritarism (5 items)

• Non-social restrictiveness (3 items)

• Normalization (2 items)

Internal consistency

• Global (NA)

• Subscale: benevolence (α = 0.63), rehabilitation in the community (α = 0.61), non-authoritarism (α = 0.52), non-social restrictiveness (α = 0.53), and normalization (α = 0.43)

Test–retest reliability

• Global (NA)

• Subscale (NA)

Validity

• NA

Buizza et al. (2005) [41]. Italy

CAMI-24

(24 items)

• General population from Brescia

• Observational (probabilistic sample)

• 280 participants

• Mean age: 48 (NA). Female: 60%

• Physical distance and fear. They are associated with age > 61 years, being divorced/widowed/separated, and never having participated in voluntary or social activities

• Social isolation. Associated with age > 41 years, higher education, and being unemployed

• Social responsibility and tolerance. There are no significative association between the social demographic variables and this factor

Factor structure

• Physical distance and fear (8 items)

• Social distance and isolation (9 items)

• Social responsibility and tolerance (7 items)

Internal consistency

• Global (NA)

• Subscales (NA)

Test–retest reliability

• Global (NA)

• Subscales (NA)

Validity

• NA

Högberg et al. (2008) [35]. Sweden

CAMI-20

(20 items)

• Student nurses selected based on their easy availability

• Observational (non-probabilistic sample)

• 421 participants

• Mean age: 28 (7). Female: NA

• NA

Factor structure

• Open-minded and pro-integration (9 items)

• Fear and avoidance (6 items)

• Community mental health ideology (5 items)

Internal consistency

• Global (α = 0.90)

• Subscales (NA)

Test–retest reliability

• Global (NA)

• Subscales (NA)

Validity

• NA

Morris et al. (2011) [33]. Ireland

CAMI-40 (40 items),

re-specified CAMI-1 (NA),

re-specified CAMI-2 (NA), Högberg CAMI-20 (20 items),

CAMI-W (20 items),

Re-specified Wolff Scale (NA)

• Nurses

• Observational (non-probabilistic sample)

• 1242 participants

• Mean age: 40 (10). Female: 66%

• NA

Factor structure

CAMI-40

• Authoritarianism (10 items)

• Benevolence (10 items)

• Social restrictiveness (10 items)

• CMHI (10 items)

Re-specified CAMI 1

• NA

Re-specified CAMI 2

• NA

Högberg CAMI-20

• Open-minded and pro-integration (9 items)

• Fear and avoidance (6 items)

• Community mental health ideology (5 items)

Wolff CAMI-20

• Fear and exclusion (11 items)

• Social control (6 items)

• Goodwill (3 items)

Re-specified Wolff scale

• NA

Internal consistency

• Global (NA)

• Subscales (NA)

Test–retest reliability

• Global (NA)

• Subscales (NA)

Validity

• NA

Abelha et al. (2015) [39]. Brazil

CAMI-BR

(40 items)

• General population from the Rio de Janeiro area

• Observational (non-probabilistic sample)

• 230 participants

• Mean age: 45 (3). Female: 68%

• NA

Factor structure

• Social restrictiveness (10 items)

• Benevolence (10 items)

• CMHI (10 items)

• Authoritarism (10 items)

Internal consistency

• Global (α = 0.84)

• Subscales: social restrictiveness (α = 0.76), benevolence (α = 0.69), CMHI (α = 0.81), and authoritarianism (α = 0.35)

Test–retest reliability

• Global (r = 0.69)

• Subscales: social restrictiveness (r = 0.64), benevolence (r = 0.62), CMHI (r = 0.54), and authoritarianism (r = 0.37)

Validity

• NA

Ochoa et al. (2016) [32]. Spain

CAMI-40

(40 items)

• Elementary school students

• Observational (non-probabilistic sample)

• 150 participants

• Mean age: 15 (1). Female: 51%

• NA

Factor structure

• Authoritarianism (10 items)

• Benevolence (10 items)

• Social restrictiveness (10 items)

• CMHI (10 items)

Internal consistency

• Global: first assessment (α = 0.86) and second assessment (α = 0.90)

aData provided by Ochoa et al. [34]

• Subscales: authoritarianism (α = 0.27), benevolence (α = 0.64), social restrictiveness (α = 0.67), and CMHI (α = 0.81)

Test–retest reliability

• Global (NA)

• Subscales: CMHI (r = 0.88), authoritarianism (r = 0.81), benevolence (r = 0.85), and social restrictiveness (r = 0.81)

Validity

• NA

Grandón et al. (2016) [40]. Chile

CAMI-10

(10 items)

• Two samples of the general population from Concepción

• Observational (non-probabilistic simple)

• 749 participants form pooling 2 samples

• First sample: mean age: 39 (13). Female: 56%

• Second sample: mean age: 42 (13). Female: 56%

NA

Factor structure

• Acceptance (5 items)

• CMHI (5 items)

Internal consistency

• Global (α = 0.69)

Subscales: acceptance (α = 0.61) and CMHI (α = 0.66)

Test–retest reliability

• Global (r = 0.79)

• Subscales: CMHI (r = 0.63), authoritarianism (r = 0.57), benevolence (r = 0.39), and social restrictiveness (r = 0.62)

Validity

• Factor 1 SDO-factor 1 CAMI (− 0.25)

• Factor 1 SDO–factor 2 CAMI (− 0.30)

• Factor 2 SDO–factor 1 CAMI (− 0.25)

• Factor 2 SDO–factor 2 CAMI (0.16)

Rubio-Valera et al. (2016) [15]. Spain

CAMI-26

(26 items)

• General population

• Observational (probabilistic sample)

• 1019 participants

• Mean age: 48 (1). Female: 51%

• NA

Factor structure

• Authoritarianism (7 items)

• Benevolence (6 items)

• Support for community mental health ideology (9 items)

Internal consistency

• Global (NA)

• Subscales: authoritarism (α = 0.54), benevolence (α = 0.63), and support for community mental health care (α = 0.72)

Test–retest reliability

• Global (NA)

• Subscales (NA)

Validity

• NA

García et al. (2017) [38]. France

CAMI-26

(26 items)

• Undergraduate nursing students

• Observational (non-probabilistic)

• 268 participants

• Mean age: NA (NA). Female: NA

• NA

Factor structure

• Benevolence (7 items)

• CMHI (5 items)

• Authoritarism (7 items)

• Restrictiveness (7 items)

Internal consistency

• Global (NA)

• Subscales (NA)

Test–retest reliability

• Global (r = 0.79)

• Subscales: CMHI (r = 0.63), authoritarianism (r = 0.57), benevolence (r = 0.39), and social restrictiveness (r = 0.62)

Validity

• CAMI is related to the housing control scale, RIBS, and MARKS

Tong et al. (2020) [36]. China

CAMI-20 (20 items)

• Medical students (MS) and primary healthcare workers (PHW)

• Observational (non-probabilistic)

• 1228 MS and 1092 PGW

• MS sample: mean age: 21 (2). Female: 63%

• PHW sample: mean age: 36.3. Female: 70%

NA

Factor structure

• Benevolence (5 items)

• Fear and exclusion (8 items)

• Support and tolerance (7 items)

Internal consistency

• Global: MS (α = 0.82) and PHW (α = 0.85)

• Subscales: MS and PHW, respectively: benevolence (α = 0.79 and 0.83), fear and exclusion (α = 0.79 and 0.85), support and tolerance (α = 0.74 and 0.85)

Test–retest reliability

• Global: MS (r = 0.79) and PHW (r = 0.75)

• Items: MS (r = 0.29 to 0.61) and PHW (r = 0.45 to 0.74)

Validity

• Convergent validity. Correlation with potentially related measures was not assessed

• Discriminant validity. Good discriminant validity between subgroups of interest (MS and PHW)

Bitta et al. (2022) [34]. Kenya

CAMI-40

(40 items)

• Population from the Kilifi County Hospital

• Observational (non-probabilistic)

• 616 participants

• Mean age: 37 (14). Female: 51%

• NA

Factor structure

• Authoritarianism (13 items)

• Benevolence (7 items)

• CMHI (3 items)

Internal consistency

• Global (ω = 0.78)

• Subscales (NA)

Test–retest reliability

• Global (r = 0.39)

• Subscales (NA)

Validity

• RIBS-factor 1 CAMI (− 0.26)

• RIBS-factor 2 CAMI (0.13)

• RIBS-factor 3 CAMI (0.31)

• RIBS-CAMI total (− 0.08)

• MAKS total-factor 1 CAMI (− 0.10)

• MAKS total-factor 2 CAMI (0.16)

• MAKS total-factor 3 CAMI (0.34)

• MAKS total-CAMI total (0.09)

Item responses

• People with mental illness experiences reported significantly better attitudes than those without

• Women had significantly higher scores in factor one scores compared to men

• Level of education had a significant association with overall scores for factor one, but not factor two or three

Kafami et al. (2023) [30]. Iran

CAMI-40

(40 items)

• General population

• Observational (non-probabilistic)

• 130 participants

• Mean age: 35 (11). Female: 79%

• NA

Factor structure

NA

Internal consistency

• Global (α = 0.59)

• Subscales: authoritarianism (α = 0.61), benevolence (α = 0.49), social restrictiveness (α = 0.64), and CMHI (α = 0.76)

Test–retest reliability

• Global (r = 0.93)

• Subscales: authoritarianism (r = 0.97), benevolence (r = 0.92), social restrictiveness (r = 0.95), and CMHI (r = 0.95)

Validity

• NA

  1. aIn those psychometric studies where a factor analysis has been carried out, resulting, for the most part, in several different factors and items, it has been decided, in the CAMI section used, to indicate the version resulting from the factor analysis previously carried out. Brockington et al. [38] – Not all the items are indicated due to their non-specification in the original article