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Peer Mental Health Stigmatization Scale (PMHSS)


The Peer mental health stigmatization scale (PMHSS) is a self-report instrument developed to measure child and adolescent stigmatizing responses towards a peer with a mental health problem. The scale contains a total of 24 statements both positive and negative about peers with mental health problems that are rated on a 5-point scale.

McKeague, L., Hennessy, E., O'Driscoll, C., & Heary, C. (2015). Peer Mental Health Stigmatization Scale: psychometric properties of a questionnaire for children and adolescents. Child and Adolescent Mental Health, 20(3), 163-170.
(opens in a new window)https://acamh.onlinelibrary.wiley.com/doi/pdf/10.1111/camh.12088

The final version of the accepted article can be downloaded as PMHSS - Accepted article CAMH 2015.  The authors request that the scale is referenced and cited appropriately.

More information on the PMHSS

The questionnaire was developed following analysis of a number of stigma measures for use with adults: the Self-Stigma of Mental Illness Scale (SSMIS; Corrigan et al., 2006), a stigma questionnaire developed by Moses (2009), the Revised Attribution Questionnaire (Corrigan et al., 2002); the Perceived Devaluation/ Discrimination Scale (PDDS; Link, Struening, Rahav, Phelan, & Nuttbrock, 1997), the attitude questions in a measure developed by Pinfold et al. (2003); and a measure of depression stigma developed by Griffiths et al. (2004).

Based on analysis of these scales, the items chosen for inclusion measured stereotypes (dangerousness, blameworthiness, poor self-care, academic ability), prejudice (fear, not trustworthy, behaviour in class), discrimination (‘hang out with’, refusing employment) and low social status (‘look down on’). These items were chosen because they are consistent with Corrigan and Shapiro’s (2010) conceptualisation of the components of stigmatising responses and are developmentally appropriate i.e. they can be applied to the lives of young people in school settings.

Sixteen of the items described young people negatively (e.g. are dangerous) and eight described them positively (e.g. are just as intelligent as others). The decision to include the positive statements was based on Hinshaw’s (2005) exhortation that printed statements about young people with mental health problems should include messages of strength, courage and resilience. These positive items are not included in the scale or the sub-scales.

The conceptual structure of the scale distinguishes between awareness of societal stigma towards young people with mental health problems and personal beliefs.  Each statement in the scale regarding perception of societal stigma has a corresponding item relating to personal endorsement of that statement (following Corrigan et al., 2006). This produced a total of 24 items, 12 items relating to societal stigma and 12 relating to personal stigma.

Many adult scales measuring stigma refer to ‘mental illness’ which is not appropriate for the context of adolescent and young adults. Following Moses (2009) we used the phrase ‘emotional and behavioural problems’ in place of the term ‘mental illness’ for all items in the PMHSS.


Corrigan, P. W., & Shapiro, J. R. (2010). Measuring the impact of programs that challenge the public stigma of mental illness. Clinical psychology review30(8), 907-922.

Corrigan, P. W., Watson, A. C., & Barr, L. (2006). The self–stigma of mental illness: Implications for self–esteem and self–efficacy. Journal of social and clinical psychology25(8), 875-884.

Corrigan, P.W., Rowan, D., Green, A., Lundin, R., River, P., Up- hoff-Wasowski, K., ... & Kubiak, M.A. (2002). Challenging two mental illness stigmas: Personal responsibility and dangerousness. Schizophrenia Bulletin, 28, 293–309.

Griffiths, K.M., Christensen, H., Jorm, A.F., Evans, K., & Groves, C. (2004). Effect of web-based depression literacy and cognitive behavioural therapy interventions on stigmatising attitudes to depression. British Journal of Psychiatry, 185, 342–349.

Hinshaw, S. P. (2005). The stigmatization of mental illness in children and parents: developmental issues, family concerns, and research needs. Journal of child Psychology and Psychiatry, 46(7), 714–734.

Link, B.G., Struening, E.L., Rahav, M., Phelan, J.C., & Nutt- brock, L. (1997). On stigma and its consequences: Evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. Journal of Health and Social Behavior, 38, 177–190.

Moses, T. (2009). Stigma and self‐concept among adolescents receiving mental health treatment. American Journal of Orthopsychiatry79(2), 261-274.


Items follow a standard format. The 8 items measuring personal endorsement of stigma begin with the phrase ‘I believe that children with emotional and behavioural problems...’ The 8 items measuring perceptions of stigma held by society began with the phrase ‘Most people believe that children with emotional and behavioural problems…’.  Positive statements were similarly prefaced with these phrases. Participants respond to all items on a five-point. The scale takes approximately 20 minutes to complete. You can get more details on administration and scoring from this PMHSS admin & scoring document.

Important note: the scale also contains 8 positive statements about children with emotional and behavioral problems – these do not form part of the scales to measure stigma.

Likert scale with response options ranging from ‘Disagree Completely’ to ‘Agree Completely’. In the version of the questionnaire used with secondary school pupils, the word ‘children’ was replaced with the word ‘teenagers’. All other aspects of the questionnaire were identical.

In the original study the reliability and validity was carried out with 562 children and adolescents aged 9–16 years (M = 12.99 years; SD = 1.6 years) in the Republic of Ireland, 316 female, all were White.


A subsequent study examined the factorial validity of the PMHSS in a wider age range of young people: (N = 963) aged 12 to 25 years; adolescents (n = 776) recruited from secondary schools and young adult university studies (n = 187) recruited online. This study employed confirmatory factor analysis (CFA) to examine the original factor structure in two different age cohorts, adolescents and young adults.

Nearchou, F., O'Driscoll, C., McKeague, L., Heary, C., & Hennessy, E. (2021). Psychometric properties of the Peer Mental Health Stigmatization Scale‐Revised in adolescents and young adults. Early Intervention in Psychiatry, 15(1), 201-205. (opens in a new window)https://doi.org/10.1111/eip.12933  

Baetens, I., Decruy, C., Vatandoost, S., Vanderhaegen, B., & Kiekens, G. (2020). School-based prevention targeting non-suicidal self-injury: A pilot study. Frontiers in Psychiatry, 11. (opens in a new window)https://doi.org/10.3389/fpsyt.2020.00437

Amudhan, S., Jangam, K., Mani, K., Murugappan, N. P., Sharma, E., Mahapatra, P., Burma, A. D., Tiwari, H. K., Ashok, A., Vaggar, S., & Rao, G. N. (2021). Project sums (scaling up of Mental Health in schools): Design and methods for a pragmatic, cluster randomised waitlist-controlled trial on Integrated School Mental Health Intervention for Adolescents. BMC Public Health, 21(1). (opens in a new window)https://doi.org/10.1186/s12889-021-12086-9

Ghina, N., Aiyub, A., & Kamal, A. (2021). Hubungan Peer Stigma dengan perilaku bullying pada remaja sekolah menengah pertama. Jurnal Ilmiah Mahasiswa Fakultas Keperawatan5(3). (opens in a new window)https://jim.usk.ac.id/FKep/article/download/18958/9257

Sarfika, R., Effendi, N., Malini, H., & Edwin Nurdin, A. (2021). Personal and perceived stigmas in adolescents toward peers with mental disorders in West Sumatra Indonesia. Open Access Macedonian Journal of Medical Sciences, 9(E), 1010–1016. (opens in a new window)https://doi.org/10.3889/oamjms.2021.6583

Guntur, A., Rahmadanty, I. P., & Ulfa, M. (2022). Mental Health Stigma Among Generation Z Students in Salafi Islamic Boarding Schools. Journal of Health Sciences15(03), 283-290. (opens in a new window)https://doi.org/10.33086/jhs.v15i03.2886

Dempsey, B., Looney, K., McNamara, R., Michalek, S., & Hennessy, E. (2022). An experimental investigation of adolescent and young adult responses to stigmatizing and supportive social media posts in response to a depressed peer. Computers in Human Behavior, 131, 107229. (opens in a new window)https://doi.org/10.1016/j.chb.2022.107229

Lynch, H., McDonagh, C., & Hennessy, E. (2021). Social anxiety and depression stigma among adolescents. Journal of Affective Disorders, 281, 744–750. (opens in a new window)https://doi.org/10.1016/j.jad.2020.11.073

McDonagh, C., Lynch, H., & Hennessy, E. (2021). Do stigma and level of social anxiety predict adolescents' help‐seeking intentions for Social Anxiety Disorder? Early Intervention in Psychiatry. (opens in a new window)https://doi.org/10.1111/eip.13197

Nearchou, F., O'Driscoll, C., McKeague, L., Heary, C., & Hennessy, E. (2020). Psychometric Properties of the Peer Mental Health Stigmatization scale‐revised in adolescents and young adults. Early Intervention in Psychiatry, 15(1), 201–205. (opens in a new window)https://doi.org/10.1111/eip.12933

Al Omari, O., Shindi, Y. A., Al Sabei, S., Al Qadire, M., Al Hashmi, I., & Khalaf, A. (2023). Translating and Testing the Validation of the Arabic Peer Mental Health Stigmatization Scale. Iranian Journal of Psychiatry, 8: 3: 311-318 (opens in a new window)https://ijps.tums.ac.ir/index.php/ijps/article/view/3342

Al Omari, O., Khalaf, A., Al Sabei, S., Wynaden, D., Ballad, C. A., Al Dameery, K., & Al Qadire, M. (2021). Associated factors of stigma toward people with mental illness among university and school students. Perspectives in Psychiatric Care. (opens in a new window)https://doi.org/10.1111/ppc.12982

de la Higuera-Romero, J., Candelas-Muñoz, A., Jiménez-González, A., Castañeda-Jiménez, C., Fuica-Pereg, P., Zurita-Carrasco, M., ... & Senín-Calderón, C. (2022). Validación y adaptación española de la escala de actitudes estigmatizadoras hacia la salud mental entre iguales (peer mental health stigmatization scale, PMHSS-24). Revista de Psiquiatría y Salud Mental, 15(3), 176-184. (opens in a new window)https://doi.org/10.1016/j.rpsm.2020.06.004

de la Higuera-Romero, J., Candelas-Muñoz, A., Jiménez-González, A., Castañeda-Jiménez, C., Fuica-Pereg, P., Zurita-Carrasco, M., ... & Senín-Calderón, C. (2022). Spanish adaptation and validation of the Peer Mental Health Stigmatization Scale (PMHSS-24). Revista de Psiquiatría y Salud Mental (English Edition)15(3), 176-184.(opens in a new window)https://www.sciencedirect.com/science/article/pii/S2173505022000395

Ma, H. I., & Hsieh, C. E. (2020). Questionnaires on stigmatizing attitudes among healthcare students in Taiwan: development and validation. BMC Medical Education, 20(1), 1-9.

(opens in a new window)https://doi.org/10.1186/s12909-020-1976-1

Multi-site: UK, USA and China
Salinger, R. (2019). Mental health perceptions and school-based treatments in the United States, United Kingdom, and China. International Journal of School & Educational Psychology7(1), 3-17. (opens in a new window)https://doi.org/10.1080/21683603.2017.1385552

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