Fan Zhiguang, Shi Xiaoli, Luo Yi, Chen Hongyan, Wen Hongjuan
Department of Psychology, Shaoxing University, Shaoxing, 312000, China.
School of Education, Jilin International Studies University, Changchun, 130117, China.
BMC Public Health. 2025 May 1;25(1):1619. doi: 10.1186/s12889-025-22743-y.
Loneliness is prevalent in patients with chronic diseases and can threaten their health status, treatment process and quality of life. The stigma of loneliness stems from a derogatory and stigmatizing label that individuals possess towards loneliness with the possibility of being socially disadvantaged, which exacerbates the negative impact of loneliness on patients with chronic diseases and jeopardizes social support. However, few studies focused on this theme in patients with chronic diseases. This study aimed to assess the psychometric characteristics of the Chinese version of the Stigma of Loneliness Scale (SLS) among patients with chronic diseases, to provide a validated tool for related research.
The current study consisted of a two-phase questionnaire survey of 704 patients with chronic diseases. Sample 1 comprised 318 patients (Age:40.87 ± 18.55) with chronic diseases, and the data obtained were used for item analysis and exploratory factor analysis. Sample 2 included 386 patients (Age:40.65 ± 17.08) with chronic diseases, and the resulting data were of use for confirmatory factor analysis, criterion validity, incremental validity, and Cronbach's α coefficient test. Moreover, in Sample 2, the equivalence of SLS in male and female cohorts and in outpatient and inpatient groups was further examined.
In the exploratory factor analysis, two dimensions were extracted: Self-Stigma of Loneliness (SSL) and Public Stigma of Loneliness (PSL). The confirmatory factor analysis revealed that the first-order two-factor model demonstrated good fit indices (χ/df = 2.754, RMSEA = 0.067, SRMR = 0.023, CFI = 0.988, IFI = 0.989, TLI = 0.983, PNFI = 0.677, PCFI = 0.681), and it was superior to both the one-factor model and the two-factor orthogonal model. The criterion validity test indicated that the SLS scores were significantly positively correlated with the scores of UCLA Loneliness Scale, Brief Illness Perception Questionnaire, Self-Concealment Scale, Social Interaction Anxiety Scale, Social Phobia Scale, Acceptance and Action Questionnaire-Second Edition, Kessler Psychological Distress Scale-6 scores. The Cronbach's α coefficient values for the SLS, SSL, and PSL were 0.961, 0.949, and 0.960, respectively. The results of the incremental validity tests indicated that stigma of loneliness and loneliness differ in psychological construct. In addition, the SLS showed measurement equivalence in populations of patients with chronic diseases of different genders, as well as ways of seeking medical care.
The Chinese version of the SLS showed favorable reliability and validity in patients with chronic disease populations, which can provide instrumental endorsement for recognition and intervention studies of stigma of loneliness.
孤独在慢性病患者中普遍存在，会威胁他们的健康状况、治疗过程和生活质量。孤独的污名源于个人对孤独持有贬低和污名化的标签，可能导致社会劣势，这加剧了孤独对慢性病患者的负面影响，并危及社会支持。然而，很少有研究关注慢性病患者的这一主题。本研究旨在评估中文版孤独污名量表（SLS）在慢性病患者中的心理测量特征，为相关研究提供一个经过验证的工具。
本研究包括对704名慢性病患者进行的两阶段问卷调查。样本1包括318名慢性病患者（年龄：40.87±18.55），所获得的数据用于项目分析和探索性因素分析。样本2包括386名慢性病患者（年龄：40.65±17.08），所得数据用于验证性因素分析、效标效度、增量效度和克朗巴哈α系数检验。此外，在样本2中，进一步检验了SLS在男性和女性队列以及门诊和住院患者组中的等效性。
在探索性因素分析中，提取了两个维度：孤独自我污名（SSL）和孤独公众污名（PSL）。验证性因素分析表明，一阶双因素模型显示出良好的拟合指数（χ/df = 2.754，RMSEA = 0.067，SRMR = 0.023，CFI = 0.988，IFI = 0.989，TLI = 0.983，PNFI = 0.677，PCFI = 0.681），并且优于单因素模型和双因素正交模型。效标效度检验表明，SLS得分与加州大学洛杉矶分校孤独量表、简易疾病感知问卷、自我隐瞒量表、社交互动焦虑量表、社交恐惧症量表、接受与行动问卷第二版、凯斯勒心理困扰量表6得分显著正相关。SLS、SSL和PSL的克朗巴哈α系数值分别为0.961、0.949和0.960。增量效度检验结果表明，孤独污名和孤独在心理结构上存在差异。此外，SLS在不同性别慢性病患者群体以及就医方式上表现出测量等效性。
中文版SLS在慢性病患者群体中显示出良好的信效度，可为孤独污名的识别和干预研究提供工具支持。
