Psychometric properties of the revised internalized skin bias questionnaire.

Background: The psychological impacts of skin disease are well documented, with patients reporting increased anxiety, depression and poorer quality of life. More recent studies suggest that adverse psychopathology is associated with re-direction of skin-disease-related social stigma towards oneself or internalized skin bias (ISB).

Objectives: To refine the Internalized Skin Bias Questionnaire (ISBQ) to reflect the construct of ISB with additional skin-specific biases as well as to evaluate its psychometric properties in a diverse sample of individuals with various skin conditions.

Methods: Two-part observational design including consensus-building surveys among a dermatology expert group and a cross-sectional survey among participants with self-reported dermatological conditions to assess instrument psychometric properties. Eligible participants completed an online survey comprised of the revised ISBQ (ISBQ-R), the Questionnaire on Experiences with Skin Diseases-Short Form (QES-SF), the Dermatology Life Quality Index (DLQI), the Beck Depression Inventory-II (BDI-II) and the Burns Anxiety Inventory (BAI).

Results: Overall, 33 experts participated including 22 (66.7%) dermatologists or dermatology researchers and 11 (33.3%) patients. Except for three items in the first round, all items received high agreement for inclusion from the expert group. The revised survey was completed by 214 participants who identified mostly as female (n = 185; 86.9%), White (n = 182; 85.5%) and non-Hispanic/Latino (n = 200; 93.4%). Adding and modifying new items resulted in an instrument with stronger internal consistency (Cronbach's alpha = 0.92) and a stronger correlation with other existing stigma measures (QES-SF; ρ = 0.72).

Conclusions: The ISBQ-R is a modified instrument with stronger internal consistency and a stronger correlation with other existing stigma measures. Additionally, the study further expanded upon previous research by exploring a two-factor structure, suggesting that the ISBQ-R could be used as a single- or a dual-factor instrument depending on investigator goals.