Endorsed and anticipated stigma inventory (EASI): A tool for assessing beliefs about mental illness and mental health treatment among military personnel and veterans

Many military personnel and veterans who would benefit from mental health treatment do not seek care, underscoring the need to identify factors that influence initiation and retention in mental health care. Both endorsed and anticipated mental health stigma may serve as principal barriers to treatment seeking. To date, most research on mental health stigma in military and veteran populations has relied on nonvalidated measures with limited content coverage and confounding in the assessment of different domains of mental health stigma. This article describes the development and psychometric evaluation of the Endorsed and Anticipated Stigma Inventory (EASI), which was designed to assess different dimensions of stigma-related beliefs about mental health among military and veteran populations. Findings based on a national sample of U.S. veterans deployed in support of Operation Enduring Freedom (OEF) in Afghanistan or Operation Iraqi Freedom (OIF) in Iraq suggest that the EASI is a psychometrically sound instrument. Specifically, results revealed evidence for the internal consistency reliability, content validity, convergent and discriminant validity, and discriminative validity of EASI scales. In addition, confirmatory factor analysis results supported the proposed factor structure for this inventory of scales.