Measuring attitudes toward self-harm among mental health care staff: psychometric evaluation of the Self-Harm Antipathy Scale (SHAS) in Denmark

BACKGROUND: Negative attitudes among mental health professionals toward individuals who self-harm can impact the quality of care and contribute to antipathy and stigma. This study aimed to investigate the psychometric properties of a Danish version of the Self-Harm Antipathy Scale (SHAS-DR), designed to measure mental health professions attitudes toward patients who self-harm.

METHODS: The SHAS-D was administered to 261 mental health professionals. Confirmatory factor analysis (CFA) was used to examine dimensionality and structural validity. Internal consistency was evaluated using Cronbach's alpha reliability and McDonald's omega coefficients, and discriminant validity was assessed via factor intercorrelations.

RESULTS: Neither a unidimensional global factor nor the originally proposed six-factor model, based on all 30 items, were supported. Consistent with a previous study, a 17-item three-factor solution and a 19-item five-factor solution showed acceptable model fit. Internal consistency was acceptable for most subscale scores. The three-factor model was superior to the five-factor model in terms of internal consistency and discriminant validity.

CONCLUSIONS: The 17-item form of the SHAS-DR, capturing three subscales, is a structurally valid and reliable tool for assessing attitudes toward self-harm in Danish mental health care. The three factors of 'Sympathy and Support', 'Judgmental Perception', and 'Acceptance and Understanding' point to central areas of antipathy and may be important targets for future training and stigma-reduction efforts among mental health care staff working with patients who engage in self-harm.