Validating the Nepalese Short Attitudes Toward Mental Health Problems Scale (N-SATMHPS): A Culturally Sensitive Tool for Assessing Mental Health Stigma

Abstract

Highlights: Public health relevance–How does this work relate to a public issue? Negative attitudes toward mental health hinder help-seeking in Nepal. Cultural factors such as shame and family honor influence public mental health perceptions. Public health significance–Why is this work of significance to public health? Provides a validated tool to measure mental health attitudes in Nepal. Identifies culturally specific dimensions of stigma relevant to collectivist societies. Public health implications–What are the key implications for practitioners, policy makers, and researchers? Can guide culturally tailored stigma-reduction programs and mental health interventions. Useful for monitoring public attitudes and evaluating mental health policies in Nepal. (1) Background: Negative attitudes toward mental health problems remain a barrier for help-seeking, especially in collectivist, lower-middle-income countries like Nepal. While the Attitudes Towards Mental Health Problems Scale (ATMHPS) has been used globally, it has not been formally validated for Nepalese populations. This study aimed to culturally adapt and psychometrically validate a concise Nepalese version of the scale. (2) Methods: We conducted a cross-sectional study and recruited participants through an opportunity sampling method. We developed the Nepalese Short Version of the Attitudes Towards Mental Health Problems Scale (N-SATMHPS) using Dataset 1 (n = 384) and validated it with Dataset 2 (n = 803). Items were selected based on internal consistency indices. Fourteen items showing the strongest reliability were retained from the original seven subscales. A confirmatory factor analysis and internal consistency testing were used to assess psychometric properties. (3) Results: The N-SATMHPS showed a strong internal consistency (α = 0.74–0.92) and excellent model fit (χ2/df = 1.92, CFI = 0.982, TLI = 0.970, RMSEA = 0.049, SRMR = 0.026). Correlations with the full version ranged from r = 0.79 to 0.96. Discriminant validity with Mental Health Literacy Questionnaire—Young Adults (MHLQ-YA) showed weak but significant correlations, confirming construct distinction. (4) Conclusions: The scale captured key Nepalese cultural constructs, such as shame and family honor. It also aligned with collectivist cultural expectations. The N-SATMHPS demonstrates strong psychometric performance and cultural relevance. It is suitable for research and intervention work aimed at reducing stigma and improving mental health in Nepal.