{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T22:52:44Z","timestamp":1781736764868,"version":"3.54.5"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"06","funder":[{"DOI":"10.13039\/100031584","name":"Deutsches Zentrum f\u00fcr\n                        Diabetesforschung","doi-asserted-by":"crossref","award":["82DZD11E03"],"award-info":[{"award-number":["82DZD11E03"]}],"id":[{"id":"10.13039\/100031584","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Exp Clin Endocrinol Diabetes"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To develop and evaluate the German versions of the Diabetes Stigma Assessment\n                        Scales for type 1 (DSAS-1) and type 2 diabetes (DSAS-2).<\/jats:p>\n                  <jats:p>The questionnaires were translated using a standardized translation and\n                        back-translation procedure. Adults with type 1 (N=636) and type 2\n                        diabetes (N=177) completed the DSAS-1 and DSAS-2 via an online panel.\n                        Factor analyses, internal consistency (Cronbach\u2019s \u03b1), and\n                        correlations with convergent measures and discriminant constructs were\n                        conducted to assess reliability and validity.<\/jats:p>\n                  <jats:p>For the DSAS-1, the expected three-factor structure was confirmed; for the\n                        DSAS-2, a two-factor solution emerged, although a forced three-factor\n                        analysis supported the original structure with minor cross-loadings. Scale\n                        consistencies were excellent (DSAS-1: 0.94, DSAS-2: 0.95, and subscales:\n                        0.86\u20130.93). Both scales showed good concurrent, convergent and discriminant\n                        validity. The DSAS-2 showed stronger associations with weight self-stigma\n                        and self-esteem than the DSAS-1, consistent with its focus on internalized\n                        stigma. Three in four persons (type 1 diabetes: 74% and type 2 diabetes:\n                        72%) endorsed at least one stigma item, mostly related to \u201cblame and\n                        judgement.\u201d<\/jats:p>\n                  <jats:p>Diabetes stigma constitutes an important psychosocial problem. The German\n                        DSAS-1and DSAS-2 are reliable, valid instruments for assessing diabetes\n                        stigma. Blame and judgement appeared as the most common form of stigma\n                        experienced in this sample.<\/jats:p>","DOI":"10.1055\/a-2835-0606","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T22:54:16Z","timestamp":1777071256000},"page":"196-201","source":"Crossref","is-referenced-by-count":0,"title":["Assessing Diabetes Stigma in German People With Diabetes:\n                    Psychometric Validation of the German Versions of the Diabetes Stigma Assessment\n                    Scales (DSAS-1 and DSAS-2)"],"prefix":"10.1055","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9484-3257","authenticated-orcid":false,"given":"Laura Yvonne","family":"Klinker","sequence":"additional","affiliation":[{"name":"Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad\n                    Mergentheim, Germany"},{"name":"German Center for Diabetes Research (DZD), Neuherberg,\n                    Germany"},{"name":"Department of Clinical Psychology and Psychotherapy, University of\n                    Bamberg, Bamberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Schmitt","sequence":"additional","affiliation":[{"name":"Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad\n                    Mergentheim, Germany"},{"name":"German Center for Diabetes Research (DZD), Neuherberg,\n                    Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Ehrmann","sequence":"additional","affiliation":[{"name":"Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad\n                    Mergentheim, Germany"},{"name":"German Center for Diabetes Research (DZD), Neuherberg,\n                    Germany"},{"name":"Department of Clinical Psychology and Psychotherapy, University of\n                    Bamberg, Bamberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilli-Sophie","family":"Priesterroth","sequence":"additional","affiliation":[{"name":"Health Psychology, Institute of Psychology, Johannes-Gutenberg\n                    University Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timm","family":"Roos","sequence":"additional","affiliation":[{"name":"Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad\n                    Mergentheim, Germany"},{"name":"Department of Clinical Psychology and Psychotherapy, University of\n                    Bamberg, Bamberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Speight","sequence":"additional","affiliation":[{"name":"School of Psychology and Institute for Health Transformation, Deakin\n                    University, Geelong, VIC, Australia"},{"name":"The Australian Centre for Behavioural Research in Diabetes, Diabetes\n                    Victoria, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Holmes-Truscott","sequence":"additional","affiliation":[{"name":"School of Psychology and Institute for Health Transformation, Deakin\n                    University, Geelong, VIC, Australia"},{"name":"The Australian Centre for Behavioural Research in Diabetes, Diabetes\n                    Victoria, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Kulzer","sequence":"additional","affiliation":[{"name":"Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad\n                    Mergentheim, Germany"},{"name":"German Center for Diabetes Research (DZD), Neuherberg,\n                    Germany"},{"name":"Department of Clinical Psychology and Psychotherapy, University of\n                    Bamberg, Bamberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Hermanns","sequence":"additional","affiliation":[{"name":"Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad\n                    Mergentheim, Germany"},{"name":"German Center for Diabetes Research (DZD), Neuherberg,\n                    Germany"},{"name":"Department of Clinical Psychology and Psychotherapy, University of\n                    Bamberg, Bamberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"e70082","DOI":"10.1111\/dme.70082","article-title":"Experiences of diabetes stigma among adults with type 1 and type 2 diabetes: A\n                    multi-study, multi-country, secondary analysis","volume":"42","author":"E Holmes-Truscott","year":"2025","journal-title":"Diabetic Med"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S2213-8587(23)00347-9","article-title":"Bringing an end to diabetes stigma and discrimination: An international\n                    consensus statement on evidence and recommendations","volume":"12","author":"J Speight","year":"2024","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"2466","DOI":"10.2337\/dc13-2536","article-title":"Personal accounts of the negative and adaptive psychosocial experiences of\n                    people with diabetes in the second diabetes attitudes, wishes and needs (DAWN2)\n                    study","volume":"37","author":"H L Stuckey","year":"2014","journal-title":"Diabetes Care"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1111\/dme.13507","article-title":"Measuring type 1 diabetes stigma: Development and validation of the type 1\n                    diabetes stigma assessment scale (DSAS-1)","volume":"34","author":"J L Browne","year":"2017","journal-title":"Diabetic Med"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.2337\/dc16-0117","article-title":"Measuring the stigma surrounding type 2 diabetes: Development and validation of\n                    the type 2 diabetes stigma assessment scale (DSAS-2)","volume":"39","author":"J L Browne","year":"2016","journal-title":"Diabetes Care"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"e034757","DOI":"10.1136\/bmjopen-2019-034757","article-title":"How self-stigma affects patient activation in persons with type 2 diabetes: A\n                    cross-sectional study","volume":"10","author":"A Kato","year":"2020","journal-title":"BMJ Open"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"108103","DOI":"10.1016\/j.jdiacomp.2021.108103","article-title":"Toward a more comprehensive understanding of the emotional side of type 2\n                    diabetes: A re-envisioning of the assessment of diabetes distress","volume":"36","author":"W H Polonsky","year":"2022","journal-title":"J Diabetes Complications"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1037\/sah0000408","article-title":"Diabetes stigma predicts higher HbA1c levels in Australian adolescents with type\n                    1 diabetes","volume":"7","author":"J A Ingram","year":"2022","journal-title":"Stigma Health"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"110774","DOI":"10.1016\/j.diabres.2023.110774","article-title":"Type 2 diabetes stigma and its association with clinical, psychological, and\n                    behavioral outcomes: A systematic review and meta-analysis","volume":"202","author":"S Akyirem","year":"2023","journal-title":"Diabetes Res Clin Pract"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"bvae136","DOI":"10.1210\/jendso\/bvae136","article-title":"Diabetes stigma and clinical outcomes: An international review","volume":"8","author":"K B Eitel","year":"2024","journal-title":"J Endocr Soc"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"811","DOI":"10.2337\/dc22-1749","article-title":"Diabetes stigma and clinical outcomes in adolescents and young adults: The\n                    search for diabetes in youth study","volume":"46","author":"K B Eitel","year":"2023","journal-title":"Diabetes Care"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"51","DOI":"10.2337\/cd20-0071","article-title":"Weight stigma and diabetes stigma: Implications for weight-related health\n                    behaviors in adults with type 2 diabetes","volume":"40","author":"R M Puhl","year":"2022","journal-title":"Clin Diabetes"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1037\/amp0000538","article-title":"Weight stigma as a psychosocial contributor to obesity","volume":"75","author":"R M Puhl","year":"2020","journal-title":"Am Psychol"},{"issue":"04","key":"ref14","first-page":"279","article-title":"Dimensionality and psychometric properties of the Greek version of the \u03a4ype 1\n                    diabetes stigma assessment scale (DSAS-1-Gr)","volume":"34","author":"E S Benioudakis","year":"2022","journal-title":"Psychiatriki"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"108765","DOI":"10.1016\/j.pec.2025.108765","article-title":"Psychometric validation and reliability of the Japanese version of the type 1\n                    diabetes stigma assessment scale (DSAS-1 JP)","volume":"136","author":"H Takaike","year":"2025","journal-title":"Patient Educ Couns"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.3906\/sag-2006-255","article-title":"Turkish validity and reliability study of type 2 diabetes stigma assessment\n                    scale","volume":"51","author":"B \u0130nkaya","year":"2021","journal-title":"Turk J Med Sci"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"579","DOI":"10.7475\/kjan.2022.34.6.579","article-title":"Validity and reliability of the korean version of the type 1 diabetes stigma\n                    assessment scale","volume":"34","author":"J Kim","year":"2022","journal-title":"Korean J Adult Nurs"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s40271-017-0289-x","article-title":"Stigma perceived and experienced by adults with type 1 diabetes: Linguistic\n                    adaptation and psychometric validation of the danish version of the type 1\n                    diabetes stigma assessment scale (DSAS-1 DK)","volume":"11","author":"U M Hansen","year":"2018","journal-title":"Patient\u2014Patient-Cent Outcomes Res"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"1057559","DOI":"10.3389\/fcdhc.2022.1057559","article-title":"A Spanish-language translation for the U.S. of the type 2 diabetes stigma\n                    assessment scale (DSAS-2 Spa-US)","volume":"3","author":"K L Joiner","year":"2022","journal-title":"Fron Clin Diabetes Healthcare"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1007\/s12529-012-9243-4","article-title":"The stigma scale for chronic illnesses 8-item version (SSCI-8): Development,\n                    validation and use across neurological conditions","volume":"20","author":"Y Molina","year":"2013","journal-title":"Int J Behav Med"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.jdiacomp.2015.01.012","article-title":"Understanding the sources of diabetes distress in adults with type 1\n                    diabetes","volume":"29","author":"L Fisher","year":"2015","journal-title":"J Diabetes Complications"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"760","DOI":"10.2337\/diacare.20.5.760","article-title":"The problem areas in diabetes scale: An evaluation of its clinical utility","volume":"20","author":"G W Welch","year":"1997","journal-title":"Diabetes Care"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"754","DOI":"10.2337\/diacare.18.6.754","article-title":"Assessment of diabetes-related distress","volume":"18","author":"W H Polonsky","year":"1995","journal-title":"Diabetes Care"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1515\/9781400876136-019","volume-title":"Society and the adolescent self-image","author":"M Rosenberg","year":"1965"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1038\/oby.2009.353","article-title":"Measuring weight self-stigma: The weight self-stigma questionnaire","volume":"18","author":"J Lillis","year":"2010","journal-title":"Obesity"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1007\/s11695-015-1598-6","article-title":"Translation and validation of the german version of the weight self-stigma\n                    questionnaire (WSSQ)","volume":"25","author":"B Hain","year":"2015","journal-title":"Obes Surg"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"e70060","DOI":"10.1111\/dme.70060","article-title":"Detecting clinical cases of binge eating in diabetes care: Introducing the\n                    diabetes eating problem survey-10 (DEPS-10) for type 1 and type 2 diabetes","volume":"42","author":"L Y Klinker","year":"2025","journal-title":"Diabetic Med"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5116\/ijme.4dfb.8dfd","article-title":"Making sense of Cronbach\u2019s alpha","volume":"2","author":"M Tavakol","year":"2011","journal-title":"Int J Med Educ"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1207\/S15327906MBR3604_06","article-title":"Sample size in factor analysis: The role of model error","volume":"36","author":"R C MacCallum","year":"2001","journal-title":"Multivar Behav Res"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"2701","DOI":"10.2147\/JMDH.S419714","article-title":"Translation, cross-cultural adaptation, and validation of measurement\n                    instruments: A practical guideline for novice researchers","volume":"17","author":"P Cruchinho","year":"2024","journal-title":"J Multidiscip Healthcare"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"e056304","DOI":"10.1136\/bmjopen-2021-056304","article-title":"How to identify clinically significant diabetes distress using the problem areas\n                    in diabetes (PAID) scale in adults with diabetes treated in primary or secondary\n                    care? Evidence for new cut points based on latent class analyses","volume":"12","author":"M de Wit","year":"2022","journal-title":"BMJ Open"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"103112","DOI":"10.1016\/j.dsx.2024.103112","article-title":"Predictors of stigma perception by people with type 1 diabetes: A\n                    cross-sectional analysis of the BETTER registry","volume":"18","author":"A Housni","year":"2024","journal-title":"Diabetes Metab Syndr: Clin Res Rev"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"386","DOI":"10.2307\/2095230","article-title":"An introduction to sample selection bias in sociological data","volume":"48","author":"R A Berk","year":"1983","journal-title":"Am Soc Rev"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"e14387","DOI":"10.1111\/dme.14387","article-title":"At multiple fronts: Diabetes stigma and weight stigma in adults with type 2\n                    diabetes","volume":"38","author":"M S Himmelstein","year":"2021","journal-title":"Diabetic Med"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"2651","DOI":"10.2337\/dc19-2447","article-title":"Psychosocial moderators of the impact of diabetes stigma: Results from the\n                    second diabetes miles\u2014Australia (MILES-2) study","volume":"43","author":"E Holmes-Truscott","year":"2020","journal-title":"Diabetes Care"}],"container-title":["Experimental and Clinical Endocrinology &amp; Diabetes"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2835-0606.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T22:32:18Z","timestamp":1781735538000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2835-0606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":35,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2026,6,17]]},"published-print":{"date-parts":[[2026,6]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2835-0606","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0947-7349","1439-3646"],"issn-type":[{"value":"0947-7349","type":"print"},{"value":"1439-3646","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]}}}