Hungarian Version of Mental Illness Continuum Beliefs Scale Passes Key Psychometric Tests

A new study from Hungary has brought a widely discussed idea in mental health research into sharper focus for Hungarian speakers: the belief that mental health and mental illness are not two separate worlds, but points on a single continuum. Researchers from Eötvös Loránd University and Semmelweis University in Budapest, working with a colleague at the University of Leipzig, have adapted the Continuum Beliefs of Mental Illness Scale, known as the CB-MIS, into Hungarian and tested how well it performs as a measurement tool. The work, published open access in BMC Psychiatry on 11 October 2026, offers the first preliminary evidence for the factor structure of the Hungarian version of the scale and suggests it could become a valuable instrument in anti-stigma research and interventions.

The premise behind the scale is deceptively simple. Many people intuitively sort psychological experiences into two rigid categories: the mentally healthy and the mentally ill. Continuum beliefs challenge that binary. They propose instead that mental health and mental difficulties lie along a spectrum, that everyone occupies some position on it, and that the boundary between normal experience and disorder is gradual rather than categorical. Previous research has linked such beliefs to reduced stigma toward mental health difficulties, which is precisely why psychologists are keen to measure them reliably across different languages and cultures. If a scale that captures continuum beliefs can be shown to work well in a new language, researchers in that country gain a tool for studying how these attitudes shape public responses to mental illness.

The Hungarian adaptation focused on the nine-item, vignette-independent version of the CB-MIS. This detail matters methodologically. Some continuum belief measures ask respondents to react to a short case description, or vignette, of a person with a mental disorder. A vignette-independent format instead asks about continuum beliefs directly, without anchoring them to a specific described individual. That makes the instrument more flexible, since it can be deployed in surveys and studies without requiring participants to first read and interpret a scenario, and it allows researchers to capture a respondent’s general orientation toward the mental health continuum rather than their reaction to one particular example.

To put the Hungarian CB-MIS through its paces, the team recruited a community-based sample of 1,065 Hungarian adults. The sample had a mean age of 37 years and was 70.6 percent female, providing a reasonably broad cross-section of the adult population rather than a narrow clinical or student group. Participants completed the adapted scale, and the researchers then ran a battery of statistical procedures to determine whether the Hungarian version behaves the way the original instrument is supposed to. The study received ethics approval from the Research Ethics Committee of the Faculty of Education and Psychology at Eötvös Loránd University, and all participants provided informed consent.

The central structural question was addressed with confirmatory factor analysis, a technique that tests whether data collected with a new version of a questionnaire fit a predefined model of how its items should group together. In this case, the analysis supported a three-factor solution, with factors labeled State, Person, and Concept. In practical terms, this means the nine items of the Hungarian scale cluster into three coherent dimensions: beliefs about mental states themselves, beliefs about the person experiencing them, and beliefs about the concept of mental illness as a category. The researchers reported that the scale showed very good factorial and discriminant validity, indicating that the three components are statistically distinguishable from one another while still contributing to a meaningful overall construct.

Reliability, the second pillar of psychometric evaluation, concerns whether the items of a scale measure their intended construct consistently. The overall Hungarian CB-MIS demonstrated acceptable internal consistency, with a Cronbach’s alpha of 0.710. The subscales told a more nuanced story: their Cronbach’s alpha values ranged from 0.542 to 0.812, meaning some of the three subscales showed relatively low internal consistency when judged by that statistic alone. Rather than dismissing the subscales, the authors turned to a complementary metric, the omega hierarchical score, which highlighted the importance of interpreting the subscale scores as well. This distinction illustrates a broader point in psychometrics: different reliability coefficients capture different aspects of measurement, and a low alpha on a short subscale does not automatically render its scores uninformative, particularly when the underlying model supports the subscale’s structure.

Beyond structure and reliability, the study examined whether the Hungarian scale correlates with other constructs in the directions theory would predict. The results were consistent with expectations. The CB-MIS exhibited moderate negative associations with stigma and with social distance, the latter reflecting people’s unwillingness to interact with someone experiencing mental health difficulties. In other words, Hungarian adults who more strongly endorsed continuum beliefs tended to report less stigmatizing attitudes and greater willingness for social contact. Conversely, the scale’s relationship with empathy, measured in the study framework alongside instruments such as the Interpersonal Reactivity Index, was moderately positive, suggesting that people who see mental health as a continuum also tend to report higher empathic orientation.

These correlational patterns are more than statistical housekeeping. They provide convergent evidence that the Hungarian CB-MIS is measuring something psychologically real and socially consequential. If continuum beliefs were unrelated to stigma, social distance, and empathy, the scale might still be internally coherent but would be of limited practical interest. The observed associations, all in theoretically sensible directions, suggest the instrument taps an attitude cluster that matters for how communities respond to mental illness. That makes the scale a plausible candidate for use in evaluating anti-stigma interventions, an application the authors explicitly recommend for future studies. Interventions that encourage people to see mental health as a continuum could, in principle, be assessed before and after delivery using the Hungarian CB-MIS, giving researchers a standardized outcome measure.

The study’s authors, Evelin Molnár of the Mental Health Sciences Division at Semmelweis University, Lina-Jolien Peter of the Department of Psychiatry and Psychotherapy at the University of Leipzig Medical Faculty, and Brigitta Szabó of Eötvös Loránd University and Semmelweis University, are careful about the scope of their claims. They describe their findings as the first preliminary evidence for the factor structure of the Hungarian CB-MIS, a framing that acknowledges both the strengths and the limits of a single community sample. Scale adaptation is rarely a one-step process; further work in different samples, and ideally with additional validation designs, would strengthen confidence in the instrument. The authors nevertheless recommend employing the nine-item, vignette-independent CB-MIS to measure the continuum of mental health and illness in future Hungarian research.

The broader significance of the study lies in the growing international effort to measure continuum beliefs rigorously. Diagnostic manuals such as the DSM-5-TR and the ICD-11 organize mental disorders into categories, and that categorical framework remains essential for clinical communication and treatment planning. Yet public understanding of mental illness often hardens those categories into a sharp us-and-them divide, which research consistently links to stigma, social exclusion, and reluctance to seek help. Instruments like the CB-MIS give researchers a way to quantify where populations stand on the continuum question and to test whether shifting that stance reduces stigma. With a validated Hungarian version now available, Hungarian-speaking populations can be included in this line of inquiry, and anti-stigma programs in Hungary can be evaluated with the same kind of psychometrically grounded tools used elsewhere. The study, published under a Creative Commons Attribution 4.0 license, is freely available to researchers and practitioners worldwide.

Subject of Research: Psychometric adaptation and validation of the Continuum Beliefs of Mental Illness Scale in Hungarian

Article Title: The adaptation of the Continuum Beliefs of Mental Illness Scale (CB-MIS) to the Hungarian language and its psychometric characteristics

Article References: The adaptation of the Continuum Beliefs of Mental Illness Scale (CB-MIS) to the Hungarian language and its psychometric characteristics. (n.d.). https://doi.org/10.1186/s12888-026-08748-w

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08748-w

Keywords: continuum beliefs, CB-MIS, scale adaptation, psychometrics, mental illness stigma, social distance, empathy, Hungarian validation, confirmatory factor analysis, anti-stigma, mental health, BMC Psychiatry