Development and Validation of the Psycho-Spiritual Severe Mental Health Indication Scale (PS-SMHIS): A Biopsychosociotechno-Spiritual Screening Instrument for Schizophrenia Spectrum and Bipolar Disorders

Abstract

Background: Severe mental illnesses, particularly schizophrenia spectrum and bipolar disorders, are frequently interpreted through spiritual and religious frameworks, especially within culturally and religiously embedded contexts. While spiritual meaning-making can be adaptive, rigid spiritual or diabolical attributions may delay help-seeking, intensify distress, and increase clinical risk. Existing psychiatric screening instruments rarely assess these attributional processes alongside symptom presentation.
Objective: This study aimed to develop and provide preliminary psychometric evidence for the Psycho Spiritual Severe Mental Health Indication Scale (PS-SMHIS), a multidimensional screening instrument designed to identify indicators of schizophrenia spectrum and bipolar disorders while concurrently assessing spiritual distress and spiritual–demonic attribution.
Methods: The study employed a cross-sectional instrument development and preliminary validation design grounded in Psycho-Spiritual Therapy and the Biopsychosociotechno-Spiritual framework. The Psycho Spiritual Severe Mental Health Indication Scale (PS SMHIS) was developed to assess clinical symptoms alongside psychospiritual attributional processes. Internal consistency reliability of the total scale and its subscales was evaluated using Cronbach’s alpha coefficients.
Results: The PS-SMHIS demonstrated good to excellent internal consistency across domains, with Cronbach’s alpha values ranging from .773 to .915. Excellent reliability was observed for the Schizophrenia Spectrum and Mania indices, acceptable reliability for the Hypomania index, and good reliability for the Depression, Spiritual Distress, and Spiritual–Diabolic Attribution indices. These findings indicate strong internal coherence across both clinical and psychospiritual constructs.
Conclusion: The PS-SMHIS shows promising preliminary reliability as a psychometrically sound, multidimensional screening instrument. By distinguishing psychiatric symptoms from spiritual distress and attributional risk, the scale supports ethical discernment, early identification, and appropriate referral. Further large-scale, cross-cultural validation studies are recommended to strengthen its clinical and pastoral applicability.