Measuring discrimination experienced by people with a mental illness: replication of the short-form DISCUS in six world regions.
Journal: Psychological medicine
Volume: 53
Issue: 9
Year of Publication: 2023
Affiliated Institutions:
Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Department of Psychiatry II, Ulm University and BKH Günzburg, Günzburg, Germany.
Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Department of Psychology, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain.
Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul, Turkey.
Department of Nursing Sciences, School of Health Sciences of Polytechnic Institute of Leiria, Leiria, Portugal.
Department of Psychiatry, Lagos University Teaching Hospital, Lagos, Nigeria.
Psychosomatic and Psychotherapy-Rehabilitation Department, National Medical Rehabilitation Institute Szanatórium u. . Budapest, Budapest, Hungary.
Department of Psychiatry, University of Campania, L. Vanvitelli, Naples, Italy.
Developmental Disorder Program, Mackenzie Presbyterian University, São Paulo, Brazil.
Department of Psychiatry, University of Leipzig Medical Center, Leipzig, Germany.
Department of Psychiatry, Medical Faculty, Greifswald University, Greifswald, Germany.
Department Psychiatry A, Razi Hospital La Manouba, Tunisia.
Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands.
Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic.
Department of Mental and Public Health, Faculty of Medicine, State University of Montes Claros, Montes Claros, MG, Brazil.
Department of Psychotic Disorders, GGZ Drenthe Mental Health Institute, Assen, The Netherlands.
Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan.
The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Psychiatry, Government Medical College, Nizamabad, Telangana State, India.
Institute of Psychiatry and Mental Health, Institute of Biomedical Research (IdISSC), San Carlos University Hospital, Complutense University, Madrid, Spain.
Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Abstract summary
The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally.This study evaluated whether the psychometric properties of a short-form version, DISC-Ultra Short (DISCUS) (11-item), could be replicated in a sample of people with a wide range of mental disorders from 21 sites in 15 countries/territories, across six global regions. The frequency of experienced discrimination was reported. Scaling assumptions (confirmatory factor analysis, inter-item and item-total correlations), reliability (internal consistency) and validity (convergent validity, known groups method) were investigated in each region, and by diagnosis group.1195 people participated. The most frequently reported experiences of discrimination were being shunned or avoided at work (48.7%) and discrimination in making or keeping friends (47.2%). Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnosis groups. Convergent validity was confirmed in the total sample and within all regions [ Internalised Stigma of Mental Illness (ISMI-10): 0.28-0.67, stopping self: 0.54-0.72, stigma consciousness: -0.32-0.57], as was internal consistency reliability ( = 0.74-0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): < 0.001].The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings.
Authors & Co-authors:
Brohan Elaine E
Thornicroft Graham G
Rüsch Nicolas N
Lasalvia Antonio A
Campbell Megan M MM
Yalçınkaya-Alkar Özden Ö
Lanfredi Mariangela M
Ochoa Susana S
Üçok Alp A
Tomás Catarina C
Fadipe Babatunde B
Sebes Julia J
Fiorillo Andrea A
Sampogna Gaia G
Paula Cristiane Silvestre CS
Valverde Leonidas L
Schomerus Georg G
Klemm Pia P
Ouali Uta U
Castelein Stynke S
Alexová Aneta A
Oexle Nathalie N
Guimarães Patrícia Neves PN
Sportel Bouwina Esther BE
Chang Chih-Cheng CC
Li Jie J
Shanthi Chilasagaram C
Reneses Blanca B
Bakolis Ioannis I
Evans-Lacko Sara S
Study Outcome
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