Measuring discrimination experienced by people with a mental illness: replication of the short-form DISCUS in six world regions

Abstract

Background The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally. Methods 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. Results 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 (α = 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: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001]. Conclusions 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.

Effect of perceived stigma on work and social roles among individuals with mental health disorders in Saudi Arabia: findings from a national survey

“…This finding is consistent with other studies worldwide [ 4 , 48 ]. Brohan et al when used (DISCUS) found that the most common experiences of discrimination were being shunned at work and discrimination in making or keeping friends [ 49 ]. The reasons for this could be that employers tend to deter from hiring and retaining mental health patients because of their cognitive and emotional limitations, which cause reduced productivity and increased costs of disability [ 50 ].…”

Discrimination reported by people with schizophrenia: cross-national variations in relation to the Human Development Index

“…, 2019 ; Brohan et al. , 2022 ), and there are now dedicated instruments to assess anticipated discrimination (Gabbidon et al. , 2013 ).…”

“…, 2019 ; Brohan et al. , 2022 ), and/or the Questionnaire on Anticipated Discrimination (Gabbidon et al. , 2013 )), would help produce the most relevant and reliable findings.…”

The development and validation of the Discrimination and Stigma Scale Ultra Short for People Living with Dementia (DISCUS-Dementia)

“…We adapted the original DISCUS, globally validated for people with mental illness, which collects quantitative information on experience of discrimination across 11 life areas. 16 Those who report discrimination are then asked to provide qualitative examples. As the original measure focused on mental illness, we first reviewed DISCUS items to ensure domains were relevant and sufficient for people living with dementia.…”

“…The Discrimination and Stigma Scale Ultra Short (DISCUS) is an existing tool that assesses the scope and context of experienced discrimination among people with mental health conditions, and has previously demonstrated excellent reliability and factor structure in large global samples. 15 , 16 We sought to adapt the DISCUS for people living with dementia, to address the aforementioned research gaps and test its psychometric properties. We refer to the adapted instrument as the Discrimination and Stigma Scale Ultra Short for People Living with Dementia (DISCUS-Dementia).…”