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12 results

  • Cultural adaptation process of six stigma assessment scales among Kannada speaking population in South India

  • Harshitha H Annajigowda, Gurucharan Bhaskar Mendon, Anish V. Cherian, Syed Shabab Wahid, Brandon A. Kohrt, Nicolas Rüsch, Sara Evans-Lacko, Elaine Brohan, Claire Henderson, Graham Thornicroft, Santosh Loganathan
  • Journal:
    Cambridge Prisms: Global Mental Health / Volume 12 / 2025
    Published online by Cambridge University Press:
    14 January 2025, e8
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  • For several years stigma researchers in India have relied on Western instruments or semi-structured stigma scales in their studies. However, these scales have not been rigorously translated and adapted to the local cultural framework. In the current study, we describe the cultural adaptation of six stigma scales with the purpose of using it in the native language (Kannada) based on translation steps of forward translation, expert review and synthesis, cultural equivalence, back translation and cognitive interview processes.

    Several items were modified in the target language at each stage of the cultural adaptation process as mentioned in the above steps across all scales. Cultural explanations for the same have been provided. Concepts such as “community forest” and “baby sitting" was replaced with equivalent native synonyms. We introduced native cultural and family values such as “joint family system” and modified the item of housing concept in one of the tools. The concept of “privacy” in the Indian rural context was observed to be familial than individual-based and modification of corresponding items according to the native context of “privacy”. Finally, items from each scale were modified but retained without affecting the meaning and the core construct.

  • FC24: Discrimination and Stigma Scale Ultra Short for People Living with Dementia (DISCUS- Dementia): Development and Psychometric Validation

  • Jem Bhatt, Elaine Brohan, Drew Blasco, Deborah Oliveira, Ioannis Bakolis, Adelina Comas-Herrera, Francesco D’Amico, Nicolas Farina, Martin Knapp, Madeleine Stevens, Graham Thornicroft, Emma Wilson, Maximilian Salcher-Konrad, Lawrence Y. Yang, Sara Evans-Lacko
  • Journal:
    International Psychogeriatrics / Volume 36 / Issue S1 / September 2024
    Published online by Cambridge University Press:
    27 November 2024, p. 53
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  • Objectives: This work was aimed at characterizing the experiences of discrimination, and report initial psychometric properties of a new tool to capture these experiences, among a global sample of people living with dementia.

    Methods: Data from 704 people living with dementia who took part in a global survey from 33 different countries and territories were analysed. Psychometric properties were examined, including internal consistency and construct validity.

    Results: A total of 83% of participants reported discrimination in one or more areas of life, and this was similar across WHO Regions. The exploratory factor analysis factor loadings and scree plot supported a unidimensional structure for the Discrimination and Stigma Scale Ultra Short for People Living with Dementia (DISCUS-Dementia). The instrument demonstrated excellent internal consistency, with most of the construct validity hypotheses being confirmed and qualitative responses demonstrating face validity.

    Conclusions: The DISCUS-Dementia performs well with a global sample of people living with dementia. This scale can be integrated into large-scale studies to understand factors associated with stigma and discrimination. It can also provide an opportunity for a structured Discussion around stigma and discrimination experiences important to people living with dementia, as well as planning psychosocial services and initiatives to reduce stigma and discrimination.

  • Psychosocial interventions for carers of people with severe mental and substance use disorders: a systematic review and meta-analysis

  • Gaia Sampogna, Elaine Brohan, Mario Luciano, Neerja Chowdhary, Andrea Fiorillo
  • Journal:
    European Psychiatry / Volume 66 / Issue 1 / 2023
    Published online by Cambridge University Press:
    24 November 2023, e98
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  • Background

    Severe mental disorders – such as schizophrenia, bipolar disorder, and substance use disorders – exert a negative impact not only on affected people but also on their carers. To support carers of people with severe mental disorders, several psychosocial interventions have been developed.

    Methods

    This systematic review and meta-analysis aimed to assess whether psychosocial interventions for carers of persons with schizophrenia, bipolar disorder, or substance use disorders produce benefit/harm with respect to a series of outcomes – including subjective and objective burden, depressive symptoms, well-being/quality of life, sleep, skills/knowledge, self-efficacy, physical health – as compared to standard support/support as usual or other control conditions.

    Results

    In carers of persons with schizophrenia, psychoeducational interventions were associated with significant improvement in personal burden, well-being, and knowledge about the illness; and a supportive-educational intervention with an improvement in personal burden. In carers of persons with bipolar disorder, psychoeducational interventions were associated with significant improvement in personal burden and depressive symptoms; family-led supportive interventions with an improvement in family burden; family-focused intervention and online “mi.spot” intervention with a significant reduction in depressive symptoms. Psychosocial interventions used for carers of persons with substance use disorders were found to be overall effective on the level of well-being, but the low number of trials did not allow detection of differences between the various psychosocial interventions.

    Conclusions

    The quality of the evidence ranged from very low to moderate, suggesting the need for further better-quality research.

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

  • Jem Bhatt, Elaine Brohan, Drew Blasco, Déborah Oliveira, Ioannis Bakolis, Adelina Comas-Herrera, Francesco D'Amico, Nicolas Farina, Martin Knapp, Madeleine Stevens, Graham Thornicroft, Emma Wilson, Maximilian Salcher-Konrad, Lawrence H. Yang, Sara Evans-Lacko
  • Journal:
    BJPsych Open / Volume 9 / Issue 5 / September 2023
    Published online by Cambridge University Press:
    31 August 2023, e164
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  • Background

    The recent World Health Organization (WHO) blueprint for dementia research and Lancet Commission on ending stigma and discrimination in mental health has identified a gap around dementia-related measures of stigma and discrimination that can be used in different cultural, language and regional contexts.

    Aims

    We aimed to characterise experiences of discrimination, and report initial psychometric properties of a new tool to capture these experiences, among a global sample of people living with dementia.

    Method

    We analysed data from 704 people living with dementia who took part in a global survey from 33 different countries and territories. Psychometric properties were examined, including internal consistency and construct validity.

    Results

    A total of 83% of participants reported discrimination in one or more areas of life, and this was similar across WHO Regions. The exploratory factor analysis factor loadings and scree plot supported a unidimensional structure for the Discrimination and Stigma Scale Ultra Short for People Living with Dementia (DISCUS-Dementia). The instrument demonstrated excellent internal consistency, with most of the construct validity hypotheses being confirmed and qualitative responses demonstrating face validity.

    Conclusions

    Our analyses suggest that the DISCUS-Dementia performs well with a global sample of people living with dementia. This scale can be integrated into large-scale studies to understand factors associated with stigma and discrimination. It can also provide an opportunity for a structured discussion around stigma and discrimination experiences important to people living with dementia, as well as planning psychosocial services and initiatives to reduce stigma and discrimination.

  • 4 - Measurement of Mental Illness Stigma and Discrimination

  • from Part I - Understanding Stigma and Mental Health
  • Edited by David L. Vogel, Iowa State University, Nathaniel G. Wade, Iowa State University
  • Book:
    The Cambridge Handbook of Stigma and Mental Health
    Published online:
    28 July 2022
    Print publication:
    11 August 2022, pp 52-70

  • Summary

    Research on the measurement of mental illness stigma and discrimination has grown rapidly in the past 15 years with a large number of measures developed. This chapter first defines mental illness stigma and discrimination and highlights the importance of using an appropriately targeted measurement strategy including consideration of key measurement principles such as content validity, context of use, and psychometric properties. Nine commonly used measures of perceived, experienced, and self -stigma and discrimination are then highlighted with measurement considerations summarized. We also discuss global and local measurement issues including translation and cross-cultural adaptation. Future directions for stigma and discrimination measurement research in mental illness stigma and discrimination are presented including the need to ensure that research includes consideration of complexity and variation in the experience of stigma and discrimination and that research is focused proportionately on communities that experience the most mental illness stigma and discrimination.

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

  • Elaine Brohan, Graham Thornicroft, Nicolas Rüsch, Antonio Lasalvia, Megan M. Campbell, Özden Yalçınkaya-Alkar, Mariangela Lanfredi, Susana Ochoa, Alp Üçok, Catarina Tomás, Babatunde Fadipe, Julia Sebes, Andrea Fiorillo, Gaia Sampogna, Cristiane Silvestre Paula, Leonidas Valverde, Georg Schomerus, Pia Klemm, Uta Ouali, Stynke Castelein, Aneta Alexová, Nathalie Oexle, Patrícia Neves Guimarães, Bouwina Esther Sportel, Chih-Cheng Chang, Jie Li, Chilasagaram Shanthi, Blanca Reneses, Ioannis Bakolis, Sara Evans-Lacko
  • Journal:
    Psychological Medicine / Volume 53 / Issue 9 / July 2023
    Published online by Cambridge University Press:
    30 March 2022, pp. 3963-3973
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  • 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.

  • 12 - Measuring stigma and discrimination related to mental illness

  • from Part II - Domains of outcome measurement
  • Edited by Graham Thornicroft, { Author Role= exceeds the limit of 5 characters including spacing}, Michele Tansella, { Author Role= exceeds the limit of 5 characters including spacing}
  • Book:
    Mental Health Outcome Measures
    Published by:
    Royal College of Psychiatrists
    Published online:
    25 February 2017, pp 204-220

  • Summary

    There has been a substantial increase in research on the stigma related to mental illness over the past 10 years (Major & O'Brien, 2005; Weiss et al, 2006). This chapter clarifies current practice in one area: the survey measurement of stigma among those who have personal experience of mental illness. The definition and construct of stigma are first discussed, and then the method and results of a review of current measures of personal mental illness stigma are presented.

    Defining stigma

    The classic starting point for defining the stigma of mental illness is Goffman's ‘an attribute that is deeply discrediting’. The recognition of this attribute leads the stigmatised person to be ‘reduced … from a whole and usual person to a tainted or discounted one’ (Goffman, 1963, p. 3). This presents stigma as the relationship between attribute and stereotype. In Goffman's terms, attributes can be categorised in three main groups: abominations of the body (e.g. physical disability or visible deformity); blemishes of individual character (e.g. mental illness, criminal conviction); and ‘tribal’ stigmas (e.g. race, gender, age).

    The work of Jones et al (1984) built on these categorisations with a focus on the study of ‘marked relationships’. In this definition, stigma occurs when the mark links the identified person, via attributional processes, to undesirable characteristics, which discredit him or her. They propose six dimensions of stigma:

    1. concealability – how obvious or detectable a characteristic is to others

    2. course – whether the difference is lifelong or reversible over time

    3. disruptiveness – the impact of the difference on interpersonal Relationships

    4. aesthetics – whether the difference elicits a reaction of disgust or is perceived as unattractive

    5. origin – the causes of the difference, particularly whether the individual is perceived as responsible for this difference

    6. peril – the degree to which the difference induces feelings of threat or danger in others.

    Elliott et al (1982) emphasised the social interaction in stigma. In their definition, stigma is a form of deviance that leads others to judge an individual as illegitimate for participation in a social interaction. This occurs because of a perception that that person lacks the skills or abilities to carry out such an interaction, and is also influenced by judgements about the dangerousness and unpredictability of the person.

  • Decision aid on disclosure of mental health status to an employer: feasibility and outcomes of a randomised controlled trial

  • Claire Henderson, Elaine Brohan, Sarah Clement, Paul Williams, Francesca Lassman, Oliver Schauman, Lisa Dockery, Simone Farrelly, Joanna Murray, Caroline Murphy, Mike Slade, Graham Thornicroft
  • Journal:
    The British Journal of Psychiatry / Volume 203 / Issue 5 / November 2013
    Published online by Cambridge University Press:
    02 January 2018, pp. 350-357
    Print publication:
    November 2013
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  • Background

    Many mental health service users delay or avoid disclosing their condition to employers because of experience, or anticipation, of discrimination. However, non-disclosure precludes the ability to request ‘reasonable adjustments’. There have been no intervention studies to support decisionmaking about disclosure to an employer.

    Aims

    To determine whether the decision aid has an effect that is sustained beyond its immediate impact; to determine whether a large-scale trial is feasible; and to optimise the designs of a larger trial and of the decision aid.

    Method

    In this exploratory randomised controlled trial (RCT) in London, participants were randomly assigned to use of a decision aid plus usual care or usual care alone. Follow-up was at 3 months. Primary outcomes were: (a) stage of decision-making; (b) decisional conflict; and (c) employment-related outcomes (trial registration number: NCT01379014).

    Results

    We recruited 80 participants and interventions were completed for 36 out of 40 in the intervention group; in total 71 participants were followed up. Intention-to-treat analysis showed that reduction in decisional conflict was significantly greater in the intervention group than among controls (mean improvement −22.7 (s.d. = 15.2) v. −11.2 (s.d. = 18.1), P = 0.005). More of the intervention group than controls were in full-time employment at follow-up (P = 0.03).

    Conclusions

    The observed reduction in decisional conflict regarding disclosure has a number of potential benefits which next need to be tested in a definitive trial.

  • Employees with mental health problems: Survey of UK employers' knowledge, attitudes and workplace practices

  • Elaine Brohan, Claire Henderson, Kirsty Little, Graham Thornicroft
  • Journal:
    Epidemiologia e Psichiatria Sociale / Volume 19 / Issue 4 / December 2010
    Published online by Cambridge University Press:
    11 April 2011, pp. 326-332

  • Aim – To investigate whether employers who have experience of hiring people with mental health problems differ significantly from those without such experience in terms of knowledge, attitudes and behaviours regarding mental health in the workplace, and the concerns which they report about employing people with mental health problems. We also examine whether non-workplace social contact is associated with the above variables. Methods – A telephone survey was conducted with a randomly selected sample of British employers. The sample included a similar number of human resource managers and managers/executive employees in other roles. Results – 502 employers took part. Having employed someone with a mental health problem was associated with closer non-workplace social contact. Those with experience of employing applicants with mental health problems had significant differences in knowledge (regarding the law), and behaviour (having a policy on hiring applicants with disabilities) but not in attitudes. Conclusions – Non-workplace social contact may be useful to consider in understanding hiring practices. The nature of social contact at work and possible lack of impact of this contact on employer attitudes and concerns warrants further study. Greater support is needed for employers to understand the law regarding mental health problems in the workplace.

    Declaration of Interest: The study was part funded by Big Lottery and Comic Relief through their funding of the Time to Change programme. The study was also supported by the National Institute for Health Research (NIHR) applied programme grant awarded to the South London and Maudsley NHS Foundation Trust. The authors report no conflict of interest in the preparation of this manuscript.

  • 12 - Measuring stigma and discrimination related to mental illness

  • from Part II - Domains of outcome measurement
    • By Elaine Brohan, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK, Mike Slade, Reader in Health Services Research at the Institute of Psychiatry, King's College London, UK, Sarah Clement, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK, Graham Thornicroft, Professor of Biomedical Statistics, Health Methodology Research Group, School of Community Based Medicine, University of Manchester, UK
  • Edited by Graham Thornicroft, Michelle Tansella
  • Book:
    Mental Health Outcome Measures
    Published online:
    02 January 2018
    Print publication:
    01 September 2010, pp 204-220

  • Summary

    There has been a substantial increase in research on the stigma related to mental illness over the past 10 years (Major & O'Brien, 2005; Weiss et al, 2006). This chapter clarifies current practice in one area: the survey measurement of stigma among those who have personal experience of mental illness. The definition and construct of stigma are first discussed, and then the method and results of a review of current measures of personal mental illness stigma are presented.

    Defining stigma

    The classic starting point for defining the stigma of mental illness is Goffman's ‘an attribute that is deeply discrediting’. The recognition of this attribute leads the stigmatised person to be ‘reduced … from a whole and usual person to a tainted or discounted one’ (Goffman, 1963, p. 3). This presents stigma as the relationship between attribute and stereotype. In Goffman's terms, attributes can be categorised in three main groups: abominations of the body (e.g. physical disability or visible deformity); blemishes of individual character (e.g. mental illness, criminal conviction); and ‘tribal’ stigmas (e.g. race, gender, age).

    The work of Jones et al (1984) built on these categorisations with a focus on the study of ‘marked relationships’. In this definition, stigma occurs when the mark links the identified person, via attributional processes, to undesirable characteristics, which discredit him or her. They propose six dimensions of stigma:

  • concealability – how obvious or detectable a characteristic is to others

  • course – whether the difference is lifelong or reversible over time

  • disruptiveness – the impact of the difference on interpersonal relationships

  • aesthetics – whether the difference elicits a reaction of disgust or is perceived as unattractive

  • origin – the causes of the difference, particularly whether the individual is perceived as responsible for this difference

  • peril – the degree to which the difference induces feelings of threat or danger in others.

    • Elliott et al (1982) emphasised the social interaction in stigma. In their definition, stigma is a form of deviance that leads others to judge an individual as illegitimate for participation in a social interaction. This occurs because of a perception that that person lacks the skills or abilities to carry out such an interaction, and is also influenced by judgements about the dangerousness and unpredictability of the person.