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. 2023 Jul;53(9):3963-3973.
doi: 10.1017/S0033291722000630. Epub 2022 Mar 30.

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

Elaine Brohan  1 , Graham Thornicroft  1   2 , Nicolas Rüsch  3 , Antonio Lasalvia  4 , Megan M Campbell  5   6 , Özden Yalçınkaya-Alkar  7 , Mariangela Lanfredi  8 , Susana Ochoa  9 , Alp Üçok  10 , Catarina Tomás  11   12   13 , Babatunde Fadipe  14 , Julia Sebes  15 , Andrea Fiorillo  16 , Gaia Sampogna  16 , Cristiane Silvestre Paula  17 , Leonidas Valverde  17 , Georg Schomerus  18 , Pia Klemm  19 , Uta Ouali  20   21 , Stynke Castelein  22   23 , Aneta Alexová  24   25 , Nathalie Oexle  3 , Patrícia Neves Guimarães  26 , Bouwina Esther Sportel  27 , Chih-Cheng Chang  28   29 , Jie Li  30 , Chilasagaram Shanthi  31 , Blanca Reneses  32 , Ioannis Bakolis  2   33 , Sara Evans-Lacko  1   34
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Measuring discrimination experienced by people with a mental illness: replication of the short-form DISCUS in six world regions

Elaine Brohan et al. Psychol Med. 2023 Jul.

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.

Keywords: DISCUS; Discrimination; Global mental health; Psychometrics; Stigma.

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Conflict of interest statement

No conflicts of interest are declared.

Figures

Fig. 1.
Fig. 1.
Multi-group CFA model for DISCUS by region1. 1The ranges for the loadings and errors reflect the standardised figures for each of the six regions. RMSEA, Root mean square error of approximation; CFI, Comparative fit index; SRMR, Standardised root mean square residual.
Fig. 2.
Fig. 2.
Multi-group CFA model for DISCUS by region and diagnosis category1. 1The ranges for the loadings and errors reflect the standardised figures for each of the five diagnosis groups. RMSEA, Root mean square error of approximation; CFI, Comparative fit index; SRMR, Standardised root mean square residual.
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