Abstract
BackgroundThe anticipation of mental health-related discrimination is common amongst people with mental health problems and can have serious adverse effects. This study aimed to develop and validate a measure assessing the extent to which people with mental health problems anticipate that they will personally experience discrimination across a range of contexts.MethodsThe items and format for the Questionnaire on Anticipated Discrimination (QUAD) were developed from previous versions of the Discrimination and Stigma Scale (DISC), focus groups and cognitive debriefing interviews which were used to further refine the content and format. The resulting provisional version of the QUAD was completed by 117 service users in an online survey and reliability, validity, precision and acceptability were assessed. A final version of the scale was agreed and analyses re-run using the online survey data and data from an independent sample to report the psychometric properties of the finalised scale.ResultsThe provisional version of the QUAD had 17 items, good internal consistency (alpha = 0.86) and adequate convergent validity as supported by the significant positive correlations with the Stigma Scale (SS) (r = 0.40, p < 0.001) and the Internalised Stigma of Mental Illness Scale (ISMI) (r = 0.40, p < 0.001). Three items were removed due to low endorsements, high inter-correlation or conceptual concerns. The finalised 14 item QUAD had good internal consistency (alpha = 0.86), good test re-test reliability (ρc = 0.81) and adequate convergent validity: correlations with the ISMI (r = 0.45, p < 0.001) and with the SS (r = 0.39, p < 0.001). Reading ease scores indicated good acceptability for general adult populations. Cross-replication in an independent sample further indicated good internal consistency (alpha = 0.88), adequate convergent validity and revealed two factors summarised by institutions/services and interpersonal/professional relationships.ConclusionsThe QUAD expanded upon previous versions of the DISC. It is a reliable, valid and acceptable measure which can be used to identify key life areas in which people may personally anticipate discrimination, and an overall tendency to anticipate discrimination. It may also be useful in planning interventions aimed at reducing the stigma of mental illness.
Highlights
The anticipation of mental health-related discrimination is common amongst people with mental health problems and can have serious adverse effects
One hundred and seventeen individuals completed the online survey in stage two, and 59 of these participants completed the Questionnaire on Anticipated Discrimination (QUAD) at the second time point to provide test-retest reliability data
Depression (34%) and bipolar disorder (31%) were the most common self-reported primary diagnoses and 46% had been hospitalised for a mental health problem
Summary
The anticipation of mental health-related discrimination is common amongst people with mental health problems and can have serious adverse effects. Goffman further noted that this fear of becoming “discredited” can have major impacts on people’s lives leading them to conceal the stigmatised condition or avoid situations in which they might be stigmatised [2]. In this case, the affected group are people with mental health problems. The concept of anticipated discrimination does not appear to be adequately covered by existing definitions of stigma This concept refers back to Goffman’s early notion of the fear of becoming personally ‘discredited’ based on a stigmatising condition and the associated negative consequences [1], but draws upon the more contemporary concept of discrimination (unfair treatment). The expectation of such rejection refers to the anticipated responses of others which may or may not be as a result of an actual experience of discrimination [6,7]
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