Discrimination And Stigma Scale Research Articles

Disease-Related Stigma, Emotional Regulation and Depression in Patients with HIV

Background: HIV/AIDS has become one of the major global health burdens. Self-stigma and emotion dysregulation in people living with HIV (PLWH) have become urgent issues and have attracted the attention of both physicians and epidemiologists. Aim: To examine the relationship between disease-related stigma, emotional regulation, and depression in patients with HIV. Method: A cross-sectional study was conducted. A purposive sample of 100 patients—70 male and 30 female diagnosed with HIV/AIDS was collected from two public hospitals in southern Punjab. Patients who had been diagnosed as being HIV positive for at least three months were included in the study. The age range of participants was 18 to 50 years. Patients with other medical issues were excluded from the study. Measures for data collection were the Discrimination and Stigma Scale (DISC), Difficulties in Emotional Regulation Scale (DERS), and Hamilton Depression Scale. The data was evaluated using SPSS version 24. Pearson’s correlation was applied. Results: There is an inverse relationship (-.34**) obtained between disease-related stigma and emotional regulation, whereas a significant positive relationship (r =.41**) is found between disease-related stigma and depression. A negative relationship (r=-.59**) is also examined between emotional regulation and depression. Emotional regulation is a mediator between disease-related stigma and depression in patients with HIV. There is a significant gender difference in depression. The mean score of depression is high among females as compared to males. Practical Implication: It improved the psychological health of HIV-positive patients by categorizing the issues they face. Conclusion: It was concluded that disease-related stigma is positively related to depression while emotional regulation is inversely related to depression. Emotional regulation also plays a mediating role between self-stigma and depression in patients with HIV positive. Women scored higher on depression as compared to men. Keywords: HIV Patients, Psychological Impact, Psychological Distress and Social Stigma.

Narrative enhancement and cognitive therapy for perceived stigma of chronic schizophrenia: A multicenter randomized controlled trial study

This study explored the effects of NECT on self-stigma among people with schizophrenia. Eighty-six participants were recruited and assigned to two groups. The NECT group received 20-session group meetings, while the control group received routine care. Self-stigma was measured by Internalized Stigma of Mental Illness Scale (ISMIS) and Discrimination and Stigma Scale (DISC). Generalized estimating equations were employed to explore the intervention's effectiveness. The NECT group showed a significant reduction in ISMIS total scores after 20 sessions and Stopping Self subscale scores of DISC decreased over time. The intervention is effective for improving self-stigma in people with schizophrenia.

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

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 (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]. 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.

Perceived stigma among caregivers of psychiatric disorders as compared to chronic dermatological disorders

Background: Literally, stigma “is a mark of disgrace associated with a particular circumstance, quality, or person” which has an impact on the physical, social and emotional health of not just the patient but also their caregivers. There is a paucity of research assessing the prevalence and impact of stigma among the caregivers of these patients. Aim: To assess the perceived stigma among caregivers of psychiatric disorders as compared to chronic dermatological disorders. Materials and Methods: By purposive sampling, 60 patients with psychiatric disorders and 60 chronic dermatological disorders were included in the study with their written informed consent. For diagnosis of psychiatric disorders International Classification of Diseases 10 Diagnostic Criteria for Research criteria was used. The diagnosis of dermatological disorders was made by the dermatologist. Patients with chronic visible dermatological disorders were selected. The caregivers of the patients after informed consent were included in the study. Their sociodemographic proforma was filled, and then Discrimination and stigma scale (DISC) and Explanatory Model Interview Catalogue (EMIC) stigma scale were applied to the two groups. The scores were analyzed using the SPSS. Results: Caregivers of patients with psychiatric disorders had significantly higher scores compared to caregivers of chronic dermatological disorder patients on the EMIC and DISC scales. Conclusion: Perceived stigma was found to be high in caregivers of both patients of psychiatric disorders and chronic dermatological disorders. It was seen that the stigma was higher in the caregivers of patients with psychiatric disorders.

Stigma and discrimination in patients with schizophrenia and bipolar mood disorder

Context: Stigma associated with mental illness is devastating and can be detrimental to recovery. Many people with serious mental illness are challenged with the symptoms and disabilities caused by the disease. In addition, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness. Aims: The aims were to study and compare stigma and discrimination in patients with schizophrenia and bipolar mood disorder. Settings and Design: This is a cross-sectional study of 100 patients selected by purposive random sampling from the psychiatry outpatient department of a tertiary care hospital. Materials and Methods: Fifty patients suffering from schizophrenia and fifty patients suffering from bipolar affective disorder (BPAD) according to the International Classification of Diseases 10 were interviewed. The Discrimination and Stigma Scale (DISC) 12 was used to assess stigma and discrimination of the patients. The DISC 12 asks participants about the experiences of discrimination in various areas of life including employment; mental health care; and interactions with friends, neighbors, and family. Statistical Analysis Used: Statistical analysis was done by using descriptive and inferential statistics using Chi-square test and Student's unpaired t-test. Results: Overall, patients of both schizophrenia and bipolar disorder suffer from stigma and discrimination of the same magnitude. Unfair treatment was similar in both the disorders, while overcoming stigma, stopping self, and positive treatment were significantly higher for patients suffering from schizophrenia as compared to BPAD. Conclusions: Irrespective of diagnosis, mental illnesses evoke stigma and discrimination which impact the lives of people with schizophrenia.

Microdecisions instead of coercion: patient participation and self-perceived discrimination in a psychiatric ward

Aims: Patients may experience unfair reception when in contact with psychiatric services. The aims are to illuminate these perceptions, and the extent of inpatients’ involvement in their care, and if degree of involvement depends on compulsory or voluntary care. Furthermore, we sought to determine if an educational intervention for staff members, including systematic listening and offering the inpatients involvement using microdecisions, affects the inpatients’ experiences and the use of coercion.Materials and methods: We used a naturalistic setting case control design in two psychiatric wards for one year, including all inpatients (n = 685) of which 458 took part of the microdecision intervention. Structured direct interviews were carried out with inpatients based on the Discrimination and Stigma Scale (DISC), Dyadic OPTION, and CollaboRATE instruments before (n = 19) and after (n = 46) the intervention. Frequencies of coercive measures before and after the intervention were compared (n = 685).Results: Respondents subjected to the intervention experienced less discrimination related to psychiatric care compared to responders not subjected. Tendencies of improvements post intervention were found for some aspects of involvement, as attention to concerns and possibilities to ask questions. A decrease in the use of coercive measures at three and six months after the start of the intervention was observed.Conclusion: Results suggest that the intervention could decrease the inpatients’ experiences of discrimination during psychiatric care as well as the use of coercion in the service. The Dyadic OPTION instrument showed a mixed picture with results implying improvements in some areas and impairments in others.

Stigma and discrimination experienced by people living with severe and persistent mental illness in assertive community treatment settings.

To describe the perceived experiences of stigma and discrimination among people living with severe and persistent mental illness in assertive community treatment (ACT teams) settings in New South Wales (NSW), Australia. The Discrimination and Stigma Scale (DISC) was used in this cross-sectional study with people living with severe and persistent mental illness. The DISC is a reliable and valid, quantitative and qualitative instrument used to explore and measure levels of negative, anticipated and positive discrimination. Relevant clinical history and socio-demographic information were also collected. A total of 50 clients participated, with 40 (80%) reporting experienced negative discrimination in at least one life area. Negative discrimination was most commonly experienced in being avoided or shunned (n=25, 50%), by neighbours (n=24, 48%) and family (n=23, 46%). Anticipated discrimination was common, with half of participants (n=25, 50%) feeling the need to conceal their mental health diagnosis. Discrimination was highly prevalent in everyday aspects of life. While healthcare professionals often tend to increase perceived stigma and discrimination, this was only experienced in interactions with general health professionals, while interactions with ACT team members decreased perceived stigma and increased positive discrimination. This indicates that healthcare professionals potentially have a significant role in reducing stigma and discrimination in mental health and that such an effect may be optimised in an ACT team setting.

Cross-national variations in reported discrimination among people treated for major depression worldwide: the ASPEN/INDIGO international study.

No study has so far explored differences in discrimination reported by people with major depressive disorder (MDD) across countries and cultures. To (a) compare reported discrimination across different countries, and (b) explore the relative weight of individual and contextual factors in explaining levels of reported discrimination in people with MDD. Cross-sectional multisite international survey (34 countries worldwide) of 1082 people with MDD. Experienced and anticipated discrimination were assessed by the Discrimination and Stigma Scale (DISC). Countries were classified according to their rating on the Human Development Index (HDI). Multilevel negative binomial and Poisson models were used. People living in 'very high HDI' countries reported higher discrimination than those in 'medium/low HDI' countries. Variation in reported discrimination across countries was only partially explained by individual-level variables. The contribution of country-level variables was significant for anticipated discrimination only. Contextual factors play an important role in anticipated discrimination. Country-specific interventions should be implemented to prevent discrimination towards people with MDD.

Impact of Stigma On Euthymic Patients with Bipolar Disorder Type I

Introduction Stigma is a serious concern for people with bipolar disorder (PBD). It may have critical yet insidious repercussions on the course of the illness and may represent a barrier to recovery. Objectives To determine the influence of social stigma and internalized stigma on residual affective symptoms, treatment adherence, global functioning and metacognitive functioning in a population of euthymic PBD. Methods A Cross-sectional study was conducted on 32 outpatients with bipolar disorder I (BDI). Residual affective symptoms were evaluated using the Young Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HRSD). Social stigma and internalized stigma were evaluated using the Discrimination and Stigma Scale (DISC). The Medication Adherence Rating Scale (MARS), the Global Assessment of Functioning (GAF) and the Metacognition Assessment Interview (MAI) were also used. Results Higher rates of social stigma were correlated with poorer global functioning (p=0.029) and poorer adherence to medication (p=0.022). However, higher social stigma correlated with better metacognitive capacities (p=0.0001, r=-0.61); good metacognition may lead to a better perception of social stigma. Self stigma was significantly correlated to residual depressive symptoms (p=0.0001) and to poorer global functioning (p=0.018) and poorer adherence to treatment (p=0.002). Better metacognitive capacities were also correlated with the ability to overcome stigma. Conclusions Social stigma and self stigma may have negative impact on several aspects of the BD that are essential to the outcome such as medical adherence, functioning and residual symptoms. Targeting stigma may help PBD achieve recovery.

Stigma, discrimination and medication adherence in schizophrenia: Results from the Swedish COAST study

The aims of this naturalistic non-interventional study were to quantify the level of stigma and discrimination in persons with schizophrenia and to test for potential associations between different types of stigma and adherence to antipsychotics. Antipsychotic medication use was electronically monitored with a Medication Event Monitoring System (MEMS®) for 12 months in 111 outpatients with schizophrenia and schizophrenia-like psychosis (DSM-IV). Stigma was assessed at endpoint using the Discrimination and Stigma Scale (DISC). Single DISC items that were most frequently reported included social relationships in making/keeping friends (71%) and in the neighborhood (69%). About half of the patients experienced discrimination by their families, in intimate relationships, regarding employment and by mental health staff. Most patients (88%) wanted to conceal their mental health problems from others; 70% stated that anticipated discrimination resulted in avoidance of close personal relationships. Non-adherence (MEMS® adherence≤0.80) was observed in 30 (27.3%). When DISC subscale scores (SD) were entered in separate regression models, neither experienced nor anticipated stigma was associated with adherence. Our data do not support an association between stigma and non-adherence. Further studies in other settings are needed as experiences of stigma and levels of adherence and their potential associations might vary by a healthcare system or cultural and sociodemographic contexts.

The development and validation of the Questionnaire on Anticipated Discrimination (QUAD)

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.

Stigma and discrimination against people with schizophrenia related to medical services

To investigate whether people with schizophrenia experience discrimination when using health care services. A cross-sectional survey in 27 countries in centres affiliated to the INDIGO Research Network, using face-to-face interviews with 777 participants with schizophrenia (62% male and 38% female). We analysed the data related to health issues, including health care, disrespect of mental health staff, and also personal privacy, safety and security, starting a family, pregnancy and childbirth. Discrimination was measured by the Discrimination and Stigma Scale (DISC), which consists of 36 items comprising three sub-scales: positive experienced discrimination; negative experienced discrimination; and anticipated discrimination. More than 17% of patients experienced discrimination when treated for physical health care problems. More than 38% of participants felt disrespected by mental health staff, with higher ratings in the post-communist countries. Mental health service providers have a key role in decreasing stigma in their provision of health care, and by doing more against stigmatizing and discriminating practices on the therapeutic and organizational level. This will require a change of attitudes and practices among mental and physical health care staff.

Discrimination in relation to parenthood reported by community psychiatric service users in the UK: a framework analysis

BackgroundExperienced discrimination refers to an individual’s perception that they have been treated unfairly due to an attribute and is an important recent focus within stigma research. A significant proportion of mental health service users report experiencing mental illness-based discrimination in relation to parenthood. Existing studies in this area have not gone beyond prevalence, therefore little is known about the nature of experienced discrimination in relation to parenthood, and how is it constituted. This study aims to generate a typology of community psychiatric service users’ reports of mental illness-based discrimination in relation to becoming or being a parent. A secondary aim is to assess the prevalence of these types of experienced discrimination.MethodsIn a telephone survey 2026 community psychiatric service users in ten UK Mental Health service provider organisations (Trusts) were asked about discrimination experienced in the previous 12 months using the Discrimination and Stigma Scale (DISC). The sample were asked if, due to their mental health problem, they had been treated unfairly in starting a family, or in their role as a parent, and gave examples of this. Prevalence is reported and the examples of experienced discrimination in relation to parenthood were analysed using the framework method of qualitative analysis.ResultsThree hundred and four participants (73% female) reported experienced discrimination, with prevalences of 22.5% and 28.3% for starting a family and for the parenting role respectively. Participants gave 89 examples of discrimination about starting a family and 228 about parenting, and these occurred in social and professional contexts. Ten themes were identified. These related to being seen as an unfit parent; people not being understanding; being stopped from having children; not being allowed to see their children; not getting the support needed; children being affected; children avoiding their parents; children’s difficulties being blamed on the parent’s mental health problem; not being listened to; and being undermined as a parent.ConclusionsThis research highlights the need for: greater support for parents with mental illness, those wishing to have children, and those who lose access or custody; services to better meet the needs of children with a mentally ill parent; training about discrimination for professionals; and parenting issues to be included in anti-stigma programmes.

Development and psychometric evaluation of the Discrimination and Stigma Scale (DISC)

Mental illness is associated with unfair treatment in a number of areas of life. There is currently no psychometrically validated measure that has been developed to specifically focus on such experienced discrimination. This study aimed to finalise the Discrimination and Stigma Scale (DISC) and establish its psychometric properties. The DISC was further developed using (1) service user and interviewer focus groups; (2) reading ease testing; and (3) cognitive debriefing interviews. The revised scale then underwent psychometric testing to establish the following properties: reliability; validity; precision; acceptability; and feasibility. The final 22-item DISC demonstrated good psychometric properties (n=86) including inter-rater reliability (weighted kappa range: 0.62–0.95), internal consistency (α=0.78) and test–retest reliability (n=46) (weighted kappa range: 0.56–0.89). Feasibility, validity and acceptability were also established. In conclusion, the 22-item DISC is recommended for use in measuring experienced stigma and discrimination. Additional work to develop a measure of anticipated stigma is recommended.

England's Time to Change Antistigma Campaign: One-Year Outcomes of Service User-Rated Experiences of Discrimination

This study evaluated the progress at one year of England's Time to Change (TTC) program, launched in 2009, toward meeting its target to reduce mental health-related stigma and discrimination by 5%. TTC comprises three national components: antistigma marketing campaign activities, mass physical exercise events (Time to Get Moving) to facilitate social contact between people with and without mental health problems, and an online resource on mental health and employment (Time to Challenge). Part of the TTC evaluation consists of an annual national phone survey of mental health service users. Participants (537 in 2008 and 1,047 in 2009) were current outpatient service users aged 18-65 registered with National Health Service community mental health teams that are selected annually to represent the range of socioeconomic deprivation. Telephone interviews were conducted with service users with the Discrimination and Stigma Scale (DISC) to document experienced discrimination and anticipated discrimination in the past 12 months. One or more experiences of discrimination were reported by 9-1% of participants in 2008 and 87% of participants in 2009 (p = .03). In 2009 significantly less discrimination was reported from a number of common sources, including family (reported by 53% in 2008 and 46% in 2009), friends (53% and 39%), finding employment (24% and 16%), and keeping employment (from 17% to 13%). Experiences of discrimination from mental health professionals did not change significantly (reported by about one-third of participants in both years). Results suggest positive progress toward meeting the program's targeted 5% reduction in discrimination.

Comparative study of experienced and anticipated stigma in Serbia and the world

The presented study is part of the International Study of Discrimination and Stigma Outcomes (INDIGO) conducted in 28 countries. The aim of this study was to compare the degree of experienced and anticipated stigma of patients with schizophrenia in Serbia with world results. The Discrimination and Stigma Scale (DISC) was applied in individual interviews. The sample comprised 732 subjects of the main study and 50 subjects from Serbia. The amount of negative experienced discrimination in Serbia is the same as in other participating countries. The Serbian sample shows more negative discrimination in intimate relationships, personal safety and general harm due to the diagnosis, but more positive discrimination within the family, privileges during treatment of somatic illnesses, and benefits enjoyed in social and retirement insurance. The Serbian sample shows less anticipated discrimination in looking for a close relationship and in stopping self from applying for work. The results show that socio-demographic variables could not predict negative experienced and anticipated discrimination, while those same variables enable the prediction of 34% of positive discrimination. Compared to other investigated countries, stigmatization processes for persons with schizophrenia do not differ considerably in Serbia, which justifies the implementation of unique anti-stigma programmes and joint upgrading of legal regulations.

Experienced and anticipated discrimination against people with schizophrenia

Aim of this research was to describe the nature, direction and severity of anticipated and experienced discrimination reported by people with schizophrenia. We applied interview to 50 patients with diagnosis of schizophrenia in two psychiatric hospitals in Belgrade. Discrimination was measured with discrimination and stigma scale (DISC) which produce 3 subscores, positive experienced discrimination, negative experienced discrimination and anticipated discrimination. The same scale was used in cross-cultural research in 27 european countries. Results have shown that participants from Serbia do not recognize discrimination in all areas of life equally. The discrimination recognized is more frequentlly negative then positive and is associated with existentially important realms of life. Due to anticipated discrimination participants in our study prevent themselves from looking for a close relationship. Anticipated discrimination could not be predicted on the grounds of experienced, positive or negative discrimination.

Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey

Many people with schizophrenia experience stigma caused by other people's knowledge, attitudes, and behaviour; this can lead to impoverishment, social marginalisation, and low quality of life. We aimed to describe the nature, direction, and severity of anticipated and experienced discrimination reported by people with schizophrenia. We did a cross-sectional survey in 27 countries, in centres affiliated to the INDIGO Research Network, by use of face-to-face interviews with 732 participants with schizophrenia. Discrimination was measured with the newly validated discrimination and stigma scale (DISC), which produces three subscores: positive experienced discrimination; negative experienced discrimination; and anticipated discrimination. Negative discrimination was experienced by 344 (47%) of 729 participants in making or keeping friends, by 315 (43%) of 728 from family members, by 209 (29%) of 724 in finding a job, 215 (29%) of 730 in keeping a job, and by 196 (27%) of 724 in intimate or sexual relationships. Positive experienced discrimination was rare. Anticipated discrimination affected 469 (64%) in applying for work, training, or education and 402 (55%) looking for a close relationship; 526 (72%) felt the need to conceal their diagnosis. Over a third of participants anticipated discrimination for job seeking and close personal relationships when no discrimination was experienced. Rates of both anticipated and experienced discrimination are consistently high across countries among people with mental illness. Measures such as disability discrimination laws might, therefore, not be effective without interventions to improve self-esteem of people with mental illness.