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 CasteleinAneta Alexová, Nathalie Oexle, Patrícia Neves Guimarães, Bouwina Esther Sportel, Chih-Cheng Chang, Jie Li, Chilasagaram Shanthi, Blanca Reneses, Ioannis Bakolis, Sara Evans-Lacko

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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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.

Original languageEnglish
Number of pages11
JournalPsychological Medicine
Publication statusE-pub ahead of print - 30-Mar-2022


  • stigma
  • mental health

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