King's College London

Research portal

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

Research output: Contribution to journalArticlepeer-review

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 & 10 more Aneta Alexová, Nathalie Oexle, Patrícia Neves Guimarães, Bouwina Esther Sportel, Chih-Cheng Chang, Jie Li, Chilasagaram Shanthi, Blanca Reneses, Ioannis Bakolis, Sara Evans-Lacko

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalPsychological Medicine
E-pub ahead of print30 Mar 2022

Bibliographical note

Funding Information: IB is supported by the NIHR Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. GT is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King's College London NHS Foundation Trust, and by the NIHR Asset Global Health Unit award. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. GT also receives support from the National Institute of Mental Health of the National Institutes of Health under award number R01MH100470 (Cobalt study). GT is supported by the UK Medical Research Council in relation to the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards. JL is supported by the programme of community mental health service model in Guangzhou (20161A031002), which was supported by the Health and Family Planning Commission of Guangzhou Municipality. Publisher Copyright: Copyright © The Author(s), 2022. Published by Cambridge University Press.


  • DISCUS_Fullpaper_v3_0(16022022)_accepted

    DISCUS_Fullpaper_v3_0_16022022_accepted.docx, 388 KB, application/vnd.openxmlformats-officedocument.wordprocessingml.document

    Uploaded date:31 Mar 2022

    Version:Accepted author manuscript

King's Authors


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.

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454