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

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.

The role of moral explanations and structural inequalities in experiences of mental illness stigma in Northern Minas Gerais, Brazil.

The process of stigmatization within different cultural contexts has long been viewed as essential in understanding the course and outcomes of mental illness. However, little research has examined which cultural constructs and categories are used to explain mental illness, and how they contribute to the way people with mental illness experience stigma and social exclusion, as well as how these beliefs affect healthcare practices. This study examines meanings ascribed to mental illness and experiences of stigma among four groups in urban settings of Minas Gerais, Brazil: persons with mental illness; their families; members of the lay public; and health professionals working at an alternative community-based psychosocial treatment service or a local university hospital. Qualitative methods, including semi-structured interviews and participant observation, were conducted with a purposive sample of 72 participants. Data were analyzed through content analysis. The findings suggest that stigma and discrimination are intrinsically rooted in a systemic process of social exclusion generated by meanings ascribed to mental illness and the structural vulnerabilities of the mental healthcare system. The findings further suggest that structural inequality is a powerful factor behind lay concepts of mental illness and that this is particularly harmful because it reinforces personal blame attributions instead of addressing the hidden structural forces that contribute to mental illness. The study highlights the subtle interrelations between cultural beliefs and structural vulnerabilities that should be addressed in mental health policy in order to diminish the effects of stigma on people with mental illnesses.

"Ele é igual aos outros pacientes": percepções dos acadêmicos de Odontologia na clínica de HIV/Aids / "He is like the other patients": perceptions of dentistry students in the HIV/AIDS clinic / "Él es igual a los demás pacientes": percepciones de los académicos de Odontología en la clínica de VIH/sida

Este estudo buscou conhecer  expectativas e percepções dos acadêmicos de Odontologia da Universidade Estadual de Montes Claros, MG, Brasil, em relação ao atendimento aos pacientes com HIV/Aids. Utilizaram-se observação participante e entrevistas semiestruturadas com nove acadêmicos, sendo identificadas três categorias de análise: ”A expectativa do atendimento na clínica de HIV/Aids”, “O medo de infectar-se” e “Mudança de comportamento”. Percebeu-se que, anterior ao contato com os pacientes, as caracterizações construídas pelos acadêmicos eram estereótipos sociais, como: pessoas magras, homossexuais masculinos e aspecto deprimido. O medo foi observado pela tendência em superestimar os riscos de transmissão, mudando os comportamentos em relação à biossegurança. A etnografia proporcionou perceber a importância da prática clínica odontológica no cotidiano acadêmico, aliada à biossegurança no rompimento dos paradigmas e preconceitos com o paciente com HIV/Aids...

This study sought to ascertain the perceptions and expectations of dentistry students at the State University of Montes Claros. MG, Brazil, regarding care provided for HIV/AIDS patients. Participant observation and semi-structured interviews with nine students were used and three categories were identified: “Expectations from care provided at the HIV/AIDS clinic”, “Fear of becoming infection” and “Behavioral change”. It was seen that, before the students came into contact with patients, they constructed characterizations based on social stereotypes such as skinny individuals, male homosexuals and depressed appearance. Fear was observed through the tendency to overestimate the risks of transmission, with changes in behavior in relation to biosafety. Through using ethnographic methodology, the importance of dental clinical practice for students’ day-to-day routine could be seen, along with biosafety for breaking through paradigms and prejudice towards HIV/AIDS patients...

Se buscó conocer las expectativas y percepciones de los académicos de Odontología de la Universidad Estadual de Montes Claros, MG, Brazil, en lo que se refiere a la atención a los pacientes con VIH/Sida. Se utilizaron observación participativa y entrevistas semi-estructuradas con nueve académicos y a partir del análisis se identificaron tres categorías: “La expectativa de la atención en la clínica de VIH/Sida”, “El miedo de infectarse” y el “Cambio de comportamiento. Antes del contacto con los pacientes, las caracterizaciones construidas por los académicos eran estereotipos sociales. El miedo se observó por la tendencia de sobreestimar los riesgos de transmisión, cambiando los comportamientos en relación a la bioseguridad. La etnografía permitió percibir la importancia de la práctica en la clínica odontológica, aliada a la bioseguridad en la ruptura de los paradigmas y prejuicios con el paciente con VIH/Sida...

Aids em área rural de Minas Gerais: abordagem cultural / AIDS in rural Minas Gerais state (Southeastern Brazil): a cultural approach

OBJETIVO: Descrever comportamentos facilitadores à exposição ao HIV/Aids em população rural. MÉTODOS: Pesquisa qualitativa realizada com 52 pacientes atendidos em ambulatório de DST/Aids, em 2002-2003. Foram feitas entrevistas abertas e semi-estruturadas em profundidade com os participantes (30 homens e 22 mulheres), conduzidas no ambulatório ou em suas residências, em municípios rurais da região norte de Minas Gerais. As entrevistas foram transcritas, analisadas em categorias: concepções da doença, trabalho, sociabilidade, informações prévias sobre a doença, modo de vida. A interpretação dos resultados baseou-se na análise de conteúdo. RESULTADOS: Na percepção dos entrevistados, a Aids era "doença de cidade grande" e de "forasteiro", desvinculada da cultura local. Todos os entrevistados se infectaram através de atividades heterossexuais ou homossexuais. A migração rural-urbana é aspecto relevante da infecção do HIV na região devido ao deslocamento em busca de trabalho. CONCLUSÕES: As noções populares de doença contribuem para vulnerabilidade à infecção pelo HIV. É necessário apreender noções culturais locais para melhor entender as categorias de pensamento dessa população, enfocando essas noções ao divulgar informações sobre a doença.

OBJECTIVE: To describe behaviors facilitating HIV/AIDS exposure in rural population. METHODS: A qualitative study was conducted comprising 52 patients who attended a STD/AIDS outpatient clinic in 2002 and 2003. In-depth open and semi-structured interviews were carried out with subjects (30 males, 22 females) at the clinic or at home in rural municipalities in the northern area of Minas Gerais state, Southeastern Brazil. Interviews were transcribed and analyzed considering categories such as disease, work, social life, prior HIV/AIDS knowledge, and lifestyle. Content analysis was used for result interpretation. RESULTS: Interviewees perceived AIDS as a "big city disease", an "outsider's disease", dissociated from local culture. They were all infected through either heterosexual or homosexual sex. Rural-urban migration is a major factor for HIV infection in the area as people migrate to search for jobs. CONCLUSIONS: Popular beliefs about HIV/AIDS disease contributes to HIV vulnerability of this population. There is a need to apprehend their cultural beliefs to better understand their ways of thinking and to focus on these local beliefs when disseminating HIV/AIDS information.

[AIDS in rural Minas Gerais state (Southeastern Brazil): a cultural approach]. / Aids em área rural de Minas Gerais: abordagem cultural.

OBJECTIVE: To describe behaviors facilitating HIV/AIDS exposure in rural population. METHODS: A qualitative study was conducted comprising 52 patients who attended a STD/AIDS outpatient clinic in 2002 and 2003. In-depth open and semi-structured interviews were carried out with subjects (30 males, 22 females) at the clinic or at home in rural municipalities in the northern area of Minas Gerais state, Southeastern Brazil. Interviews were transcribed and analyzed considering categories such as disease, work, social life, prior HIV/AIDS knowledge, and lifestyle. Content analysis was used for result interpretation. RESULTS: Interviewees perceived AIDS as a "big city disease", an "outsider's disease", dissociated from local culture. They were all infected through either heterosexual or homosexual sex. Rural-urban migration is a major factor for HIV infection in the area as people migrate to search for jobs. CONCLUSIONS: Popular beliefs about HIV/AIDS disease contributes to HIV vulnerability of this population. There is a need to apprehend their cultural beliefs to better understand their ways of thinking and to focus on these local beliefs when disseminating HIV/AIDS information.