Anticipated and experienced stigma and discrimination in the workplace among individuals with major depressive disorder in 35 countries: qualitative framework analysis of a mixed-method cross-sectional study.

OBJECTIVES: Workplace stigmatisation and discrimination are significant barriers to accessing employment opportunities, reintegration and promotion in the workforce for people with mental illnesses in comparison to other disabilities. This paper presents qualitative evidence of anticipated and experienced workplace stigma and discrimination among individuals with major depressive disorder (MDD) in 35 countries, and how these experiences differ across countries based on their Human Development Index (HDI) level. DESIGN: Mixed-method cross-sectional survey. PARTICIPANTS, SETTING AND MEASURES: The qualitative data were gathered as part of the combined European Union Anti-Stigma Programme European Network and global International Study of Discrimination and Stigma Outcomes for Depression studies examining stigma and discrimination among individuals with MDD across 35 countries. Anticipated and experienced stigma and discrimination were assessed using the Discrimination and Stigma Scale version 12 (DISC-12). This study used responses to the open-ended DISC-12 questions related to employment. Data were analysed using the framework analysis method. RESULTS: The framework analysis of qualitative data of 141 participants identified 6 key 'frames' exploring (1) participants reported experiences of workplace stigma and discrimination; (2) impact of experienced workplace stigma and discrimination; (3) anticipated workplace stigma and discrimination; (4) ways of coping; (5) positive work experiences and (6) contextualisation of workplace stigma and discrimination. In general, participants from very high HDI countries reported higher levels of anticipated and experienced discrimination than other HDI groups (eg, less understanding and support, being more avoided/shunned, stopping themselves from looking for work because of expectation and fear of discrimination). Furthermore, participants from medium/low HDI countries were more likely to report positive workplace experiences. CONCLUSIONS: This study makes a significant contribution towards workplace stigma and discrimination among individuals with MDD, still an under-researched mental health diagnosis. These findings illuminate important relationships that may exist between countries/contexts and stigma and discrimination, identifying that individuals from very high HDI countries were more likely to report anticipated and experienced workplace discrimination.

The Capabilities Questionnaire for the Community Mental Health Context (CQ-CMH): A measure inspired by the capabilities approach and constructed through consumer-researcher collaboration.

OBJECTIVE: The involvement of people with psychiatric disabilities in research and service evaluation has traditionally been rare, especially in the construction of outcome measures. This study documents a collaborative process with consumers from 2 Portuguese community mental health services in the construction of the Capabilities Questionnaire for the Community Mental Health context (CQ-CMH). The measure is inspired by Nussbaum's capabilities approach and aims to measure consumers' capabilities when supported by the community mental health services. METHOD: Focus groups with 50 consumers from 2 programs generated data about their gains from and goals for participation in the programs. A Steering Committee-comprising 3 consumers and 2 researchers-analyzed the data, generated a list of items, sorted them according to Nussbaum's list of capabilities, and developed a rating scale. To check face validity, the questionnaire was tested with 15 consumers. RESULTS: The collaborative process led to the transformation of traditional research roles, the promotion of empowerment to participants, the ecological validity of the results, and a cultural adaptation of Nussbaum's list to the context of the study. The resulting CQ-CMH is composed of 104 items organized by 10 capabilities, and 1 open-ended question about service improvements. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The capabilities approach and the collaborative process undertaken both support the exercise of choice and control by people with psychiatric disabilities. The capabilities measure-constructed by consumers-may be used as an outcome measure in service evaluation. The questionnaire will undergo further testing of its validity and psychometric qualities.

Properties of the Portuguese version of the empowerment scale with mental health organization users.

BACKGROUND: This study examines the reliability and validity of the Portuguese version of the Empowerment Scale (ES) to be used in the community/psychosocial mental health field. Authors also reviewed the properties of the development and cross-cultural adaptation of the ES. Because mental health services are required to encourage empowerment and recovery-oriented interventions, adequate empowerment-oriented outcome measures are needed to evaluate services and study interventions across countries. METHODS: The current research was part of a larger research project with 213 participants. A confirmatory factor analysis (CFA) was conducted to observe the ES's construct-related validity, and a reliability analysis for internal consistency. The ES concurrent validity with the recovery and psychiatric symptoms measures was also assessed using the Pearson's correlation coefficient. RESULTS: The CFA supported the five-factor configuration for the refined model of measure as satisfactory. The Portuguese version of the ES presented an overall satisfactory reliability (α = .79) and was positively correlated with personal recovery (r = .71) and inversely with psychiatric symptoms (r = -.22). CONCLUSIONS: The overall scale was considered reliable and valid to be used by Portuguese researchers and practitioners to evaluate empowering interventions in mental health services. Furthermore, in the effort to increase ES construct-related validity, this article suggests further improvements to enhance the empowerment measure.