Brief battery for measurement of stigmatizing versus affirming attitudes about mental illness Patrick W. Corrigan n , Karina J. Powell, Patrick J. Michaels Illinois Institute of Technology, Chicago, IL, USA article info Article history: Received 8 August 2012 Received in revised form 22 September 2013 Accepted 4 December 2013 Available online 18 December 2013 Keywords: Social stigma Psychometrics Public opinion Attitude abstract Decreasing the stigma of mental illness is not sufficient. Rather promoting important ideas, such as recovery, empowerment, and self-determination, is important to increase social inclusion, or more broadly, affirming attitudes. The goal of this article is to evaluate the psychometrics of a battery of measures that assess both stigmatizing and affirming attitudes toward people with mental illnesses. The aforementioned battery was used in four separate RCTs on stigma change with different samples: college students, adults, health care providers, and mental health service providers. Test–retest indices were satisfactory for all samples except for the Empowerment Scale score for the mental health providers. Attribution Questionnaire-9 (AQ-9) scores were significantly and inversely associated with the three affirming attitude scale scores for eight of twelve correlations, with five of these meeting the Bonferroni Criterion. Research on social attitudes and structures needs to incorporate assessment of affirming perspectives about a group and effective anti-stigma programs need to promote social inclusion and affirming attitudes. & 2013 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Advocates and researchers agree; stigma significantly impedes the life opportunities of people with serious mental illness. For this reason, many anti-stigma programs have emerged in the past decade to address public stigma and promote societal inclusion (Hinshaw, 2006; Thornicroft, 2006). Their goal has been to diminish the stereotypes and discrimination that comprise stigma and typically emerge in self-report measures as attitudes (Corrigan and Shapiro, 2010). Yet evaluating stigma is not sufficient; absence of stereotypes does not promote social inclusion (i.e., communities accepting people with psychiatric disabilities, encouraging their goals, and providing appropriate support in the process). The goal of this paper was to test the psychometrics of a brief battery of measures that reflect both stigmatizing and affirming attitudes; a battery that might be used to test the impact of anti-stigma and socially inclusive programs. Researchers have distinguished public stigma (the impact of population-endorsement of the stigmatizing attitudes) from self- stigma (the impact of internalizing those attitudes) (Sartorius and Schulze, 2005). Public stigma, the focus of this paper, has been described in terms of cognitive behavioral structures that have developed out of social psychology: stereotypes, prejudice, and discrimination (Corrigan, 2005; Nelson, 2009). Stereotypes are common beliefs about a social group and, for people with mental illness, include dangerousness and responsibility. Stereotypes are learned by most people in a cultural group and are therefore inescapable. Prejudice is the egregious consequence of stereo- types: people agree with the beliefs (“That’s right. People with mental illness are dangerous.”), leading to emotional reactions (“Because they are dangerous, I fear them.”). Other emotional reactions related to the stereotypes of mental illness are pity and anger. Discrimination is the behavioral consequence and may include social avoidance or endorsement of treatment coercion and institutionalization (Corrigan, 2005; Nelson, 2009). Stigma change programs target stereotypes and their discriminatory consequences. Social attitudes need to reflect affirming perspec- tives about a group as well, including efforts to assess inclusion of the outgroup among the opportunities available to the majority. Social inclusion broadly speaking has been defined as a societal zeitgeist that promotes perceived and real access to the economic, interpersonal, spiritual, and political resources available to all adults that are necessary for obtaining their personal goals (Leff and Warner, 2006; Lloyd et al., 2008). Three important conceptual evolutions in the mental health system – recovery, empowerment, and self-determination – have influenced ideas of social inclusion, or what we more broadly construe as affirming attitudes. Affirm- ing attitudes include notions that people with mental illness recover, that they should determine for themselves life and Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres Psychiatry Research 0165-1781/$ - see front matter & 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.psychres.2013.12.006 n Correspondence to: College of Psychology, Illinois Institute of Technology, 3424 S State Street, Chicago, IL 60616. Tel.: þ1 312 567 6751; fax: þ1 312 567 6753. E-mail address: corrigan@iit.edu (P.W. Corrigan). Psychiatry Research 215 (2014) 466–470