title: The development and validation of the Questionnaire on Anticipated Discrimination (QUAD).
abstract: BACKGROUND
  The anticipation of mental health-related discrimination is common amongst people with mental health problems and can have serious adverse effects. This study aimed to develop and validate a measure assessing the extent to which people with mental health problems anticipate that they will personally experience discrimination across a range of contexts.
  
  
  METHODS
  The items and format for the Questionnaire on Anticipated Discrimination (QUAD) were developed from previous versions of the Discrimination and Stigma Scale (DISC), focus groups and cognitive debriefing interviews which were used to further refine the content and format. The resulting provisional version of the QUAD was completed by 117 service users in an online survey and reliability, validity, precision and acceptability were assessed. A final version of the scale was agreed and analyses re-run using the online survey data and data from an independent sample to report the psychometric properties of the finalised scale.
  
  
  RESULTS
  The provisional version of the QUAD had 17 items, good internal consistency (alpha = 0.86) and adequate convergent validity as supported by the significant positive correlations with the Stigma Scale (SS) (r = 0.40, p < 0.001) and the Internalised Stigma of Mental Illness Scale (ISMI) (r = 0.40, p < 0.001). Three items were removed due to low endorsements, high inter-correlation or conceptual concerns. The finalised 14 item QUAD had good internal consistency (alpha = 0.86), good test re-test reliability (ρ(c) = 0.81) and adequate convergent validity: correlations with the ISMI (r = 0.45, p < 0.001) and with the SS (r = 0.39, p < 0.001). Reading ease scores indicated good acceptability for general adult populations. Cross-replication in an independent sample further indicated good internal consistency (alpha = 0.88), adequate convergent validity and revealed two factors summarised by institutions/services and interpersonal/professional relationships.
  
  
  CONCLUSIONS
  The QUAD expanded upon previous versions of the DISC. It is a reliable, valid and acceptable measure which can be used to identify key life areas in which people may personally anticipate discrimination, and an overall tendency to anticipate discrimination. It may also be useful in planning interventions aimed at reducing the stigma of mental illness.
authors.affiliation: Health Service and Population Research Department, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. jheanell.gabbidon@kcl.ac.uk.
authors.forename: Jheanell
authors.initials: J
authors.lastname: Gabbidon
authors.forename: Elaine
authors.initials: E
authors.lastname: Brohan
authors.forename: Sarah
authors.initials: S
authors.lastname: Clement
authors.forename: R Claire
authors.initials: RC
authors.lastname: Henderson
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
mesh_terms: D000328:Adult; D000368:Aged; D004644:Emotions; D005260:Female; D017144:Focus Groups; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008603:Mental Health; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D008875:Middle Aged; D011287:Prejudice; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012107:Research Design; D057545:Social Stigma; D011795:Surveys and Questionnaires