Development and Preliminary Validation of a Comprehensive, International Measure of Beliefs about the Causes of Mental Illness: The Mental Illness Attribution Questionnaire

Abstract The study of mental illness attributions, or beliefs about the causes of mental illness, is well-documented and ongoing in the academic literature. Attributions have traditionally been dichotomized along four dimensions based on their locus, controllability, specificity, and stability and have been associated with a wide variety of thoughts, emotions, beliefs, and actions related to mental illness. However, more recent studies have introduced a new cross-cultural model incorporating lay beliefs about the specific biological, emotional, social, and spiritual causes of mental health problems. The present research outlines the design and initial validation of a comprehensive, international measure of causal beliefs using this new model, the Mental Illness Attribution Questionnaire (MIAQ). The four-stage research project included item formulation, piloting, identification of factor structure, qualitative rating tasks, and initial validation with a sample of 680 international students representing 94 nations. Factors captured causes related to supernatural forces, social/stress, lifestyle, physical health, substance use, heredity/biology, and personal weakness. This structure was tested for model fit using confirmatory factor analysis across three vignette conditions – one each describing a man with schizophrenia, depression, or alcoholism – with further examination yielding strong test-retest reliability and promising convergent, discriminant, and cultural validity data. Taken together, these results provide tentative support for the reliability and validity of the MIAQ as a comprehensive measure of seven categories of mental illness attribution. The measure was validated using existing standards for international scale development and has strong potential for understanding attribution and stigmatizing behavior across cultures.