Examining Attitudes Towards Mental Health Diagnoses: A Q-Methodology Study

Figures & data

Figure 1. Sorting Grid.

Table 1. Participant Factor Loadings (2.dp) and Relationship to Mental Health.

Participant	Relationship with Mental Health	Factor 1	Factor 2	Factor 3	Factor 4
1	Accessed services / worked in services / academic	.67	−.18	.35	.37
2	Worked in services / academic	.83^a	−.11	.22	.12
3	Accessed services / worked in services	.03	.08	.05	.13
4	Worked in services	.31	.22	.13	.40^a
5	Accessed services / worked in services	.79^a	−.08	.29	.08
6	Worked in services	.68	−.01	.31	.34
7	Worked in services	−.12	.65^a	.03	.14
8	Worked in services	.54^a	.01	.26	.27
9	Worked in services	.45	.14	.28	.50
10	Accessed services / worked in services	−.09	.60	−.34	.43
11	Accessed services / worked in services / academic	.65^a	−.02	−.29	.19
12	Worked in services	.80^a	−.17	.20	.03
13	Worked in services	−.07	.72^a	.16	.23
14	Worked in services	.83^a	−.04	−.02	.15
15	Worked in services / academic	.33	.25	−.10	.63^a
16	Accessed services / worked in services	.74	.03	.44	.22
17	Accessed services	.15	.33	.44^a	.21
18	Accessed services / worked in services	.36	.43	−.17	.59
19	Accessed services / worked in services	−.03	.62	.02	.36
20	Worked in services	−.11	.60^a	.05	.24
21	Accessed services / worked in services	.56	−.20	.56	.03
22	Accessed services / worked in services	.28	.62^a	−.04	.05
23	Accessed services	.81^a	−.04	.14	−.18
24	Accessed services	.73^a	−.27	.26	−.10
25	Accessed services / worked in services	.52	.01	.01	.48
26	Accessed services	−.35	.77^a	−.24	.19
27	Accessed services	.09	.14	.11	.65^a
28	Accessed services / worked in services / academic	.16	.42	.11	.57
29	Worked in services	.70^a	−.12	−.00	.06
30	Worked in services	−.05	.38	.17	.31
31	Accessed services	−.19	.56	−.30	.55
32	Accessed services / worked in services	−.02	.30	.12	.56^a
33	Worked in services	.42	.47	.30	.18
34	Accessed services / worked in services	.57	−.11	.63	.03
35	Accessed services / worked in services / academic	.26	.06	.59^a	.10
36	Academic	.16	.35	−.09	.62
37	Accessed services	−.15	.59^a	.08	.03
38	Accessed services	−.25	.57^a	.01	.31
39	Accessed services	−.29	.40	−.04	.34
40	Accessed services / worked in services	−.09	.51^a	.12	.28
41	Accessed services / worked in services	.47	.19	.09	.55

Bold denotes significant factor loadings (p < .01). ^aDenotes exemplars.

Table 2. Statement Rankings for the Idealised Q-sorts across Viewpoints. Distinguishing Statements for a Viewpoint are Shown in Bold.

Statement	Factor 1	Factor 2	Factor 3	Factor 4
1. MH diagnoses suggest relatives are to blame for the diagnosed person’s distress	−2	−5	−3	−4
2. Professionals are good at agreeing on who meets diagnostic criteria for specific MH diagnoses	−3	0	−3	−3
3. MH diagnoses are needed because some symptoms are only partly explained by a person’s experiences	−4	+4	−1	0
4. MH diagnoses help people to get support and adjustments associated with work / school	+2	+4	+1	+1
5. MH diagnoses consume a person’s identity	+3	−2	+1	−2
6. MH diagnoses help people to understand their difficulties	−1	+5	0	+2
7. MH diagnoses have a positive impact on various areas of a person’s life	−3	+1	−2	−1
8. MH diagnoses enable oppressive practices (e.g. sectioning and restraint)	+4	−2	+3	0
9. MH diagnoses accurately represent the symptoms people experience	−4	−1	−4	−1
10. It is problematic to apply ‘western’ MH diagnostic criteria to people from ‘non-western’ cultures or faiths	+2	−1	+2	+3
11. MH diagnoses make it harder for a person to see similarities between themselves and others who have different MH diagnoses	0	−4	−1	−1
12. MH diagnoses make others take a person’s distress more seriously	0	+3	−2	+3
13. MH diagnoses highlight an individual’s strengths and resources	−4	−3	+1	−3
14. MH diagnoses make it harder for people to access services offering financial, social, or housing support	0	−4	−2	−1
15. Others interpret everything about a diagnosed person through the lens of their diagnosis	+1	0	+3	0
16. MH diagnoses are needed for research	0	+2	0	+3
17. The initial relief that people may feel when they are given a MH diagnosis is short-lived	+1	−1	0	+1
18. MH diagnoses offer more benefits to services than to service users	+3	−3	−1	−1
19. MH diagnoses support people to get the right medication	−3	+3	0	+3
20. People from different racial backgrounds get different diagnoses because of cultural / racial biases within the diagnostic system	+3	−1	+4	+4
21. Some MH diagnoses are more stigmatising than others	+3	+4	+5	+4
22. MH diagnoses remove blame from the diagnosed person	0	0	−1	−2
23. MH diagnoses help people to feel they have a shared experience with others	+1	+1	+1	+4
24. Diagnostic criteria imply there are normal and abnormal ways of thinking, feeling, and behaving	+1	0	+4	+2
25. MH diagnoses enable professionals to safeguard the diagnosed person from risk of abuse	0	+1	−2	+1
26. People use their MH diagnoses to account for their behaviour	+2	+2	+2	0
27. MH diagnoses help people to manage their distress	−1	+2	−5	+1
28. MH diagnoses give people hope for recovery / change	−2	+3	+2	+2
29. MH diagnoses support psychological understandings about a person’s distress	−1	+5	−3	+1
30. Getting the correct diagnosis is more important than the relationship between service user and professional	−3	−2	0	−5
31. MH diagnoses are well supported by biological evidence	−5	+1	+2	−1
32. MH diagnoses medicalise human responses to distressing circumstances	+5	−2	−2	+2
33. MH diagnoses are more problematic for people whose culture, religion, or family view MH as a taboo or stigmatising subject	+1	+2	+4	+2
34. MH diagnoses offer a short-hand description which is easily understood by others	0	−2	−1	+5
35. MH diagnoses tell us about the likely course and outcome of someone’s distress	−1	0	−4	−1
36. MH diagnoses support people to get the right talking therapy for them	−2	+3	−1	+1
37. MH diagnoses are needed for the structuring, funding, and management of mental health services	−2	+3	0	+4
38. Loved ones become less understanding and less supportive because of a MH diagnosis	0	−3	−3	−3
39. Diagnosing someone with a MH label increases the chance that they will receive more MH diagnoses in the future	+3	0	+2	0
40. MH diagnoses support professionals to empathise with service users	−2	0	−2	−4
41. MH diagnoses support the financial interests of pharmaceutical companies	+5	−3	0	−2
42. Giving a MH diagnosis is one of the most damaging things a professional can do to a person	+2	−5	+2	−5
43. MH diagnoses offer descriptions rather than explanations of people’s problems	+4	−1	0	+3
44. MH diagnoses help us to see the link between distress and discrimination	−4	−2	−4	−2
45. MH diagnoses support collaboration between professionals and service users	−2	+2	−3	−2
46. MH diagnoses are just as valid as diagnoses in the rest of medicine	−5	+2	+4	0
47. MH diagnoses help to ensure that professionals are appropriately trained for the people they work with	−1	+4	+1	+2
48. MH diagnoses act as a barrier to professionals understanding how individuals make sense of their experiences	+2	−1	+3	0
49. Diagnostic criteria help to ensure people are discharged from services when they no longer need support	−1	−1	−5	−2
50. We need to be certain about the cause of MH problems for diagnostic labels to be useful	+1	+1	0	−4
51. MH diagnoses cause people to experience stigma, discrimination, and exclusion	+1	+1	+5	0
52. MH diagnoses are based on made up categories and diagnostic criteria	+4	−4	−4	+1
53. MH diagnoses make it difficult to see a link between adversity and distress	+4	−3	+3	−3
54. Men and women get different diagnoses because of gender biases within the diagnostic system	+2	0	+3	+5
55. MH diagnoses make it harder for people to access mental health services	0	−4	−1	−4
56. MH diagnoses help people to accept they need support	−1	+1	+1	0
57. If we reject MH diagnoses, we reject the role biology plays in a person’s distress	−3	0	+1	−3

Note: “MH” = mental health.

Data availability statement

A dataset of individual ranking of statements can be shared with researchers for reanalysis provided the researchers have obtained appropriate ethical approval and any reanalysis is deemed to fit with the aims of the original study that participants consented to take part in.