Two decades and counting: The enduring legacy of the Attribution Questionnaire

Luca Pingani; Erika De Marco; Sara  Evans-Lacko; Mattia Marchi; Matteo Meloni; Nicolas  Rüsch; Gian Maria Galeazzi

doi:10.23750/abm.2026.16883

Two decades and counting: The enduring legacy of the Attribution Questionnaire

Authors

Luca Pingani Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Dipartimento ad Attività Integrata Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
Erika De Marco Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
Sara Evans-Lacko Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
Mattia Marchi Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Dipartimento ad Attività Integrata Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
Matteo Meloni Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
Nicolas Rüsch Department of Psychiatry II, Ulm University and BKH Günzburg, Germany
Gian Maria Galeazzi Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Dipartimento ad Attività Integrata Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy

Keywords:

Mental Health Stigma; Attribution Questionnaire; Discrimination; Public Perception; Structural Equation Modeling

Abstract

Background and aim: This study examines the psychometric properties of three versions of the Attribution Questionnaire (AQ) in an Italian context. The AQ is a widely used tool for assessing public stigma toward mental illness, a phenomenon that profoundly affects individuals, their quality of life, and healthcare policies. The three versions analyzed include the AQ-21 (2003), comprising six domains (Personal Responsibility, Fear, Pity, Anger, Helping, Coercion/Segregation); the AQ-26 (2008), reorganized into six factors (Fear/Dangerousness, Help/Interaction, Responsibility, Forced Treatment, Empathy, Negative Emotions); and the Italian AQ-27, an expanded version with nine domains.

Methods: A total of 233 participants, recruited via snowball sampling, completed the AQ-27-I. Confirmatory Factor Analysis and Structural Equation Modeling were used to evaluate the fit of the AQ models and to explore causal relationships between latent variables within the best-fitting model.

Results: All three AQ versions demonstrated acceptable psychometric properties, with the AQ-27 emerging as the most robust due to its more detailed structural configuration. Analysis of AQ-27-I identified two distinct models: the personal responsibility model and the dangerousness model. The former showed that attributing responsibility for mental distress to individuals is associated with anger and a paradoxical combination of desires to help and segregate those individuals. The latter confirmed that perceiving individuals with mental illness as dangerous leads to heightened fear and increased social avoidance.

Conclusions: The findings confirm the AQ-27’s reliability in assessing public stigma and emphasize the importance of exploring interactions between its domains. A better understanding of stigma dynamics could enhance targeted interventions.

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