People with disabilities make up over one fifth of the population in the United States. These individuals experience ableism in a variety of forms, and this can result in negative educational, social, health, and employment outcomes. One way in which ableism is perpetuated is through microaggressions, which have been referred to as “death by a thousand paper cuts.” This study operationalizes and measures the construct of ableist microaggressions by developing an Ableist Microaggression Scale (AMS-65), and then uses this scale to examine the relationship between ableist microaggressions and the mental health of adults with disabilities using the Mental Health Inventory-18 (MHI-18).
The AMS-65 was created through two phases. The first used qualitative interviews of 13 disability connected stakeholders to better understand ableist microaggressions. The researcher then co-created a list of items with the participants, and these items were part of a large cross-sectional survey (N=984). Exploratory and confirmatory factor analysis were used in the scale development analysis, as was independent sample t-tests examining differences between disabled and non-disabled individuals. Following this scale creation, a second survey was conducted among disabled adults (N=311). Mean scores on the AMS-65 and MHI-18 (and sub-scales of these scales) were correlated to assess the relationship between the experiences of ableist microaggressions and the mental health outcomes of adults with disabilities.
Using psychometric techniques and a split sample cross validation, the initial 110 item scale was reduced down to 65 items with two sub-scales; Interpersonal and Disability in Society, overall Cronbach’s Alpha AMS-65 = .98. Disabled participants scored significantly higher than non-disabled participants; t(974) = 22.70, p < .001, with disabled individuals receiving higher scores (M=2.52, SD=.81) than non-disabled participants (M=1.48, SD=.42), providing evidence of construct validity. With the secondary survey of just disabled adults, the mean AMS-65 scores and the mean total MHI-18 scores were correlate; r(269) = -.19, p < .001. Regarding the MHI-18 sub-scales, the means on the depression (r(273) = -.15, p < .05), anxiety (r(275) = -.19, p < .01) and behavior control (r(274) = -.24, p < .001) sub-scales were all correlated with means scores on the AMS-65. When participants with mental health disabilities/impairments were removed from the full analysis, correlations increased, and the positive affect subscale also was negatively correlated with the AMS-65. There were also significant findings between visibility of disability and experiences of ableist microaggressions.
Social workers and other human services professionals need to better understand the connection between the experiences of ableist microaggressions and the mental health of their clients with disabilities, especially as there is currently little in the way of interventions or support to help people with disabilities engage in an ableist work. Additionally, findings suggest the need further research on these exhibited relationships and potential interventions to support disabled adults. Finally, future research should further test and validate the AMS-65 with different methods (paper or in person versus the Internet), and with different sub-sets of the disabled population to better understand the nuances of measuring ableist microaggressions.