AimsMental wellbeing, encompassing dimensions of hedonia (feeling good) and eudaimonia (functioning well), is considered a valuable resource for individuals and communities. The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS; Tennant et al., 2007), a 14-item positively worded measure of mental wellbeing, has been extensively psychometrically validated within the UK and cross-culturally. However, it is yet to be validated for use with individuals with intellectual disabilities, a priority given the paucity of measures of mental wellbeing for this population. The aim of this study was to assess the psychometric properties of a newly adapted version of the WEMWBS and the Short 7-item WEMWBS (SWEMWBS) for individuals with mild to moderate intellectual disabilities (WEMWBS-ID/SWEMWBS-ID).MethodThe WEMWBS item wordings and response options were revised by clinicians and researchers expert in the field of intellectual disability, and a visual aid was added to the scale. The adapted version was reviewed by 10 individuals with intellectual disabilities. Individuals aged 16+ with mild to moderate intellectual disabilities were recruited using volunteer sampling. Data from three studies conducted in the UK were collated to evaluate the psychometric properties of the WEMWBS-ID (n=96) and additional data from a study conducted in Canada (n=27) was used in addition to the UK data to evaluate the SWEMWBS-ID (n=123). The WEMWBS-ID was administered by researchers via an online meeting using the screenshare function. A subsample (n=22) completed the scale twice for test-retest reliability. Furthermore, as a relationship between wellbeing and self-esteem has been demonstrated in previous research, 95 of the UK participants also completed an adapted 6-item version of the adapted Rosenberg Self-Esteem Scale (RSES) to assess convergent validity.ResultsThe WEMWBS-ID demonstrated good internal consistency (α=0.86), excellent test-retest reliability (ICC=0.88) and good convergent validity (r=0.68) with the RSES. Confirmatory factor analysis supported the hypothesised one-factor structure and the measure demonstrated an adequate model fit. The SWEMWBS-ID showed poorer internal consistency (α=0.67), good test-retest reliability (ICC=0.67) and good convergent validity (r=0.61). The results from the confirmatory factor analysis indicated a good model fit.ConclusionsThe results from this initial evaluation of the WEMWBS-ID and SWEMWBS-ID suggest that the scales have promising psychometric properties, when administered by a researcher to individuals with mild to moderate intellectual disabilities. The generalisability of the findings is limited by the sample size and sampling strategy and a further exploration of the scales with larger samples is warranted. Suggestions for future research are discussed.

There is a dearth of studies that have examined the attitudes of society toward people with intellectual disabilities (IDs) on a global scale. This study set out to gauge the extent to which ID continues to be stigmatized and to which initiatives are in place to increase their inclusion and tackle stigma around the globe. Data were collected using a web survey from 667 experts and organizations in the (intellectual) disability field pertaining to 88 countries and covering all world regions. Information about the study was disseminated by four multinational disability organizations, and the survey was available in five languages. Findings and responses indicated that the general public in many parts of the world broadly support the fundamental principle of inclusion of children and adults with IDs, yet negative attitudes persist. High levels of stigma and denial of fundamental rights still appeared a reality in many places. Initiatives to tackle stigma appeared patchy and least in evidence where they were most needed. In many parts of the world the life chances of people with IDs often appear still very poor, and support and advocacy almost entirely their families' responsibility. More needs to be done globally to reduce the stigma associated with ID and to promote active engagement and regular social interactions between persons with IDs and their fellow citizens without IDs.

BACKGROUNDIntellectual disability research has concentrated on self-reported explicit attitudes with little focus on implicit attitudes. Such attitudes are evaluations which occur with or without conscious awareness, respectively. This investigation examined participants' (N = 234) attitudes towards individuals with intellectual disabilities with reference to participants' gender, age, level of education, frequency of contact and closeness.METHODUK adults completed explicit (ATTID) and implicit attitude (ST-IAT) measures, and provided demographics via an online survey.RESULTSParticipant demographics predicted explicit attitudes-with differing cognitive, affective and behavioural associations. Contact frequency was most significant. Implicit attitudes were not predicted, evidencing implicit-explicit attitude differences.CONCLUSIONSThe results encourage more implicit-explicit attitude relationship research regarding disability. The associations between demographics, contact and implicit attitudes should be explored further. Research should question whether implicit attitudes reflect participants' true beliefs-denoting less importance to demographics-or whether they reflect wider societal values rather than individuals' attitudes.

Stigma as an important public health concern has been recognised in relation to conditions as diverse as HIV, leprosy, and mental illness. Little attention has been paid to date, however, to the pernicious effects of stigma on the wellbeing and life chances of one heavily stigmatised population: people with intellectual disabilities. Of the 15 billion people globally affected by disability,1WHO & World BankWorld Report on Disability. WHO, Geneva2011Google Scholar an estimated 2%, or 300 million, have an intellectual disability. They experience the same disadvantages and inequities as do people with other types of disabilities, but often face the additional disadvantage of having their needs inadequately understood and met, having limited recourse to assert their rights, and being poorly represented, including within the Disability Rights movement. The majority live in low-income and middle-income countries where there is little impetus or resource to assess or diagnose their struggles in meeting the cognitive, social, and economic demands of everyday life. Whether labelled intellectually disabled or not, they are generally among the most marginalised groups within society, experiencing high levels of health, social, and financial inequities.1WHO & World BankWorld Report on Disability. WHO, Geneva2011Google Scholar, 2Emerson E Hatton C Health Inequalities and People with Intellectual Disabilities. Cambridge University Press, Cambridge2013Crossref Scopus (136) Google Scholar The 2008 UN Convention on the Rights of Persons with Disabilities (CRPD) requires governments to raise awareness of disability and challenge prejudice and discrimination (Article 8), and to ensure equal and effective legal protection against discrimination (Article 5). Earlier global comparative data on attitudes to intellectual disability is limited to a study from 2003, which included ten countries across four continents, and to a 2007 WHO Atlas, focusing on resources but including some indicators of attitudes.3Siperstein G Norins J Corbin S Shriver T Multinational study of attitudes toward individuals with intellectual disabilities. Special Olympics, Washington, DC2003Google Scholar, 4WHOAtlas of global resources for persons with intellectual disabilities. World Health Organization, Geneva2007Google Scholar To determine current issues related to persons with intellectual disabilities, we undertook a global study, examining government action as reported to the CRPD Committee and gathering data from 667 disability experts and organisations from 88 countries regarding the extent to which low awareness of intellectual disability and stigma are continuing concerns, and what is being done to tackle these concerns.5Scior K Hamid A Hastings R et al.Intellectual disabilities: raising awareness and combating stigma—a global review. University College London, London2015https://www.ucl.ac.uk/ciddr/publicationsGoogle Scholar The results indicate that in many (mostly high-income and upper-middle-income) countries the general public agrees with inclusion in principle, but often view it as impractical and unachievable. A "not in my own backyard" attitude and a fear that inclusion of people with intellectual disabilities may affect the resources and achievements of those without disabilities, particularly in school and work environments, persists. Of equal concern, in many middle-income and low-income countries, children and adults with intellectual disabilities still face high levels of stigma and denial of fundamental rights and freedoms. Their invisibility is accompanied by low expectations of people with intellectual disabilities—in many countries they are still widely viewed as incapable, unable to live independently or to contribute to society. Furthermore, throughout Africa and Asia, in former states of the Soviet Union, and in some parts of South and Central America, an active desire to segregate them from society continues because of deep rooted prejudice and stigmatising beliefs about the causes of intellectual disability. Our data suggest that efforts to combat intellectual disability stigma in such countries are small in number and entirely dependent on parent organisations and non-governmental organisations. The imbalance between the world regions where intellectual disability stigma is of greatest concern and where efforts are underway to tackle such stigma is evident the figure, which categorises interventions reported to us by world region. Our analysis of UN CRPD committee reports indicates that people with intellectual disabilities, despite their substantial numbers, continue to be low priority in government policy and programmes worldwide. Although governments report initiating many programmes to raise disability awareness, these rarely include intellectual disability. Of particular concern, whereas global public awareness of many health conditions and disability issues has grown, public understanding of intellectual disability is still frequently rife with confusion and misconceptions. This poor understanding is due in part to the wide continuum of disabling conditions subsumed under this label and the frequent lack of outward signs of an intellectual disability. However, lack of public education and anti-stigma programmes are at least equally to blame, as is the assumption implicit in disability awareness programme that education about other types of disability will also lead to a better understanding of intellectual disability. In conclusion, there is a need for greater recognition among policy makers and programme leaders of the detrimental effect stigma has on the life chances of children and adults with intellectual disabilities. Findings from our study show that the voice of people with intellectual disabilities is often unheard and their visibility in society and the Disability Rights movement is generally low. Much more action is needed to achieve their equal rights. The crucial role of parent advocates, particularly in low-income and middle-income countries, merits greater support, and greater prominence must be given to self-advocacy as powerful means of reducing stigma. Given the large number of individuals with intellectual disabilities and their families, this is an issue no longer to be ignored. We declare no competing interests. The work reported here was funded by University College London and the Royal Mencap Society.