Gender of both the respondent and the vignette subject significantly influences stigma attributions measured by the AQ-9, with women receiving more pity and help attributions while men receive more fear, danger, avoidance, and coercion attributions.
Key Findings
Results
Women respondents tended to be more compassionate and perceive more danger or fear toward people with mental health problems, while men respondents expressed more anger or guilt.
Sample consisted of 2,746 adults from the general Spanish population stratified by gender
Respondents completed the Attribution Questionnaire 9 (AQ-9), a measure of mental health stigma
Men's responses aligned with traditional gender roles, specifically expressing more anger or guilt attributions
Analyses of variance (ANOVAs) for independent samples were used to examine differences by respondent gender
Results
The gender of the vignette subject influenced stigma attributions, with female vignettes eliciting more pity and helping intentions, and male vignettes eliciting more fear, danger, avoidance, and coercion.
Three versions of the AQ-9 vignette were used: female gender, male gender, and neutral gender formulations
Participants showed a tendency to feel more pity and help toward women depicted in vignettes
Male vignette subjects were associated with attributions of fear, danger, avoidance, and coercion
Measurement invariance analyses were carried out across vignette gender conditions
Results
The neutral gender vignette generated more segregation attributions compared to gendered vignettes.
Segregation attributions were higher in the neutral vignette condition than in either the male or female vignette conditions
This finding suggests that the traditionally used neutral or male-default framing in stigma instruments may not be equivalent to gendered framings
The study used a cross-sectional design with a stratified sample of 2,746 Spanish adults
Background
Mental health stigma assessment instruments have traditionally used male or gender-neutral questionnaires, potentially biasing measurement.
The AQ-9 (Attribution Questionnaire 9) was adapted into three gendered versions to test the influence of vignette gender
The study was motivated by the observation that assessment of mental health problems has traditionally been conducted with male or gender-neutral questionnaires
The authors argue this represents a methodological gap with implications for validity of stigma measurement
Conclusions
The study recommends taking gender into account when designing stigma assessment instruments, with implications discussed from an intersectional perspective.
The authors discuss implications and recommendations from an intersectional perspective
Findings underline the need to consider both respondent gender and the gender of the person described in vignettes
The cross-sectional design with stratification by gender across a general Spanish population sample (n=2,746) supports generalizability to the adult Spanish population
What This Means
This research suggests that the way mental health stigma is measured can be significantly affected by gender — both the gender of the person being asked questions and the gender of the person being described in the questionnaire scenario. The study gave 2,746 Spanish adults one of three versions of a standard stigma questionnaire (the AQ-9), where the fictional person with a mental health problem was described as either a woman, a man, or in gender-neutral terms. The results showed that women respondents tended to feel more compassion and fear, while men tended to express more anger or guilt — patterns that reflect traditional gender role expectations. When the fictional person in the questionnaire was a woman, respondents were more likely to feel pity and a desire to help; when the fictional person was a man, respondents were more likely to report fear, a sense of danger, and desires to avoid or control that person. Interestingly, the gender-neutral version of the questionnaire produced the highest levels of segregation-type responses.
These findings matter because most mental health stigma questionnaires have historically used male or gender-neutral descriptions, which this study suggests may not capture the full picture of how stigma actually operates. Different groups of people may experience stigma in meaningfully different ways depending on their gender, and instruments that ignore this may give an incomplete or misleading view of the problem. This research suggests that researchers and clinicians designing or using stigma assessment tools should carefully consider whether the gender framing of their instruments might be shaping the responses they receive, and that an intersectional approach — one that considers how multiple social identities interact — is important for accurately understanding mental health stigma.
Clara González-Sanguino, M. A. Castellanos, A. B. Santos-Olmo, S. Zamorano, B. Ausín, Manuel Muñoz. (2026). The Influence of Gender on Measuring Mental Health Stigma. A Cross-Sectional Vignette Study With the Attribution Questionnaire 9.. Psicothema. https://doi.org/10.70478/psicothema.2026.38.07