Early intervention for stigma towards mental illness? Promoting positive attitudes towards severe mental illness in primary school children

Identifying and changing cognitive vulnerability in the classroom: preliminary evaluation of CUES-Ed, a school-based universal cognitive behavioural early intervention service for 7-10 year olds

BACKGROUND

School-based early intervention may alleviate current emotional and behavioural problems, and, by targeting underlying vulnerability, safeguard children's future mental health. Improving on mixed outcomes to date is an international public health priority. CUES-Ed is a classroom-based, clinician-led, universal cognitive behavioural programme for primary school children, designed to promote emotional literacy and regulation. Additionally, CUES-Ed targets cognitive mechanisms implicated in the future development of mental disorder: stigmatising appraisals of emotional expression and of unusual perceptual experiences, and the tendency to jump-to-conclusions (JTC). We report here on fitness for purpose of our in-service assessment of cognitive vulnerability, and change in cognitive vulnerability following CUES-Ed and compared with a naturalistic waitlist.

METHODS

From 05/2017-11/2017, 960 children participated (900 CUES-Ed; 60 naturalistic waitlist). Assessments were completed in whole classes; 732 children provided pre-post data on all measures; 227 were missing data through absence or poor completion (n = 1 declined assessment).

RESULTS

Relationships between baseline cognitive vulnerability measures and their components were consistent with reliable and valid assessment. Cognitive vulnerability reduced from before to after CUES-Ed and compared with the naturalistic waitlist, for JTC (large effects) and stigmatising appraisals (small-medium effects), for all children (ESs pre-post: 0.2-1.0; between-group: 0.1-1.0) and vulnerable subgroups (ESs pre-post: 0.5-1.7; between-group: 0.2-2.0).

CONCLUSIONS

Targeted cognitive vulnerability mechanisms change following CUES-Ed. As stigmatising appraisals and JTC may increase vulnerability to future mental illness, findings suggest a promise in reducing future risk. A formally controlled research study, with longer-term follow-up, is required to test this. Limitations and implications for future evaluation are discussed.

Difference and Disdain as Indicators of the Public Stigma of Mental Illness

ABSTRACT

Viewing a stigmatized group as different from everyone else is believed to be a contentless stigma that leads to disdain. This study tests whether three emotions-intergroup anxiety, anger, and empathy-mediate the path between difference and disdain. Six hundred thirty-eight research participants from MTurk provided valid responses to an online survey via Qualtrics. The survey used standardized measures of difference, disdain, intergroup anxiety, anger, and empathy. The hypothesized path model was tested using structural equation modeling (SEM). Fit indicators from SEM and corresponding betas supported a two-mediator model. Specifically, difference was found to be significantly associated with disdain. The path between the two was positively mediated by anger and negatively mediated by empathy. Difference and disdain may become important constructs in predicting and assessing stigma change. Perspective-taking that enhances empathy may prove especially useful for decreasing difference and disdain perceptions about people with mental illness.

A Feeling of Otherness: A Qualitative Research Synthesis Exploring the Lived Experiences of Stigma in Individuals with Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) consists of Crohn’s disease and ulcerative colitis, chronic conditions involving inflammation and ulceration of the gastrointestinal tract. Individuals with IBD may be susceptible to experiencing health-related stigma: experienced, perceived, or internalised social exclusion, rejection, blame, or devaluation resulting from negative social judgements based on the disease. This qualitative research synthesis draws together findings from 38 studies describing lived experiences to develop a unified interpretative account of the experience of stigma in IBD. Analysis developed two categories: ‘The IBD journey’ explores the dynamic ways in which having IBD impacted on individuals’ self-identity and ‘a need to be understood’ examines the tension between wanting to be understood whilst feeling their true experiences needed to be hidden from or were misjudged by the social sphere. The overarching concept ‘feeling of otherness’ highlights that, rather than a static, binary experience, individuals moved across a continuum ranging from the excluding experience of feeling stigmatised and othered, to the inclusive experience of integration. Individuals fluctuated along this continuum across different physical, social, and health contexts. Psychological adjustment to IBD, drawing on experience of adaptive coping, and reconnecting with valued others through illness disclosure strengthened stigma resistance during more challenging times.

Reducing prejudice toward Syrian refugee children: A vicarious contact intervention among Turkish elementary school children

We conducted an experimental intervention to test the effectiveness of vicarious contact in the relationship between Turkish and Syrian elementary school children; the participants were Turkish children. We used a mixed-methods approach, investigating effects by using both quantitative and qualitative methodologies. Participants in the experimental condition were asked to read stories on positive contact between Turkish and Syrian children over the course of six weekly sessions. The results revealed that vicarious contact, compared to a control condition where participants did not engage in any activity, led to greater intentions to help outgroup members. Importantly, effects only emerged among children who reported higher initial negative outgroup attitudes. Results from qualitative data revealed that vicarious contact produced richer, more positive, and complex representations of the relationships and friendships between groups. We discuss the theoretical and practical implications of these findings.

Educational interventions improving knowledge about epilepsy in preschool children

OBJECTIVE

Sufficient public knowledge about epilepsy is a starting point for reducing epilepsy-related stigma and improving quality of life of people with this condition. Thus, interventions aimed at improving such knowledge are greatly needed. However, there is a significant lack of such interventions and none have been applied to preschool children. We aimed to develop effective interventions using the educational board game Action Zone! and a technique known as educational story, and by focusing on the acquisition of knowledge about epilepsy in children aged 5-6 years with no previous knowledge of epilepsy.

METHODS

Knowledge about epilepsy was measured using a 20-item test consisting of questions selected from educational game and an 11-item test used successfully in our previous intervention study focused on children aged 9-11 years. Both measures exhibited acceptable internal consistency with Cronbach's alpha of 0.72 and 0.67. In total, 296 children participated in three intervention studies (educational game, educational story, and a revised version of educational story). Level of knowledge was assessed immediately after each intervention and again one month later.

RESULTS

We found that all interventions were effective (p = 0.001) in comparison of retest results with baseline of zero level of knowledge based on the statements of children before intervention. Intervention based on educational game resulted in a higher percentage of correct responses in comparison with educational story (p = 0.020). However, the revised version of educational story developed using participatory action research was superior in comparison with the original version (p < 0.001) and fully comparable with educational game (p = 0.864).

CONCLUSIONS

The results showed the aforesaid interventions were significant and effective ways to establish basic knowledge about epilepsy in the given age group.

A Review of School-Based Interventions to Reduce Stigma towards Schizophrenia

Schizophrenia is among the most stigmatized mental illness. Adolescence may be a critical time to intervene, before stigmatizing attitudes have been solidified. As such, schools may be in a unique position to provide anti-stigma interventions to a large number of students. The aim of this paper was to review and critically analyze the most recent (2003-present) school-based schizophrenia stigma interventions, with seven studies identified. Studies were analyzed according to their intervention method, outcome measures, and experimental design. Substantial heterogeneity between studies precluded concrete conclusions or recommendations regarding the effectiveness of school-based schizophrenia stigma interventions. However, the most effective and informative studies utilized combinations of rigorous experimental design, psychometrically-validated measures examining multiple different factors related to stigma, and longer-term follow-up analyses. Future researchers are encouraged to utilize intervention methods and outcomes measures that are developed from and relevant to adolescent populations, rather than adapted from that of adults.

Comparing story reading and video watching as two distinct forms of vicarious contact: An experimental intervention among elementary school children

Research has shown that vicarious contact, that is observing an interaction between ingroup and outgroup members, can improve intergroup relations. Although vicarious contact has been operationalized in different ways, mainly via story reading or video watching, an experimental comparison of these different strategies is still missing. We conducted a school intervention with the aim of comparing the two most used forms of vicarious contact, namely story reading and video watching. Elementary schoolchildren without disabilities (N = 292) were assigned to one of three different conditions: reading a story; watching a video; control. In the two vicarious contact conditions, participants read or watched the story of a child with disability becoming friends with children without disabilities; in the control condition, participants only completed the dependent measures. Results revealed that, in general, both vicarious contact conditions were equally effective in improving outgroup attitudes and behavioural intentions. In addition, they operated with the same strength through the same underlying processes (IOS, ingroup norms). We discuss theoretical and practical implications in the context of vicarious contact as a prejudice-reduction intervention.

Using intercultural videos of direct contact to implement vicarious contact: A school-based intervention that improves intergroup attitudes

We aimed to create an engaging and dynamic intervention for schools that uses videos of direct school peer contact to implement a vicarious contact intervention. Participants were ethnic majority (Italian) and minority (immigrant) high school students ( N = 485; age ranging from 14 to 22 years old, Mage = 17.24 years), who were asked to watch and evaluate videos created by peers from their school for a competition for the best video on intercultural friendships. Results revealed that vicarious contact, relative to a control condition where participants were not shown any videos, improved outgroup attitudes, reduced negative outgroup stereotypes, and increased willingness to engage in contact with the outgroup. These effects only emerged when intercultural friendships in the videos were salient. Inclusion of the other in the self, but neither intergroup anxiety nor fear of rejection by the outgroup, significantly mediated the effect of the videos on outcomes. We discuss theoretical and practical implications of the findings.