The Generalised Anxiety Stigma Scale (GASS): psychometric properties in a community sample

College students' utilization of the Internet to search for mental health information: Effects on mental health literacy, stigma, and help-seeking

OBJECTIVE

The current study examined how college students search online for mental health information and the impact of these searches on mental health literacy, stigma, and help-seeking.

METHOD

Undergraduate participants (N = 270; Fall 2015 to Spring 2019) were randomly assigned to search online for information about coping with anxiety for themselves or a friend (experimental activity), or to utilize Google Maps to answer navigational questions (control).

RESULTS

Participants who conducted an online search demonstrated greater mental health literacy including optimism about psychotherapy, and lower levels of certain types of stigma, but lower willingness to seek/recommend professional help. Participants were more likely to recommend professional help for a friend compared to themselves.

CONCLUSIONS

Online searches for mental health information have the potential to increase mental health literacy. Universities can harness the Internet to reduce help-seeking barriers but should also address when it is appropriate to engage in self-help versus seek professional help.

Randomised controlled trial of an online mental health and suicide gatekeeper resource for parents and caregivers: study protocol

INTRODUCTION

Rates of help-seeking for mental disorders and suicide are low among children and adolescents. Parents are viewed as gatekeepers for their care, yet they may lack the knowledge and skills to identify needs or facilitate service access. The primary aim is to test the effect of a new gatekeeper resource for parents and caregivers on their self-efficacy to recognise, respond and access support for mental health problems and suicide risk in their child.

METHODS AND ANALYSIS

A two-arm randomised controlled trial will compare an online mental health and suicide gatekeeper resource for parents and caregivers to a waitlist control. Australian parents of children aged 5-17 years recruited through social media and community advertising will participate in an online trial. Participants randomised to the intervention condition will be emailed the resource to work through at their own pace. The resource consists of three sections providing parents and caregivers with confidence, knowledge and skills to recognise and respond to mental health problems and suicide risk in their child, as well as support them in accessing professional help. The primary outcome measure is self-efficacy to recognise, respond and provide support for mental health problems and suicide risk, while secondary outcomes include perceived knowledge, stigma, literacy, help-seeking attitudes, intentions and barriers. Data will be collected at preintervention, postintervention (4 weeks after accessing the resource) and 12-week follow-up. Primary analyses will compare changes in self-efficacy in the intervention condition relative to the waitlist control using mixed-model repeated measures analyses.

ETHICS AND DISSEMINATION

The ethical aspects of the study were approved by the Australian National University Human Research Ethics Committee (Protocol 2023/195). If effective, the resource will fill an important gap in resources for parents, with the potential for dissemination through school groups, community organisations and clinical settings.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry, ACTRN12623000933651.

Adapting the Opening Minds Stigma Scale for Healthcare Providers to Measure Opioid-Related Stigma

The opioid crisis in Canada continues to cause a devastating number of deaths. Community-based naloxone programs have been identified as one of the solutions for combatting this crisis; however, there are disparities in which pharmacies stock and offer naloxone. Opioid-related stigma is a major barrier for limited naloxone distribution through pharmacies. Therefore, the development of anti-stigma interventions is crucial to improve naloxone distribution in Canada. However, there is no validated tool to specifically measure opioid-related stigma. The Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) is a validated scale used to measure mental illness-related stigma. This study will adapt the OMS-HC by using four different opioid-related terminologies to determine which is the most stigmatizing to use in an opioid-related anti-stigma intervention. Pharmacy students completed four versions of the adapted OMS-HC. The average OMS-HC scores and Cronbach's α co-efficient were calculated for each version. The term "opioid addiction" was found to be the most stigmatizing term among participants and will be used in the adapted version of the OMS-HC in a future anti-stigma interventions.

Rural US residents recognize anxiety better than urbanites and suburbanites but hold similar stigma

PURPOSE

Recognizing signs of psychological distress is a critical first step in assisting people who are struggling with poor mental health to access help. However, community-level factors that impact recognition and stigma are underexplored. The purpose of this study is to investigate the relationship between rurality, other community-level variables, and individual variables with regard to the recognition and stigma of anxiety.

METHODS

We use a survey of US adults (N = 627), including a rural oversample, and a cloaked vignette approach. We assess the ability to identify anxiety and measure associated stigma. The analysis applies an ecological model in multinomial logistic regressions.

FINDINGS

About half of the respondents recognize anxiety from a list of possibilities when provided with a vignette detailing common anxiety symptoms. Respondents living in rural areas are nearly twice as likely to correctly identify anxiety than nonrural respondents. About one-fifth of respondents agree with a statement designed to measure stigma: that exhibiting the symptoms is a sign of personal weakness. Respondents able to identify anxiety show less stigma. Respondents from counties with high mental health provider access were less likely to endorse the stigma statement.

CONCLUSIONS

Rural areas seem poised to reduce the stigma associated with anxiety, because residents are more adept at identifying anxiety than people living elsewhere. Future work could focus on effective mechanisms for reducing stigma associated with anxiety in rural areas, and whether anxiety recognition and stigma are changing.

How to measure mental illness stigma at work: development and validation of the workplace mental illness stigma scale

Introduction

The study objective was to design a new theoretically driven multidimensional scale for the use in the empirical measurement of stigmatizing attitudes towards persons with mental illness within the return-to-work process as this integral part of vocational reintegration has been widely neglected by scholars so far.

Methods

Therefore, we developed and validated a 21-item instrument to comprehensively measure the three-factorial structure of stigmatizing attitudes (affect, cognition, behavior) across two studies (overall N = 251).

Results

In both studies the new scale proved to be highly internally consistent, and its proposed three-factor structure was equally supported across the two studies. Convergent and discriminant validity were demonstrated by moderate and high correlations or zero correlations with pertinent measures. Furthermore, construct validity of the new scale was supported by significant positive associations with relevant personality characteristics within stigma research.

Discussion

The WMISS is the first instrument to measure mental health stigma specifically within the return-to-work-process and demonstrates strong psychometric properties. Inclusion of this scale in future research can help facilitate understanding of mental illness stigma within the occupational sector and assist with targeted intervention development.

Understanding parental knowledge, attitudes and self-efficacy in professional help-seeking for child anxiety

BACKGROUND

Child anxiety disorders are highly prevalent yet undertreated. As parents are often 'gatekeepers' to children receiving treatment and support, this study aimed to investigate modifiable parental factors affecting professional help-seeking for their children from general practitioners (GPs), psychologists, and paediatricians.

METHODS

In this study, 257 Australian parents of children aged 5-12 years with elevated anxiety symptoms completed a cross-sectional online survey. The survey assessed help-seeking from a GP, psychologist, and paediatrician (General Help Seeking Questionnaire), as well as anxiety knowledge (Anxiety Literacy Scale), help-seeking attitudes (Attitudes Toward Seeking Professional Psychological Help), personal stigma (Generalised Anxiety Stigma Scale) and self-efficacy (Self-Efficacy in Seeking Mental Health Care).

RESULTS

66.9 % of participants had sought help from a GP, 61.1 % from a psychologist, and 33.9 % from a paediatrician. Help-seeking from a GP or psychologist was associated with lower personal stigma (p = .02 and p = .03 respectively). Participants who sought help from a psychologist also had more positive attitudes toward seeking professional support (p = .01). Conversely, knowledge of anxiety disorders and self-efficacy were not associated with help-seeking from any source.

LIMITATIONS

Limitations of the study include the representativeness of our sample (female gender, higher education level); unexplained variance potentially accounted for by other factors (e.g., structural barriers); lack of prior validation of measures in a parent sample.

CONCLUSIONS

This research will inform the development of public health policy and psychoeducation interventions for parents, to reduce personal stigma and increase positive attitudes toward professional help-seeking, in turn improving help-seeking for child anxiety.

Attitude of Syrian students toward GAD patients: An online cross-sectional study

Generalized Anxiety Disorder (GAD) is a prevalent condition and a significant cause of mental disability and poor quality of life. People with GAD have chronic worrying, restlessness, and discrimination from the general public; Little is known about the stigmatizing attitudes toward people with GAD among Syrian students. The questionnaires contained demographic data about age, gender, social status, personal stigma toward GAD scale, perceived stigma toward GAD scale, social distance with those with GAD, the participants' usual source of their knowledge about GAD, helpful interventions, and supporting information. A total of 1,370 replies were collected, but only 1,358 were used for analysis as 12 participants declined to complete the survey. About 44.1% of participants agreed that people with GAD could snap out of the problem, most of them being females (32.4% of the total population). Compared to medical students, more non-medical students (7.1% of the total population) believed that anxiety is a sign of personal weakness. This study demonstrated that Syrian college students showed a high level of stigmatizing and socially distancing attitudes toward people with GAD, particularly female and non-medical students.

¡Yo no Estoy Loca! A Behavioral Health Telenovela Style Entertainment Education Video: Increasing Mental Health Literacy Among Latinas

Lack of knowledge and negative attitudes towards mental health is linked to low utilization of services among Latinxs. Entertainment-education videos have been effective at increasing literacy and reducing stigma across different health domains but Latinxs have not been a focus of research. We developed an E-E video aimed at reducing stigma and increasing mental health literacy. Focus groups (N = 28) and expert consultants (N = 2) were used to aid in the development of the video. After the video was developed, we conducted a randomized control trial (RCT) in which Latina participants (N = 111) were assigned to view the video or receive an informational brochure. Results indicated that participants in the video intervention condition experienced statistically significant increases in mental health literacy as compared to the participants in the flyer condition and that both the video and the flyer contributed to shifts in stigma.

Social Contact: Next Steps in an Effective Strategy to Mitigate the Stigma of Mental Illness

People living with mental illnesses and their families may conceal their conditions to avoid prejudice and discrimination. Stigma often prevents people from receiving adequate health care and other social support services which could exacerbate social and health consequences such as unemployment, homelessness, substance use, and compulsory hospitalization. In this paper, we discuss social contact as a promising anti-stigma strategy for enhancing social interactions among people with mental illnesses, their families, and those without mental illnesses. In particularly, we consider next steps for an approach that works to reduce the stigma-related burden of mental illness. For social contact to be effective in reducing mental illness stigma, it requires broad social buy-in as well as implementation within care systems. Engagement with this approach can be driven through diverse contact-based education using collaborative efforts of society, academic institutions, policy-makers, health professionals, media, and governments. Ultimately, this work aims to consider the next steps in enacting social contact as an anti-stigma strategy through direct interventions and contact-based education. The success of this approach requires pragmatic public policies to support its implementation.

Help-seeking attitudes and intentions for generalised anxiety disorder in adolescents: the role of anxiety literacy and stigma

Help seeking for anxiety tends to be low in adolescents. Identifying modifiable factors that may facilitate help seeking is important. The aim of the current study is to test the effects of generalized anxiety disorder (GAD) literacy and stigma (personal and perceived) on attitudes and intentions toward seeking help from professionals and key adult sources. 1767 adolescents aged 12-18 years participated in the current study and completed measures of GAD literacy, GAD stigma, professional help-seeking attitudes, and intentions to seek help from a range of sources. The results of the study found that participants had limited GAD literacy and up to 20% personally agreed with stigmatising statements about GAD. Participants reported greater intentions to seek help from parents than from formal sources. More positive attitudes toward seeking help were associated with higher levels of GAD literacy (p < 0.001) and lower personal GAD stigma (p < 0.001). Lower perceived GAD stigma was associated with increased intentions to seek help from their mothers (p < 0.05) or fathers (p < 0.01), while lower personal GAD stigma was also associated with help-seeking intentions from their mothers (p < 0.05). Higher perceived GAD stigma was associated with intentions to seek help from nobody (p < 0.001). Overall, the current study highlights the important role that parents can play in the help-seeking process for adolescents, with parents often the most accessible source of help. Improving parent and adolescent knowledge and attitudes towards GAD may help to improve early help seeking in young people.

The Behavioral Model of Health: Education, Behavioral Health Factors, and Stigma as Predictors of Help-Seeking Attitudes

Per the behavioral model of health, help-seeking attitudes (and even behavioral health service use) are a function of predisposing and enabling individual characteristics (e.g. demographic characteristics, health beliefs), as well as contextual characteristics (resources, social structures such as education etc.). While researchers have examined how demographic (gender and ethnicity) and socioeconomic (education and income) characteristics, psychological factors, and internal barriers relate to help-seeking attitudes, the majority of these works have investigated how different variables independently act on help-seeking attitudes in lieu of more comprehensively investigating how they operate in tandem. The purpose of the current study was to examine how demographic (gender and ethnicity) and socioeconomic (education and income) characteristics, behavioral health factors, and internal barriers relate to help-seeking attitudes in a diverse sample of primary care patients. We also sought to examine differences in demographic and socioeconomic characteristics in mental health literacy, stigma, and help-seeking attitudes. Participants were 286 primary care patients. Results from this study indicate that a combination of socioeconomic characteristics (i.e. education), behavioral health factors (level of distress and history of behavioral health service utilization), and internal barriers (personal stigma) predicted help-seeking attitudes among primary care patients. There was an inverse relationship between education and personal stigma and help-seeking attitudes such that higher levels of education and higher levels of personal stigma were associated with more negative help-seeking attitudes.

The Skidmore Anxiety Stigma Scale (SASS): A covert and brief self-report measure

Shame and concerns about stigma are salient barriers to treatment for people with anxiety disorders, and yet very little stigma research has focused on this class of disorders. One explanation for this research gap is the absence of a brief, psychometrically sound measure for assessing public stigma for the anxiety disorders as a class. This (three-study) paper presents the psychometric properties of a 7-item scale that covertly assesses anxiety stigma by presenting as a test of knowledge. Items for the measure were derived from a mixed-methods project (Study 1) which assessed patient (N = 47) experiences with stigma. Subsequently, exploratory factor analysis (N = 270) demonstrated that the scale fit a one-factor solution (Study 2). Study 3 comprehensively evaluated the measure's psychometric properties, including confirming the one-factor solution. Results further demonstrated test-retest reliability, convergent and discriminant validity, and internal consistency. This brief measure fills an important gap by providing means for covertly assessing public stigma encountered by individuals with anxiety disorders and thus subverts social desirability concerns that plague self-report measures of stigma. Thus, the SASS increases the feasibility of work capturing the nature and impact of anxiety stigma - a highly relevant barrier to treatment.

Stigmatization Toward Patients with Mental Health Diagnoses: Tehran’s Stakeholders’ Perspectives

Background: The stigma associated with mental health disorders has an enormous impact on decisions concerning receiving mental health services. Objectives: The current qualitative study aimed to describe the stigma toward mental disorders in Tehran, Iran. Methods: The current grounded theory study conducted from 2013 to 2016 in Tehran (Iran). Fourteen participants were sampled using purposive and theoretical sampling techniques. Data were collected through face-to-face interviews, focused groups, and written narratives. The Corbin and Strauss coding paradigm (2008) was used to analyze data. Results: Three main categories of stigmatization toward patients with mental health diagnoses were extracted: (1) barriers to stigma reduction; (2) strategies to reduce stigma; and (3) outcomes of stigma reduction such as negative consequences of stigma toward mental disorders and positive impacts of stigma reduction toward mental disorders. Conclusions: To improve mental health services for patients in Tehran (Iran), it is imperative to reduce the stigma toward mental disorders, educate the community, including the general population and healthcare professionals, and remove existing barriers to receive mental health services.

What is good mental health? A scoping review

Promotion of good mental health in young people with and without mental disorders has received little empirical research attention and interventions for improving mental health in young people are not well established. This situation could be explained among other reasons due to the difficulties to define and operationalise what good mental health is. The current manuscript, produced by the European College of Neuropsychopharmacology Thematic Working Group on the Prevention of Mental Disorders and Mental Health Promotion (ECNP TWG PMD-MHP), presents a critical review of the available operationalizations for good mental health. A pragmatic conceptual operationalisation of good mental health is a much-needed step towards more standardised research in this field. Good mental health can be defined as a state of well-being that allows individuals to cope with the normal stresses of life and function productively. Universal and selective interventions are suitable to promote mental health. Core domains that define good mental health encompass: (i) mental health literacy, (ii) attitude towards mental disorders, (iii) self-perceptions and values, (iv) cognitive skills, (v) academic/ occupational performance, (vi) emotions, (vii) behaviours, (viii) self-management strategies, (ix) social skills, (x) family and significant relationships (xi) physical health, (xii) sexual health, (xiii) meaning of life, (xiv) and quality of life. These domains should be widely traceable in the literature and can be used to conduct further empirical research in the field of good mental health. Such data can lead to more robust evidence to identify and establish the pathways to follow in order to improve mental health.

Self-help interventions to reduce self-stigma in people with mental health problems: A systematic literature review

People with mental health problems often experience self-stigma, whereby they internalise stereotypic or stigmatising views held by others. Self-stigma is known to have negative effects on self-esteem and self-efficacy and a continuing impact on psychological wellbeing. Self-help interventions designed to reduce self-stigma may have an important contribution to make. This review aimed to provide an overview and critical appraisal of the literature on self-help interventions that target self-stigma related to mental health problems. A systematic review of five electronic databases (PsycINFO, MEDLINE, CINAHL Plus, Scopus and EMBASE) was carried out to identify articles published between January 2007 and July 2019. Eight articles that reported on self-help interventions for self-stigma were identified and evaluated using a combination of quality appraisal and narrative synthesis.

Conceptualizing and Measuring Mental Illness Stigma: The Mental Illness Stigma Framework and Critical Review of Measures

Although the last decade has seen a proliferation of research on mental illness stigma, lack of consistency and clarity in both the conceptualization and measurement of mental illness stigma has limited the accumulation of scientific knowledge about mental illness stigma and its consequences. In the present article, we bring together the different foci of mental illness stigma research with the Mental Illness Stigma Framework (MISF). The MISF provides a common framework and set of terminology for understanding mechanisms of mental illness stigma that are relevant to the study of both the stigmatized and the stigmatizer. We then apply this framework to systematically review and classify stigma measures used in the past decade according to their corresponding stigma mechanisms. We identified more than 400 measures of mental illness stigma, two thirds of which had not undergone any systematic psychometric evaluation. Stereotypes and discrimination received the most research attention, while mechanisms that focus on the perspective of individuals with mental illness (e.g., experienced, anticipated, or internalized stigma) have been the least studied. Finally, we use the MISF to discuss the strengths and weaknesses of mental illness stigma measurement, identify gaps in the literature, and provide recommendations for future research.

The quality of mental health literacy measurement tools evaluating the stigma of mental illness: a systematic review

AIMS

Stigma of mental illness is a significant barrier to receiving mental health care. However, measurement tools evaluating stigma of mental illness have not been systematically assessed for their quality. We conducted a systematic review to critically appraise the methodological quality of studies assessing psychometrics of stigma measurement tools and determined the level of evidence of overall quality of psychometric properties of included tools.

METHODS

We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library and ERIC databases for eligible studies. We conducted risk-of-bias analysis with the Consensus-based Standards for the Selection of Health Measurement Instruments checklist, rating studies as excellent, good, fair or poor. We further rated the level of evidence of the overall quality of psychometric properties, combining the study quality and quality of each psychometric property, as: strong, moderate, limited, conflicting or unknown.

RESULTS

We identified 117 studies evaluating psychometric properties of 101 tools. The quality of specific studies varied, with ratings of: excellent (n = 5); good (mostly on internal consistency (n = 67)); fair (mostly on structural validity, n = 89 and construct validity, n = 85); and poor (mostly on internal consistency, n = 36). The overall quality of psychometric properties also varied from: strong (mostly content validity, n = 3), moderate (mostly internal consistency, n = 55), limited (mostly structural validity, n = 55 and construct validity, n = 46), conflicting (mostly test-retest reliability, n = 9) and unknown (mostly internal consistency, n = 36).

CONCLUSIONS

We identified 12 tools demonstrating limited evidence or above for (+, ++, +++) all their properties, 69 tools reaching these levels of evidence for some of their properties, and 20 tools that did not meet the minimum level of evidence for all of their properties. We note that further research on stigma tool development is needed to ensure appropriate application.

The Prejudice towards People with Mental Illness (PPMI) scale: structure and validity

BACKGROUND

Although there is a substantial body of research on the stigma associated with mental illness, much of the extant research has not explicitly focused on the concept of prejudice, which drives discriminatory behaviour. Further, research that has investigated prejudice towards people with mental illness has conceptual, theoretical and psychometric limitations. To address these shortcomings, we sought to develop a new measure, the Prejudice towards People with Mental Illness (PPMI) scale, based on an improved conceptualisation and integration of the stigma and prejudice areas of research.

METHODS

In developing the new scale, we undertook a thematic analysis of existing conceptualisations and measures to identify a pool of potential items for the scale which were subsequently assessed for fidelity and content validity by expert raters. We tested the structure, reliability, and validity of the scale across three studies (Study 1 N = 301; Study 2 N = 164; Study 3 N = 495) using exploratory factor, confirmatory factor, correlational, multiple regression, and ordinal logistic regression analyses using both select and general community samples.

RESULTS

Study 1 identified four factors underlying prejudice towards people with mental illness: fear/avoidance, malevolence, authoritarianism, and unpredictability. It also confirmed the nomological network, that is, the links of these attitudes with the proposed theoretical antecedents and consequences. Studies 2 and 3 further supported the factor structure of the measure, and provided additional evidence for the nomological network.

CONCLUSIONS

We argue that research into prejudice towards people with mental illness will benefit from the new measure and theoretical framework.

Development and Preliminary Psychometric Evaluation of a Patient-Reported Outcome Measure for Lung Cancer Stigma: The Lung Cancer Stigma Inventory (LCSI)

INTRODUCTION

Among patients with lung cancer, stigma is associated with negative psychosocial and behavioral outcomes. There is a need to develop psychometrically robust patient-reported outcome (PRO) measures for stigma that incorporate perspectives of patients diagnosed with lung cancer. As part of our multi-phase process of measure development and validation, we report on scale formation and preliminary psychometric evaluation of the Lung Cancer Stigma Inventory (LCSI).

METHOD

Building on previously reported concept elicitation (Phase I) work, Phase II of LCSI development involved item generation and refinement, informed by literature review, provider input, and patient (N=20) feedback. Phase III focused on initial psychometric scale evaluation in a unique sample of 231 lung cancer patients.

RESULTS

Based on provider input and patient cognitive interviews, 49 items were included in a preliminary measure. In an exploratory factor analysis (EFA) of the 37 retained items, three factors emerged: Perceived Stigma, Internalized Stigma, and Constrained Disclosure. Internal consistency of the final, 25-item LCSI scale was high (Cronbach's alpha= 0.89) and the three subscales demonstrated good internal consistency. The test-retest correlation was high (r = 0.91), suggesting strong stability of measurement over time. There was good convergent validity between the LCSI and an existing measure of lung cancer stigma, the Cataldo Lung Cancer Stigma Scale (CLCSS; r= 0.58, p< 0.001).

DISCUSSION

In a multi-phase process, we have developed a reliable, multi-dimensional measure of lung cancer stigma, the Lung Cancer Stigma Inventory (LCSI). Subsequent work will be conducted to establish further evidence of validity and clinically meaningful change.

The City MISS: development of a scale to measure stigma of perinatal mental illness

OBJECTIVE

This study aimed to develop and validate a scale to measure perceived stigma for perinatal mental illness in women.

BACKGROUND

Stigma is one of the most frequently cited barriers to seeking treatment and many women with perinatal mental illness fail to get the treatment they need. However, there is no psychometric scale that measures how women may experience the unique aspects of perinatal mental illness stigma.

METHOD

A draft scale of 30 items was developed from a literature review. Women with perinatal mental illness (n = 279) were recruited to complete the City Mental Illness Stigma Scale. Concurrent validity was measured using the Internalised Stigma of Mental Illness Scale. Factor analysis was used to create the final scale.

RESULTS

The final 15-item City Mental Illness Stigma Scale has a three-factor structure: perceived external stigma, internal stigma and disclosure stigma. The scale accounted for 54% of the variance and had good internal reliability and concurrent validity.

CONCLUSION

The City Mental Illness Stigma Scale appears to be a valid measure which provides a potentially useful tool for clinical practice and research in stigma and perinatal mental illness, including assessing the prevalence and characteristics of stigma. This research can be used to inform interventions to reduce or address the stigma experienced by some women with perinatal mental illness.

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families

Despite the central role culture plays in racial and ethnic disparities in mental health among ethnic minority and immigrant children and families, existing measures of engagement in mental health services have failed to integrate culturally specific factors that shape these families' engagement with mental health services. To illustrate this gap, the authors systematically review 119 existing instruments that measure the multi-dimensional and developmental process of engagement for ethnic minority and immigrant children and families. The review is anchored in a new integrated conceptualization of engagement, the culturally infused engagement model. The review assesses culturally relevant cognitive, attitudinal, and behavioral mechanisms of engagement from the stages of problem recognition and help seeking to treatment participation that can help illuminate the gaps. Existing measures examined four central domains pertinent to the process of engagement for ethnic minority and immigrant children and families: (a) expressions of mental distress and illness, (b) causal explanations of mental distress and illness, (c) beliefs about mental distress and illness, and (d) beliefs and experiences of seeking help. The findings highlight the variety of tools that are used to measure behavioral and attitudinal dimensions of engagement, showing the limitations of their application for ethnic minority and immigrant children and families. The review proposes directions for promising research methodologies to help intervention scientists and clinicians improve engagement and service delivery and reduce disparities among ethnic minority and immigrant children and families at large, and recommends practical applications for training, program planning, and policymaking.

Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: findings from a cross-sectional survey in Singapore

OBJECTIVES

To examine whether self-stigma mediates the relationship between perceived stigma and quality of life, self-esteem and general functioning among outpatients with depression, schizophrenia, anxiety and obsessive-compulsive disorder (OCD).

DESIGN

Cross-sectional survey.

SETTING

Outpatient clinics at a tertiary psychiatric hospital in Singapore.

PARTICIPANTS

280 outpatients with a primary clinical diagnosis of either schizophrenia, depression, anxiety or OCD.

METHODS

Data were collected in relation to self-stigma, perceived stigma, self-esteem, functioning and quality of life. In order to examine the mediating role of self-stigma on the relationship between perceived stigma and psychosocial outcomes, bootstrapping mediation analyses were used.

RESULTS

Mediation analyses revealed that the relationship between perceived stigma and psychosocial outcomes was subject to the effects of self-stigma among the overall sample. Separate mediation analyses were conducted by diagnoses and showed differences in the mediating effects of self-stigma. Among the whole sample and the subsample with OCD, self-stigma mediated the relationship between perceived stigma and all psychosocial outcomes. For those with anxiety, depression and schizophrenia, the mediating effects of self-stigma were present in all relationships except (1) perceived stigma with physical health in the anxiety sample, (2) perceived stigma with social relationships in the depression sample and (3) perceived stigma with physical health in the schizophrenia sample.

CONCLUSIONS

The mediating effects of self-stigma on the relationship between perceived stigma and various psychosocial outcomes are evident and differ across diagnoses. Interventions to address and reduce the effects of self-stigma along with targeted treatments and psychoeducation to assist people with mental illness overcome or better manage self-stigma while providing them the skills to counteract public stigma are needed.

Help seeking for social anxiety: A pilot randomised controlled trial

OBJECTIVE

Although social anxiety disorder is a persistent and debilitating condition, only a minority of people with social anxiety disorder seek help and little is known about methods for promoting help seeking for social anxiety disorder. This pilot trial explored the potential effectiveness of an online program designed to increase help-seeking intentions for social anxiety disorder.

METHODS

Australian adults with symptoms of untreated social anxiety disorder were recruited online and randomised to either the Shyness Information Online intervention (n = 41) or an online attention control condition (n = 41). Each program together with a baseline and postintervention survey was delivered in one session. The primary outcome was intentions to seek help from a professional. Secondary measures included anxiety literacy, help-seeking attitudes, internalised stigma, and perceived need for treatment. The acceptability of the program content and feasibility of the recruitment method were also examined.

RESULTS

Although they did not demonstrate a significantly greater increase in help-seeking intentions relative to the control group (p = 0.097), those receiving the intervention showed more favourable attitudes towards seeking psychological help (Hedges'g = 0.38; p = 0.025) and a higher level of perceived need for treatment (p ≤ 0.001). Participants also showed a greater knowledge about social anxiety disorder at post-intervention than the control participants (adjusted Hedges' g = 0.46, p < 0.001). Most respondents were satisfied with the intervention content; the recruitment strategy appeared feasible.

CONCLUSIONS

Further investigation of the intervention is warranted to test its effectiveness, explore the relationships between factors that influence social anxiety disorder help-seeking behaviour and to further test the validity of the social anxiety disorder help-seeking model on which the intervention was based.

Relationship between anxiety and medical disorders among compulsory military service candidates between the years 1998-2013

One of the most common psychiatric diagnoses among adolescents is anxiety disorder. Many of the anxiety symptoms are expressed physiologically, and therefore can mimic other medical conditions. The aim of this study was to examine the association between anxiety disorders and other medical conditions sharing common symptoms with anxiety (MDSCSA: Irritable Bowel Syndrome, asthma, migraine and hyperhidrosis). The study was based on the national database of the candidates for military service in Israel. Data for the years 1998-2013 was retrieved to create the study dataset. The final cohort population was comprised of 1,229,461 military service candidates. Anxiety prevalence and its association with other medical conditions sharing the same symptoms was examined in the cohort. The results showed significant statistical association between anxiety and IBS, asthma, migraine and hyperhidrosis. These findings support the fact that there is a clear association between anxiety disorder and the examined medical conditions. Moreover, in the military setting, the primary care physician has an important role in giving a correct diagnosis for soldiers presenting with symptoms that can be regarded both to anxiety and to other physical illnesses.

Effectiveness of MH-Guru, a brief online mental health program for the workplace: A randomised controlled trial

BACKGROUND

Depression and anxiety interfere with an individual's quality of life and result in substantial economic costs to the workplace through lost productivity. The internet offers an unparalleled opportunity for the large scale, cost-effective delivery of mental health awareness and destigmatisation programs in the workplace. However, to date high quality assessments of the effectiveness of such workplace programs have been confined to health professional settings. The current study reports the effectiveness of Mental Health Guru (MH-Guru), a two-module online mental health workplace induction program.

METHODS

A total of 507 employees from a large multi-departmental government workplace were randomised to a 2-week online depression and anxiety educational program (Mental Health Guru; MH-Guru), or a Wait List Control condition. Participants completed online surveys at baseline, 1 week post-intervention and at 6-month follow-up. Primary outcome measures included depression and anxiety literacy, personal stigma about depression and anxiety, and help seeking intentions for anxiety and depression at post-test. Secondary measures included help-seeking attitudes and self-reported help seeking behaviour. Satisfaction measures were also collected.

RESULTS

Dropout at post intervention was 26.7% and 21.0% for the MH-Guru and Control conditions respectively. Relative to Control, MH-Guru participants showed significantly greater improvements in depression and anxiety literacy at post intervention. Between group standardized effect sizes at post-test and 6-months were 0.78 and 0.81 for depression literacy and 0.80 and 0.79 for anxiety literacy. Compared to the Control participants, the MH-Guru group also showed significantly greater reductions in depression and anxiety personal stigma. Between group effect sizes in stigma for depression were - 0.56 and - 0.47 at post-test and 6-months respectively and - 0.42 at both time points for anxiety. The MH-Guru intervention was not associated with a differentially greater increase in anxiety or depression help-seeking intentions or improvement in help seeking attitudes compared to the Control group. However, self-reported help-seeking behaviour was significantly greater in the MH-Guru group at post-test. In addition, the MH-Guru group showed greater intentions to seek help for depression from the Internet at 6-month follow-up. Satisfaction items suggested that the program was acceptable to employees.

CONCLUSIONS

Brief online programs such as MH-Guru have the potential to play an important role in increasing mental health awareness and decreasing stigmatizing attitudes in the workplace, and by extension the general community.

Perceived Stigma among Recipients of Mental Health Care in the General Canadian Population

OBJECTIVES

The Mental Health Experiences Scale is a measure of perceived stigma, the perception of negative attitudes and behaviours by people with mental disorders. A recent Canadian survey (Canadian Community Health Survey-Mental Health) included this scale, providing an opportunity to describe perceived stigma in relation to diagnosis for the first time in the Canadian general population.

METHODS

The survey interview began with an assessment of whether respondents had utilised services for an "emotional or mental health problem" in the preceding 12 months. The subset reporting service utilisation were asked whether others "held negative opinions" about them or "treated them unfairly" for reasons related to their mental health. The analysis reported here used frequencies, means, cross-tabulation, and logistic regression, all incorporating recommended replicate sampling weights and bootstrap variance estimation procedures.

RESULTS

Stigma was perceived by 24.4% of respondents accessing mental health services. The frequency was higher among younger respondents (<55 years), those who were not working, those reporting only fair or poor mental health, and the subset who reported having received a diagnosis of a mental disorder. Sex and education level were not associated with perceived stigma. People with schizophrenia reported stigmatization only slightly more frequently than those with mood and anxiety disorders.

CONCLUSIONS

Stigmatization is a common, but not universal, experience among Canadians using services for mental health reasons. Stigmatization was a problem for a sizeable minority of respondents with mood, anxiety, and substance use disorders as well as bipolar and psychotic disorders.

Predictors of personal, perceived and self-stigma towards anxiety and depression

BACKGROUND

Stigma towards individuals experiencing a mental illness is associated with a range of negative psychological, social and financial outcomes. Factors associated with stigma remain unclear; the relationship between stigma and various personal factors may depend on both the type of disorder being stigmatised and what type of stigma is assessed. Different forms of stigma include personal stigma (negative attitudes towards others), perceived stigma (perceived attitudes of others) and self-stigma (self-attribution of others' negative attitudes).

METHOD

Three hundred and fifty university students and members of the general public completed an online survey assessing contact with and knowledge of both depression and anxiety, age, gender, current depression and anxiety symptoms, and personal, perceived and self-stigma for both depression and anxiety.

RESULTS

Greater contact with, and knowledge of that illness predicted lower personal stigma for both anxiety and depression. Participants with greater levels of current depression symptomatology and females, reported higher perceived stigma towards depression. Males reported higher personal stigma for anxiety. For both anxiety and depression, higher current symptomatology was associated with greater levels of self-stigma towards the illness.

CONCLUSIONS

Findings confirm the role of contact and knowledge in personal stigma for both disorders, consistent with previous findings. This finding also supports evidence that interventions addressing these factors are associated with a decline in personal stigma. However, lack of relationship between contact with, and knowledge of a mental illness and perceived and self-stigma for either depression or anxiety suggests that these factors may not play a major role in perceived or self-stigma. The identification of symptomatology as a key factor associated with self-stigma for both anxiety and depression is significant, and has implications for community-wide interventions aiming to increase help-seeking behaviour, as well as individual treatment strategies for clinicians. Further research should examine whether these relationships hold for groups with clinically diagnosed depression and anxiety disorders.

Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review

BACKGROUND

Mental health literacy has received increasing attention as a useful strategy to promote early identification of mental disorders, reduce stigma and enhance help-seeking behaviors. However, despite the abundance of research on mental health literacy interventions, there is the absence of evaluations of current available mental health literacy measures and related psychometrics. We conducted a scoping review to bridge the gap.

METHODS

We searched PubMed, PsycINFO, Embase, CINAHL, Cochrane Library, and ERIC for relevant studies. We only focused on quantitative studies and English publications, however, we didn't limit study participants, locations, or publication dates. We excluded non-English studies, and did not check the grey literature (non peer-reviewed publications or documents of any type) and therefore may have missed some eligible measures.

RESULTS

We located 401 studies that include 69 knowledge measures (14 validated), 111 stigma measures (65 validated), and 35 help-seeking related measures (10 validated). Knowledge measures mainly investigated the ability of illness identification, and factual knowledge of mental disorders such as terminology, etiology, diagnosis, prognosis, and consequences. Stigma measures include those focused on stigma against mental illness or the mentally ill; self-stigma ; experienced stigma; and stigma against mental health treatment and help-seeking. Help-seeking measures included those of help-seeking attitudes, intentions to seek help, and actual help-seeking behaviors.

CONCLUSIONS

Our review provides a compendium of available mental health literacy measures to facilitate applying existing measures or developing new measures. It also provides a solid database for future research on systematically assessing the quality of the included measures.

Stigma experienced by people using mental health services in San Diego County

OBJECTIVE

This paper describes how individuals struggling with severe mental illness experience stigma along multiple dimensions including their experiences of discrimination by others, their unwillingness to disclose information about their mental health, and their internalization or rejection of the negative and positive aspects of having mental health problems.

METHODS

This cross-sectional study employs descriptive analyses and linear regression to assess the relationship between demographics, mental health diagnoses and self-reported stigma among people receiving mental health services in a large and ethnically diverse county public mental health system (n = 1,237) in 2009. We used the King Stigma Scale to measure three factors related to stigma: discrimination, disclosure, and positive aspects of mental illness.

RESULTS

Most people (89.7 %) reported experiencing some discrimination from having mental health problems. Regression analyses revealed that younger people in treatment experienced more stigma related to mental health problems. Women reported experiencing more stigma than men, but men were less likely to endorse the potentially positive aspects of facing mental health challenges than women. Although people with mood disorders reported more discomfort with disclosing mental illness than people with schizophrenia, they did not report experiencing more discrimination than people with schizophrenia.

CONCLUSIONS

Study findings suggest that the multidimensional experiences of stigma differ as a function of age, gender, and diagnosis. Importantly, these findings should inform anti-stigma efforts by describing different potential treatment barriers due to experiences of stigma among people using mental health services, especially among younger people and women who may be more susceptible to stigma.

Evaluation of an online psychoeducation intervention to promote mental health help seeking attitudes and intentions among young adults: randomised controlled trial

BACKGROUND

Research has consistently identified a disparity between the prevalence of mental health concerns among young adults and their rates of formal help seeking. However, a few randomised controlled trials have identified effective interventions for increasing formal help seeking among young adults. The aim of this study was to evaluate the effectiveness of a brief online psychoeducational intervention, targeting depression, anxiety and suicide stigma, for increasing positive attitudes towards help seeking and increasing help seeking intentions among young adults.

METHOD

The study followed a single-blind parallel group randomized controlled trial design with 67 young adult (18-25 years) Australian participants, assigned to receive online psychoeducation (n=33) or online attention-matched control information (n=34) over 3 weeks. Participants in the experimental group received information on depression, anxiety, and suicide. The control group received information unrelated to mental health. Primary outcome measures were mental health literacy, mental illness stigma, attitudes toward professional help seeking and intentions to seek help. Secondary outcome variables were symptomology, satisfaction and adherence.

RESULTS

Significant between-group differences were found for the pre- to post-test, including increased anxiety literacy (Cohen׳s d=0.65), decreased depression stigma (d=0.53), and increased help seeking attitudes and intentions for the experimental group (d=0.58 and d=0.53, respectively).

LIMITATIONS

Due to the small sample size and homogenous nature of the sample, generalisations should be made with caution.

CONCLUSIONS

This study demonstrates the utility and effectiveness of a brief online psychoeducation intervention for promoting help seeking among young adults.

Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials

The stigma associated with mental disorders is a global public health problem. Programs to combat it must be informed by the best available evidence. To this end, a meta-analysis was undertaken to investigate the effectiveness of existing programs. A systematic search of PubMed, PsycINFO and Cochrane databases yielded 34 relevant papers, comprising 33 randomized controlled trials. Twenty-seven papers (26 trials) contained data that could be incorporated into a quantitative analysis. Of these trials, 19 targeted personal stigma or social distance (6,318 participants), six addressed perceived stigma (3,042 participants) and three self-stigma (238 participants). Interventions targeting personal stigma or social distance yielded small but significant reductions in stigma across all mental disorders combined (d=0.28, 95% CI: 0.17-0.39, p<0.001) as well as for depression (d=0.36, 95% CI: 0.10-0.60, p<0.01), psychosis (d=0.20, 95% CI: 0.06-0.34, p<0.01) and generic mental illness (d=0.30, 95% CI: 0.10-0.50, p<0.01). Educational interventions were effective in reducing personal stigma (d=0.33, 95% CI: 0.19-0.42, p<0.001) as were interventions incorporating consumer contact (d=0.47, 95% CI: 0.17-0.78, p<0.001), although there were insufficient studies to demonstrate an effect for consumer contact alone. Internet programs were at least as effective in reducing personal stigma as face-to-face delivery. There was no evidence that stigma interventions were effective in reducing perceived or self-stigma. In conclusion, there is an evidence base to inform the roll out of programs for improving personal stigma among members of the community. However, there is a need to investigate methods for improving the effectiveness of these programs and to develop interventions that are effective in reducing perceived and internalized stigma.

Recruitment of mental health survey participants using Internet advertising: content, characteristics and cost effectiveness

Postal and telephone survey research is threatened by declining response rates and high cost. Online recruitment is becoming more popular, although there is little empirical evidence about its cost-effectiveness or the representativeness of online samples. There is also limited research on optimal strategies for developing advertising content for online recruitment. The present study aimed to assess these aspects of online recruitment. Two mental health surveys used advertisements within a social network website (Facebook) to recruit adult Australian participants. The initial survey used advertisements linking directly to an external survey website, and recruited 1283 participants at $9.82 per completed survey. A subsequent survey used advertisements linking to a Facebook page that featured links to the external survey, recruiting 610 participants at $1.51 per completion. Both surveys were more cost-effective than similar postal surveys conducted previously, which averaged $19.10 per completion. Online and postal surveys both had somewhat unrepresentative samples. However, online surveys tended to be more successful in recruiting hard-to-reach populations. Advertising using "problem" terminology was more effective than "positive" terminology, while there was no significant effect of altruistic versus self-gain terminology. Online recruitment is efficient, flexible and cost-effective, suggesting that online recruitment has considerable potential for specific research designs.

Opening Minds Stigma Scale for Health Care Providers (OMS-HC): examination of psychometric properties and responsiveness

BACKGROUND

Diminishing stigmatization for those with mental illnesses by health care providers (HCPs) is becoming a priority for programming and policy, as well as research. In order to be successful, we must accurately measure stigmatizing attitudes and behaviours among HCPs. The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) was developed to measure stigma in HCP populations. In this study we revisit the factor structure and the responsiveness of the OMS-HC in a larger, more representative sample of HCPs that are more likely to be targets for anti-stigma interventions.

METHODS

Baseline data were collected from HCPs (n = 1,523) during 12 different anti-stigma interventions across Canada. The majority of HCPs were women (77.4%) and were either physicians (MDs) (41.5%), nurses (17.0%), medical students (13.4%), or students in allied health programs (14.0%). Exploratory factor analysis (EFA) was conducted using complete pre-test (n = 1,305) survey data and responsiveness to change analyses was examined with pre and post matched data (n = 803). The internal consistency of the OMS-HC scale and subscales was evaluated using the Cronbach's alpha coefficient. The scale's sensitivity to change was examined using paired t-tests, effect sizes (Cohen's d), and standardized response means (SRM).

RESULTS

The EFA favored a 3-factor structure which accounted for 45.3% of the variance using 15 of 20 items. The overall internal consistency for the 15-item scale (α = 0.79) and three subscales (α = 0.67 to 0.68) was acceptable. Subgroup analysis showed the internal consistency was satisfactory across HCP groups including physicians and nurses (α = 0.66 to 0.78). Evidence for the scale's responsiveness to change occurred across multiple samples, including student-targeted interventions and workshops for practicing HCPs. The Social Distance subscale had the weakest level of responsiveness (SRM ≤ 0.50) whereas the more attitudinal-based items comprising the Attitude (SRM ≤ 0.91) and Disclosure and Help-seeking (SRM ≤ 0.68) subscales had stronger responsiveness.

CONCLUSIONS

The OMS-HC has shown to have acceptable internal consistency and has been successful in detecting positive changes in various anti-stigma interventions. Our results support the use of a 15-item scale, with the calculation of three sub scores for Attitude, Disclosure and Help-seeking, and Social Distance.

Predictors of Generalized Anxiety Disorder stigma

The stigma associated with mental illness can lead to a range of negative outcomes, including delaying or avoiding help seeking. Identifying the characteristics of people who are more likely to hold stigmatizing attitudes enables the development of targeted stigma reduction programs. However, no previous research has systematically examined the predictors of anxiety stigma. This study used the Generalized Anxiety Stigma Scale (GASS) to assess the predictors of personal stigma and perceived stigma associated with Generalized Anxiety Disorder. A community sample of 617 Australian adults completed a survey that included the GASS, the Depression Stigma Scale, exposure to anxiety disorders, emotional distress and a range of demographic characteristics. Linear regression models indicated that women, people with greater exposure to anxiety disorders and people reporting a previous anxiety diagnosis had lower personal stigma toward anxiety. Higher exposure to anxiety disorders and rurality were significantly associated with higher perceived anxiety stigma. Results also suggested that respondents who had only been exposed to anxiety disorders through the media tended to be no more stigmatizing than respondents who had direct contact with people with an anxiety disorder. Media campaigns may be an effective vehicle for decreasing stigmatizing views in the community.

Unmet depression information needs in the community

BACKGROUND

Despite the well acknowledged importance of consumer health information, little is known about the public's depression information needs. This study aimed to develop a formal measure of unmet need for depression information in the community, to investigate the level of this unmet need and to identify its predictors.

METHODS

Data were collected as part of a survey of 12,319 Australian adults aged 18-65 years. This survey incorporated 21 questions targeting depression information need, together with measures of demographic status, self-reported current depression and personal stigma. The information needs data were subjected to principal components analysis followed by linear regression analyses to determine the demographic and other predictors of each of the resulting components.

RESULTS

Between 50 and 75% of participants endorsed the need for more information on each of the 21 information need topics. The PCA yielded a 20-item Depression Information Needs Scale (DINS) of high reliability and factor validity comprising four subscales: General (facts about depression), Specific Treatments, Research and Policies, and Lived Experience. Controlling for other factors, those with self-reported current depression and those without tertiary education had greater information needs across all four factors.

LIMITATIONS

The survey response rate was low and further research is required to establish the adequacy of the psychometric properties of the DINS.

CONCLUSIONS

Given the high unmet need for depression information there is a need to develop and implement evidence-based strategies for ensuring the accessibility and uptake of depression information relevant to the needs of members of the community.

The Y-Worri Project: study protocol for a randomised controlled trial

Background

Anxiety disorders are one of the most common psychological problems in adolescents. The school system has been identified as an ideal setting for the implementation of prevention and early intervention programs for anxiety; however, few programs are routinely delivered in schools and little is known about the best delivery methods. The aim of the current project is two-fold: to test the effectiveness of an intervention program for anxiety relative to a control condition, and to compare two methods of implementing the program.

Methods/design

This study is a three-arm cluster randomised controlled trial consisting of a wait-list control condition and two intervention conditions evaluating the effectiveness of an Internet-based program for preventing generalised anxiety. The first intervention condition will involve classroom teachers supervising student completion of the intervention program, while the second intervention condition will involve the classroom teacher and an education officer from the local youth mental health centre supervising the program’s completion. At least 30 schools from across Australia will be recruited to the trial, with adolescents aged between 14 and 18 years invited to participate. Participants in the intervention conditions will complete the e-couch Anxiety and Worry program during class periods over six weeks. The primary outcome measure will be a scale reflecting the number and severity of generalised anxiety symptoms, while secondary outcomes will be symptoms of depression, social anxiety and anxiety sensitivity. Data will be collected at pre-intervention, post-intervention, 6- and 12-month follow-up. Intention-to-treat analyses will be conducted.

Discussion

If demonstrated effective, a new service delivery model for the implementation of mental health programs in schools could be indicated. Such a model would significantly contribute to the mental health of young people in Australia by providing preventive interventions for mental health problems and consequently reducing the need for clinical services.

Trial registration

The Australian New Zealand Clinical Trials Registry ACTRN12610001103055

Internet-based interventions to promote mental health help-seeking in elite athletes: an exploratory randomized controlled trial

Background

Mental disorders are more common in young adults than at any other life stage. Despite this, young people have low rates of seeking professional help for mental health problems. Young elite athletes have less positive attitudes toward seeking help than nonathletes and thus may be particularly unlikely to seek help. Interventions aimed at increasing help-seeking in young elite athletes are warranted.

Objective

To test the feasibility and efficacy of three Internet-based interventions designed to increase mental health help-seeking attitudes, intentions, and behavior in young elite athletes compared with a control condition.

Methods

We conducted a randomized controlled trial (RCT) of three brief fully automated Internet-based mental health help-seeking interventions with 59 young elite athletes recruited online in a closed trial in Australia. The interventions consisted of a mental health literacy and destigmatization condition, a feedback condition providing symptom levels, and a minimal content condition comprising a list of help-seeking resources, compared with a control condition (no intervention). We measured help-seeking attitudes, intentions and behavior using self-assessed surveys. Participation was open to elite athletes regardless of their mental health status or risk of mental illness.

Results

Of 120 athletes initially agreeing to participate, 59 (49%) submitted a preintervention or postintervention survey, or both, and were included in the present study. Adherence was satisfactory, with 48 (81%) participants visiting both weeks of assigned intervention material. None of the interventions yielded a significant increase in help-seeking attitudes, intentions, or behavior relative to control. However, at postintervention, there was a trend toward a greater increase in help-seeking behavior from formal sources for the mental health literacy/destigmatization condition compared with control (P = .06). This intervention was also associated with increased depression literacy (P = .003, P = .005) and anxiety literacy (P = .002, P = .001) relative to control at postintervention and 3-month follow-up, respectively, and a reduction in depression stigma relative to control at postintervention (P = .01, P = .12) and anxiety stigma at 3-month follow-up (P = .18, P = .02). The feedback and help-seeking list interventions did not improve depression or anxiety literacy or decrease stigmatizing attitudes to these conditions. However, the study findings should be treated with caution. Due to recruitment challenges, the achieved sample size fell significantly short of the target size and the study was underpowered. Accordingly, the results should be considered as providing preliminary pilot data only.

Conclusions

This is the first RCT of an Internet-based mental health help-seeking intervention for young elite athletes. The results suggest that brief mental health literacy and destigmatization improves knowledge and may decrease stigma but does not increase help-seeking. However, since the trial was underpowered, a larger trial is warranted.

Trial Registration

2009/373 (www.clinicaltrials.gov ID: NCT00940732), cited at http://www.webcitation.org/5ymsRLy9r.