Effectiveness of an intervention for reducing social stigma towards mental illness in adolescents

The peer mental health stigmatization scale-revised (PMHSS-R): Psychometric properties and cross-cultural factorial invariance in university students in Ireland and Argentina

INTRODUCTION

The study aimed to assess the psychometric quality of the Peer Mental Health Stigmatization Scale - Revised (PMHSS-R), by examining its factorial structure among young adults in Ireland and Argentina.

METHOD

A total of 429 participants aged between 18 and 25 years old were recruited (n = 187 Ireland, n = 242 Argentina). The PMHSS-R was completed by Irish participants and was translated, pilot-studied, and subsequently completed by Argentinian participants.

RESULTS

A Confirmatory Factor Analysis demonstrated optimal factor loadings for an eight-item solution and acceptable internal consistency for both scale dimensions in the Argentinian sample. Satisfactory levels of partial scalar invariance were achieved between countries, indicating that the scale measures mental health stigma consistently across cultures.

DISCUSSION AND CONCLUSIONS

Our findings highlight the PMHSS-R as a cross-culturally valid and reliable psychometric instrument to evaluate interventions targeting stigma. In conclusion, the PMHSS-R can be used in cross-cultural research to compare levels of mental health stigma and investigate the interplay between stigma and other psychologically relevant constructs between different countries and cultural contexts.

Involving Persons With Lived Experience to Improve Vocational Students' Stigmatizing Attitudes Toward Mental Disorders: A Quasi-Experimental Study

BACKGROUND

Mental health problems are estimated to affect one in six individuals in the European Union. Fifty percent of mental disorders start in adolescence, around the age of 14. The stigma associated with having a mental health problem is one of the main barriers to seeking help for psychiatric and psychological disorders among adolescents and young adults. Interventions to reduce social stigma could contribute to increased help-seeking behavior in this population. AIMS: To assess the effectiveness of a direct contact intervention in the classroom by persons with lived experience to reduce vocational students' stigmatizing attitudes. METHOD: One person with lived experience and one first-degree relative implemented a classroom intervention lasting 90 min. Its effectiveness was measured using a quasi-experimental study with a pretest-posttest design and within-subject control. RESULTS: A total of 128 students from three different Vocational and Technical Schools from Spain participated in the study. After the intervention, statistically significant differences were observed in the scores of 11 of the 13 dimensions measured with the Spanish Mental Illness Stigma Attribution Questionnaire (AQ-27-E) and the Community Attitudes toward Mental Illness (CAMI) questionnaires. No differences associated with gender or familiarity with the mental disorder were observed. CONCLUSION: Vocational students' negative attitudes and emotions can be improved through a direct contact intervention in the classroom involving people who have experienced a mental disorder themselves. The age range for optimal results with this type of intervention appears to be 18 to 20 years.

The effects of a psychiatric clerkship on stigmatizing attitudes toward mental disorders as held by German medical students

Background

According to the United Nations, access to medical care is a fundamental human right. However, there is widespread stigmatization of severe mental illnesses and this appears to seriously hamper the quality of healthcare in people with psychiatric co-morbidity. Thus, interventions that help reduce stigma among healthcare providers are urgently needed.

Purpose

The objective of the current study was to investigate the effects of a psychiatric clerkship on stigmatizing attitudes toward mental disorders held by medical students.

Methods

Between 2018 and 2019, a total of 256 third- and fourth-year students from Marburg University Medical School (Germany) completed two surveys-one before and one after a 2 week clerkship program that was designed to prioritize direct interaction with the patients. For measuring stigma, the questionnaires contained questions about students' attitudes toward psychiatry (ATP), including the Opening Minds Scale for Healthcare Providers (OMS-HC), Community Attitudes Toward the Mentally Ill (CAMI), and measurements according to the Stereotype-Content Model (SCM). We conducted pre-vs.-post comparisons using the Wilcoxon signed rank test with continuity correction or paired t-test and employed the Spearman method for correlational analysis. We considered p < 0.05 significant and adjusted all p-values reported here using the Benjamini-Hochberg procedure to account for family-wise error.

Results

After the clerkship, a significantly reduced stigma was found, as assessed with ATP (mean p < 0.001), OMS-HC (sum and subscale "attitudes" p < 0.001; subscale "disclosure" p = 0.002), and both SCM subscales (p < 0.001). Moreover, we observed significant associations between stigma expression (e.g., OMS-HC sum) and the willingness of students to choose psychiatric residency after finishing medical school (before clerkship: p < 0.001; ρ = -0.35; change after clerkship: p = 0.004; ρ = -0.2).

Conclusion

Our findings indicate that a psychiatric clerkship that involves students in direct interaction with patients may effectively reduce stigma. Therefore, we advocate the incorporation of components of direct interaction in medical education to combat stigma and unequal treatment, as this could improve outcomes in patients with severe mental illnesses.

The effectiveness of anti-stigma interventions for reducing mental health stigma in young people: A systematic review and meta-analysis

Experiencing mental health stigma during adolescence can exacerbate mental health conditions, reduce quality of life and inhibit young people's help-seeking for their mental health needs. For young people, education and contact have most often been viewed as suitable approaches for stigma reduction. However, evidence on the effectiveness of these anti-stigma interventions has not been consistent. This systematic review evaluated the effectiveness of interventions to reduce mental health stigma among youth aged 10-19 years. The review followed Cochrane and PRISMA guidelines. Eight databases were searched: PubMed, PsycINFO, MEDLINE, Web of Science, Scopus, EMBASE, British Education Index and CNKI. Hand searching from included studies was also conducted. Randomised controlled trials and experimental designs that included randomised allocation to interventions and control groups were included in the review. Narrative synthesis was employed to analyse the results. A meta-analysis was conducted to determine the effectiveness of included interventions. Twenty-two studies were included in the review. Eight studies reported positive effects, 11 studies found mixed effects and 3 studies reported no effect on indicators of mental health stigma among youth. Seven of the effective studies were education-based. Eleven studies were suitable for meta-analysis, and the multivariate meta-analytic model indicated a small, significant effect at post-intervention (d = .21, p < .001), but not at follow-up (d = .069, p = .347). Interventions to reduce stigma associated with mental health conditions showed small, short-term effects in young people. Education-based interventions showed relatively more significant effects than other types of interventions.

Justification of Discrimination against People with Mental Illness in Republic of Korea

AIMS

This study aimed to analyze the process in which individual values and beliefs affected social distance against people with mental illness by mediating cognition, based on applying the justification-suppression model to the stigma of mental illness.

METHODS

An online survey was conducted with 491 adults aged 20 to 64 years. Their sociodemographic characteristics, personal values, and beliefs, justification for discrimination, and social distance were measured to assess their perceptions of, and behaviors towards, persons with mental illness. Path analysis was performed to examine the magnitude and significance of the hypothetical relationship between variables.

RESULTS

Protestant ethic values and morality significantly affected the justification of inability and dangerousness and attribute responsibility. Excluding attribute responsibility, the justification of inability and dangerousness significantly predicted social distance. In other words, the higher the Protestant ethic values, the higher the morality of binding, and the lower the morality of individualizing, the higher the level of justification based on inability and dangerousness. Such justification has been found to increase social distance from persons with mental illness. In addition, mediating effects were the largest in the path of the morality of binding → justification of dangerousness → social distance.

CONCLUSIONS

The study proposes various strategies to deal with individual values, beliefs, and justification logic to reduce social distance against those with mental illness. These strategies include a cognitive approach and empathy, both of which inhibit prejudice.

Assessment of the treatment needs of community recovery Services in Spain: From the perspective of service users, families, and mental health professionals

Profile of Community Recovery Services users has changed over the years and has become more diverse. To explore the evolution of treatment needs, this study aimed to identify users' needs, from the point of view of different agents implicated in the recovery process. We explored the consistency between the agents using the focus group technique. We defined four groups (n = 58): service users, family members, professionals, and referring professionals. We pre-identified topics related to recovery, such as illness-related losses, imaginary of CRS, expectations, activities, and life goals. All agents recognised losses related to the mental illness, the need for carrying activities out of the Community Recovery Services, and for including families in the recovery process. The groups differed in some areas, such as the identification of activities that should be encouraged, or the importance of promoting vital expectations. Our findings suggest that it is important to identify the needs of different agents involved in the recovery process. There is consistency in the service users' needs, but there are some differences that need to be considered. Interventions should be personalised, covering functional, cognitive, and relational losses related to the mental illness.

Role of politically motivated internet addiction and ideological passion in linking college student's mental health education and wellbeing

College students are increasingly reporting common mental health issues like depression and anxiety, raising severe concerns for students' psychological wellbeing. Specifically, after the emergence of Post-COVID-19, digitization caused a potential role in mitigating students' psychological concerns. Therefore, the role of mental health education has been regarded as a topic of interest in managing the issue of Chinese college students' mental wellbeing. This study intends to look into the relationship between mental health education and psychological wellbeing, along with the moderating role of politically motivated internet addiction and the ideological passion of college students. For the given reason, the random sampling method was employed for collecting data from target respondents. The study uses 750 questionnaires prepared on a five-point Likert scale that were distributed to the respondents with an expected response rate of 50%. The partial least square (PLS) software was used to analyze the data for this study. The study concludes that there is a significant moderating role of politically motivated internet addiction and ideological passion in the relationship between college students' mental health and wellbeing. The study meaningfully contributes to the body of knowledge by establishing the unique, positive moderating role of Politically motivated internet addition in strengthening the relationship which undoubtedly will assist in improving the psychological wellbeing of college students through mental health education policies and implications.

The use of film-based interventions in adolescent mental health education: A systematic review

Film-based interventions have been embraced by adolescents as educational tools, but their efficacy in mental health education remains under-explored. In this review, we systematically examined the use of film-based interventions in adolescent mental health education. A systematic review of the empirical literature was conducted using the following databases: Academic Search Complete, Education Full Text [H.W. Wilson], CINAHL Plus with Full Text, Humanities Full Text [H.W. Wilson], MEDLINE, APA PsycArticles, APA PsycInfo, Psychology and Behavioral Sciences Collection, Social Sciences Full Text [H.W. Wilson], Soc Index, ERIC. Risk of Bias were assessed using Version 2 of the Cochrane RoB tool for randomised trials (RoB2) or the Cochrane Collaboration Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I). Ten peer-reviewed studies were included in this review. Film emerged as a promising education method for enhancing metal health literacy and reducing stigma. Mixed reports were found for improving attitudes towards help-seeking, with narrative-based films having a weaker effect on attitudes towards help-seeking when compared with more instructive approaches. No study focussed on resilience. This review highlights the utility and potential for film-based interventions in adolescent mental health education. Further research is warranted around how best to implement such interventions to engage adolescents.

Advancing research to eliminate mental illness stigma: an interventional study to improve community attitudes towards depression among University students in Singapore

BACKGROUND

After decades of anti-stigma initiatives, the Advancing Research To Eliminate Mental Illness Stigma (ARTEMIS) intervention study is one of the first in Singapore to evaluate the effects of an anti-stigma intervention on attitudes towards depression in university students.

METHODS

390 university students from a local university in Singapore were voluntarily recruited for the study. The ARTEMIS intervention comprises an educational and social contact component, as well as a question and answer (Q&A) session with experts in the area of mental health. The Community Attitudes towards Mental Illness (CAMI) scale was administered at baseline, post-intervention and at 3-months follow-up. A confirmatory factor analysis (CFA) was conducted.

RESULTS

The CFA identified a 3-factor model for the CAMI with a decent fit (RMSEA = 0.06, CFI = 0.93, TLI = 0.93, SRMR = 0.06). Favourable shifts in attitudes across the factors were observed immediately after the intervention (p <  0.001). Gender (β = - 1.19, 95% CI: - 2.10, - 0.27, p = 0.01) and nationality (β = - 1.23, 95% CI: - 2.35, - 0.11, p = 0.03) were identified as significant correlates for the community mental health ideology (CMHI) factor. Linear effects indicated that having a close social contact with mental illness observed a smaller decrease in authoritarianism scores from pre- to post-intervention (β = 0.85, 95% CI: 0.18, 1.53, p = 0.01); whereas quadratic effects found a greater decrease in scores from post-intervention to after 3-months for benevolence (β = - 0.34, 95% CI: - 0.52, - 0.16, p <  0.001) and CMHI (β = - 0.22, 95% CI: - 0.45, - 0.002, p = 0.048).

CONCLUSION

The anti-stigma intervention shows promising short-term results across the CAMI dimensions even after adjusting for sociodemographic correlates. However, the intervention did not observe the sustained attitude shifts after 3-months. Recommendations for future anti-stigma interventions were also considered.

Psychometric properties of the Peer Mental Health Stigmatization Scale-Revised in adolescents and young adults

AIM

This study aimed to examine the factorial validity and reliability of the Peer Mental Health Stigmatization Scale (PMHSS) in adolescents and young adults.

METHODS

Young people (N = 963) aged 12 to 25 years (M = 16.1, SD = 3.08) were recruited across two studies. Study 1 included adolescents (n = 776) recruited from secondary schools and study 2 included young adults (n = 187) recruited from universities. All participants completed the PMHSS.

RESULTS

Exploratory factor analysis resulted in a bi-factorial solution of the PMHSS by retaining 11 items out of the original 16 that loaded on the latent factors of stigma agreement and stigma awareness. Confirmatory factor analysis established the factor structure of the tool in adolescents and young adults.

CONCLUSIONS

This shorter version of the PMHSS remains the only validated tool that measures stigma awareness and stigma agreement in youth. We recommend that this version is used in future research.

Interventions to Reduce Stigma Related to Mental Illnesses in Educational Institutes: a Systematic Review

This investigation reviews the effectiveness of anti-stigma interventions employed at educational institutes; to improve knowledge, attitude and beliefs regarding mental health disorders among students. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist guidelines were followed and protocol was registered in PROSPERO (CRD42018114535). Forty four randomized controlled trials were considered eligible after screening of 104 full-text articles against inclusion and exclusion criteria.Several interventions have been employed to tackle stigma toward psychiatric illnesses, including education through lectures and case scenarios, contact-based interventions, and role-plays as strategies to address stigma towards mental illnesses. A high proportion of trials noted that there was a significant improvement for stigma (19/25, 76%), attitude (8/11, 72%), helping-seeking (8/11, 72%), knowledge of mental health including recognition of depression (11/14, 78%), and social distance (4/7, 57%). These interventions also helped in reducing both public and self-stigma. Majority of the studies showed that the anti-stigma interventions were successful in improving mental health literacy, attitude and beliefs towards mental health illnesses.

Identifying the prerequisites, facilitators, and barriers in improving adolescents' mental health literacy interventions: A systematic review

The present study aimed at identifying the prerequisites, facilitators, and barriers to adolescent mental health literacy interventions. To that end, databases PsycINFO, Science Direct, Scopus, Emerald, PubMed, Web of Science, and Google Scholar were systematically searched, out of which 39 articles that had the inclusion criteria were analyzed by the content analysis. Databases searched from September 30, 2018, to October 10, 2018, with the keywords "health literacy," "mental health literacy," "mental disorders," adolescents, students, and more. Seven themes were identified as the prerequisites for interventions to improve adolescents' mental health literacy including education at the school level, parents' education, training of trainers and providers, cooperation and participation among providers, intervention assessment and monitoring, provision of educational content, consideration of the cultural and linguistic issues. Five themes were identified as facilitators: using interactive learning and teaching methods, supplying diverse and stimulating educational content, employing trainers with different backgrounds, having direct contact with people with mental illness, and utilizing technological advancements in education. Finally, short-time intervention, the collaboration between school administrators and researchers, lack of valid information sources were identified as barriers.