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Evaluating an Antistigma Intervention Combining Personal Account With Musical Performance Among Rural Adolescents

Authors:
Janet C Lindow at University of Kansas Medical Center
Janet C Lindow
Mercedes N. Becker
Mercedes N. Becker
Mercedes N. Becker
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Paul A. Nakonezny
Paul A. Nakonezny
Paul A. Nakonezny
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Matthew J. Byerly
Matthew J. Byerly
Matthew J. Byerly
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Abstract

Mental health-related stigma contributes to poorer disease outcomes among youth with mental disorders. In this study, the short-term impact on mental health stigma of a universal, contact-based intervention was evaluated among students attending 4 rural high schools using an uncontrolled within-subjects pre/posttest design. Among the 736 participants, a significant reduction in stigma, particularly in students with higher preintervention stigma ratings, was found along with significant increases in help-seeking attitudes and willingness to consider working in mental health professions. These initial findings suggest that the brief contact-based intervention, delivered with a novel, musical component, may reduce mental health stigma among adolescents.
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Evaluating an Antistigma Intervention Combining Personal Account
With Musical Performance Among Rural Adolescents
Janet C. Lindow and Mercedes N. Becker
Montana State University
Paul A. Nakonezny
University of Texas Southwestern Medical Center
Matthew J. Byerly
Montana State University
Mental health-related stigma contributes to poorer disease outcomes among youth with
mental disorders. In this study, the short-term impact on mental health stigma of a
universal, contact-based intervention was evaluated among students attending 4 rural
high schools using an uncontrolled within-subjects pre/posttest design. Among the 736
participants, a significant reduction in stigma, particularly in students with higher
preintervention stigma ratings, was found along with significant increases in help-
seeking attitudes and willingness to consider working in mental health professions.
These initial findings suggest that the brief contact-based intervention, delivered with
a novel, musical component, may reduce mental health stigma among adolescents.
Keywords: mental health stigma, intervention, adolescent, contact-based, help-seeking
Supplemental materials: http://dx.doi.org/10.1037/rmh0000122.supp
Fifty percent of all individuals with mental
disorders in the United States develop them by
age 14 (Merikangas et al., 2010), making ado-
lescence a critical period for addressing mental
health education, including stigma. Stigmatiz-
ing attitudes often prevent adolescents with
mental disorders from seeking health care ser-
vices, potentially contributing to disease pro-
gression and increased risk of suicide (Salerno,
2016). In addition, stigma may increase social
isolation, damage self-esteem, reduce hope for
recovery, and negatively influence the develop-
ment of autonomy of youth with mental disor-
ders (Salerno, 2016).
In rural U.S. regions, mental health literacy is
often low, stigma is high, and both negatively
affect help-seeking behaviors (Gamm, Stone, &
Pittman, 2010). For the youth who do seek help,
XJanet C. Lindow and Mercedes N. Becker, Center for
Mental Health Research and Recovery, Department of Cell
Biology and Neuroscience, Montana State University; Paul
A. Nakonezny, Department of Clinical Science and the
Department of Psychiatry, University of Texas Southwest-
ern Medical Center; Matthew J. Byerly, Center for Mental
Health Research and Recovery, Department of Cell Biol-
ogy and Neuroscience, Montana State University.
Janet C. Lindow is now at the Department of Psychiatry,
University of Arizona College of Medicine, and the South-
ern Arizona Veterans Affairs Health Care System, Tucson,
Arizona. Matthew J. Byerly is now at the Department of
Psychiatry, University of Arizona College of Medicine,
and the Southern Arizona Veterans Affairs Health Care
System.
Janet C. Lindow and Mercedes N. Becker contributed
equally to this work.
This study was funded by Montana State University
research funds. The funders of this research had no role in
the study design, analysis, interpretation of results, or prep-
aration of this paper. The content is the sole responsibility
of the authors and does not necessarily represent the offi-
cial views of any of the funders. The authors have no
biomedical financial interests or potential conflicts of in-
terest to declare. The team thanks Jason DeShaw for de-
veloping and delivering the described intervention. The
study team is also grateful to the participating schools’
administration, students, parents, and communities for their
support of this study.
Correspondence concerning this article should be ad-
dressed to Janet C. Lindow, who is now at Biomedical
Research and Education Foundation of Southern Arizona,
MC (0-151), Tucson, AZ 85723. E-mail: jlindow@alum
.mit.edu
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Journal of Rural Mental Health
© 2019 American Psychological Association 2019, Vol. 43, No. 4, 130–137
ISSN: 1935-942X http://dx.doi.org/10.1037/rmh0000122
130
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Aim The onset of mental illness is most common in adolescence, therefore mental health promotion efforts frequently target this age group. Evaluation literature in this area is largely segmented into specific domains in terms of settings, countries, and/or groups of young people, but an overall understanding and comparison across these areas is lacking. The current review aims to provide such an overview of interventions/programs which attempt to improve adolescents' mental health literacy, attitudes/stigma and behaviours. Methods A systematic mapping review synthesized the strengths and weaknesses of published interventions/programs to improve mental health outcomes in youth. Ten databases and grey literature sources were searched, and results were categorized according to sample, location/setting, type of information presented, delivery and testing procedures, mental health outcome/s evaluated, and limitations. Results One hundred and forty articles met the inclusion criteria; 126 were original records and 14 were reviews. Mental health literacy and attitudes/stigma were examined most frequently, and studies were predominantly conducted in school‐based environments and high income economies. Intervention/program effectiveness varied across outcome/s measured, setting, and control group usage, with mental health literacy exhibiting the most positive changes overall. Common limitations included no long‐term follow up or control group inclusion. Conclusions Despite generally positive changes seen throughout studies in this area, effectiveness differed across a range of methodological domains. Most research is conducted in schools and higher income economies, but the lack of investigation in other contexts (i.e., internet or community) or lower income countries suggests our understanding in this area is constrained.
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Background: We aimed to assess whether short video interventions could reduce stigma among nursing students. Methods: A multi-centre, randomised controlled trial was conducted. Participating schools were randomly selected and randomly assigned to receive: (1) an informational leaflet, (2) a short video intervention or (3) a seminar involving direct contact with a service user. The Community Attitudes towards Mental Illness (CAMI) and Reported and Intended Behaviour Scale (RIBS) were selected as primary outcome measures. SPANOVA models were built and Cohen’s d calculated to assess the overall effects in each of the trial arms. Results: Compared to the baseline, effect sizes immediately after the intervention were small in the flyer arm (CAMI: d = 0.25; RIBS: d = 0.07), medium in the seminar arm (CAMI: d = 0.61; RIBS: d = 0.58), and medium in the video arm (CAMI: d = 0.49 RIBS: d = 0.26; n = 237). Effect sizes at the follow-up were vanishing in the flyer arm (CAMI: d = 0.05; RIBS: d = 0.04), medium in the seminar arm (CAMI: d = 0.43; RIBS: d = 0.26; n = 254), and small in the video arm (CAMI: d = 0.22 RIBS: d = 0.21; n = 237). Conclusion: Seminar had the strongest and relatively stable effect on students’ attitudes and intended behaviour, but the effect of short video interventions was also considerable and stable over time. Since short effective video interventions are relatively cheap, conveniently accessible and easy to disseminate globally, we recommend them for further research and development.
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Effectiveness of Universal School-Based Mental Health Awareness Programs Among Youth in the United States: A Systematic Review
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Aim: To evaluate the effectiveness of an intervention for reducing social stigma towards mental illness in adolescents. The effect of gender and knowledge of someone with mental illness was measured. Methods: Two hundred and eighty secondary school students were evaluated using the Community Attitudes towards Mental Illness (CAMI) questionnaire. The schools were randomized and some received the intervention and others acted as the control group. The programme consisted of providing information via a documentary film and of contact with healthcare staff in order to reduce the social stigma within the school environment. Results: The intervention was effective in reducing the CAMI authoritarianism and social restrictiveness subscales. The intervention showed significant changes in girls in terms of authoritarianism and social restrictiveness, while boys only showed significant changes in authoritarianism. Following the intervention, a significant reduction was found in authoritarianism and social restrictiveness in those who knew someone with mental illness, and only in authoritarianism in those who did not know anyone with mental illness. Conclusion: The intervention was effective to reduce social stigma towards people with mental illness, especially in the area of authoritarianism. Some differences were found depending on gender and whether or not the subjects knew someone with mental illness.
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Video is considered to be an effective, easy to use tool employed in anti-stigma interventions among young people. Mass media has been shown to be effective for reducing stigma; however, there is insufficient evidence to determine the destigmatization effects of videos specifically. This article systematically reviews the effectiveness of video intervention in reducing stigma among young people between 13 and 25 years. We searched 13 electronic databases including randomized controlled trials, cluster randomized controlled trials, and controlled before and after studies. Of the 1426 abstracts identified, 23 studies (reported in 22 papers) met the inclusion criteria. Video interventions led to improvements in stigmatising attitudes. Video was found to be more effective than other interventions, such as classical face-to-face educational sessions or simulation of hallucinations. According to results of two studies, social contact delivered via video achieved similar destigmatization effect to that delivered via a live intervention. Although the quality of studies as well as the form of video interventions varied, the findings suggest that video is a promising destigmatization tool among young people; however, more studies in this area are needed. There was a lack of evidence for interventions outside of school environments, in low- and middle-income countries, and studies, which looked at long-term outcomes or measured impact on actual behaviour and implicit attitudes. The review generates recommendations for video interventions targeted at young people.
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The Development of an Empirical Model of Mental Health Stigma in Adolescents
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Background: Research on mental health stigma in adolescents is hampered by a lack of empirical investigation into the theoretical conceptualisation of stigma, as well as by the lack of validated stigma measures. This research aims to develop a model of public stigma toward depression in adolescents and to use this model to empirically examine whether stigma is composed of three separate dimensions (Stereotypes, Prejudice and Discrimination), as is theoretically proposed. Method: Adolescents completed self-report measures assessing their stigmatising responses toward a fictional peer with depression. An exploratory factor analysis (EFA; N=332) was carried out on 58-items, which proposed to measure aspects of stigma. A confirmatory factor analysis (CFA; N=236) was then carried out to evaluate the validity of the observed stigma model. Finally, higher-order CFAs were conducted in order to assess whether the observed model supported the tripartite conceptualisation of stigma. Results: The EFA returned a seven-factor model of stigma. These factors were designated as Dangerousness, Warmth & Competency, Responsibility, Negative Attributes, Prejudice, Classroom Discrimination and Friendship Discrimination. The CFA supported the goodness-of-fit of this seven-factor model. The higher-order CFAs indicated that these seven factors represented the latent constructs of, Stereotypes, Prejudice and Discrimination, which in turn represented Stigma. Conclusions: Overall, results support the tripartite conceptualisation of stigma and suggest that measurements of mental health stigma in adolescents should include assessments of all three dimensions. These results also highlight the importance of establishing valid and reliable measures for assessing stigma in adolescents.
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