Content uploaded by Doron Amsalem
Author content
All content in this area was uploaded by Doron Amsalem on Jun 06, 2022
Content may be subject to copyright.
Original Investigation | Psychiatry
Effect of a Brief Social Contact Video on Transphobia and Depression-Related
Stigma Among Adolescents
A Randomized Clinical Trial
Doron Amsalem, MD; Justin Halloran, BS; Brent Penque, MD, PhD; Jillian Celentano, BS; Andrés Martin, MD, MPH
Abstract
IMPORTANCE Transphobia and stigma remain barriers to seeking mental health care for gender-
diverse adolescents.
OBJECTIVE To examine the utility of brief social contact–based video interventions of transgender
protagonists with depression to reduce transphobia and depression-related stigma and increase
treatment-seeking intentions among adolescents in the general population.
DESIGN, SETTING, AND PARTICIPANTS During August 2021, a total of 1437 participants were
recruited and randomly assigned to 1 of 4 video-based conditions in a 2:2:1:1 ratio: (1) transgender
adolescent girls, (2) transgender adolescent boys, (3) cisgender adolescent girls, or (4) cisgender
adolescent boys.
INTERVENTIONS In each of the approximately 110-second videos, an empowered presenter shared
their personal story about coping with depression and reaching out for help.
MAIN OUTCOMES AND MEASURES The primary outcome was the score on the Attitudes Toward
Transgender Men and Women (ATTMW) scale. Secondary outcomes were (1) a “gender
thermometer” rating for warmth in transgender perception, (2) the Depression Stigma Scale (DSS)
score, and (3) the General Health-Seeking Questionnaire (GHSQ) score.
RESULTS Of the 1437 randomized participants, 1098 (76%) completed the postintervention
assessment and passed all the validity tests (mean [SD] age, 16.9 [1.2] years; 481 [44%] male; 640
[58%] White). A significant change in attitudes toward transgender youth was found within the
intervention group only (mean [SD] ATTMW scores: intervention group, 34.6 [23.1] at baseline to
32.8 [24.2] after intervention; P< .001; control group, 33.5 [23.4] at baseline to 32.4 [24.1] after
intervention; P= .01). The mean (SD) total DSS scores decreased significantly across study groups
(intervention: 1.3 [3.3]; control: 1.7 [3.3]; P< .001). A significant increase in intention to seek help
from a parent was found in the intervention (mean [SD] GHSQ score, 0.2 [1.1]) and control (mean [SD]
GHSQ score, 0.3 [1.2]) groups (P< .001), as was a decrease in those not wanting to seek help from
anyone (mean [SD] GHSQ score: intervention, 0.2 [1.6], P= .009; control, 0.3 [1.2], P< .001)
Secondary analyses revealed significant differences in baseline ATTMW scores and intervention
effects between transgender and gender-diverse and cisgender participants and between lesbian,
gay, bisexual, or queer (LGBQ) and straight participants (F = 36.7, P< .001) and heterosexual
participants (F = 37.0, P< .001). A significant difference was also found in mean (SD) transgender
warmth scores from baseline to after intervention between groups (2.6° [13.1°] in the intervention
group vs 0.4° [8.3°] in the control group; P< .001).
(continued)
Key Points
Question Can a 110-second video of a
transgender protagonist describing their
personal history of coping with
depression reduce adolescent
transphobia and depression-
related stigma?
Findings In this randomized clinical trial
of 1098 adolescents, a significant
change in attitudes was found toward
transgender youth only in the
intervention groups, especially among
participants who self-identified as
cisgender and/or of heterosexual
orientation. As anticipated, a significant
reduction in depression-related stigma
was also found across all study groups.
Meaning Brief social contact–based
videos proved efficacious in reducing
adolescent transphobia and
depression-related stigma.
+Visual Abstract
+Invited Commentary
+Supplemental content
Author affiliations and article information are
listed at the end of this article.
Open Access. This is an open access article distributed under the terms of the CC-BY License.
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376 (Reprinted) February 25, 2022 1/12
Downloaded From: https://jamanetwork.com/ on 02/26/2022
Abstract (continued)
CONCLUSIONS AND RELEVANCE In this randomized clinical trial, brief social contact–based videos
proved efficacious in reducing transphobia and depression-related stigma and in increasing
treatment-seeking intentions among adolescents in the general population. By personifying,
individualizing, and providing face and voice to the experience of transgender youth, other
adolescents, especially those who are cisgender and/or of a heterosexual orientation, can gain
empathetic insights into the lives of their often marginalized and stigmatized fellow youth.
TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04969003
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376
Introduction
Transgender and gender-diverse (TGD) youth are disproportionally affected by depression, anxiety,
and suicidal ideation when compared with their cisgender peers.
1-5
Although gender diversity by
itself is not pathological and does not require mental health treatment, mental health issues can be
secondary to gender dysphoria, and TGD youth may benefit from mental health treatment and
gender-affirming medical care. The prevalence of suicidal ideation among TGD youth has been
reported to be almost two-thirds in some studies,
6-9
with an alarming 41% suicide attempt rate. Data
indicate that the proportion of youth who openly self-identify as TGD has increased substantially
over the years.
10,11
The most recent Centers for Disease Control and Prevention Youth Risk Behavior
Survey
12
reported that 1.8% of high school youth identify as transgender, and recent studies
13-15
among 3441 young people have found that 90 (3%) identified as gender nonbinary.
The stigma surrounding mental illness acts as a barrier to young people seeking care, such that
reducing stigmatized perceptions among young people could enhance their likelihood to seek help or
treatment.
16-21
It is well known that transphobia, a form of stigma against TGD youth, may lead to
social discrimination, minority stress, and internalized self-hate, creating risk factors for mental
illness in this population.
22
For example, transgender high school students report significantly higher
rates of victimization and harassment than their cisgender peers and are more likely to feel unsafe.
23
Considered through the minority stress model, transgender youth struggle with distal factors, such
as discrimination, and proximal ones, such as concealment and internalized transphobia.
24
Moreover,
recent changes in legislation, such as bills that target gender-affirming medical care or place
restrictions on bathrooms or sports for transgender youth, are increasing.
25,26
Thus, TGD youth
struggling with depression often face the dual stigma of marginalized gender identity and
mental illness.
Social contact–based interventions are the most successful way to reduce stigma.
27
Video-
based social contact interventions have effectively improved attitudes toward mental illness and
reduced stigma and discrimination.
28,29
A previous study
15
among 1183 adolescents demonstrated
the efficacy of brief videos (102-113 seconds each) in decreasing depression-related stigma and
increasing participants’ reported willingness to seek mental health care. Brevity has advantages,
including lower cost, less resource use, and greater ease of dissemination to large audiences. Shorter
videos are also better suited to younger audiences. Social contact with TGD individuals has been
shown to improve attitudes and reduce transphobia, but no study to date has examined the efficacy
of a brief video intervention in changing the perceptions of general-population youth toward
TGD people.
30-34
With these considerations in mind, we conducted a randomized clinical trial of adolescents in
the general population to test the utility of a brief video-based intervention of transgender
adolescent protagonists in order to reduce transgender-related stigma (transphobia) and
depression-related stigma and increase treatment-seeking intentions. We hypothesized that when
compared with the control condition of cisgender protagonists describing their depression and
JAMA Network Open | Psychiatry Effect of a Video on Transphobia and Depression-Related Stigma Among Adolescents
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376 (Reprinted) February 25, 2022 2/12
Downloaded From: https://jamanetwork.com/ on 02/26/2022
pathways to care, the transgender protagonist interventions would result in greater reduction in
transphobia and similar changes in depression-related stigma and treatment-seeking intentions.
Methods
Participants and Recruitment
We recruited 1437 evaluable participants using CloudResearch,
35
a crowdsourcing platform widely
used in behavioral research and with extensive experience in recruiting underrepresented groups,
including minors. We included only English-speaking youth, 14 to 18 years of age, living in the US. We
focused on this age range because it overlaps with the median age of onset of major depressive
disorder and/or suicidal ideation. All participants reviewed an informed assent page and provided
written informed consent (parental consent was waived). Participants were recruited and completed
the study during August 2021. All data were deidentified. This randomized clinical trial wasapproved
by the Yale Human Investigations Committee and followed the Consolidated Standards of Reporting
Trials (CONSORT) reporting guideline. The trial protocol is available in Supplement 1.
We randomly assigned participants to 1 of 4 video conditions on a 2:2:1:1 ratio (transgender girl,
transgender boy, cisgender girl, and cisgender boy) (Figure 1). For participants who self-identified
as transgender or gender nonbinary (n = 131), we constrained randomization to the transgender girl
or transgender boy conditions. There are 2 explanations for this decision. First, an earlier study
15
showed a significant effect for the intervention groups in reducing depression-related stigma and
increasing treatment-seeking intent, especially among viewers who shared demographic
characteristics with the protagonist. Considering the relatively high level of depression and suicidality
among TGD adolescents, randomizing those teens to 1 of the intervention groups seemed clinically
justified for this high-risk population. Second, based on the previous findings
15
that greater
identification with the video presenter correlates with greater effect, we were interested in
examining whether a transgender person watching someone who identifies similarly would show a
greater decrease in stigma and increase in treatment seeking. We would not anticipate a change in
transphobia among TGD adolescents exposed to cisgender protagonists. Assuming a low number of
participants who would identify as TGD, we only assigned those individuals into 1 of 2
intervention groups.
We used several accepted methods to exclude invalid participants to ensure the quality of the
collected data, as described in a previous study.
15
In addition, we used 3 questions to exclude
inattentive or disengaged participants, each phrased in a consistent way and requiring a single,
forced answer (eg, “Please mark the third option below”). Volunteers were compensated $3.50 for
their participation. We directed respondents who agreed to participate to an online data collection
platform (Qualtrics).
Figure 1. Study Flow Diagram
119 Excluded for
missing data
66 Excluded for
missing data
1437 Randomized
511 Video of a transgender
girl (intervention)
393 Underwent
post-intervention
assessment
391 Underwent
post-intervention
assessment
166 Underwent
post-intervention
assessment
148 Underwent
post-intervention
assessment
510 Video of a transgender
boy (intervention)
202 Video of a cisgender
girl (control)
214 Video of a cisgender
boy (control)
118 Excluded for
missing data
36 Excluded for
missing data
JAMA Network Open | Psychiatry Effect of a Video on Transphobia and Depression-Related Stigma Among Adolescents
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376 (Reprinted) February 25, 2022 3/12
Downloaded From: https://jamanetwork.com/ on 02/26/2022
Intervention
We used 2 brief intervention videos (114-118 seconds each), excerpted from filmed interviews with
two 17-year-old transgender adolescents, 1 female (“Monica”) and 1 male (“Parker”). One of us (J.C.), a
transgender woman with experience working with gender-fluid youth, helped develop the scripts
and supported the actors during the rehearsal and filming sessions. These scripts aimed to reflect
some of the objective realities of being transgender in a way that was true to life, while avoiding
exaggeration that could further entrench gender stereotypes. For example, the youth described their
difficulties of “living in the wrong body” and feeling “trapped and [as if] there was no way out.” They
also explained that because of these sentiments their depression worsened and led to thoughts that
life is not worth living and even of dying by suicide. Later, they discussed how sharing these intimate
feelings with family and friends and subsequently receiving professional help changed their lives for
the better. The control videos (102-113 seconds each), the same ones used in the previous study,
15
included 2 young cisgender adolescent protagonists,1afemale (“Ali”) and 1 a male (“Danny”), who
described how they had coped with depressive symptoms and ultimately recovered through the help
and support they received. The 4 video clips are available for viewing through links in eAppendix 1 in
Supplement 2.
Instruments
The primary outcome was the Attitudes Toward Transgender Men and Women (ATTMW) scale, a
measure of transphobic attitudes toward transgender individuals.
36
We adjusted the wording of the
scale to assess the attitudes toward transgender adolescents and combined the female and male
subscales into a single, overarching summary scale. The scale is scored along a 7-point Likert-type
range that goes from strongly disagree (score of 1) to strongly agree (score of 7). Higher scores
indicate greater transphobia. The ATTMW is highly reliable and has a Cronbach α of 0.97.
36
Secondary outcome measures included a “gender thermometer,”
37
a tool developed to assess
attitudes regarding sexual orientation and gender diversity, to gauge participants’ attitudes around
gender diversity. The thermometer provides the following prompt: “Using a scale from 0 to 100,
please tell us about your personal feelings toward each of the following groups of friends, teachers,
or colleagues. As you do this task, think of an imaginary thermometer. The warmer or more favorable
you feel toward the group, the higher the number you should give it. The colder or less favorable you
feel, the lower the number. If you feel neither warm nor cold toward the group, rate it 50.” We asked
respondents about their attitudes toward (1) heterosexual; (2) lesbian, gay, bisexual, and queer
(LGBQ); and (3) transgender people. Higher ratings indicate warmer, closer, more favorable feelings
toward the group in question, whereas lower ratings indicate colder, more distant, or negative
feelings. As in the previous study,
15
we assessed stigma toward depression using the Depression
Stigma Scale (DSS)
38
and treatment-seeking intentions using the General Help-Seeking
Questionnaire (GHSQ).
39
Statistical Analysis
We used Pearson χ
2
and 1-way analysis of variance (ANOVA) to compare demographic variables
across groups. We used paired 2-tailed ttests to compare ATTMW and “temperature” mean scores at
baseline and after intervention. We also used 1-way ANOVA to compare baseline differences in
outcome measures across gender and sexual orientation subgroups. We then used paired ttests to
compare changes between the baseline and postintervention periods across study groups. For all t
tests, we used the Bonferroni correction, considering as significant only those results with P< .001.
We conducted all statistical analyses using SPSS software, version 26.0 (IBM Inc).
JAMA Network Open | Psychiatry Effect of a Video on Transphobia and Depression-Related Stigma Among Adolescents
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376 (Reprinted) February 25, 2022 4/12
Downloaded From: https://jamanetwork.com/ on 02/26/2022
Results
Sample Characteristics
We recruited and proportionally randomized 1437 participants, of whom 1098 (76%) completed the
postintervention assessment and passed all the validity tests (mean [SD] age, 16.9 [1.2] years; 473
[43%] female; 481 [44%] male; 131 [12%] transgender or nonbinary; 183 [17%] African American or
Black; 89 [8%] Asian; 261 [24%] Hispanic or Latinx; 28 [3%] American Indian or Alaska Native; 640
[58%] White; and 158 [14%] of other race or ethnicity, including 2 Middle Eastern, 126 unspecified,
and 30 who preferred not to answer) (Figure 1). Demographic characteristics did not differ between
those who completed the study and those who dropped out (n = 339). Study groups did not differ
by gender, age, race, or ethnicity, but LGBQ participants were underrepresented in the control
groups because TGD participants were preferentially randomized to the intervention groups
(Table 1).
Attitudes Toward Transgender Men and Women
Although we found no between-group difference before and after the intervention (mean [SD]
ATTMW scores of 1.8 [7.5] in the intervention group vs 1.1 [8.5] in the control group; independent
t=1.1,df = 879, P= .25), a difference was found within the intervention group only vs the control
group (34.6 [23.1] at baseline to 32.8 [24.2] at after intervention [paired t= 5.3, P< .001] vs 33.5
[23.4] at baseline to 32.4 [24.1] after intervention [paired t=2.6,P= .01]). The intervention group
had significant reductions in 6 of 12 ATTMW items, and the control group in only 1 (Table 2). We
found relatively low baseline mean (SD) ATTMW scores for TGD people (14.5 [5.9]) (ie, low
stigmatization). One-way ANOVA showed a significant difference between mean (SD) baseline
scores for boys (28.5 [27.4]), girls (17.9 [21.0]), and TGD adolescents (12.9 [7.2]; F = 36.7, P< .001).
Table 1. DemographicCharacteristics of Study Participants
a
Characteristic
Intervention (transgender protagonist) Control (cisgender protagonist)
Total (N = 1098) Statistic PvalueFemale (n = 393) Male (n = 391) Female (n = 148) Male (n = 166)
Age, mean (SD), y 16.9 (1.1) 16.8 (1.2) 17.1 (1.1) 16.8 (1.2) 16.9 (1.2) 2.07
b
.10
Gender
Female 163 (42) 154 (39) 70 (47) 86 (52) 473 (43)
1.39
c
.71
Male 155 (39) 168 (43) 78 (53) 80 (48) 481 (44)
Nonbinary 45 (12) 46 (12) NA NA 91 (8)
Transgender 27 (7) 13 (3) NA NA 40 (4)
Prefer not to answer 3 (1) 10 (3) NA NA 13 (1)
Sexual orientation
Heterosexual 222 (57) 219 (56) 107 (72) 114 (69) 662 (60)
27.1
c
.001
LGBQ 135 (34) 119 (30) 33 (22) 36 (22) 323 (29)
I am not sure 30 (8) 38 (10) 7 (5) 12 (7) 87 (8)
Prefer not to answer 6 (2) 15 (4) 1 (1) 4 (2) 26 (2)
Race and ethnicity
African American or Black 61 (16) 75 (19) 18 (12) 29 (18) 183 (17)
12.0
c
.44
Asian 37 (9) 28 (7) 14 (10) 10 (6) 89 (8)
Hispanic or Latinx 96 (24) 87 (22) 38 (26) 40 (22) 261 (24)
American Indian or Alaska Native 6 (2) 11 (3) 5 (3) 6 (4) 28 (3)
White 227 (58 229 (59) 85 (57) 99 (60) 640 (58)
Other
d
62 (16) 48 (12) 26 (18) 22 (13) 158 (14)
Abbreviations: LGBQ, lesbian, gay,bisexual, or queer; NA, not applicable.
a
Data are presented as number (percentage) of study participants unless otherwise indicated.
b
One-way analysis of variance.
c
Pearson χ
2
test.
d
Other includes 126 with unspecified race, 30 who preferred not to answer,and 2 of Middle Eastern race.
JAMA Network Open | Psychiatry Effect of a Video on Transphobia and Depression-Related Stigma Among Adolescents
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376 (Reprinted) February 25, 2022 5/12
Downloaded From: https://jamanetwork.com/ on 02/26/2022
One-way ANOVA also showed a differential baseline pattern between heterosexual (27.9 [27.3]) and
LGBQ adolescents (12.4 [11.9]; F = 37.0, P< .001).
Independent ttests showed a significant difference between the changes in “gender
temperature” mean (SD) scores from baseline to after intervention in the intervention vs control
groups (2.6° [13.1°] vs 0.4° [8.3°]; t= 3.2, P< .001). Paired ttests showed a significant difference in
the intervention groups only (70.5° [32.3°] at baseline to 73.0° [32.0°] after intervention, t= 5.5,
P< .001, Cohen d= 0.20 in the intervention group vs 69.3° [32.8°] at baseline to 69.8° [32.4] after
intervention, P= .36, in the control group). One-way ANOVA showed a significant difference
between mean (SD) baseline “gender temperature” ratings between boys (54.6° [34.7°]), girls (78.4°
[26.9°]), and TGD adolescents (91.0° [15.5°]; F = 92.4, P< .001) (Figure 2A). One-way ANOVA also
showed a differential response pattern in baseline “gender temperature” ratings between
heterosexual (58.6° [34.8°]) and LGBQ (87.3° [19.0°]; F = 57.4, P< .001) participants (Figure 2B).
Independent ttests showed a significant difference in the change from baseline to after intervention
between the heterosexual (3.7° [16.4°]) and LGBQ groups (1.2° [5.9°]; F = 36.4, P< .001, Cohen
d= 0.19).
Table 2. Comparison Between Video Intervention and Control Group Scores on the AttitudesToward TransgenderMen and Women Scale (ATTMW)
Among Cisgender Participants
a
Attitude toward transgender adolescents
Intervention (transgender protagonist) (n = 640) Control (cisgender protagonist) (n = 314)
Mean (SD)
t
b
Pvalue
Mean (SD)
t
b
PvalueBaseline Post Baseline Post
1. Will never really be women/men 3.0 (2.1) 2.8 (2.1) 3.1 <.001 3.0 (2.2) 2.9 (2.1) 1.3 .18
2. Are not really females/males 3.0 (2.1) 2.9 (2.2) 2.6 .011 2.9 (2.1) 2.9 (2.1) 0.4 .68
3 Will only be able to look like women/men,
but not be women/men
3.0 (2.1) 2.8 (2.1) 3.2 <.001 3.0 (2.1) 3.0 (2.1) 0.8 .40
4. Are unable to accept who they really are 3.0 (2.1) 2.9 (2.1) 1.8 .07 3.0 (2.1) 2.9 (2.0) 2.2 .03
5. Are trying to be someone they’re not 2.9 (2.1) 2.8 (2.1) 2.2 .03 2.9 (2.2) 2.9 (2.1) 0.1 .91
6. Are denying their DNA 3.3 (2.2) 3.1 (2.2) 2.9 .003 3.3 (2.2) 3.1 (2.2) 2.9 .004
7. Cannot just “identify” as females/males 3.0 (2.1) 2.9 (2.1) 2.3 .019 3.1 (2.2) 2.9 (2.1) 2.9 .005
8. Are unnatural 3.1 (2.2) 2.9 (2.1) 3.1 <.001 2.9 (2.1) 2.9 (2.1) 0.1 .91
9. Don’t really understand what it means to be
a female/male
3.0 (2.0) 3.0 (2.1) 0.1 .97 2.9 (2.0) 2.9 (2.1) 0.6 .50
10. Only think they are females/males 3.3 (2.0) 3.0 (2.1) 4.8 <.001 3.1 (1.9) 3.0 (2.0) 2.4 .02
11. Are defying nature 3.2 (2.1) 3.0 (2.1) 3.8 <.001 3.1 (2.0) 3.0 (2.0) 1.6 .11
12. There is something unique about being a
woman/man that transgender adolescents can
never experience
3.7 (2.1) 3.3 (2.1) 6.9 <.001 3.5 (2.1) 3.3 (2.1) 3.4 <.001
Total scores 37.3 (21.8) 35.4 (23.3) 5.3 <.001 36.7 (22.0) 35.5 (23.0) 2.6 .01
a
Item ratings ranged from 1 (strongly disagree) to 7 (strongly agree) on a Likert-typescale, with higher scores indicating higher stigma. Cohen deffect sizes ranged from 0.13 to 0.27.
b
Paired ttest.
Figure 2. Comparison of Baseline and Postintervention Scores on Personal Feelings Toward Transgender People
After Social-Contact Video Intervention
100
90
80
70
60
50
Gender temperature score
Teenage boys
P
<.001
Teenage girls
P
<.001
TGD adolescents
P
=.004
Change in scores by gender identity
A
100
90
80
70
60
50
Gender temperature score
Straight
P
<.001
LGBQ
P
=
.002
Change in scores by sexual orientation
B
Postintervention
Baseline
A higher score indicates improvement in stigmatizing
attitudes and warmer feeling toward transgender
people. Error bars indicate standard error of the mean.
The Cohen deffect sizes ranged from 0.22 to 0.25.
LGBQ indicates lesbian, gay,bisexual, and queer; TGD,
transgender and gender diverse.
JAMA Network Open | Psychiatry Effect of a Video on Transphobia and Depression-Related Stigma Among Adolescents
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376 (Reprinted) February 25, 2022 6/12
Downloaded From: https://jamanetwork.com/ on 02/26/2022
Depression Stigma Scale
As hypothesized, all study groups demonstrated a significant change between preintervention and
postintervention DSS scores, and univariate ANOVA showed no between-group differences. Table 3
presents the 9 DSS item mean scores and compares baseline and postintervention ratings between
the intervention (n = 784) and control (n = 314) groups. The mean (SD) DSS total scores decreased
significantly across study groups (intervention: 1.3 [3.3]; control: 1.7 [3.3]; paired tⱖ9.4; P< .001;
Cohen dⱖ0.38). We found significant reductions in the same 4 (of 9) items across study groups:
weak (1.8 [1.1] to 1.7 [1.1], t=3.7,P< .001 in the intervention group vs 1.9 [1.2] to 1.7 [1.1], t=4.7,
P< .001 in the control group), dangerous (2.2 [1.1] to 1.9 [1.1], t=6.9,P< .001 in the intervention
group to 2.3 [1.1] to 1.9 [1.1], t=7.6,P< .001 in the control group), unpredictable (2.9 [1.2] vs 2.6 [1.2],
t= 8.8, P< .001 in the intervention group vs 2.9 [1.1] to 2.5 [1.2], t=6.7,P< .001 in the control
group), and wouldn’t tell (3.0 [1.3] to 2.5 [1.3], t=9.4,P< .001 in the intervention group vs 3.0 [1.3]
to 2.5 [1.3], t=7.4,P< .001 in the control group).
General Help-Seeking Questionnaire
We found a significant increase in intention to seek help from a parent in the intervention (mean [SD]
GHSQ score, 0.2 [1.1]) and control (mean [SD] GHSQ score, 0.3 [1.2]) groups (paired tⱖ3.5, P< .001)
and a decrease in those not wanting to seek help from anyone (mean [SD] GHSQ score, 0.2 [1.6],
t=2.6,P= .009 in the invention group vs 0.3 [1.2], t=3.9,P< .001 in the control group) (eAppendix
2inSupplement 2).
Discussion
In this randomized clinical trial, we tested the efficacy of 2 brief social contact–based video
interventions that featured 2 transgender adolescents aiming to reduce transphobia and depression-
related stigma and to increase treatment-seeking intentions among 1098 adolescents in the general
population. As hypothesized, these approximately 110-second videos had a significantly greater
effect on lowering transphobia compared with 2 comparable videos that featured cisgender
adolescents and a similar effect in changing depression-related stigma and treatment-seeking
intentions. The latter finding is a replication of a previous study
15
among 1183 adolescents. Each of
the 4 videos provided direct and personal exposure to the struggles and difficulties of a transgender
or cisgender protagonist, who presented as a potential peer. Consistent with previous studies
13-15
Table 3. Comparison BetweenSocial-Based Video Inter ventionand Control Group Scores on the Depre ssion Stigma Scale (DSS)
a
Attitude toward depression
Intervention (transgender protagonist) (n = 784) Control (cisgender protagonist) (n = 314)
Mean (SD)
t
b
Pvalue
Mean (SD)
t
b
PvalueBaseline Post Baseline Post
1. People with depression could snap out of it if
they wanted
1.7 (1.1) 1.7 (1.1) 2.0 .04 1.8 (1.2) 1.7 (1.2) 1.5 .13
2. Depression is a sign of personal weakness 1.8 (1.1) 1.7 (1.1) 3.7 <.001 1.9 (1.2) 1.7 (1.1) 4.7 <.001
3. Depression is not a real medical illness 1.4 (0.9) 1.4 (0.8) 0.5 .59 1.5 (0.9) 1.4 (0.9) 1.7 .09
4. People with depression are dangerous 2.2 (1.1) 1.9 (1.1) 6.9 <.001 2.3 (1.1) 1.9 (1.0) 7.6 <.001
5. It is best to avoid people with depression,
so you don’t become depressed yourself
1.6 (0.9) 1.5 (0.9) 2.6 .009 1.6 (0.9) 1.5 (0.8) 3.2 .002
6. People with depression are unpredictable 2.9 (1.2) 2.6 (1.2) 8.8 <.001 2.9 (1.1) 2.5 (1.2) 6.7 <.001
7. If I had depression, I would not tell anyone 3.0 (1.3) 2.6 (1.3) 9.4 <.001 3.0 (1.3) 2.5 (1.3) 7.4 <.001
8. I would not employ someone if I knew they
had been depressed
1.6 (1.0) 1.5 (0.9) 2.4 .02 1.6 (0.9) 1.5 (0.9) 1.6 .10
9. I would not vote for a politician if I knew
they had been depressed
1.7 (1.0) 1.7 (1.0) 0.2 .87 1.6 (1.0) 1.7 (1.0) 0.9 .33
Total scores 17.8 (5.5) 16.5 (6.2) 10.6 <.001 18.2 (5.4) 16.4 (5.9) 9.4 <.001
a
Item ratings ranged from 1 (strongly disagree) to 5 (strongly agree) on a Likert-typescale, with higher scores indicating higher stigma. Cohen deffect sizes ranged from 0.13 to 0.53.
b
Paired ttest.
JAMA Network Open | Psychiatry Effect of a Video on Transphobia and Depression-Related Stigma Among Adolescents
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376 (Reprinted) February 25, 2022 7/12
Downloaded From: https://jamanetwork.com/ on 02/26/2022
conducted among young adults, this randomized clinical trial showed the effectiveness of a brief
contact-based video intervention in changing stigmatized perceptions and attitudes among
adolescents in the general population. Our data show the effect of an empowered presenter with
personal lived experience, seen as a potential peer, and with emotional characteristics that resonate
with the audience. Their brief video depictions disconfirmed stereotypes by balancing difficulties
with messages of hope.
40
A previous study
41
of interventions to reduce transphobia have a variety of contexts, as
specifically designed to create changes at the structural, interpersonal, or individual levels. Existing
studies on social contact–based interventions are scarce
42
and have included transgender speaker
panels,
22
game-based interventions,
43
and film-based interventions to improve parents’ responses
to their LGBTQ children.
44
Brief social contact interventions may better suit younger audiences who
are used to consuming knowledge through social media platforms (for example, Instagram and
TikTok limit the length of uploaded videos to 1 minute). In addition, we can anticipate the scalability
and replicability of the brief video intervention approach given low production costs and ease of
adjusting underlying scripts, target populations, and specific goals.
Our findings regarding baseline differences across gender and sexual orientation in attitudes
toward transgender youth are consistent with previous studies.
32,45-47
However, in secondary, post
hoc analyses, we found that the intervention had the greatest effect among male and/or
heterosexual adolescents and the smallest effect among participants who self-identified as TGD
and/or LGBQ. This finding contradicts previous data,
13,48
which showed a positive correlation
between the intervention effect and the level of identification with the video protagonist. One
possible explanation for this unexpected finding lies within the differences at baseline: men and/or
heterosexual participants had a higher rate of stigma at baseline, and TGD and/or LGBQ participants
had more favorable attitudes, introducing a possible ceiling effect that limited further improvement.
Taken together, these findings have several implications. The first and more clinically relevant is
that short videos hold promise as interventions that can have a substantial public health effect. The
findings from this report corroborate those from our earlier studies
13-15
: a brief social-based video
intervention reduces depression-related stigma and increases treatment-seeking intentions. The
second implication is regarding the interventions specifically tailored to transgender youth. By
personifying, individualizing, and providing face and voice to the experience of transgender youth,
other adolescents, especially those of cisgender and/or heterosexual orientation groups, can gain
empathetic insights into the lives of their often marginalized and stigmatized peers.
49,50
Third, these
interventions can be used for educational purposes in general, specifically in training health care
professionals. A previous study
51
has shown that didactic information is insufficient to improve
medical students’ perspectives toward transgender people.
Limitations
Our study has several limitations. First, results on the ATTMW, our primary outcome measure, were
equivocal, with strong within-group findings (intervention greater than control) but no between-
group difference (intervention equal to control). “Gender temperature” ratings, measuring a similar
construct, were significant both within and between groups. This unexpected finding may be due to
possible confounding between depressive symptoms and protagonists’ descriptions of their earlier
gender dysphoria. Future studies would benefit from disambiguating these 2 factors because they
each have a strong emotional pull on participants and may have obscured findings. Second, findings
may be limited to CloudResearch participants, who may not be fully representative of the general
population. Fifty-eight percent of participants described their race as White, 14% as African
American, and 8% as Asian, and 24% reported Hispanic ethnicity, slightly diverging from the US
population’s distribution. Third, we did not use standard criterion to collect gender identity. Current
guidelines suggest the 2-step method, in which the first question addresses the participant’s sex
assigned at birth and the second their gender identity. Fourth, by randomly assigning transgender or
nonbinary individuals to only 2 of the 4 intervention videos, we may have obscured response
JAMA Network Open | Psychiatry Effect of a Video on Transphobia and Depression-Related Stigma Among Adolescents
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376 (Reprinted) February 25, 2022 8/12
Downloaded From: https://jamanetwork.com/ on 02/26/2022
patterns unique to this sizable fraction of our sample (12%). Fifth, our study included only 2 time
points and did not evaluate longer-term effects. However, we are not aware of any such studies with
underage participants. Sixth, we only assessed attitudes, the reporting of which is subject to social
desirability and may not be indicative of actual behavior. However, a meta-analysis
52
of the
experimental evidence available by 2006 showed that change in attitudes does in fact lead to
behavioral change.
Conclusions
In this randomized clinical trial, a brief contact-based video intervention effectively reduced reported
attitudes of transphobia, particularly among cisgender and/or heterosexual youth. It also reduced
depression-related stigma and increased treatment-seeking intentions among adolescents in the
general population. This simple, easy-to-disseminate online intervention may have the added
potential of improving access to treatment specifically among TGD adolescents with depression or
suicidal thoughts. Future studies should explore whether and how to tailor brief contact-based
interventions to specific populations and to emerging online platforms for content dissemination.
ARTICLE INFORMATION
Accepted for Publication: December 23, 2021.
Published: February 25, 2022. doi:10.1001/jamanetworkopen.2022.0376
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Amsalem D
et al. JAMA Network Open.
Corresponding Author: Doron Amsalem, MD, New York State Psychiatric Institute and Department of Psychiatry,
Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr, New York,NY 10032 (doron.
amsalem@nyspi.columbia.edu).
Author Affiliations: New York State Psychiatric Institute and Department of Psychiatry, Columbia University
Vagelos College of Physicians and Surgeons, New York (Amsalem); Child Study Center, Yale School of Medicine,
New Haven, Connecticut (Halloran, Penque, Martin); Department of Social Work and Marriage and Family Therapy,
Southern Connecticut State University, New Haven(Celentano); Simulated Participant Program, Teaching and
Learning Center, Yale School of Medicine, New Haven, Connecticut (Celentano, Martin).
Author Contributions: Drs Amsalem and Martin had full access to all the data in the study and take responsibility
for the integrity of the data and the accuracy of the data analysis.
Concept and design: Amsalem, Halloran, Penque, Martin.
Acquisition, analysis, or interpretation of data: Amsalem, Penque, Celentano, Martin.
Drafting of the manuscript: Amsalem, Halloran, Martin.
Critical revision of the manuscript for important intellectual content: Penque, Celentano, Martin.
Statistical analysis: Amsalem, Martin.
Obtained funding: Martin.
Administrative, technical, or material support: All authors.
Supervision: Martin.
Conflict of Interest Disclosures: Mr Halloran reported receiving grants from Yale School of Medicine Medical
Student Research Fellowship outside the submitted work. No other disclosures were reported.
Funding/Support: This study was supported by the Riva Ariella Ritvo Endowment at the Yale School of Medicine
and by grant R25 MH077823 (Research Education for Future Physician-Scientists in Child Psychiatry) from the
National Institute of Mental Health.
Role of the Funder/Sponsor:The funding sources had no role in the design and conduc t of the study; collection,
management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and
decision to submit the manuscript for publication.
Data Sharing Statement: See Supplement 3.
JAMA Network Open | Psychiatry Effect of a Video on Transphobia and Depression-Related Stigma Among Adolescents
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376 (Reprinted) February 25, 2022 9/12
Downloaded From: https://jamanetwork.com/ on 02/26/2022
Additional Contributions: We thank the 4 adolescents who participated in the videos and contributed to stigma
reduction and treatment-seeking among youth.
REFERENCES
1. Price-Feeney M, Green AE, Dorison S. Understanding the mental health of transgender and nonbinary youth.
J Adolesc Health. 2020;66(6):684-690. doi:10.1016/j.jadohealth.2019.11.314
2. Connolly MD, Zervos MJ, Barone CJ II, Johnson CC, Joseph CLM. The mental health of transgender youth:
advances in understanding. J Adolesc Health. 2016;59(5):489-495. doi:10.1016/j.jadohealth.2016.06.012
3. Reisner SL, Vetters R, Leclerc M, et al. Mental health of transgender youth in care at an adolescent urban
community health center: a matched retrospective cohort study. J Adolesc Health. 2015;56(3):274-279. doi:10.
1016/j.jadohealth.2014.10.264
4. Becerra-Culqui TA, Liu Y, Nash R, et al. Mental health of transgender and gender nonconforming youth
compared with their peers. Pediatrics. 2018;141(5):e20173845. doi:10.1542/peds.2017-3845
5. Costa R, Dunsford M, Skagerberg E, Holt V, Carmichael P, Colizzi M. Psychological support, puberty suppression,
and psychosocial functioning in adolescents with gender dysphoria. J Sex Med. 2015;12(11):2206-2214. doi:10.1111/
jsm.13034
6. Eisenberg ME , GowerAL , McMorris BJ, Rider GN, Shea G, Coleman E. Risk and protective factors in the lives of
transgender/gender nonconformingadolescents. J Adolesc Health. 2017;61(4):521-526. doi:10.1016/j.jadohealth.
2017.04.014
7. Thoma BC, Salk RH, Choukas-Bradley S, Goldstein TR, Levine MD, Marshal MP. Suicidality disparities between
transgender and cisgender adolescents. Pediatrics. 2019;144(5):e20191183. doi:10.1542/peds.2019-1183
8. Toomey RB, Syvertsen AK, Shramko M. Transgenderadole scent suicide behavior. Pediatrics. 2018;142(4):
e20174218. doi:10.1542/peds.2017-4218
9. The Trevor Project. 2020 national survey on LGBTQ youth mental health. 2020. Accessed April 26, 2021. https://
www.thetrevorproject.org/wp-content/uploads/2020/07/The-Trevor-Project-National-Survey-Results-2020.pdf
10. Meer wijk EL, Sevelius JM. Transgender population size in the united states: a meta-regression of
population-based probability samples. Am J Public Health. 2017;107(2):e1-e8. doi:10.2105/AJPH.2016.303578
11. Richards C, Bouman WP, Seal L, Barker MJ, Nieder TO, T’Sjoen G. Non-binary or genderqueer genders. Int Rev
Psychiatry. 2016;28(1):95-102. doi:10.3109/09540261.2015.1106446
12. Johns MM, Lowry R, Andrzejewski J, et al. Transgender identity and experiences of violence victimization,
substance use, suicide risk, and sexual risk behaviors among high school students - 19 states and large urban school
districts, 2017. MMWR Morb Mortal Wkly Rep. 2019;68(3):67-71. doi:10.15585/mmwr.mm6803a3
13. Amsalem D, Yang LH, Jankowski S, Lieff SA, Markowitz JC, Dixon LB. Reducing stigmatoward individuals with
schizophrenia using a brief video: a randomized controlled trial of young adults. Schizophr Bull. 2021;47(1):7-14.
doi:10.1093/schbul/sbaa114
14. Amsalem D, Markowitz JC, Jankowski SE, et al. Sustained effect of a brief video in reducing public stigma
toward individuals with psychosis: a randomized controlled trial of young adults. Am J Psychiatry. 2021;178(7):
635-642. doi:10.1176/appi.ajp.2020.20091293
15. Amsalem D, Martin A. Reducing depression-related stigma and increasing treatment seeking among
adolescents: randomized controlled trial of a brief video intervention. J Child Psychol Psychiatry. Published online
April 6, 2021. doi:10.1111/jcpp.13427
16. Rowe SL, French RS, Henderson C, Ougrin D, Slade M, Moran P. Help-seeking behaviour and adolescent self-
harm: a systematic review.AustNZJPsy
chiatry. 2014;48(12):1083-1095. doi:10.1177/0004867414555718
17. Divin N, Harper P, Curran E, Corry D, Leavey G. Help-seeking measures and their use in adolescents:
a systematic review.Adolesc Res Rev. 2018;3(1):113-122. doi:10.1007/s40894-017-0078-8
18. Children Commissioners. Lightning review: access to child and adolescent mental health services. Children
Commissioners. 2016. Accessed September 1, 2021. https://www.childrenscommissioner.gov.uk/wp-content/
uploads/2017/06/Childrens-Commissioners-Mental-Health-Lightning-Review.pdf
19. Mehta N, Clement S, Marcus E, e t al. Evidence for effective interventions to reduce mental health-related
stigma and discrimination in the medium and long term: systematic review. Br J Psychiatry. 2015;207(5):377-384.
doi:10.1192/bjp.bp.114.151944
20. Corrigan PW, Michaels PJ, Vega E, et al. Key ingredients to contact-based stigma change: a cross-validation.
Psychiatr Rehabil J. 2014;37(1):62-64. doi:10.1037/prj0000038
21. Corrigan P W, ed. On the Stigma of Mental Illness: Practical Strategies for Research and Social Change. American
Psychological Association; 2005. doi:10.1037/10887-000
JAMA Network Open | Psychiatry Effect of a Video on Transphobia and Depression-Related Stigma Among Adolescents
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376 (Reprinted) February 25, 2022 10/12
Downloaded From: https://jamanetwork.com/ on 02/26/2022
22. Chodzen G, Hidalgo MA , Chen D, Garofalo R. Minority stress factors associated with depression and anxiety
among transgender and gender-nonconforming youth. J Adolesc Health. 2019;64(4):467-471. doi:10.1016/j.
jadohealth.2018.07.006
23. Kosciw JG, Clark CM, Truong NL, Zongrone AD. The 2019 national school climate survey: the experiences of
lesbian, gay, bisexual, transgender, and queer youth in our nation’s schools. GLSEN. 2020. Accessed September 1,
2021. https://www.glsen.org/sites/default/files/2021-04/NSCS19-FullReport-032421-Web_0.pdf
24. Douglass RP, Conlin SE. Minority stress among LGB people: investigating relations among distal and proximal
stressors. Curr Psychol. Published online June 27, 2020. doi:10.1007/s12144-020-00885-z
25. Turban JL, Kraschel KL, Cohen IG. Legislation to criminalize gender-affirming medical care for transgender
youth. JAMA. 2021;325(22):2251-2252. doi:10.1001/jama.2021.7764
26. Murchison GR, Agénor M, Reisner SL, Watson RJ. School restroom and locker room restrictions and sexual
assault risk among transgender youth. Pediatrics. 2019;143(6):e20182902. doi:10.1542/peds.2018-2902
27. Thornicroft G, Mehta N, Clement S, et al. Evidence for effective interventions to reduce mental-health-related
stigma and discrimination. Lancet. 2016;387(10023):1123-1132.doi:10.1016/S0140-6736(15)00298-6
28. Koike S, Yamaguchi S, Ojio Y, et al. A randomised controlled trial of repeated filmed social contact on reducing
mental illness-related stigma in young adults. Epidemiol Psychiatr Sci. 2018;27(2):199-208.doi:10.1017/
S2045796016001050
29. Clement S, van Nieuwenhuizen A, Kassam A, et al. Filmed v. live social contact interventions to reduce stigma:
randomised controlled trial. Br J Psychiatry. 2012;201(1):57-64. doi:10.1192/bjp.bp.111.093120
30. Tadlock BL, Flores AR, Haider-Markel DP,Lewis DC, Miller PR, Taylor JK. Testing contact theory and attitudes
on transgender rights. Public Opin Q. 2017;81(4):956-972. doi:10.1093/poq/nfx021
31. Earle M, Hoffarth MR, Prusaczyk E, MacInnis C, Hodson G. A multilevel analysis of LGBT (lesbian, gay, bisexual,
transgender) rights support across 77 countries: the role of contact and country laws. Br J Soc Psychol. 2021;60
(3):851-869. doi:10.1111/bjso.12436
32. Worthen MGF, Tanzilli A, Caristo C, Lingiardi V. Social contact, social distancing, and attitudes toward LGT
individuals: a cross-cultural study of college students in the United States, Italy, and Spain. J Homosex. 2019;66
(13):1882-1908. doi:10.1080/00918369.2018.1519302
33. Greenburg J, Gaia AC. Interpersonal contact, stereotype acceptance, gender role beliefs, causal attribution,
and religiosity as predictors of attitudes toward transgender individuals. Psi Chi J Psychol Res. 2019;24(1):18-32. doi:10.
24839/2325-7342.JN24.1.18
34. Walch SE, Sinkkanen KA, Swain EM, Francisco J, Breaux CA, Sjoberg MD. Using intergroup contact theory to
reduce stigma against transgender individuals: impact of a transgender speaker panel presentation: using
intergroup contact theory to reduce stigma. J Appl Soc Psychol. 2012;42(10):2583-2605. doi:10.1111/j.1559-1816.
2012.00955.x
35. Chandler J, Rosenzweig C, Moss AJ, Robinson J, Litman L. Online panels in social science research: expanding
sampling methods beyond Mechanical Turk. Behav ResMethods. 2019;51(5):2022-2038. doi:10.3758/s13428-
019-01273-7
36. Billard TJ. Attitudes toward transgender men and women: development and validationof a new measure.
Front Psychol. 2018;9:387. doi:10.3389/fpsyg.2018.00387
37. Norton AT, Herek GM. Heterosexuals’ attitudes toward transgender people: findings from a national
probability sample of US adults. Sex Roles. 2013;68(11-12):738-753. doi:10.1007/s11199-011-0110-6
38. Griff iths KM, Christensen H, Jorm AF, Evans K, Groves C. Effect of web-based depression literacy and
cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial.
Br J Psychiatry. 2004;185:342-349.doi:10.1192/bjp.185.4.342
39. Wilson CJ, Deane FP, Marshall KL, Dalley A. Reducing adolescents’ perceived barriers to treatment and
increasing help-seeking intentions: effects of classroom presentations by general practitioners. J Youth Adolesc.
2008;37(10):1257-1269. doi:10.1007/s10964-007-9225-z
40. Reinke RR, Corrigan PW, Leonhard C, Lundin RK, Kubiak MA. Examining two aspects of contact on the stigma
of mental illness. J Soc Clin Psychol. 2004;23(3):377–89. doi:10.1521/jscp.23.3.377.35457
41. Chaudoir SR, Wang K, Pachankis JE. What reduces sexual minority stress? a review of the intervention
“toolkit”. J Soc Issues. 2017;73(3):586-617. doi:10.1111/josi.12233
42. Parker CM, Hirsch JS, Philbin MM, Parker RG. The urgent need for research and interventions to address
family-based stigma and discrimination against lesbian, gay, bisexual, transgender, and queer youth. J Adolesc
Health. 2018;63(4):383-393. doi:10.1016/j. jadohealth.2018.05.018
JAMA Network Open | Psychiatry Effect of a Video on Transphobia and Depression-Related Stigma Among Adolescents
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376 (Reprinted) February 25, 2022 11/12
Downloaded From: https://jamanetwork.com/ on 02/26/2022
43. Coulter RW, Sang JM, Louth-Marquez W, et al. Pilot testing the feasibility of a game intervention aimed at
improving help seeking and coping among sexual and gender minority youth: protocol for a randomized controlled
trial. JMIR Res Protoc. 2019;8(2):e12164. doi:10.2196/12164
44. Huebner DM, Rullo JE, Thoma BC, McGarrity LA, Mackenzie J. Piloting Lead with Love: a film-based
intervention to improve parents’ responses to their lesbian, gay,and bisexual children. J Prim Prev. 2013;34(5):
359-369. doi:10.1007/s10935-013-0319-y
45. Mc Carthy J. Mixed views among americans on transgender issues. Gallup. 2021. Accessed September 1, 2021.
https://news.gallup.com/poll/350174/mixed-views-among-americans-transgender-issues.aspx
46. King WM, Hughto JMW, Operario D. Transgenderstigma: a critical scoping review of definitions, domains, and
measures used in empirical research. Soc Sci Med. 2020;250:112867. doi:10.1016/j.socscimed.2020.112867
47. Cheung RYM, Mak WWS, Tsang PS, Lau JTF. Stigma of psychosis: do diagnostic label, symptom manifestation,
and gender matter? Am J Orthopsychiatry. 2018;88(5):529-537. doi:10.1037/ort0000315
48. Amsalem D, Lazarov A, Markowitz JC, Smith TE, Dixon LB, Neria Y. Video intervention to increase treatment-
seeking by healthcare workers during the COVID-19 pandemic: randomised controlled trial. Br J Psychiatry.
2022;220(1):14-20. doi:10.1192/bjp.2021.54
49. Monahan JL, Murphy ST,Zajonc RB. Subliminal mere exposure: specif ic, general, and diffuse effects. Psychol
Sci. 2000;11(6):462-466. doi:10.1111/1467-9280.00289
50. Moreland RL , Topolinski S. The mere exposure phenomenon: a lingering melody by Robert Zajonc. Emotion
Review.2010;2(4):329-339. doi:10.1177/1754073910375479
51. Turban JL, Winer J, BoulwareS, VanDeusen T, Encandela J.Knowledge and attitudes toward transgender
health. Clin Teach. 2018;15(3):203-207. doi:10.1111/tct.12738
52. Webb TL, Sheeran P. Does changing behavioral intentions engender behavior change? a meta-analysis of the
experimental evidence. Psychol Bull. 2006;132(2):249-268. doi:10.1037/0033-2909.132.2.249
SUPPLEMENT 1.
Trial Protocol
SUPPLEMENT 2.
eAppendix 1. Links to Four Video Conditions
eAppendix 2. Comparison Between Baseline and Postintervention Scores (n = 1,009) on the GeneralHelp-Seeking
Questionnaire (GHSQ)
SUPPLEMENT 3.
Data Sharing Statement
JAMA Network Open | Psychiatry Effect of a Video on Transphobia and Depression-Related Stigma Among Adolescents
JAMA Network Open. 2022;5(2):e220376. doi:10.1001/jamanetworkopen.2022.0376 (Reprinted) February 25, 2022 12/12
Downloaded From: https://jamanetwork.com/ on 02/26/2022
