Honest, Open, Proud for Soldiers with Mental Illness

NCT03218748 | Completed

• 1 other identifier: HOP Soldiers
• Study Type: interventional
• Target: 99
• Locations: 2 countries
• Sites: 3

Brief Summary

The purpose of the study is to evaluate the feasibility and efficacy of the group-based intervention "Honest, Open, Proud" among soldiers with mental illness.

Conditions

Mental Illness

Keywords

Mental illness; Disclosure; stigma; soldiers; secrecy

Outcome Measures

Primary Outcomes (2)

• Stigma Stress Scale, 8 items

  (Rüsch et al. 2009a; Rüsch et al. 2009b)

  3 weeks (T1)

• WHOQoL BREF; Domain psychological quality of life, 6 items

  (WHOQoL Group 1998)

  6 weeks (T2)

Secondary Outcomes (11)

• Empowerment Scale, Subscale 'Self-esteem', 9 items

  baseline, 3, 6 and 12 weeks (T3)

• Psychological Well-Being Scale, 18 items

  baseline, 3, 6 and 12 weeks

• Internalized Stigma of Mental Illness Inventory, Brief Version, 10 items

  baseline, 3, 6 and 12 weeks

• Self-Stigma of Mental Illness Scale, Short Version, subscale Self-Concurrence, 5 items

  baseline, 3, 6 and 12 weeks

• Secrecy and Social Withdrawal subscales of the Stigma Coping Orientation Scales, 12 items

  baseline, 3, 6 and 12 weeks

Study Arms (2)

Honest, Open, Proud

EXPERIMENTAL

The group program is about disclosure versus secrecy of one's mental illness. The groups are facilitated by two peers (soldiers with lived experience of mental illness). Each group runs for three weeks, one meeting per week, and two hours per meeting. There is one 2-hour booster session in week 6. Fidelity to manual: rated by a research assistant who is present during the group session

Behavioral: Honest, Open, Proud (HOP)

Control group

NO INTERVENTION

Treatment as usual (TAU)

Interventions

Honest, Open, Proud (HOP) BEHAVIORAL

Three lessons, one for each two-hour session plus one booster session 1. Considering the pros and cons of disclosure: Discussion of one's idea of identity and mental illness, weighing the costs and benefits of (non-) disclosure 2. Different ways to disclose: Discussion of different levels of (non-) disclosure, considering costs and benefits of each level, selecting persons to disclose to and how to test them out, anticipating responses of others to one's disclosure 3. Telling one's story: Practice how to tell one's story, identifying peers who might be helpful with the coming out process 4. Booster session Reviewing previous intentions to disclose one's mental illness, discussion whether one disclosed and evaluating this experience

Also known as: Coming Out Proud (COP)

Honest, Open, Proud

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• At least one self-reported current axis I or axis II disorder according to DSM-5, which is not restricted to only substance-related disorder(s)
• Age 18 or above
• Ability to provide written informed consent
• Fluent in German (needed for self-report measures)
• At least a moderate level of self-reported disclosure-related distress/difficulty (score 4 or higher on the screening item 'In general, how distressed or worried are you in terms of secrecy or disclosure of your mental illness to others?', rated from 1, not at all, to 7, very much)
• Current inpatient, day-clinic or outpatient treatment at the Center for Military Mental Health, Berlin, Germany
• from April 2018 onwards we decided to also include non-military first responders (fire fighters or police officers) who are treated in the Center for Military Mental Health, Berlin, Germany

You may not qualify if:

• Self-reported diagnosis of only a substance- or alcohol-related disorder, without non-substance related current psychiatric comorbidity. We will exclude people who only have a substance-/alcohol-related disorder because the disclosure of these disorders is not the topic of the HOP intervention
• Intellectual disability
• Organic disorders

Sponsors & Collaborators

• University of Ulm: lead
• Center for Military Mental Health, Berlin, Germany: collaborator
• Illinois Institute of Technology, Chicago, USA: collaborator

Study Sites (3)

Illinois Institute of Technology

Chicago, Illinois, 60616, United States

Location

Center for Military Mental Health

Berlin, 10115, Germany

Location

Department of Psychiatry II, Section Pubic Mental Health, Ulm University, Bezirkskrankenhaus Günzburg

Ulm, 89073, Germany

Location

Related Publications (14)

• Rogers ES, Chamberlin J, Ellison ML, Crean T. A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatr Serv. 1997 Aug;48(8):1042-7. doi: 10.1176/ps.48.8.1042.

  PMID: 9255837 BACKGROUND

• Boyd JE, Otilingam PG, Deforge BR. Brief version of the Internalized Stigma of Mental Illness (ISMI) scale: psychometric properties and relationship to depression, self esteem, recovery orientation, empowerment, and perceived devaluation and discrimination. Psychiatr Rehabil J. 2014 Mar;37(1):17-23. doi: 10.1037/prj0000035.

  PMID: 24660946 BACKGROUND

• Corrigan PW, Michaels PJ, Vega E, Gause M, Watson AC, Rusch N. Self-stigma of mental illness scale--short form: reliability and validity. Psychiatry Res. 2012 Aug 30;199(1):65-9. doi: 10.1016/j.psychres.2012.04.009. Epub 2012 May 10.

  PMID: 22578819 BACKGROUND

• Rusch N, Abbruzzese E, Hagedorn E, Hartenhauer D, Kaufmann I, Curschellas J, Ventling S, Zuaboni G, Bridler R, Olschewski M, Kawohl W, Rossler W, Kleim B, Corrigan PW. Efficacy of Coming Out Proud to reduce stigma's impact among people with mental illness: pilot randomised controlled trial. Br J Psychiatry. 2014;204(5):391-7. doi: 10.1192/bjp.bp.113.135772. Epub 2014 Jan 16.

  PMID: 24434073 BACKGROUND

• Link BG, Mirotznik J, Cullen FT. The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided? J Health Soc Behav. 1991 Sep;32(3):302-20.

  PMID: 1940212 BACKGROUND

• Rusch N, Corrigan PW, Heekeren K, Theodoridou A, Dvorsky D, Metzler S, Muller M, Walitza S, Rossler W. Well-being among persons at risk of psychosis: the role of self-labeling, shame, and stigma stress. Psychiatr Serv. 2014 Apr 1;65(4):483-9. doi: 10.1176/appi.ps.201300169.

  PMID: 24382666 BACKGROUND

• Rusch N, Heekeren K, Theodoridou A, Dvorsky D, Muller M, Paust T, Corrigan PW, Walitza S, Rossler W. Attitudes towards help-seeking and stigma among young people at risk for psychosis. Psychiatry Res. 2013 Dec 30;210(3):1313-5. doi: 10.1016/j.psychres.2013.08.028. Epub 2013 Sep 4.

  PMID: 24012162 BACKGROUND

• Rusch N, Evans-Lacko SE, Henderson C, Flach C, Thornicroft G. Knowledge and attitudes as predictors of intentions to seek help for and disclose a mental illness. Psychiatr Serv. 2011 Jun;62(6):675-8. doi: 10.1176/ps.62.6.pss6206_0675.

  PMID: 21632739 BACKGROUND

• Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998 May;28(3):551-8. doi: 10.1017/s0033291798006667.

  PMID: 9626712 BACKGROUND

• Rusch N, Corrigan PW, Powell K, Rajah A, Olschewski M, Wilkniss S, Batia K. A stress-coping model of mental illness stigma: II. Emotional stress responses, coping behavior and outcome. Schizophr Res. 2009 May;110(1-3):65-71. doi: 10.1016/j.schres.2009.01.005. Epub 2009 Feb 23.

  PMID: 19237266 BACKGROUND

• Rusch N, Corrigan PW, Wassel A, Michaels P, Olschewski M, Wilkniss S, Batia K. A stress-coping model of mental illness stigma: I. Predictors of cognitive stress appraisal. Schizophr Res. 2009 May;110(1-3):59-64. doi: 10.1016/j.schres.2009.01.006. Epub 2009 Mar 6.

  PMID: 19269140 BACKGROUND

• Ryff, C. D. (1989): Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology (57): 1069-1081.

  BACKGROUND

• Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x.

  PMID: 11556941 BACKGROUND

• Rusch N, Helms C, Horger J, Hohle B, Bernert H, Muschner P, Rose C, Corrigan PW, Mulfinger N, Zimmermann P, Willmund GD. The peer-led Honest, Open, Proud program to decrease the impact of mental illness stigma among German military personnel: randomized controlled trial. Soc Psychiatry Psychiatr Epidemiol. 2025 Jul 22. doi: 10.1007/s00127-025-02960-x. Online ahead of print.

  PMID: 40696200 DERIVED

MeSH Terms

Conditions

Mental Disorders; Social Stigma

Condition Hierarchy (Ancestors)

Social Behavior; Behavior

Study Officials

• Nicolas Rüsch, Dr.

  Department of Psychiatry II, Section Public Mental Health, Ulm University, Bezirkskrankenhaus Günzburg

  PRINCIPAL INVESTIGATOR

• Gerd-Dieter Willmund, Dr.

  Center for Military Mental Health, Berlin, Germany

  PRINCIPAL INVESTIGATOR

• Peter Zimmermann, Dr.

  Center for Military Mental Health, Berlin, Germany

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: July 12, 2017
• First Posted: July 17, 2017
• Study Start: November 15, 2017
• Primary Completion: October 1, 2024
• Study Completion: October 1, 2024
• Last Updated: December 11, 2024

Record last verified: 2024-12

Data Sharing

• IPD Sharing: Will not share

Locations

US (1); DE (2)