A School-Based Intervention to Reduce Stigma & Promote Mental-Health Service Use

NCT03597048 | Completed DMC

• 2 other identifiers: R01MH095254-01R01MH095254
• Study Type: interventional
• Target: 751
• Locations: 0 countries
• Sites: N/A

Brief Summary

This is a school-based field experiment conducted in sixth grade classrooms to evaluate a multifaceted intervention designed to change attitudes and behaviors regarding mental illnesses. The research tests hypotheses as to whether alone or in combination interventions that are 1) a curriculum-based in-class presentations, 2) contact-based with a person who has experienced a mental illness, or 3) or based on educational materials distributed in classes improve knowledge/attitudes and encourage help seeking for mental health problems in a follow up study lasting two years.

Conditions

Stigma, Social; Mental Illness

Keywords

stigma intervention

Outcome Measures

Primary Outcomes (2)

• Changes in Knowledge and Attitudes about Mental Illness

  This is a 21-item measure (alpha .78) adapted from items created by Wahl and colleagues. It asks children their level of agreement (from strongly agree to strongly disagree) with statements such as "it would be embarrassing to have a mental illness," "people with mental illness tend to be violent and dangerous," "schizophrenia is a mental disorder that involves multiple personalities," and "I would be frightened if a person with a mental illness approached me." High scores indicate greater knowledge and more positive attitudes. Regressed change is assessed by controlling pre-intervention values of the variable. Regressed change outcomes variables are 3 weeks post intervention, 6 months post intervention, 12 months post intervention, 18 months post intervention and 24 months post intervention.

  Assessed 3 weeks post-intervention, and then 6, 12, 18 and 24 months post intervention.

• Changes in Help Seeking Behaviors

  Participants reported whether they had talked to 1) friends, 2) parents, 3) a doctor, 4) a therapist or whether they had 5) taken medication for a mental health problem. To gauge the intensity of help seeking an index was created that assigned a 4 to youths who either saw a therapist or took medications, a 3 to youths who talked to a doctor but did not see a therapist or take medication, a 2 to youths who talked to their parents but did not see a doctor, a therapist or take medication, a 1 to youths who talked to friends but engaged in none of the other help seeking behaviors and finally a 0 to youths who engaged in none of these help seeking behaviors. Regressed change is assessed by controlling pre-intervention values of the variable. Regressed change outcomes variables are 3 weeks post intervention, 6 months post intervention, 12 months post intervention, 18 months post intervention and 24 months post intervention.

  Assessed 3 weeks post-intervention, and then 6, 12, 18 and 24 months post intervention.

Secondary Outcomes (3)

• Changes in Children's Social Distance Scale

  Assessed pre-intervention, 3 weeks post-intervention, and then 6, 12, 18 and 24 months post intervention.

• Changes in Problem Behavior Frequency Aggression Scale

  Assessed 3 weeks post-intervention, and then 6, 12, 18 and 24 months post intervention.

• Changes in Mental Health Problem Recognition

  Assessed 3 weeks post-intervention, and then 6, 12, 18 and 24 months post intervention.

Study Arms (8)

Curriculum

EXPERIMENTAL

Participants received only the curriculum intervention

Behavioral: Curriculum

Contact

ACTIVE COMPARATOR

Participants received only the contact intervention

Behavioral: Contact

Materials

ACTIVE COMPARATOR

Participants received only the materials intervention

Behavioral: Materials

Curriculum and Contact

EXPERIMENTAL

Participants received both curriculum and contact interventions

Behavioral: Curriculum; Behavioral: Contact

Curriculum and Materials

EXPERIMENTAL

Participants received curriculum and materials interventions

Behavioral: Curriculum; Behavioral: Materials

Contact and Materials

ACTIVE COMPARATOR

Participants received contact and materials intervention

Behavioral: Contact; Behavioral: Materials

Curriculum, Contact and Materials

ACTIVE COMPARATOR

Participants received curriculum, contact and materials interventions

Behavioral: Curriculum; Behavioral: Contact; Behavioral: Materials

No intervention

NO INTERVENTION

Participants received no intervention

Interventions

Curriculum BEHAVIORAL

The curriculum intervention is a three- module, three-hour curriculum delivered by teachers in sixth grade classrooms over a three- to six-day period. The curriculum is designed to increase knowledge and improve attitudes about mental illnesses so as to improve the school climate with respect to mental illness stigma and encourage help seeking for youth in need.

Also known as: Eliminating the Stigma of Differences

Curriculum; Curriculum and Contact; Curriculum and Materials; Curriculum, Contact and Materials

Contact BEHAVIORAL

The contact intervention involves two college students-a 27-year-old male with a history of bipolar I disorder and a 24-year-old female with a history of bipolar II disorder-who each make a ten-minute in-class presentation (20 minutes total) describing onset and course of their symptoms, hospitalizations and treatments, their feelings about the illness, coping strategies, and impact of the illness on social relationships and functioning at school and work.

Contact; Contact and Materials; Curriculum and Contact; Curriculum, Contact and Materials

Materials BEHAVIORAL

The materials intervention is implemented by teachers who prominently display posters in the classroom for two weeks and provide students with bookmarks. The materials focus on individuals' with mental illnesses emphasizing their personal traits and abilities as opposed to language that labels a person as "mentally ill."

Contact and Materials; Curriculum and Materials; Curriculum, Contact and Materials; Materials

Eligibility Criteria

• Age: 10 Years - 14 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• Sixth-grade students enrolled in required physical education/health classes at 14 participating schools in the Arlington, Texas School district.

You may not qualify if:

• Sixth grade students who did not have caregiver's consent to participate.
• Sixth grade students who did not give assent to participate.

Sponsors & Collaborators

• University of California, Riverside: lead
• National Institute of Mental Health (NIMH): collaborator

Related Publications (13)

• Corrigan P. How stigma interferes with mental health care. Am Psychol. 2004 Oct;59(7):614-625. doi: 10.1037/0003-066X.59.7.614.

  PMID: 15491256 BACKGROUND

• Corrigan PW, Larson JE, Michaels PJ, Buchholz BA, Rossi RD, Fontecchio MJ, Castro D, Gause M, Krzyzanowski R, Rusch N. Diminishing the self-stigma of mental illness by coming out proud. Psychiatry Res. 2015 Sep 30;229(1-2):148-54. doi: 10.1016/j.psychres.2015.07.053. Epub 2015 Jul 18.

  PMID: 26213379 BACKGROUND

• CRANDALL VC, CRANDALL VJ, KATKOVSKY W. A CHILDREN'S SOCIAL DESIRABILITY QUESTIONNAIRE. J Consult Psychol. 1965 Feb;29:27-36. doi: 10.1037/h0020966. No abstract available.

  PMID: 14277395 BACKGROUND

• Dusenbury L, Brannigan R, Falco M, Hansen WB. A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Educ Res. 2003 Apr;18(2):237-56. doi: 10.1093/her/18.2.237.

  PMID: 12729182 BACKGROUND

• Link BG, Struening EL, Neese-Todd S, Asmussen S, Phelan JC. Stigma as a barrier to recovery: The consequences of stigma for the self-esteem of people with mental illnesses. Psychiatr Serv. 2001 Dec;52(12):1621-6. doi: 10.1176/appi.ps.52.12.1621.

  PMID: 11726753 BACKGROUND

• Link BG, Yang LH, Phelan JC, Collins PY. Measuring mental illness stigma. Schizophr Bull. 2004;30(3):511-41. doi: 10.1093/oxfordjournals.schbul.a007098.

  PMID: 15631243 BACKGROUND

• Pullmann MD, Bruns EJ, Sather AK. Evaluating fidelity to the wraparound service model for youth: application of item response theory to the Wraparound Fidelity Index. Psychol Assess. 2013 Jun;25(2):583-98. doi: 10.1037/a0031864. Epub 2013 Apr 1.

  PMID: 23544392 BACKGROUND

• Raudenbush SW, Bryk AS. Hierarchical linear models: Applications and data analysis methods. Newbury Park, CA: Sage; 2002.

  BACKGROUND

• Snijders TAB, Bosker R. Multilevel analysis. Thousand Oaks, CA: Sage; 1999.

  BACKGROUND

• Wahl OF, Susin J, Kaplan L, Lax A, Zatina D. Changing Knowledge and Attitudes with a Middle School Mental Health Education Curriculum. Stigma Res Action. 2011;1(1):44-53. doi: 10.5463/sra.v1i1.17.

  PMID: 21731851 BACKGROUND

• West P, Sweeting H, Der G, Barton J, Lucas C. Voice-DISC identified DSM-IV disorders among 15-year-olds in the west of Scotland. J Am Acad Child Adolesc Psychiatry. 2003 Aug;42(8):941-9. doi: 10.1097/01.CHI.0000046907.27264.E4.

  PMID: 12874496 BACKGROUND

• Painter K, Phelan JC, DuPont-Reyes MJ, Barkin KF, Villatoro AP, Link BG. Evaluation of Antistigma Interventions With Sixth-Grade Students: A School-Based Field Experiment. Psychiatr Serv. 2017 Apr 1;68(4):345-352. doi: 10.1176/appi.ps.201600052. Epub 2016 Nov 15.

  PMID: 27842475 RESULT

• Link BG, DuPont-Reyes MJ, Barkin K, Villatoro AP, Phelan JC, Painter K. A School-Based Intervention for Mental Illness Stigma: A Cluster Randomized Trial. Pediatrics. 2020 Jun;145(6):e20190780. doi: 10.1542/peds.2019-0780. Epub 2020 May 20.

  PMID: 32434761 DERIVED

MeSH Terms

Conditions

Social Stigma; Mental Disorders

Condition Hierarchy (Ancestors)

Social Behavior; Behavior

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Outcomes were self-reported and completed on lap top computers without interaction with assessors. Research staff conducting home visits were not aware of which arm participants received.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Distinguished Professor of Public Policy

Model Details: A two by two by two cluster randomized fully -crossed factorial design

Study Record Dates

• First Submitted: June 27, 2018
• First Posted: July 24, 2018
• Study Start: July 1, 2011
• Primary Completion: June 30, 2015
• Study Completion: June 30, 2015
• Last Updated: July 24, 2018

Record last verified: 2018-07

Data Sharing

• IPD Sharing: Will not share