Expanded-Coming-Out-Proud Group on Reducing Self-stigma for People With a Severe Mental Illness- A Randomized Control Trial With Six-month Follow-up

NCT07812298 | Completed

• 1 other identifier: 12609519
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

Globally, approximately one-third of people with severe mental illness report self-stigma. Self-stigma negatively affects recovery by lowering quality of life, self-esteem, and self-efficacy, and reducing treatment adherence, which can lead individuals to refuse psychiatric medication, experience increased psychiatric symptoms, and relapse. Multi-component interventions, which combine several single interventions, have been found to produce better outcomes than single interventions alone, but few studies have been conducted in this area. To address this research gap, this study aimed to develop and evaluate the longer-term impact of a 12-session Expanded Coming Out Proud (ECOP) group delivered by a social worker and a peer support worker, with skills in empowerment and transforming negative self-stigmatising beliefs, to reduce self-stigma in people with severe mental illness in Hong Kong. This study was a multicentre, randomised controlled trial with 6-month follow-up. The intervention group received ECOP in addition to treatment as usual (TAU), which included interest classes and recreational activities, while the control group received TAU.

Conditions

Expanded Coming Out Proud Group; Control Group

Keywords

Expanded Coming Out Proud group; Self-stimga; Empowerment; Cognitive Behavioural Therapy; Honest Open and Proud; Depression

Outcome Measures

Primary Outcomes (1)

• Chinese Internalised Stigma of Mental Illness (ISMI)

  The Chinese Internalised Stigma of Mental Illness is a 24-item self-report scale measuring changes in self-stigma, with good validity and reliability (α = 0.93; Young et al., 2016). The ISMI has been used in research studies on self-stigma (Lamarca et al., 2024). Each item (e.g., "I am disappointed in myself for having a mental illness") is rated on a 4-point scale, ranging from strongly agree (1) to strongly disagree (4). Item scores are averaged, with higher scores indicating greater self-stigma. As suggested by previous studies (Brohan et al., 2010), an ISMI score of 2.50 or above is regarded as high self-stigma, while a score below 2.50 is regarded as low self-stigma; this classification was adopted in this study.

  From enrollment to the end of the treatment at 12 weeks, 3-month follow-up and 6-month follow-up.

Secondary Outcomes (3)

• Chinese Beck Depression Inventory (BDI)

  From enrollment to the end of the treatment at 12 weeks, 3-month follow-up and 6-month follow-up

• Chinese Rosenberg Self-Esteem Scale (RSES)

  From enrollment to the end of the treatment at 12 weeks, 3-month follow-up and 6-month follow-up.

• Personal Empowerment Self-Assessment Scale (PESAS)

  From enrollment to the end of the treatment at 12 weeks, 3-month follow-up and 6-month follow-up.

Study Arms (2)

Expanded Coming Out Proud group (ECOP)

EXPERIMENTAL

In addition to Treatment as usual (TAU), the ECOP was conducted in collaborating community mental health centres over a 12-week intervention period, with one session per week, each lasting about 1.5 hours.

Behavioral: Expanded Coming Out Proud group

Control group

OTHER

Participants in the control group received TAU, including interest classes and leisure activities provided by collaborating community mental health centres, which were the same as those received by the intervention group

Behavioral: control group

Interventions

control group BEHAVIORAL

Participants in the control group received TAU, including interest classes and leisure activities provided by collaborating community mental health centres, which were the same as those received by the intervention group

Control group

Expanded Coming Out Proud group BEHAVIORAL

The ECOP consisted of 12 sessions, covering the following topics: sharing the experience of stigma (session 1); challenging social stigmatized beliefs (session 2); transforming self-stigmatized beliefs with CBT skill, e.g. guided discovery, pie-chart, behavioural experiment, (session 3-6); relaxation and social skill training on facing social stigma situations (session 7-8); reflecting the risks and benefits of secrecy and disclosure of mental illness (session 9); exploring the five levels of disclosure, which range from the lowest level of maintaining secrecy to the highest level of broadcasting one's experience with mental illness (session 10); learning to share own story with a mental illness (session learning to share own story with a mental illness (session 11); summary (session 12).

Expanded Coming Out Proud group (ECOP)

Eligibility Criteria

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

You may qualify if:

• aged 18 years or older;
• diagnosed with a mental illness by their medical officers according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, Text Revision) (American Psychiatric Association, 2022); and
• receiving community mental health services provided by collaborative local non-governmental organisations

You may not qualify if:

• having suicidal risk;
• unstable mental state;
• were unable to participate independently in group activities; and
• exhibited disruptive behaviour

Sponsors & Collaborators

• City University of Hong Kong: lead
• Hong Kong Shue Yan University: collaborator
• Hong Kong Baptist University: collaborator

Study Sites (1)

City University of Hong Kong

Kowloon Tong, Hong Kong, Hong Kong

Location

Related Publications (10)

• Ng, P. Y.-N., Chiu, R., Young, K.-W. D., Chen, Q.-R. J., & Corrigan, P. (2026). Randomized Controlled Trial of Expanded Coming Out Group on Reducing Self-Stigma of Schizophrenia People. Research on Social Work Practice, 36(1), 59-72

  RESULT

• Byrne, B. M., Stewart, S. M., & Lee, P. W. H. (2004). Validating the Beck Depression Inventory-II for Hong Kong Community Adolescents. International Journal of Testing, 4(3), 199-216

  RESULT

• Dubreucq J, Plasse J, Franck N. Self-stigma in Serious Mental Illness: A Systematic Review of Frequency, Correlates, and Consequences. Schizophr Bull. 2021 Aug 21;47(5):1261-1287. doi: 10.1093/schbul/sbaa181.

  PMID: 33459793 RESULT

• Yanos PT, DeLuca JS, Roe D, Lysaker PH. The impact of illness identity on recovery from severe mental illness: A review of the evidence. Psychiatry Res. 2020 Jun;288:112950. doi: 10.1016/j.psychres.2020.112950. Epub 2020 Apr 5.

  PMID: 32361335 RESULT

• Lamarca M, Espinosa V, Acuna V, Vila-Badia R, Balsells-Mejia S, Moritz S, Berna F, Konig C, Gaweda L, Group P, Barajas A, Ochoa S. Reducing self-stigma in psychosis: A systematic review and meta-analysis of psychological interventions. Psychiatry Res. 2024 Dec;342:116262. doi: 10.1016/j.psychres.2024.116262. Epub 2024 Nov 16.

  PMID: 39549598 RESULT

• Fox AB, Earnshaw VA, Taverna EC, Vogt D. Conceptualizing and Measuring Mental Illness Stigma: The Mental Illness Stigma Framework and Critical Review of Measures. Stigma Health. 2018 Nov;3(4):348-376. doi: 10.1037/sah0000104. Epub 2017 Sep 21.

  PMID: 30505939 RESULT

• Corrigan PW, Kosyluk KA, Rusch N. Reducing self-stigma by coming out proud. Am J Public Health. 2013 May;103(5):794-800. doi: 10.2105/AJPH.2012.301037. Epub 2013 Mar 14.

  PMID: 23488488 RESULT

• Peng W, Zhou Y, Chu J, Liu Z, Zheng K, Yao S, Yi J. Factorial and Criterion Validities of the Chinese Version of Rosenberg Self-Esteem Scale Among Undergraduate Students. Psychol Res Behav Manag. 2024 Dec 5;17:4135-4144. doi: 10.2147/PRBM.S494452. eCollection 2024.

  PMID: 39654814 RESULT

• Young DK, Ng PY. The prevalence and predictors of self-stigma of individuals with mental health illness in two Chinese cities. Int J Soc Psychiatry. 2016 Mar;62(2):176-85. doi: 10.1177/0020764015614596. Epub 2015 Nov 18.

  PMID: 26582785 RESULT

• Young, D. K.-W., Ng, P. Y. N., Pan, J.-Y., & Cheng, D. (2017). Validity and reliability of Internalized Stigma of Mental Illness (Cantonese). Research on Social Work Practice, 27(1), 103-110

  RESULT

MeSH Terms

Conditions

Empowerment; Depression

Interventions

Control Groups

Condition Hierarchy (Ancestors)

Social Behavior; Behavior; Behavioral Symptoms

Intervention Hierarchy (Ancestors)

Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: INVESTIGATOR
• Masking Details: A research assistant who was blinded to the randomised allocation of participants conducted data collection and outcome assessment with standardized assessment tools
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Model Details: The ECOP was conducted in collaborating community mental health centres over a 12-week intervention period, with one session per week, each lasting about 1.5 hours. A program manual with standardized and detailed guidelines were designed and written by the research team. In this study, the ECOP consisted of 12 sessions, covering the following topics: sharing the experience of stigma (session 1); challenging social stigmatized beliefs (session 2); transforming self-stigmatized beliefs with CBT skill, e.g. guided discovery, pie-chart, behavioural experiment, (session 3-6); relaxation and social skill training on facing social stigma situations (session 7-8); reflecting the risks and benefits of secrecy and disclosure of mental illness (session 9); exploring the five levels of disclosure, which range from the lowest level of maintaining secrecy to the highest level of broadcasting one's experience with mental illness (session 10); learning to share own story with a mental illness (session

Study Record Dates

• First Submitted: September 4, 2026
• First Posted: September 10, 2026
• Study Start: July 20, 2022
• Primary Completion: March 31, 2024
• Study Completion: December 31, 2024
• Last Updated: September 10, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

HK (1)