Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: Systematic review

Abstract

BackgroundMost research on interventions to counter stigma and discrimination has focused on short-term outcomes and has been conducted in high-income settings.AimsTo synthesise what is known globally about effective interventions to reduce mental illness-based stigma and discrimination, in relation first to effectiveness in the medium and long term (minimum 4 weeks), and second to interventions in low- and middle-income countries (LMICs).MethodWe searched six databases from 1980 to 2013 and conducted a multi-language Google search for quantitative studies addressing the research questions. Effect sizes were calculated from eligible studies where possible, and narrative syntheses conducted. Subgroup analysis compared interventions with and without social contact.ResultsEighty studies (n = 422 653) were included in the review. For studies with medium or long-term follow-up (72, of which 21 had calculable effect sizes) median standardised mean differences were 0.54 for knowledge and −0.26 for stigmatising attitudes. Those containing social contact (direct or indirect) were not more effective than those without. The 11 LMIC studies were all from middle-income countries. Effect sizes were rarely calculable for behavioural outcomes or in LMIC studies.ConclusionsThere is modest evidence for the effectiveness of anti-stigma interventions beyond 4 weeks follow-up in terms of increasing knowledge and reducing stigmatising attitudes. Evidence does not support the view that social contact is the more effective type of intervention for improving attitudes in the medium to long term. Methodologically strong research is needed on which to base decisions on investment in stigma-reducing interventions.

Qualitative analysis of UK and USA open mental health Facebook groups for mental health support (Preprint)

“…This may reduce geographical constraints [54] and provide access to hard-toreach demographics [30-33, 37, 38], as individuals may join groups all over the world. Indeed this could limit social barriers often related to mental health care and support seeking [55], in particular feelings of stigmatisation [28,29]. Thus the diversity of group membership may have offered members alternative perspectives from individuals from other countries and cultures when seeking support and advice, supporting previous findings [19].…”

“…This may increase the level of disclosure, which in turn could build trust and provide the knowledge that the online environment is a safe place, thus promoting group cohesion [27]. Other benefits of utilising online sources of support include reduced feelings of stigmatisation [28,29], and the capacity of the internet to access hard to reach demographic groups [30], such as men [31,32], young people [33][34][35][36], differing socioeconimic groups [37], and ethnic minorities [38].…”

The WPA- Lancet Psychiatry Commission on the Future of Psychiatry

“…So far, research has yielded little evidence as to how psychiatrists can influence these attitudes in public campaigns. 136 The next 10 years should see more systematic research on how the public should be informed about mental distress and mental disorders, so that better initiatives can be designed to build on and strengthen caring attitudes and integrative behaviour towards people with mental disorders in general populations.…”

The Impact of Social Marketing Campaigns on Reducing Mental Health Stigma: Results From the 2009–2014 Time to Change Programme

“…The novel aspect of TTC programme is the explicit target to change behaviour. The key active ingredients are forms of contact between people with and without experience of mental illness [24][25][26][27][28].…”