A Game-Based School Program for Mental Health Literacy and Stigma Regarding Depression (Moving Stories): Protocol for a Randomized Controlled Trial

Abstract

Background The prevalence of elevated depressive symptoms among youth in most western societies is high. Yet, most adolescents who are experiencing depressive symptoms do not seek help. Low mental health literacy, high stigma, and low social support have been shown to hinder help-seeking. A small number of interventions has been developed to target mental health literacy and stigma, but few focus on actual help-seeking and first aid behavior. We have developed a game-based school program called Moving Stories that targets mental health literacy, including knowledge and behavior, and stigma among adolescents, in regard to depression specifically. Objective Our aim is to describe the protocol for a study that will test the effectiveness of the program Moving Stories in a Dutch adolescent sample. We hypothesize that adolescents who participate in the program Moving Stories will have better mental health literacy and less stigma regarding depression compared to adolescents in the nonintervention control group at posttest and at 3- and 6-months follow-up. We also expect a positive change in actual help-seeking and first aid behavior at 3- and 6-months follow-up. Methods Moving Stories has been developed by a professional game design company in collaboration with researchers and relevant stakeholders. The effectiveness of Moving Stories will be tested through a randomized controlled trial with two conditions: Moving Stories versus control. Participants will fill in questionnaires at pretest, posttest, and 3- and 6-months follow-up. Our power analysis showed a required sample size of 180 adolescents. Results Four high schools have agreed to participate with a total of 10 classes. A total of 185 adolescents filled in the pretest questionnaire. The last of the follow-up data was collected in December 2018. Conclusions If Moving Stories proves to be effective, it could be implemented as a school-based program to target mental health literacy and stigma regarding depression; this could, in turn, improve early help-seeking in adolescents suffering from depression. Trial Registration Nederlands Trial Register NTR7033; https://www.trialregister.nl/trial/6855 International Registered Report Identifier (IRRID) DERR1-10.2196/11255

A review of mental health literacy strategy for adolescence

“…It is since education is important to improve mental health science, such as depression [31], reduce stigma, and improve access to the care [32]. This strategy could be done by i) creating a synergy with a school-based mental health literacy program, ii) reporting mental health cases in the educational unit, iii) promoting mental health by using games [33], group dynamics, modeling, kinds of music, video, photo novel, and comic [34], iv) forming a University level agency to find out the report of mental health disorders at each educational unit to be followed up, and v) providing an integrated program about school-based anti-stigma in their mental health literacy programs [35]. Individual-based strategy.…”

Feasibility of a serious game coupled with a contact-based session led by lived experience workers for depression prevention in high-school students

“…Also, the teacher, trained as gatekeeper, will be able to guide students towards school mental health professionals. Further details about the content of Moving Stories and its development are described extensively elsewhere [ 32 ].…”

The modules of mental health programs implemented in schools in low- and middle-income countries: findings from a systematic literature review

“…Available literature highlights that schools play a major role in the provision of, and improving, access to mental health interventions to children and adolescents [2,[5][6][7][8][9][10][11][12][13]. Evidence from high-income countries (HICs) indicates that several programs have been developed and implemented to meet the mental health needs of children and adolescents [14][15][16][17][18][19][20]. While this is the case in HICs, little is known about the development of these programs in lowand middle-income countries (LMICs).…”