Indirect social contact interventions to reduce mental health-related stigma in low- and middle-income countries: systematic review

Abstract

Aims Mental health-related stigma and discrimination are a complex and widespread issue with negative effects on numerous aspects of life of people with lived experience of mental health conditions. Research shows that social contact is the best evidence-based intervention to reduce stigma. Within the context of a rapid development of remote technology, and COVID-19-related restrictions for face-to-face contact, the aim of this paper is to categorise, compare and define indirect social contact (ISC) interventions to reduce stigma and discrimination in mental health in low- and middle-income countries (LMICs). Methods MEDLINE, Global Health, EMBASE, PsychINFO, Cochrane Central Register of Control Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched using a strategy including terms related to ‘stigma and discrimination’, ‘intervention’, ‘indirect social contact’, ‘mental health’ and ‘low- and middle-income countries’. Relevant information on ISC interventions was extracted from the included articles, and a quality assessment was conducted. Emerging themes were coded using a thematic synthesis method, and a narrative synthesis was undertaken to present the results. Results Nine studies were included in the review overall. One study was ineffective; this was not considered for the categorisation of interventions, and it was considered separately for the comparison of interventions. Of the eight effective studies included in synthesis, interventions were categorised by content, combination of stigma-reducing strategies, medium of delivery, delivery agents, target condition and population, as well as by active or passive interaction and follow-up. Most of the interventions used education and ISC. Recovery and personal experience were important content components as all studies included either one or both. Cultural adaptation and local relevance were also important considerations. Conclusions ISC interventions were effective in overall terms for both the general public and healthcare providers, including medical students. A new definition of ISC interventions in LMICs is proposed. More research and better reporting of intervention details are needed to explore the effectiveness of ISC strategies in LMICs, especially in regions where little relevant research has been conducted.

Public mental illness disclosure on social media and the effects on stigma toward people with mental illness: A systematic review.

“…These formats included text-based messages, videos, theater performances, and combinations of multiple materials. Relevant literature reviews showed comparable destigmatizing effects across formats (Makhmud et al, 2022;Maunder & White, 2019;Naslund & Deng, 2021). However, it remains unclear whether the message format plays a role in achieving intended stigma reduction goals in public mental illness disclosures on social media.…”

“…These typically involve the use of video or audio narratives of people with lived experience of mental illness (Zhuang & Guidry, 2022). Others involve activities such as reading a vignette depicting a person with mental illness and imagining the desired level of contact with them (Makhmud et al, 2022; White et al, 2021).…”

Pharmacy and nursing students' stigma and perceptions toward individuals with mental illness impacted through interaction with a website featuring lived experiences

“…Though this type of direct (i.e., live, face‐to‐face) social contact intervention may help to reduce stigma in health care, 13 it can be challenging to implement as a live face‐to‐face activity due to timing, space, ability to scale up to larger groups, and logistical concerns 14 . Indirect social contact interventions such as viewing of online videos, films, or pre‐recorded narratives (including PhotoVoice [https://photovoice.org/]) depicting lived experience with mental illness have been associated with reductions in stigma among health care providers 13,15,16 …”

“…14 Indirect social contact interventions such as viewing of online videos, films, or pre-recorded narratives (including PhotoVoice [https:// photovoice.org/]) depicting lived experience with mental illness have been associated with reductions in stigma among health care providers. 13,15,16 SNAP the Stigma (SNAP) is an engagement and awareness website to de-stigmatize and humanize mental illness. 17 SNAP was created by researchers at a midwestern university to encourage the sharing of lived experiences through PhotoVoice, a participatoryaction method in which participants capture and reflect upon photos of their lived experiences.…”

Effects of the Mental Health Supporter Training Program on mental health‐related public stigma among Japanese people: A pretest/posttest study

“…The influential meta‐analysis by Corrigan and colleagues and other systematic reviews 9–12 revealed that interventions for mental health‐related public stigma reduction have small to moderate immediate effect sizes. Also, factors such as cultural and social norms, as well as support for public policies related to mental illness, are important to consider in efforts to reduce public stigma 1,9,13 . Several countries have previously launched public anti‐stigma campaigns.…”