Reducing stigma in high school students: A cluster randomized controlled trial of the National Alliance on Mental Illness’ Ending the Silence intervention.

Abstract

Beyond education and contact program components, existing research on how to design a successful adolescent stigma reduction intervention has been inconclusive. This study evaluated the effectiveness of a school-based mental health (MH) stigma reduction and health promotion program, Ending the Silence (ETS), developed by the National Alliance on Mental Illness (NAMI). A diverse sample of 206 high school students in New York City participated in the current study. Using a cluster randomized controlled trial design, 14 ninth-12th grade classes (Grade 9 -12) were randomly assigned to the ETS program or an active control presentation on careers in psychology. Students completed 4 surveys throughout the study (pre, immediate post-presentation, 4 weeks post, 8 weeks post). Prospective results (over 2 months) and qualitative feedback were analyzed. Prospectively, mixed effects modeling indicated significant effects in favor of the ETS group for reduced negative stereotypes, improved mental health knowledge, and less anticipated risk for disclosing to a counselor. There were also trends in favor of the ETS group for reductions in intended social distancing and negative affect, and improvements in help-seeking intentions. Other predictors of stigma included mental health knowledge, gender, race/ethnicity, prior contact with mental illness, and grade level. Qualitative feedback indicated positive impressions of ETS overall, but suggestions for more interactive activities and discussion. Relatively brief programs such as ETS appear to be a practical vehicle for stigma reduction. Future research is warranted on longer-term programs and adolescent development variables.

Review: School‐based interventions to improve mental health literacy and reduce mental health stigma – a systematic review

“…This approach is based on the intergroup contact theory, which suggests that cross‐group interactions, and hence interactions with commonly stigmatised groups, may reduce prejudice (Allport, 1954; Pettigrew, 1998). Our results showed that the medium of contact, whether it was live or filmed, did not predict whether an intervention was effective or not, as there was an equal number of interventions that incorporated live contact (Chisholm et al., 2016; DeLuca, 2020b; DeLuca et al., 2020; Link et al., 2020; Painter et al., 2017) or filmed contact (Aseltine & DeMartino, 2004; Chan et al., 2009; Milin et al., 2016) amongst those that were effective. This is in line with other studies in the literature that found that live contact and filmed contact are equally effective (Clement et al., 2012).…”

“…Results suggest that improvements were retained for at least 6 months, although all four studies found that MH knowledge dropped to a lower level from post‐intervention to follow‐up (Chan et al., 2009; DeLuca, 2020b; DeLuca et al., 2020; Perry et al., 2014; Yamaguchi et al., 2020). Of these, three studies incorporated live contact with people with experience of mental disorders alongside educational content in the intervention (Chisholm et al., 2016; DeLuca, 2020a, 2020b; Link et al., 2020; Painter et al., 2017), and three studies incorporated filmed contact (Aseltine & DeMartino, 2004; Chan et al., 2009; Milin et al., 2016). One study (Teesson et al., 2020) reported mixed results, with significant improvements when compared to alternative intervention ( p ‐values ranging from <.0001 to .0014) but not usual health classes.…”

“…One study found mixed results, as significant improvement was observed with one of the vignettes only ( p < .001) but not the other ( p = .056; Hart et al., 2018). Four studies found no significant differences in behavioural intentions towards people with mental disorders (Ahmad et al., 2020; Chisholm et al., 2016; DeLuca et al., 2020; Swartz et al., 2017).…”

“…(2014) found the reverse, that is no improvement post‐ intervention but significant improvements at 6‐months follow‐up ( p < .05). Two studies found reported different results with different measures (DeLuca, 2020b; DeLuca et al., 2020; Pitre et al., 2007): DeLuca and colleagues found that the intervention group had significantly reduced stigma scores on Attitudes about Mental Illness and its Treatment Scale ( p = .014), but not the Attitudes Toward Serious Mental Illness – Adolescent Version ( p = .892); Pitre and colleagues found that intervention groups had significant improvements on the Separatism ( p < .01), Restrictiveness ( p < .005) and Stigmatisation ( p < .025) subscales of the Opinions about Mental Illness Scale but not the Benevolence, Stereotyping and Pessimistic Prediction subscales (all p s > .01). Three studies found no significant differences in attitudes and beliefs regarding mental disorders (Ahmad et al., 2020; Pinto‐Foltz, 2009; Saporito et al., 2011).…”

Review: School‐based mental health literacy interventions to promote help‐seeking – a systematic review

“…Five studies addressed the knowledge of when and how to seek help for mental disorders in the context of assisting others to seek help (DeLuca et al, 2020;Klingman & Hochdorf, 1993;O'Mara et al, 2013;Painter et al, 2017;Yamaguchi, Ojio, et al, 2020). Four studies reported statistically significant improvements in knowledge of when and how to seek help for mental disorders (p-values ranging from <.001 to <.05; Klingman & Hochdorf, 1993;O'Mara et al, 2013;Painter et al, 2017;Yamaguchi, Ojio, et al, 2020).…”