The Perceived Stigma Reduction Expressed by Young Adults in Response to Suicide Prevention Videos

Abstract

Evidence indicates that stigma impedes an individual’s chance of seeking professional help for a mental health crisis. Commonly reported aggregate-level results for stigma-reduction efforts obfuscate how much stigma reduction is needed to incur a practically meaningful change within an individual, defined here as an attitudinal shift and openness towards seeking mental health for oneself and/or support for others. When basing conclusions and recommendations about stigma-reducing interventions on aggregate scales, it is unclear how much stigma reduction is needed to incur meaningful change within an individual. We explored the impact of reductions in stigma of help-seeking scores in response to an online suicide prevention video among young adults in the United States, using online surveys to collect qualitative and quantitative data. We compared mean changes in the stigma scores from pre- to post-test (video exposure) of 371 young U.S. adults using standard t-tests and individual level analysis. A separate thematic analysis of free-text responses was also conducted from a smaller, randomly-selected subgroup, capturing individuals’ attitudes towards help-seeking for mental health problems. Great attention was given to participants to ensure that they were in a campus setting where counseling services were available. Four main themes emerged: (1) small changes in stigma scores were associated with individual reports of meaningful reductions in their attitudes towards professional counseling; (2) increased empathy towards victims of suicide and other mental health problems sometimes indicated increased empathy for victims of suicide and decreased openness in professional help; (3) empathy towards victims sometimes took the form of increased scores and grief or sadness, possibly thwarting the potential for help-seeking; and (4) self-reports of decreased stigma were not always associated with increased openness towards help-seeking. Results also indicated that small stigma score charges, not meeting statistical significance, were often associated with increased openness towards seeking help. These findings, discovered using mixed-methods, contribute to the body of literature regarding stigma towards suicide and help-seeking by demonstrating deficits in the aggregate-only analysis of stigma-reducing interventions specifically aimed at suicide prevention. Such individuation in stigma experiences indicates that public education on how to reduce the stigma of help-seeking for suicide prevention needs to consider individual-level analyses for improving target populations. Recommendations for future research include additional studies prior to releasing suicide prevention videos to public forums where they may be seen by individuals without access to help.

Digital Interventions to Enhance Readiness for Psychological Therapy: Scoping Review

“…A total of 6 studies in the sample [ 62 , 64 , 65 , 67 , 86 , 90 ] assessed 2 distinctly different interventions in their analysis (ie, the components of the interventions were distinct); therefore, we separated them into individual records. In all, 2 studies assessed slight variations in the same intervention [ 52 , 87 ]; however, we did not segregate these studies because they only reflected minor variations in what was essentially the same intervention. Furthermore, 3 sets of 2 studies in the sample analyzed the same interventions: [ 66 , 69 ], [ 54 , 58 ], and [ 51 , 89 ]; therefore, we grouped them together.…”

“…Some indicated that the interventions increased help-seeking intentions [ 72 , 83 ], whereas others showed no effect on intentions [ 64 , 71 , 79 ], despite their effectiveness in improving attitudes toward treatment or motivation to change. Some indicated improved symptoms [ 62 , 71 , 78 ], whereas others reported reduced stigma or improved literacy [ 14 , 52 , 72 , 79 ]. In addition, all the pre-post studies in the review found that their interventions either reduced client symptoms [ 53 , 73 ] or increased client interest in further treatment [ 51 , 73 ], and all the observational studies in the sample indicated positively skewed effects of their interventions on help-seeking actions, behaviors, or intentions [ 49 , 57 , 69 , 76 , 77 , 82 , 84 ].…”

“…Stigma adds another layer of complexity to the help-seeking and treatment readiness process; Keller et al [ 52 ] found that informational videos on suicide prevention increased empathy, while simultaneously decreasing help seeking. Previous research shows that different types of stigma (eg, public stigma vs internalized self-stigma [ 97 ]) affect help seeking in different ways [ 98 ].…”

“…Another aspect of evaluation involves the chosen research methodology, which not only has a fundamental impact on the outcomes of the study but also on how we come to understand complex social constructs such as stigma, motivation, and the stages of change. Using quantitative measures to isolate and examine phenomena such as attitudes and emotions is limited because these experiences are highly subjective and contextual [ 52 ]; we miss vital information when we detach these occurrences from what gives them meaning. Considering that only one-fourth of the studies in this review included qualitative data collection, there exists a significant gap in our understanding of the nuances of this process at the individual level.…”

“…In terms of study design, among the 45 studies, 19 (43%) were randomized controlled trials, 7 (16%) were observational studies, 6 (13%) were protocols, 4 (9%) were studies exploring the development process of interventions, 3 (7%) were pre-post designs, 2 (4%) were nonrandomized controlled trials, 2 (4%) were historically controlled studies, 1 (2%) was a qualitative evaluation, and 1 (2%) study presented the results of multiple studies (2 randomized controlled trials and 1 pre-post study). Only 26% (12/45) of the studies included qualitative data collection, 18% (8/45) used mixed methods [50][51][52][53][54][55][56][57], and 9% (4/45) were purely qualitative [58][59][60][61]. Depression (9/45, 20%) and unspecified general mental health (9/45, 20%) were the most common target conditions covered, with comorbid anxiety and depression being the next most frequent (6/45, 14%).…”