Mental Health Stigma Reduction Research Articles

Cultural adaptation of INDIGO mental health stigma reduction interventions using an ecological validity model in north India.

The International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership is a multi-country international research program in seven sites across five low- and middle-income countries (LMICs) in Africa and Asia to develop, contextually adapt mental health stigma reduction interventions and pilot these among a variety of target populations. The aim of this paper is to report on the process of culturally adapting these interventions in India using an established framework. As part of this larger program, we have contextualized and implemented these interventions from March 2022 to August 2023 in a site in north India. The Ecological Validity Model (EVM) was used to guide the adaptation and contextualization process comprising eight dimensions. Six dimensions of the Ecological Validity Model were adapted, namely language, persons, metaphors, content, methods, and context; and two dimensions, namely concepts and goals, were retained. Stigma reduction strategies with varied target groups, based on culturally appropriate adaptations, are more likely to be acceptable to the stakeholders involved in the intervention, and to be effective in terms of the program impact.

Community-powered change in the Omaha metropolitan area: Examining a digital approach to mental health stigma reduction during the COVID-19 pandemic

ABSTRACT Mental health stigma is associated with a range of negative health outcomes, and there is a need for more information on how to apply evidence-based digital strategies to various geographic areas. This case study reviews the creation and implementation of a community-based participatory digital media campaign that uses a collective impact framework to address mental health stigma reduction in the Omaha metropolitan area. The campaign was delivered during the COVID-19 pandemic and consisted of various components, including two social media campaigns which delivered evidence-based messaging through user-generated content from local individuals: Spokesimals Midwest paired images of local pets with educational mental health messages, while WhatMakesUs featured personal testimonials of people’s experiences with mental health. Campaign reach was amplified by engagement with community-based organizations and local influencers. Within the first 10 months, WhatMakesUs and Spokesimals Midwest received 412 testimonials and pet submissions. The campaign partnered with 47 community-based organizations, and 50 influencers achieved over 27,000 engagements and a reach of 173.5K on social media. The positive metrics from the first 10 months of the campaign show promise in the use of this model to impact mental health stigma in the Midwestern United States.

Mental Health Stigma Reduction in the Midwestern United States: Evidence from a Digital Campaign Using a Collective Impact Model.

Addressing mental stigma is a key component of improving mental health outcomes. A digital media campaign was implemented to reduce mental health stigma in the Omaha Metropolitan area. The campaign used evidence-based approaches within a collective impact framework. Two surveys were conducted at baseline and at 10-month follow-up to evaluate the campaign within the Omaha and Council Bluffs intervention region, and a control region in Iowa. Analysis revealed significant improvements in desires for social distance and perceptions toward treatment efficacy within the intervention group. Improvements were seen across measures of personal and community attitudes towards mental health conditions, confidence in supporting others, and likelihood of disclosing a mental health condition. The trends were generally not replicated within the control group. Respondents who were aware of the campaign showed fewer stigmatizing views, including lower desires for social distance, improved attitudes toward treatment, and significant improvements in providing support and caring for their own mental health. The results suggest that the implemented evidenced-based approach could potentially create positive shifts in stigma reduction. This evaluation further supports the potential for scaling and adapting digital media campaigns for stigma reduction in different geographic locations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10900-022-01130-3.

Applying Theoretical Perspectives and Activism to Understand and Combat Mental Health Stigma

Mental health-related stigma results in individual, communal, and societal consequences such as stereotypical thoughts, prejudiced feelings and attitudes, discriminatory behaviours, social injustice, and inequity toward individuals with mental health issues. As a result, individuals living with mental illness often experience decreased self-esteem, loss of identity, isolation, exacerbated mental illness, internalized self-stigma, housing and employment discrimination, academic challenges, and barriers in various aspects of life. Research indicated that stigma continues to persist despite increased knowledge about mental health, expanded treatment options, and an abundance of mental health promotion and stigma reduction programs. Thus, we must further examine mental health-related stigma from various theoretical conceptualizations to understand its persistence. This paper applied two theoretical frameworks: Social Learning Theory and Sociological Imagination Theory to better understand mental health stigma. It argues that activism aids in reducing mental health stigma. This paper also suggests that program developers of future mental health stigma reduction efforts should apply activism into their initiatives to promote social justice and equity for people living with mental disorders.

Barriers to accessing psycho-oncological support in head and neck cancer: A qualitative exploration of healthcare professionals' perspectives.

Disease- and treatment-related consequences in Head and Neck Cancer (HNC) can result in psychological issues for which specialist psychological support, dubbed psycho-oncology, is recommended. Health and Social Care Professionals (HSCPs) function as a crucial link between survivors and these services, through onward referral pathways. However, little is known about these HSCPs' perspectives on barriers to accessing psycho-oncology in HNC. The current study sought to investigate such perspectives. Eleven HSCPs from national cancer centres across Ireland were recruited using purposive sampling. A qualitative, cross-sectional research design was implemented utilising virtual semi-structured interviews. Interviews were audio-recorded, transcribed, and analysed using inductive, reflexive thematic analysis. The researcher identified four themes relating to barriers to psycho-oncology access: Lack of Access and Perceived Elitism in Onward Referral; Communication Barriers; Stigma Associated with Mental Illness and Psychological Services, and Inadequate Signposting and Advertising of Existing Psycho-Oncology Services. These findings indicate that HSCPs face multiple barriers when attempting to refer HNC survivors to psycho-oncology services. Some of these barriers relate to survivors, others to HSCPs themselves, and some to professionals within psycho-oncology services. By removing barriers in onward referral faced by HSCPs, HNC survivors may more readily link in with pre-existing psycho-oncology services in the future. The following may assist with removing such barriers: increased inter-professional dialogue between HSCPs and psycho-oncology services and communication skills training; mental health stigma reduction campaigns targeted at survivors, HSCPs, and wider society; and increased signposting of available psycho-oncology services and in-service training for HSCPs.

Predictors of Help-Seeking: Self-Concept Clarity, Stigma, and Psychological Distress

Multiple studies have shown that individuals with low self-concept clarity (SCC) are highly susceptible to mental health problems (depression and anxiety). However, despite the increased vulnerability to psychopathology, prior research has not examined the relationship between SCC and help-seeking. Hence, to develop a comprehensive understanding of the aforementioned relationship, well-established predictors of help-seeking (psychological distress and stigma) were included in this study. A total of 111 students completed an online survey. Results indicated that lower SCC was associated with higher psychological distress, lower help-seeking propensity, and higher stigma. However, SCC was not found to be a unique predictor of help-seeking above and beyond the established predictors in the multiple regression analysis. Stigma was further divided into perceived public, personal, and perceived peer stigma. The past literature showed no association between perceived public stigma and help-seeking. In addition, perceived public stigma has been found to be higher than personal stigma. Thus, the current study altered the perceived stigma reference group (from “public” to “peer”) to investigate if this change would influence the association with help-seeking. Consistent with prior research, a significant mean difference was found such that perceived public stigma remained significantly higher than personal stigma (95% CI [1.45, 2.34]) and was not correlated with help-seeking or personal stigma. However, both personal and perceived peer stigma were negatively correlated with help-seeking and positively correlated with each other, such that high personal and peer stigma were associated with lower help-seeking. The results can provide insight for future help-seeking intervention programs and mental health stigma reduction campaigns.

Mental Health Stigma Reduction Through Simulated Professional Practice: A Mixed Methods Study

BackgroundThe stigma associated with mental illness is important to address when teaching nursing students about mental health. While previous research demonstrated that in-person clinical mental health experiences reduce stigma, no parallel studies have been conducted on simulated clinical experiences. MethodThis project compared students who attended either a mental health theory course and five simulations or just the theory course. Pre and post attitudes were assessed using the Attitude towards Mental Illness Questionnaire and the Perceived Stigma Questionnaire as well as qualitative interviews. ResultsFindings indicate participants in the mental health simulations reported statistically significant lower levels of mental illness stigma post simulation. ConclusionThis suggests that simulation can be an effective tool to influence attitudes, including towards mental illness and mental health nursing.

Current strategies in the reduction of stigma among caregivers of patients with mental illness: a scoping review

Mental healthcare and wellness are a global concern and have increasingly become an essential service and priority from a human rights perspective. However, negative attitudes towards mental health, such as stigmatisation and discrimination from communities and family members, continue to pose challenges for deinstitutionalisation and home care of mentally ill persons. This study aimed to review the literature on the content and implementation methods of stigma reduction interventions for family/community caregivers of patients with mental illness to inform the development of an anti-stigma intervention for such caregivers in low- and middle-income countries like South Africa. A scoping literature review was conducted of English language studies published from 2008 to 2019 in peer-reviewed journals, using established guidelines for the study objectives. Primary interventions targeting caregivers of mental health patients were searched from PsycINFO, ScienceDirect, CINAHL, and Medline. In total, nine full-text articles were extracted for inclusion in the review, indicating a scarcity of literature on anti-stigma interventions aimed at primary caregivers of mental health patients. Interventions varied in terms of educational content, duration, delivery methods, and sample sizes. Intervention delivery was primarily through face-to-face, telephone, and online methods. Anti-stigma interventions for caregivers of patients with mental illness are varied and show positive short-term impacts on mental health stigma reduction among family caregivers. The evolution of health systems is a feasible approach towards integrating learning and trials that are needed to assess long-term impacts.

Mental Health Stigma Reduction in the Midwest: Evidence from a Digital Campaign Using a Collective Impact Model

Mental Health Stigma Reduction in the Midwest: Evidence from a Digital Campaign Using a Collective Impact Model

The Collective Impact Model for Mental Health Stigma Reduction: A Campaign in the Omaha Metropolitan Area

The Collective Impact Model for Mental Health Stigma Reduction: A Campaign in the Omaha Metropolitan Area

Core components of mental health stigma reduction interventions in low- and middle-income countries: a systematic review.

To identify and categorise core components of effective stigma reduction interventions in the field of mental health in low- and middle-income countries (LMICs) and compare these components across cultural contexts and between intervention characteristics. Seven databases were searched with a strategy including four categories of terms ('stigma', 'mental health', 'intervention' and 'low- and middle-income countries'). Additional methods included citation chaining of all papers identified for inclusion, consultation with experts and hand searching reference lists from other related reviews. Studies on interventions in LMICs aiming to reduce stigma related to mental health with a stigma-related outcome measure were included. All relevant intervention characteristics and components were extracted and a quality assessment was undertaken. A 'best fit' framework synthesis was used to organise data, followed by a narrative synthesis. Fifty-six studies were included in this review, of which four were ineffective and analysed separately. A framework was developed which presents a new categorisation of stigma intervention components based on the included studies. Most interventions utilised multiple methods and of the 52 effective studies educational methods were used most frequently (n = 83), and both social contact (n = 8) and therapeutic methods (n = 3) were used infrequently. Most interventions (n = 42) based their intervention on medical knowledge, but a variety of other themes were addressed. All regions with LMICs were represented, but every region was dominated by studies from one country. Components varied between regions for most categories indicating variation between cultures, but only a minority of studies were developed in the local setting or culturally adapted. Our study suggests effective mental health stigma reduction interventions in LMICs have increased in quantity and quality over the past five years, and a wide variety of components have been utilised successfully - from creative methods to emphasis on recovery and strength of people with mental illness. Yet there is minimal mention of social contact, despite existing strong evidence for it. There is also a lack of robust research designs, a high number of short-term interventions and follow-up, nominal use of local expertise and the research is limited to a small number of LMICs. More research is needed to address these issues. Some congruity exists in components between cultures, but generally they vary widely. The review gives an in-depth overview of mental health stigma reduction core components, providing researchers in varied resource-poor settings additional knowledge to help with planning mental health stigma reduction interventions.

'Tell Your Story': a randomized controlled trial of an online intervention to reduce mental health stigma and increase help-seeking in refugee men with posttraumatic stress.

Refugees report elevated rates of posttraumatic stress disorder (PTSD), but are relatively unlikely to seek help for their symptoms. Mental health stigma is a key barrier to help-seeking amongst refugees. We evaluated the efficacy of an online intervention in reducing self-stigma and increasing help-seeking in refugee men. Participants were 103 refugee men with PTSD symptoms from Arabic, Farsi or Tamil-speaking backgrounds who were randomly assigned to either receive an 11-module online stigma reduction intervention specifically designed for refugees ('Tell Your Story', TYS) or to a wait-list control (WLC) group. Participants completed online assessments of self-stigma for PTSD and help-seeking, and help-seeking intentions and behaviors at baseline, post-intervention, and at a 1 month follow-up. Intent-to-treat analyses indicated that, compared to the WLC, TYS resulted in significantly smaller increases in self-stigma for seeking help from post-treatment to follow-up (d = 0.42, p = 0.008). Further, participants in the TYS conditions showed greater help-seeking behavior from new sources at follow-up (B = 0.69, 95% CI 0.19-1.18, p = 0.007) than those in the WLC. The WLC showed significantly greater increases in help-seeking intentions from post-intervention to follow-up (d = 0.27, p = 0.027), relative to the TYS group. This is the first investigation of a mental health stigma reduction program specifically designed for refugees. Findings suggest that evidence-based stigma reduction strategies are beneficial in targeting self-stigma related to help-seeking and increasing help-seeking amongst refugees. These results indicate that online interventions focusing on social contact may be a promising avenue for removing barriers to accessing help for mental health symptoms in traumatized refugees.

“Be creative and you will reach more people”: youth’s experiences participating in an arts-based social action group aimed at mental health stigma reduction

ABSTRACTBackground: Starting in 2013, the Mental Health Youth Action Board, made up of 15 teens ages 15–18, was created to advise a large children’s hospital on improvements in mental health care and produce social action projects to impact community perceptions of mental health.Methods: This participatory qualitative case study explored the experiences of 14 young people who participated in the Mental Health Youth Action Board between 2013 and 2016.Results: There were two higher order themes: process and outcomes. Process-related themes included how this was a unique leadership experience, the importance of the arts-based approach, and value of the intentionally constructed storytelling process. These processes led to youth growing as advocates for mental health.Conclusions: Arts-based approaches to social action that allow youth to share personal experiences of stigmatized topics can promote healing and support their growth as leaders.

Missed Opportunities for Military Suicide Prevention: Perspectives of Suicide Loss Survivors

ABSTRACTSuicide remains a significant public health problem for the United States military, and surviving family members of military suicide can help generate lessons learned for suicide prevention. Individuals who lost a family member to military suicide (N = 66) rated the likelihood that 25 specific suicide prevention activities may have prevented the decedent's suicide. The highest rated activities included (a) mental health stigma reduction; (b) military leadership caring, support, and guidance; (c) confidential mental health service provision; (d) appropriate crisis management services; and (e) recognition of warning signs. Findings are discussed within the framework of future research and policy endeavors.

A smart-phone intervention to address mental health stigma in the construction industry: A two-arm randomised controlled trial

BackgroundHigh levels of self-stigma are associated with a range of adverse mental health, treatment, and functional outcomes. This prospective study examined the effects of an electronic mental health stigma reduction intervention on self-stigma (self-blame, shame, and help-seeking inhibition) among male construction workers in Australia. MethodMale construction workers (N = 682) were randomly assigned to receive either the intervention condition or the wait list control over a six-week period. Self-stigma was assessed using the Self-Stigma of Depression Scale at post-intervention. We conducted linear regression to assess the effectiveness of the intervention on self-stigma, adjusting for relevant covariates. ResultsSelf-stigma was relatively low in the sample. The intervention had no significant effect on self-stigma, after adjusting for confounders. There were reductions in stigma in both the intervention and control groups at 6-week follow-up. Process evaluation indicated that participants generally enjoyed the program and felt that it was beneficial to their mental health. ConclusionsThese observations underscore the need for further research to elucidate understanding of the experience of self-stigma among employed males.

Training to reduce behavioral health disparities: How do we optimally prepare family medicine residents for practice in rural communities?

Family physicians are a critical part of the healthcare system in rural areas, but little is known about the training they need to more effectively address behavioral health disparities. Practicing family physicians in Montana were surveyed about the behavioral health needs of their patients, the behavioral resources at their disposal, their prioritization of a number of behavioral skills and interventions in the training of family physicians, factors that limit their own use of behavioral skills, and the extent of their behavioral science training. Respondents across the state reported high rates of mental/emotional health issues and high need for health behavior change in their patients. Surprisingly, although rural family physicians reported access to significantly fewer behavioral health resources, they did not rate any of the behavioral skills as higher training priorities than their urban counterparts and they were more likely to identify limitations (lack of patient interest, lack of confidence or competence, and inadequate knowledge or training) on their own use of such skills in practice. Family physicians, both rural and urban, whose residency programs had a higher emphasis on behavioral science felt better prepared to use behavioral skills in practice. Consequently, rural training programs are encouraged to emphasize behavioral science training for their family medicine residents, particularly training that focuses on mental health stigma reduction, emphasizes time savings and practicality, covers more severe psychiatric presentations, promotes cultural sensitivity to rural values of autonomy and self-sufficiency, and teaches skills to advocate for individual and community health with regard to behavioral health disparities.

“I’m in a good place now”: A case study of empowerment of a combat veteran engaged in peer-led disaster relief

ABSTRACTThis qualitative single case study examines the lived experience of empowerment of a combat veteran with posttraumatic stress disorder (PTSD) who engages in volunteer, peer-led disaster response activities with Team Rubicon (TR), a nongovernmental organization. Team Rubicon members utilize unique skill sets of both military veterans and civilian first responders to rapidly deploy response teams to domestic and global emergencies. Minimal research to date disseminates experiences of empowerment among combat veterans. The single case study methodological approach offers a rich descriptive and contextual analysis for exploring implications for mental health stigma reduction in combat veterans through an empowerment lens. The study serves to: provide a preliminary foundation for continued theory building of empowerment in combat veterans through peer-led disaster relief settings, expand research, and offer practical implications for social workers in stigma reduction efforts.

Acceptability of mental health stigma-reduction training and initial effects on awareness among military personnel.

The purpose of this paper is to report on the development of a mental health stigma reduction toolkit and training, and the acceptability and level of stigma awareness following the stigma-reduction training for military personnel. The overall aims of the training were to provide discussion tools highlighting the experiences of Marines seeking help for stress concerns, improve communication between leaders and their Marines around the issue of help seeking, and familiarize Marines with behavioral health treatment. Senior enlisted leaders and officers (N = 52) from a Marine Corps battalion participated in a pretest, 2-h stigma-reduction training and immediate posttest. Acceptability of the training was measured by querying participants about the usefulness and helpfulness of the training among other factors, and stigma awareness was measured with 10 items about mental health stigma. The stigma-reduction training and materials were well accepted by participants. In addition, there was a significant improvement in four of ten stigma-reduction awareness concepts measured before and immediately after the training, which included an increase in agreement that mental health treatments are usually effective in reducing stress reactions [t(51) = −3.35, p = 0.002], and an increase in disagreement that seeking counseling after a deployment will jeopardize future deployments [t(51) = −3.05, p = 0.004]. Level of agreement with several statements including those regarding perceptions of invincibility, and malingering, among others, did not change significantly after the training. The stigma-reduction training containing educational and contact strategies was highly acceptable to the leaders and may have promise for initially dispelling myths associated with seeking help for stress concerns among military service members; however, results indicate that there is clearly more work to be done in combatting stigma.

Social Marketing’s Unique Contribution to Mental Health Stigma Reduction and HIV Testing: Two Case Studies

Since its inception in 2005, articles in Health Promotion Practice's social marketing department have focused on describing social marketing's unique contributions and the application of each to the practice of health promotion. This article provides a brief review of six unique features (marketing mix, consumer orientation, segmentation, exchange, competition, and continuous monitoring) and then presents two case studies-one on reducing stigma related to mental health and the other a large-scale campaign focused on increasing HIV testing among African American youth. The two successful case studies show that social marketing principles can be applied to a wide variety of topics among various population groups.