Reducing depression-related stigma and increasing treatment seeking among adolescents: randomized controlled trial of a brief video intervention

The effect of continuum beliefs on public stigma of depression with evidence from explicit and implicit sources

Stigmatization of depression serves as a significant barrier to both treatment-seeking behaviors and recovery outcomes. While the Continuum Beliefs Approach (CBA) has shown promise in reducing explicit stigma, its impact on implicit attitudes remains unclear. Participants were randomly assigned to continuum beliefs, categorical beliefs, or control groups. Explicit stigma was measured through questionnaires (n = 323) and implicit stigma were assessed using the Single Category Implicit Association Test (n = 252). Results revealed that the continuum beliefs group exhibited significantly lower explicit stigma across cognitive (negative stereotypes), affective (prejudicial affective reactions), and behavioral (social distance acceptance) dimensions. However, no between-group differences emerged for implicit stigma, with participants across all groups demonstrating significant implicit stigma toward depression. While continuum belief interventions effectively reduce explicit stigma, they appear insufficient to modify the deeply ingrained automatic biases that constitute implicit stigma toward depression. These findings highlight the complexity of stigma reduction efforts and the limitations of brief interventions in modifying implicit stigma towards depression.

The Daily Process of Interpersonal Conflict and Mood among Chinese Adolescents: A Multilevel Moderated Mediation Analysis of Cognitive Appraisal, Social Support and Psychological Capital

A growing body of literature has confirmed the within-person process from interpersonal conflict to adolescent mood on a day-to-day timescale. However, research on how, when and for whom adolescent interpersonal conflict relates to their daily mood is underdeveloped. This study examined whether interpersonal conflict is related to mood through threat appraisal and self-blaming attribution and whether these relationships would be moderated by daily social support and psychological capital. Daily experience-sampling data were collected over 14 consecutive days from 264 Chinese adolescents (Mage = 14.74 years, SD = 1.48). The results indicate that adolescents had more negative moods and less positive moods on the days when they experienced more conflicts than usual. Same-day threat appraisal serves as a mediator in the relationship between interpersonal conflicts and negative mood, and same-day threat appraisal and self-blaming attributions play serial mediating roles in the relationship between interpersonal conflicts and same-day positive mood. Furthermore, the relationship between interpersonal conflict and same-day positive mood was moderated by daily social support and psychological capital, i.e., this relationship was stronger in days with more social support and in adolescents with high levels of psychological capital, which is consistent with the reverse stress-buffer model. These findings reveal the instant cognitive mechanism of interpersonal conflict and daily mood and identify when and for whom interpersonal conflict is associated with daily mood.

Climate change hopefulness, anxiety, and behavioral intentions among adolescents: randomized controlled trial of a brief "selfie" video intervention

AIM

We tested the utility of showing "selfie" videos to increase adolescents' climate change hope, agency, and behavioral intentions, and to decrease their climate anxiety.

METHODS

We conducted a randomized controlled trial among healthy volunteers, ages 14 to 18, enrolled through a crowdsourcing platform. We randomly assigned participants (N = 1039) to view one of three 110-s-long video interventions featuring the same adolescent protagonist: positive (depicting an action-oriented stance); negative (defeatist stance); and control (neutral stance and unrelated content). The primary outcome was climate change hope; secondary outcomes were climate change anxiety, behavioral intention scales, and 100-point sliders about hopefulness and agency.

RESULTS

Viewing positive "selfie" videos proved effective among adolescents in increasing hopefulness and a sense of agency regarding climate change (< 0.001), but not in decreasing climate anxiety or increasing intentions to engage in pro-environmental behaviors.

CONCLUSION

Brief video-based interventions featuring adolescent protagonists showed potential to increase hope and agency regarding climate change. While this single exposure did not directly affect anxiety levels or behavioral intentions, future research should examine whether repeated exposure and different "doses" of such interventions might influence these outcomes. The ubiquity and reach of social media hold promise to scale these inexpensive and specifically tailored interventions.

Mood Disorder Public Stigma in Jewish Communities in the United States

This study employed an experimental vignette design in Jewish communities in the United States (n = 243) to investigate whether public stigma toward target individuals with major depressive disorder or bipolar disorder presenting with either mania or depression was associated with their gender and symptomatology. The Mental Illness Stigma Scale (Day et al., in J Appl Soc Psychol 37(10):2191-2219, 2007) was used to measure the following dimensions of public stigma: (a) anxiety; (b) relationship disruption; (c) hygiene; (d) visibility; (e) treatability; (f) professional efficacy; and (g) recovery. The influence of characteristics of survey respondents on public stigma was also examined. In Jewish communities in the United States, mood disorder symptomatology was associated with the stigma dimensions of recovery, relationship disruption, and hygiene. Among respondents, younger and middle-aged males reported increased treatment efficacy stigma. Research implications include designing stigma reduction interventions tailored to specific diagnostic (e.g., bipolar disorder) and demographic (e.g., younger males) groups within the Jewish community.

Effect of a Short, Animated Storytelling Video on Transphobia Among US Parents: Randomized Controlled Trial

Background

Parents play a pivotal role in supporting transgender and gender diverse (TGD) youth. Yet only 35% of TGD youth describe their home as a gender-affirming place. Lack of parental support contributes to recent findings that TGD youth are approximately three times more likely to attempt suicide than their cisgender peers. In contrast, parents' affirmation of their children's gender identity significantly improves their mental health outcomes, by reducing anxiety, depression, and suicidality.

Objective

Addressing the urgent need for effective, scalable interventions, this study evaluates a novel digital approach: short, animated storytelling videos. We hypothesized that our 2.5-minute video intervention would reduce antitransgender stigma, or transphobia, and improve attitudes toward gender diverse children among US parents.

Methods

We recruited 1267 US parents, through the Prolific Academic (Prolific) online research platform, and randomized them into video intervention or control groups. We measured transphobia using the Transgender Stigma Scale, and attitudes toward transgender children using the gender thermometer, before and after watching the video. We compared outcomes between the two groups using 2 × 3 ANOVA. Both groups were invited to return 30 days later for follow-up assessment, before being offered posttrial access to the intervention video, which portrayed an authentic conversation between a mother and her transgender child.

Results

Single exposure to a short, animated story video significantly reduced transphobia and improved attitudes toward transgender children among US parents, immediately post intervention. We observed a significant group-by-time interaction in mean Transgender Stigma Scale scores (F2,1=3.7, P=.02) and significant between-group changes when comparing the video and control groups from baseline to post intervention (F1=27.4, P<.001). Effect sizes (Cohen d) indicated small to moderate immediate changes in response to the 2.5-minute video, though the effect was no longer observed at the 30-day follow-up. Gender thermometer scores revealed significant immediate improvements in the attitudes of participants in the video intervention arm, and this improvement was sustained at the 30-day time point.

Conclusions

Short, animated storytelling is a novel digital approach with the potential to boost support and affirmation of transgender children, by offering authentic insights into the lived experiences of TGD youth. Repeated exposures to such interventions may be necessary to sustain improvements over time. Future studies could test a series of short, animated storytelling videos featuring the lived experiences of several TGD youth. Evaluating the effect of such a series could contribute to the fields of digital health communication and transgender health. Digital approaches, such as short, animated storytelling videos, that support empathy and acceptance of TGD youth could foster a more inclusive society in which every child can thrive.

Interventions to Reduce Mental Health Stigma in Young People: A Systematic Review and Meta-Analysis

Importance

Mental health stigma is a considerable barrier to help-seeking among young people.

Objective

To systematically review and meta-analyze randomized clinical trials (RCTs) of interventions aimed at reducing mental health stigma in young people.

Data Sources

Comprehensive searches were conducted in the CENTRAL, CINAHL, Embase, PubMed, and PsycINFO databases from inception to February 27, 2024. Search terms included "stigma," "mental health," "mental disorders," "adolescents," "youth," and "randomized controlled trial."

Study Selection

Inclusion criteria encompassed RCTs involving interventions aimed at reducing mental health stigma among young people (aged 10-24 years). Studies had to report outcomes related to stigma or help-seeking behaviors. Exclusion criteria included grey literature and studies without results.

Data Extraction and Synthesis

Data were extracted independently by 7 authors (M.A.C., D.N., F.B., S.C., Á.I.L., J.C., V.M.) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed with the Cochrane risk-of-bias tool. Three-level multivariate meta-analyses were conducted to account for within-study correlations and to maximize data use. Standardized mean differences (SMDs) (Hedges g) and odds ratios (ORs) with 95% CIs were calculated. The data analysis was conducted from May 30 through July 4, 2024.

Main Outcomes and Measures

Primary outcomes included stigma-related knowledge, attitudes, behaviors, and general stigma. Help-seeking outcomes were categorized into attitudes, intentions, and behaviors. Secondary outcomes included self-efficacy and empowerment.

Results

A total of 97 studies were included in the systematic review, representing 43 852 young people (mean [IQR] age, 18.7 [15.8-21.3] years; mean [IQR] females, 59.2% [49.4%-72.0%]), and 74 studies were included in 3-level multivariate meta-analyses. Significant short-term effect sizes were found for stigma-related knowledge (SMD, 0.66; 95% CI, 0.43-0.89), attitudes (SMD, 0.38; 95% CI, 0.20-0.56), behaviors (SMD, 0.29; 95% CI, 0.13-0.45), and general stigma (SMD, 0.20; 95% CI, 0.06-0.34) and for help-seeking attitudes (SMD, 0.18; 95% CI, 0.09-0.28) and intentions (SMD, 0.14; 95% CI, 0.07-0.21). Social contact interventions had a greater influence on stigma-related behaviors than did educational approaches.

Conclusions and Relevance

These findings suggest that interventions to reduce mental health stigma among youth are beneficial in the short term. Further high-quality RCTs with long-term follow-up are needed to better understand and enhance these interventions' outcomes.

The effect of caregiver opinion leaders to increase demand for evidence-based practices for youth anxiety: A cluster randomized controlled trial

Background

Dissemination initiatives have the potential to increase consumer knowledge of and engagement with evidence-based treatments (e.g., cognitive behavioral therapy [CBT]). Opinion leaders (OLs) have been used in public health campaigns, but have not been examined for the dissemination of mental health treatments. This study uses the Theory of Planned Behavior to test the dissemination strategy of involving an OL in an educational presentation to increase caregiver demand for CBT for youth anxiety.

Method

Participants (N = 262; 92% female; 69% White, 82% non-Hispanic) were caregivers who registered for a virtual presentation on youth anxiety treatment through their child's school. Schools within 1.5-hr drive of Philadelphia, PA were cluster-randomized (k = 25; two-arm prospective randomization) to the OL condition (presented by a clinical researcher and local caregiver OL; n = 119 participants) or the researcher-only condition (n = 143 participants). Presentations occurred from May 2021 to May 2022. Measures were completed pre- and post-presentation and at 3-month follow-up.

Results

Relative to the researcher co-presenter, participants rated the OL as significantly more relatable, familiar, similar, and understanding of their community, but less credible than the researcher co-presenter. In both conditions, there was a significant pre-post increase in participants' knowledge of, attitudes about, subjective norms related to, and intention of seeking CBT for youth anxiety, but not stigma. Presentation conditions did not differ in change on these measures, or on rates of seeking youth anxiety CBT at follow-up.

Conclusions

Although involvement of a caregiver OL did not increase caregiver demand for evidence-based treatment for youth anxiety, the outreach presentation was associated with increases in knowledge of, attitudes about, subjective norms related to, and intention to seek CBT for youth anxiety. Involving OLs in researcher-delivered dissemination efforts may not be necessary for all consumer audiences, but may be beneficial for engendering a sense of relatability, similarity, and connection with disseminators.

Pediatricians at the forefront of child mental health? A Delphi method exploration

BACKGROUND

Rising mental health challenges among children and adolescents are a global concern. However, a shortage of professionals, inadequate competence and lack of resources hamper necessary care, presenting a major challenge to health service provision. Community pediatricians, frequently the initial contact for mental health issues, are in a key position to improve access to care. The Delphi method was employed as an initial step toward redefining the role of pediatricians and the re-design of pediatric responses within Israeli primary mental health care.

METHOD

Ninety-two experts, including pediatricians, psychiatrists, mental health and child-development professionals, and parents of children with emotional-behavioral challenges participated in a three-round Delphi study. A survey including 6 topics (37 items, 9 demographic questions) was distributed, probing the envisioned role of pediatricians in children's mental health care.

RESULTS

There was strong endorsement between experts regarding pediatricians' potential roles in risk identification, parental guidance, psycho-education, and health policy isuues such as referrals to mental health professionals, and the need for training in this domain. However, discord arose concerning changes in the service framework and pediatricians' role in psychiatric drug prescription. The majority agreed on the necessity of close support from mental health experts, despite differing in the form it should take.

CONCLUSIONS

This study underscores the critical need for mental health training among pediatricians and advocates for a structured, consensus-driven model to bolster early detection and initial treatment of mental health issues in children. The findings highlight the potential for leveraging this model to drive health policy changes and improve service delivery in pediatric mental health care, and might inform other health systems considering extending pediatricians' roles. By equipping pediatricians with essential competencies, this approach can broaden mental health service delivery and reduce stigma. Aligning the model with expert consensus paves the way for impactful policy reform, enhancing pediatricians' roles in mental health risk identification and intervention, and advancing child health services.

Help-Seeking Among Children Impacted by Commercial Sexual Exploitation: A Scoping Review

This scoping review aims to summarize current research on help-seeking behaviors and patterns among children who have experienced commercial sexual exploitation of children (CSEC) victimization and/or are at high risk of exploitation. Because the literature on help-seeking specific to CSEC victimization is limited, the current review was expanded to summarize findings from help-seeking research for children who have experienced harms that often co-occur with CSEC, such as maltreatment and homelessness. The authors searched three large article databases (PsycInfo, Ovid MEDLINE, and Web of Science) for articles that were (a) empirical; (b) measured or used the term "help-seeking" in their framing and/or results; (c) included children between the ages of 12 and 18; (d) primarily focused on children from the United States; (e) published in English. Ultimately, 22 articles met all inclusion criteria and were included in the final review. Results suggest that cisgender white females are the most likely to seek help, followed by sexual and gender minority children. Cisgender male children were the least likely to engage in help-seeking behaviors. Universally, children were more likely to engage in informal help-seeking rather than formal help-seeking, with younger children being more likely to reach out to parents and older children more likely to reach out to friends. Importantly, ethnically diverse children were under-represented, leading to limited information about how and why these children seek help. Implications for help-seeking by children impacted by commercial sexual exploitation are discussed, providing guidance for programming and research related to CSEC prevention.

Do Types of Information in an Animated Video Intervention Affect University Students' Autism Knowledge and Openness Towards Peers on the Autism Spectrum?

This pre-test post-test control group design sought to compare the effectiveness of delivering different types of information ([1] factual information vs. [2] factual information + descriptive and explanatory information vs. [3] factual information + descriptive, explanatory + directive information) in an animated video intervention in increasing university students' autism knowledge and openness toward peers on the autism spectrum. The sample consisted of 92 undergraduates (27 males, 65 females; age range = 18-36) from various universities in Singapore. Participants were randomly assigned to one of the three experimental conditions/videos, where they completed a measure of their autism knowledge and openness scale, before viewing a 5-minute long animated video containing different types of information about autism. After which, participants completed the measure of autism knowledge and openness scale again, followed by a measure of their empathy level. Results indicated that participants' autism knowledge improved following the viewing of the animated video. However, the three different videos containing different types of information did not differ in influencing participants' openness toward peers on the autism spectrum. Nevertheless, qualitative responses proposed that the video containing factual information, with descriptive, explanatory, and directive information was useful in helping participants to know how to interact with their peers on the autism spectrum. The findings of this study provide preliminary support for the most effective method to educate and raise awareness about autism, among the general student population in order to foster a supportive and inclusive environment.

College students' intent to intervene with a hypothetical peer exhibiting depression: Leveraging lessons learned during the COVID-19 pandemic

This study assesses college students' intent to intervene when presented with a hypothetical peer exhibiting depression in one of three scenarios: depression, sadness, and depression in quarantine during COVID-19. Using the Theory of Planned Behavior (TPB), variations in constructs associated with intent were examined by context (external triggers vs. no trigger), knowledge of, and experience with depression. One hundred and sixteen health sciences students read three vignettes and completed an enhanced TPB questionnaire. Intent to intervene was greater when the vignette target was experiencing depression with external stressors. Prior experience with depression and knowing someone with depression were associated with greater intent to connect the hypothetical peer to counseling resources regardless of vignette scenario. Due to increased mental health concerns resulting from the COVID-19 pandemic, efforts promoting awareness of mental illness in peers may benefit from increasing education about stressors and causes of depression that may not be observable.

Association between atherogenic index of plasma and depressive symptoms in US adults: Results from the National Health and Nutrition Examination Survey 2005 to 2018

OBJECTIVE

This study, utilizing data from the U.S. National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018, investigates the association between the atherogenic index of plasma (AIP), a lipid biomarker, and symptoms of depression in American adults.

METHODS

In this cross-sectional study of 12,534 adults aged 20 years and older, depressive symptoms were measured utilizing the Patient Health Questionnaire-9 (PHQ-9) scale. Weighted logistic regression models were employed to scrutinize the independent relationship between AIP levels and the likelihood of developing such symptoms. Moreover, a series of subgroup analyses were conducted to delve deeper into these relationships.

RESULTS

Following adjustment for confounders, logistic regression by grouping AIP into quartiles revealed a significant association between AIP and an augmented likelihood of self-reported depression. Participants in the fourth quartile (Q4) exhibited a higher odds ratio (OR = 1.34, 95 % CI: 1.02-1.75, p < 0.05) compared to those in the first quartile (Q1). Notably, subgroup analysis unveiled significant interactions involving the smoking and diabetes subgroups, indicating that smoking status and diabetes may modify the relationship between AIP and depression incidence.

CONCLUSION

This study reveals a positive correlation between AIP and the self-reported likelihood of depression among US adults, thereby underscoring AIP's potential clinical utility as a biomarker for depressive disorders. Our findings emphasize the necessity to consider and optimize cardiovascular health factors within depression management strategies and offer fresh insights into the development of risk stratification and intervention methods for psychiatric conditions.

Digital empowerment in mental health: A meta-analysis of internet-based interventions for enhancing mental health literacy

Background

Poor mental health literacy (MHL) in the global population significantly contributes to the treatment gap associated with mental disorders. In the digital age, leveraging Internet-based MHL interventions offers scalability and broader accessibility. This meta-analysis aimed to evaluate the effects of Internet-based interventions in improving MHL and mental health.

Method

Up to Feb 2024, seven databases were searched for Internet-based interventions on MHL (knowledge, stigma, help-seeking attitudes and intentions) and mental disorders (general distress, anxiety, and depressive symptoms). The random-effects meta-analyses at post-intervention and long-term follow-up assessments were performed.

Results

Twenty-nine eligible studies involving 11,582 participants were included. Significant positive effects were observed across various domains: knowledge increase (immediate: g = 0.459, 95 %CI: 0.285 to 0.634; follow-up: g = 0.487, 95 %CI: 0.348 to 0.626), immediate stigma reduction (g = -0.332, 95 %CI: -0.479 to -0.186), immediate enhancement of help-seeking attitudes (g = 0.168, 95 %CI: 0.046 to 0.3291) and help-seeking intentions (g = 0.135, 95 %CI: 0.072 to 0.198), as well as immediate mental health improvements (g = -0.074, 95 %CI: -0.115 to -0.033).

Conclusion

Overall, these findings underscore the promising effects of internet-based interventions in improving MHL and mental health, while maintaining these effects over time remains challenging, particularly in reducing stigma and promoting long-term help-seeking behaviors. Addressing methodological limitations, adopting a more interactive approach, and implementing targeted interventions are crucial to maximizing the effectiveness and advancing mental health care worldwide.

The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial

BACKGROUND

Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers.

OBJECTIVE

This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people.

METHODS

This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability.

RESULTS

No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems.

CONCLUSIONS

Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110.

Blueprint for destigmatizing depression and increasing openness to treatment among adolescents using brief social contact-based videos: a qualitative study

Background

Depression is a major public health concern for adolescents, who exhibit low rates of connection to care despite significant needs. Although barriers to help-seeking such as stigma are well documented, interventions to address stigma and to increase help-seeking behavior are insufficient. Dissemination of short videos in social media offer a promising approach, but designing effective stimuli requires better insight into adolescents' perspectives of their own experiences, barriers, and possible interventions.

Methods

We conducted 20 semi-structured interviews with adolescents recruited online via RecruitMe, a Columbia University clinical research registry, to explore their perceptions of depression stigma, barriers to care, the role of schools, and the role of brief video interventions. Thematic analysis guided our analytic approach.

Results

We developed a model consisting of three major domains: (1) Barriers to Help-Seeking, which depicts participants debating their locus of control, naming social, parental, and peer stigma, and acknowledging systemic barriers; (2) Importance of School Systems, in which participants elaborated on the role of schools filling unmet needs and the importance of being taken care of; and (3) Role of Social Media Videos, characterized by adolescents who are seeking legitimacy, finding cultural authenticity, and working towards creating an accessible blueprint for better mental healthcare.

Discussion

We provide insights into adolescents' perceptions of help-seeking for depression and what nuances they would hope to see reflected in future interventions, most notably school-based interventions and peer social media videos. Our study offers a steppingstone towards the creation of brief, social contact-based video interventions focused on destigmatizing depression and promoting openness to treatment among adolescents.

The differential influence of self-construal on the effect of self-efficacy on the help-seeking process: A quasi-experimental online study among people with untreated depressive symptoms

BACKGROUND

Despite available professional healthcare, people often delay or avoid help-seeking. Understanding the underlying reasons is crucial and research has explored the role of self-efficacy in this context. Additionally, studies have highlighted the significance of culturally influenced self-construals in individuals' health behaviour. There seems to be a relationship between self-efficacy and self-construal. The aim of the study is to explore the influence of self-efficacy on help-seeking, considering self-construal as a moderator. Differential experiences of self-efficacy and varying associations among help-seeking variables based on self-construal are posited.

METHODS

A quasi-experimental online study is conducted with a baseline assessment, including self-efficacy interventions, and follow-ups at three and six months. Self-construal groups are compared, i.e., independent vs. interdependent individuals. A series of multi-group path analyses are conducted to examine potential variations in the interventional effects and among the help-seeking variables respective of help-seeking instance, i.e. professional mental health care or informal care. Self-construal functions as the global moderator.

RESULTS

The study included N = 1'368 participants, 65.6 % identifying as female and an average age of 42.38 (SD = 15.22). More independent compared to more interdependent individuals were older, more frequently identified as male, had higher socioeconomic status, fewer depressive symptoms, and greater self-efficacy. Multi-group path analyses for professional mental health care (CFI = 0.992, RMSEA = 0.018, SRMR = 0.004) and informal help (CFI = 0.999, RMSEA = 0.004, SRMR = 0.006) demonstrated excellent model fits. The analysis for informal help was interpretable, as the unconstrained model had a significantly better fit than the constrained model. There were varying associations among help-seeking variables based on self-construals. The intervention effect was differential, with independent participants benefiting significantly (β = 0.203), while the effect was non-significant for interdependent participants.

DISCUSSION

The study's findings, strengths, and limitations are discussed in relation to current research. Results indicate differential experiences of self-efficacy interventions based on individuals' self-construal. Moreover, varying associations among help-seeking variables suggest self-construal-based differences in their interrelationships. These findings highlight the importance of considering self-construal in health related research.

Online randomised trials with children: A scoping review

BACKGROUND

Paediatric trials must contend with many challenges that adult trials face but often bring additional obstacles. Decentralised trials, where some or all trial methods occur away from a centralised location, are a promising strategy to help meet these challenges. This scoping review aims to (a) identify what methods and tools have been used to create and conduct entirely online-decentralised trials with children and (b) determine the gaps in the knowledge in this field. This review will describe the methods used in these trials to identify their facilitators and the gaps in the knowledge.

METHODS

The methods were informed by guidance from the Joanna Briggs Institute and the PRISMA extension for scoping reviews. We systematically searched MEDLINE, CENTRAL, CINAHL, and Embase databases, trial registries, pre-print servers, and the internet. We included randomised and quasi-randomised trials conducted entirely online with participants under 18 published in English. A risk of bias assessment was completed for all included studies.

RESULTS

Twenty-one trials met our inclusion criteria. The average age of participants was 14.6 years. Social media was the most common method of online recruitment. Most trials employed an external host website to store and protect their data. Duration of trials ranged from single-session interventions up to ten weeks. Fourteen trials compensated participants. Eight trials involved children in their trial design process; none reported compensation for this. Most trials had a low risk of bias in "random sequence generation", "selective reporting", and "other". Most trials had a high risk of bias in "blinding participants and personnel", "blinding of outcome assessment", and "incomplete outcome data". "Allocation concealment" was unclear in most studies.

CONCLUSIONS

There was a lack of transparent reporting of the recruitment, randomisation, and retention methods used in many of the trials included in this review. Patient and public involvement (PPI) was not common, and the compensation of PPI partners was not reported in any study. Consent methods and protection against fraudulent entries to trials were creative and thoroughly discussed by some trials and not addressed by others. More work and thorough reporting of how these trials are conducted is needed to increase their reproducibility and quality.

ETHICS AND DISSEMINATION

Ethical approval was not necessary since all data sources used are publicly available.

Selfie Videos to Reduce Stigma and Increase Treatment Seeking Among Youths: Two Noninferiority Randomized Controlled Trials

OBJECTIVE

Confronting stigma early in life could enhance treatment seeking. In two randomized controlled trials (RCTs), one focused on psychosis and the other on adolescent depression, the efficacy and equivalence of brief social contact-based videos were evaluated and compared with a control condition. The outcomes of interest were changes in illness-related stigma and treatment-seeking intention. The hypotheses were that the intervention videos would show greater efficacy than control conditions and that traditional and selfie videos would demonstrate similar efficacy.

METHODS

Young adults (study 1, N=895) and adolescents (study 2, N=637) were randomly assigned to view intervention videos (in traditional or selfie styles) or to a control condition. In short videos (58-102 seconds), young presenters humanized their illness by emotionally describing their struggles and discussing themes of recovery and hope.

RESULTS

Repeated-measures analyses of variance and paired t tests showed significant differences in stigma and treatment seeking between the intervention and control groups and similar efficacy of the traditional and selfie videos. Cohen's d effect sizes ranged from 0.31 to 0.76 for changes in stigma from baseline to 30-day follow-up in study 1 and from 0.13 to 0.47 for changes from baseline to postintervention in study 2.

CONCLUSIONS

The RCTs demonstrated the efficacy of brief videos, both traditional and selfie, in reducing illness-related stigma among young adults and adolescents and in increasing treatment-seeking intention among adolescents. Future studies should explore the effects of brief videos presented by social media influencers on mental health stigma and treatment engagement.

A Review on Mental Illness and Stigma

The concept of stigma is a universal problem that has been the subject of many studies. The phenomenon of stigmatization in psychiatric disorders is also an issue that should be particularly emphasized. Studies have reported that the diagnostic groups most exposed to stigmatization are psychotic disorders, bipolar disorders, depressive disorders, anxiety disorders, and substance use disorders. The stigma process is shaped especially by the clinical features of psychiatric disorders and the society’s attributions to the causes of psychiatric disorders. IIn order for interventions to be developed to prevent stigmatization to be effective, the causes of stigmatization must first be understood.. Therefore, in this study, it is aimed to review the stigmatization processes separately according to the types of psychiatric disorders.

Collaborating with transgender youth to educate healthcare trainees and professionals: randomized controlled trial of a didactic enhanced by brief videos

BACKGROUND

In collaboration with members of the transgender and gender diverse (TGD) community, we created a didactic resource about the unique needs of TGD youth.

METHODS

We developed teaching materials enhanced by video clips of two TGD adolescents openly sharing aspects of their lived experience. We compared the video and no video conditions in a randomized controlled trial (RCT) in which participants were assigned to one of four parallel conditions: 1) a transgender [TgV] or 2) a cisgender [CgV] woman presenting with videos embedded into the presentation, 3) the same cisgender woman presenting without the videos [CgN], or 4) a no intervention control [NiC]. Our primary outcome was change in the total score of the Transgender Knowledge, Attitudes, and Beliefs Scale (T-KAB).

RESULTS

We recruited and proportionally randomized 467 individuals, 200 of whom completed ratings before and after the intervention: TgV (n = 46), CgV (N = 46), CgN (n = 44), and NiC (n = 64). Mean scores on all measures of TGD acceptance increased in the video group, compared to the no video group. Improvements persisted after 30 days (p < 0.01), except on perceptions about TGD family members. The three active intervention groups did not differ in efficacy.

CONCLUSIONS

These findings provide empirical evidence that a well-informed presenter, regardless of their gender, can achieve similar improvements in perceptions and knowledge about TGD youth when using a resource that can be disseminated free of cost.

Destigmatizing perceptions about Black adolescent depression: randomized controlled trial of brief social contact-based video interventions

OBJECTIVE

To test the utility of brief social contact-based video interventions of a Black adolescent girl to reduce stigmatized attitudes and increase help-seeking intentions around adolescent depression.

METHODS

We conducted a randomized controlled trial (RCT) with 14- to18-year-old healthy volunteers drawn from the general US population. We enrolled participants through a crowdsourcing platform (n = 1,093) and randomly assigned participants to one of three video conditions (117 s each): depressed (DEP); depressed, adjusted to aspects unique to being a Black adolescent girl (including experienced or internalized racism; ADJ); and control (CONT). The primary outcome was the Depression Stigma Scale (DSS); secondary outcomes were the General Health-Seeking Questionnaire (GHSQ), and thermometers for Black and white race perception "warmth".

RESULTS

Following the intervention, the DSS changed from baseline across the three conditions (p < .001). ADJ outperformed both DEP (p = .031) and CONT (p < .001). A race-by-intervention interaction (p < .001) revealed different response profiles between Black (ADJ = DEP = CONT; p = .726) and non-Black participants (ADJ > DEP > CONT; p < .001). DEP and ADJ both resulted in higher treatment-seeking intentions for both the emotional problems and the suicidal thought subscales of the GHSQ. We found a race-by-intervention interaction (p = .01) for the Black thermometer, which revealed a significant 2° increase in warmth among white (p < .001), but not Black, viewers (p = .06).

CONCLUSIONS

On a short-term basis, brief social contact-based videos proved effective among adolescents in reducing depression-related stigma, increasing help-seeking intentions, and providing an "empathic foothold" in the lives of racially stigmatized groups. Even as the enduring effects of these interventions remain to be determined, the deployment on social media of short videos opens new opportunities to reach a large number of at-risk youth."

Strategies and Lessons Learned During Cleaning of Data From Research Panel Participants: Cross-sectional Web-Based Health Behavior Survey Study

Background

The use of web-based methods to collect population-based health behavior data has burgeoned over the past two decades. Researchers have used web-based platforms and research panels to study a myriad of topics. Data cleaning prior to statistical analysis of web-based survey data is an important step for data integrity. However, the data cleaning processes used by research teams are often not reported.

Objective

The objectives of this manuscript are to describe the use of a systematic approach to clean the data collected via a web-based platform from panelists and to share lessons learned with other research teams to promote high-quality data cleaning process improvements.

Methods

Data for this web-based survey study were collected from a research panel that is available for scientific and marketing research. Participants (N=4000) were panelists recruited either directly or through verified partners of the research panel, were aged 18 to 45 years, were living in the United States, had proficiency in the English language, and had access to the internet. Eligible participants completed a health behavior survey via Qualtrics. Informed by recommendations from the literature, our interdisciplinary research team developed and implemented a systematic and sequential plan to inform data cleaning processes. This included the following: (1) reviewing survey completion speed, (2) identifying consecutive responses, (3) identifying cases with contradictory responses, and (4) assessing the quality of open-ended responses. Implementation of these strategies is described in detail, and the Checklist for E-Survey Data Integrity is offered as a tool for other investigators.

Results

Data cleaning procedures resulted in the removal of 1278 out of 4000 (31.95%) response records, which failed one or more data quality checks. First, approximately one-sixth of records (n=648, 16.20%) were removed because respondents completed the survey unrealistically quickly (ie, <10 minutes). Next, 7.30% (n=292) of records were removed because they contained evidence of consecutive responses. A total of 4.68% (n=187) of records were subsequently removed due to instances of conflicting responses. Finally, a total of 3.78% (n=151) of records were removed due to poor-quality open-ended responses. Thus, after these data cleaning steps, the final sample contained 2722 responses, representing 68.05% of the original sample.

Conclusions

Examining data integrity and promoting transparency of data cleaning reporting is imperative for web-based survey research. Ensuring a high quality of data both prior to and following data collection is important. Our systematic approach helped eliminate records flagged as being of questionable quality. Data cleaning and management procedures should be reported more frequently, and systematic approaches should be adopted as standards of good practice in this type of research.

The effects of a video-based randomized controlled trial intervention on depression stigma and help-seeking attitudes in university students

University students are a risk group for developing mental illness, but they do not receive the care they need because of hampered help-seeking induced by stigma. This study evaluates the effects of a video-based stigma reduction intervention and help-seeking attitudes promotion in university students. We randomly distributed a sample of university students among one control group (CG, n = 188) and two intervention groups (IG-1, n = 222 and IG-2, n = 216): IG-1 watched a contact-based video and IG-2 the same video plus a psychoeducational video. The study followed an experimental single-blind randomized control trial design with a pre-test before the intervention (M0), a post-test, and a follow-up test. We evaluated participants using a sociodemographic questionnaire, the Attitudes Toward Seeking Professional Psychological Help Questionnaire, the Depression Stigma Scale, the 9-item Patient Health Questionnaire, and the 7-item Generalized Anxiety Disorder. A total of 626 participants with a mean age of 19.85 (SD=1.48) responded to all evaluation moments. At M0, there were no differences between groups on stigma or help-seeking attitudes. Immediately after the intervention, stigma levels significantly decreased, and help-seeking attitudes significantly improved. These effects persisted for the next five months. Video-based depression stigma reduction intervention can be an essential tool to reduce depression stigma and improve help-seeking attitudes.

Ill-Informed, Uplifted, and Unaware: A Psychiatrist Lives With a Condition Under His Purview

As part of a series of autobiographical case reports about physicians reporting on their own medical afflictions, a psychiatrist reflects on his lifelong experience with an illness under his discipline’s purview.

LovesCompany: evaluating the safety and feasibility of a mental health-focused online community for adolescents

Background: Adolescents are at risk for mental health (MH) disorders but are unlikely to seek services and may be reluctant to talk about their MH. An anonymous, online MH-focused community could help reduce suffering. However, online forums can also promote negative behaviours such as cyberbullying. This study aimed to evaluate the safety and feasibility of an online community - LovesCompany - to improve MH outcomes for adolescents.Methods: American adolescents (14-17 years) were recruited through social media. Eligible participants were randomised to LovesCompany or a placebo MH resource site. Outcomes were assessed every other week for six months, and at twelve months. Multilevel models assessed group differences in depression, anxiety, and suicidal ideation. A subgroup of participants participated in qualitative interviews.Results: Participants (N = 202) were mostly female (70%), White non-Hispanic (69%), and cisgender (80%). There were no instances of inappropriate behaviour such as bullying or posting explicit content. Symptoms for both groups improved over time. Participants appreciated hearing others' experiences and valued the opportunity to offer support.Conclusion: Although adolescents are often resistant to MH treatment, they appear to be interested in anonymous, online, MH-focused conversation, and can benefit from giving and seeking support. Finding a balance between an appealing user experience, ethical considerations, and resource needs is challenging.

Making It Real: From Telling to Showing, Sharing, and Doing in Psychiatric Education

OBJECTIVE

Innovations in contemporary medical education could inform remedies to address enduring challenges such as the marginalization and stigmatization of psychiatry, of mental illnesses, and of those affected by them.

METHODS

In blending the works of Bleakley, Bligh, and Brown (2011) and of Kumagai and Naidu (2015), we developed an overarching heuristic with practical relevance and concrete applications to psychiatric education.

RESULTS

We identify three areas to enhance psychiatric education embedded into this blended framework: 1) Showing, or the more accurate depiction or imaging of mental illnesses and of psychiatric practice, as exemplified by the incorporation into didactic content of asynchronous video-based clinical materials produced with specific educational objectives in mind; 2) Sharing, or addressing the image problem of mental illnesses, of those living with or affected by them, and of psychiatry as a profession, as exemplified by psychiatrists embracing their role as experts by professional and personal experience when sharing their own journeys with mental illness, treatment, and recovery; and 3) Doing, or reimagining reflective psychiatric practice, as exemplified by the novel methodology of co-constructive patient simulation (CCPS), through which learners can engage in reflective practice and supervision in a participatory and democratic setting that does not privilege participants' hierarchical standing.

CONCLUSION

The blended model and the sample applications we describe offer a range of teaching, learning, and professional development opportunities, should psychiatric educators choose to pursue them and reap their promise.

Designing Videos With and for Adults With ADHD for an Online Intervention: Participatory Design Study and Thematic Analysis of Evaluation

BACKGROUND

Adults with attention deficit hyperactivity disorder (ADHD) represent a heterogeneous group with both strengths and difficulties associated with the diagnosis. An online intervention attuned to their needs may improve their everyday functioning. When designing online interventions, it is important to adapt the therapeutic content to the values and needs of the target group.

OBJECTIVE

This paper describes and evaluates a participatory process used to produce content for an online intervention for adults with ADHD by producing video vignettes clarifying core training principles grounded in the participants' everyday experiences.

METHODS

We report on the qualitative data from 2 research phases: the design and evaluation of video vignettes for an online intervention. In the first phase, 12 adults with ADHD, 2 clinicians, and 2 research assistants participated in the production of video vignettes for the online intervention. In the second phase, participants (n=109) gave feedback on the videos as part of a clinical trial of the intervention. A subgroup (n=7) was interviewed in-depth regarding their experiences with the videos. The qualitative data were analyzed using thematic analysis.

RESULTS

In the first phase, the participants with ADHD contributed with experiences from challenging everyday situations. In the process, we navigated between therapeutic principles and the participants' experiential perspectives to create content relevant and consistent with the target group's values and experiences. In the second phase, we identified 3 themes related to the participants' experiences and interpretation of the video vignettes: (1) recognition of ADHD-related challenges, (2) connection with the characters and the situations, and (3) video protagonists as companions and role models for change.

CONCLUSIONS

A participatory design process for designing online mental health interventions can be used to probe and balance between the therapeutic principles defined by clinicians and the participants' experiences with mental health issues in the production of therapeutic content. In our study, the inclusion of video vignettes in an online intervention enabled a contextualized and relevant presentation of everyday experiences and psychosocial factors in the life of an adult with ADHD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04511169; https://clinicaltrials.gov/ct2/show/NCT04511169.

Effectiveness of a Video-Based Intervention on Reducing Perceptions of Fear, Loneliness, and Public Stigma Related to COVID-19: A Randomized Controlled Trial

Objectives: During the first peak of the COVID-19 outbreak in the United States, we investigated the impact of digital interventions to reduce COVID-19 related fear, loneliness, and public stigma. Methods: We recruited and randomly assigned 988 United States residents to: 1) no intervention 2) informational sheet to learn about COVID-19, 3) (2) AND video encouraging digital social activity, 4) (2) AND video sensitizing to COVID-19 related stigma (registered in Clinicaltrials.gov). Surveys were conducted between April 2-16, 2020. We employed generalized linear mixed models to investigate intervention effects. Results: 10% of the participants reported not being afraid of people COVID-19+ and 32% reported not feeling lonely. Stigma and fear items reflected acute worries about the outbreak. Relative to the informational sheet only group, video groups led to greater reduction in perceptions of fear towards COVID-19+ (ORvideo.solo = 0.78, p-val<0.001; ORvideo.friend = 0.79, p-val<0.001) and of stigma (BETAvideo.solo = -0.50, p-val<0.001; BETAvideo.friend = -0.69, p-val<0.001). Conclusion: Video-based interventions lead to reductions in COVID-19-related fear and stigma. No difference in social activity among groups was found, potentially explaining lack of efficacy on loneliness.