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Amsalem D, Fisch CT, Wall M, Liu J, Lazarov A, Markowitz JC, LeBeau M, Hinds M, Thompson K, Smith TE, Lewis-Fernández R, Dixon LB, Neria Y. The role of income and emotional engagement in the efficacy of a brief help-seeking video intervention for essential workers. J Psychiatr Res 2024; 173:232-238. [PMID: 38554618 DOI: 10.1016/j.jpsychires.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/23/2023] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Recently we showed that a brief video-based intervention can improve openness to help-seeking and decrease treatment-related stigma among essential workers, particularly for female and Black individuals viewing demographically matched protagonists. The current randomized controlled trial explored two additional factors which may enhance the efficacy of this intervention: income level, known to be associated with help-seeking, and emotional engagement, which may enhance a person's ability to engage with the intervention. We hypothesized that income level and emotional engagement would correlate with changes in openness to help-seeking ("openness") and stigma. METHODS Essential workers (N = 1405) randomly viewed a control video or a brief video of an actor portraying an essential worker describing COVID-19-related anxiety and depression and treatment benefits. Openness and stigma were assessed at baseline, post-intervention, and 30-day follow-up, with emotional engagement assessed post-intervention. RESULTS The brief video intervention demonstrated immediate increases in openness (p < 0.001, Cohen's d = 0.39) and decreases in stigma (p < 0.001, d = 0.14) compared to the control. Reported income level affected neither dependent variable. Participants who scored higher on the emotional engagement scale reported greater change in openness and stigma. LIMITATIONS Use of a crowdsourcing platform may limit generalizability. CONCLUSIONS The 3-min video showed modest effect sizes for immediate increased openness and reduced stigma, with greater emotional engagement heightening the effect, suggesting a possible mediator to the intervention. Income level did not affect intervention outcomes. Research should explore the role of income by adding income-related content to the brief-video interventions and assessing whether links to referrals could foster immediate behavioral change. TRIAL REGISTRATION NCT04964570.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA.
| | - Chana T Fisch
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA
| | - Melanie Wall
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Jun Liu
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Israel
| | - John C Markowitz
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Mariah LeBeau
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA
| | - Melissa Hinds
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA
| | - Kip Thompson
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Thomas E Smith
- Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA; New York State Office of Mental Health, USA
| | - Roberto Lewis-Fernández
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Yuval Neria
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
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Amsalem D, Wall M, Lazarov A, Markowitz JC, Fisch CT, LeBeau M, Hinds M, Liu J, Fisher PW, Smith TE, Hankerson S, Lewis-Fernández R, Dixon LB, Neria Y. Brief Video Intervention to Increase Treatment-Seeking Intention Among U.S. Health Care Workers: A Randomized Controlled Trial. Psychiatr Serv 2023; 74:119-126. [PMID: 36097721 DOI: 10.1176/appi.ps.20220083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Many health care workers avoid seeking mental health care, despite COVID-19-related increases in risk of psychopathology. This study assessed the effects of two versions (distinguished by the race of the protagonist) of a brief social contact-based video on treatment-seeking intention and stigma toward mental health services among U.S. health care workers. METHODS Participants (N=1,402) were randomly assigned to view a 3-minute video in which a Black or White female nurse described struggles with COVID-19-related anxiety and depression, barriers to care, and how therapy helped, or to view a control video unrelated to mental health. Half of the participants receiving the intervention watched the same video (i.e., booster) again 14 days later. Treatment-seeking intention and treatment-related stigma were assessed at baseline, postintervention, and 14- and 30-day follow-ups. RESULTS Both intervention videos elicited an immediate increase in treatment-seeking intention in the intervention groups (p<0.001, effect size [ES]=21%), with similar effects among those who watched the booster video (p=0.016, ES=13%) and larger effects among those who had never sought treatment (p<0.001, ES=34%). The increased effects were not sustained 14 days after the initial video or at 30-day follow-up. The results showed an immediate reduction in stigma, but with no booster effect. The race of the protagonist did not influence outcomes. CONCLUSIONS This easily administered intervention could increase the likelihood of care seeking by proactively encouraging health care workers with mental health challenges to pursue treatment. Future studies should examine whether the inclusion of linkable referrals to mental health services helps to increase treatment-seeking behavior.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Melanie Wall
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Amit Lazarov
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - John C Markowitz
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Chana T Fisch
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Mariah LeBeau
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Melissa Hinds
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Jun Liu
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Prudence W Fisher
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Thomas E Smith
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Sidney Hankerson
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Roberto Lewis-Fernández
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Yuval Neria
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
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Amsalem D, Wall M, Lazarov A, Markowitz JC, Fisch CT, LeBeau M, Hinds M, Liu J, Fisher PW, Smith TE, Hankerson S, Lewis-Fernández R, Neria Y, Dixon LB. Destigmatising mental health treatment and increasing openness to seeking treatment: randomised controlled trial of brief video interventions. BJPsych Open 2022; 8:e169. [PMID: 36111611 PMCID: PMC9534926 DOI: 10.1192/bjo.2022.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite an elevated risk of psychopathology stemming from COVID-19-related stress, many essential workers stigmatise and avoid psychiatric care. This randomised controlled trial was designed to compare five versions of a social-contact-based brief video intervention for essential workers, differing by protagonist gender and race/ethnicity. AIMS We examined intervention efficacy on treatment-related stigma ('stigma') and openness to seeking treatment ('openness'), especially among workers who had not received prior mental healthcare. We assessed effectiveness and whether viewer/protagonist demographic concordance heightened effectiveness. METHOD Essential workers (N = 2734) randomly viewed a control video or brief video of an actor portraying an essential worker describing hardships, COVID-related anxiety and depression, and psychotherapy benefits. Five video versions (Black/Latinx/White and male/female) followed an identical 3 min script. Half the intervention group participants rewatched their video 14 days later. Stigma and openness were assessed at baseline, post-intervention, and at 14- and 30-day follow-ups. Trial registration: NCT04964570. RESULTS All video intervention groups reported immediately decreased stigma (P < 0.0001; Cohen's d = 0.10) and increased openness (P < 0.0001; d = 0.23). The initial increase in openness was largely maintained in the repeated-video group at day 14 (P < 0.0001; d = 0.18), particularly among viewers without history of psychiatric treatment (P < 0.0001; d = 0.32). Increases were not sustained at follow-up. Female participants viewing a female protagonist and Black participants viewing a Black protagonist demonstrated greater openness than other demographic pairings. CONCLUSIONS Brief video-based interventions improved immediate stigma and openness. Greater effects among female and Black individuals viewing demographically matched protagonists emphasise the value of tailored interventions, especially for socially oppressed groups. This easily disseminated intervention may proactively increase care-seeking, encouraging treatment among workers in need. Future studies should examine intervention mechanisms and whether linking referrals to psychiatric services generates treatment-seeking.
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Affiliation(s)
- Doron Amsalem
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Melanie Wall
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Israel
| | - John C Markowitz
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Chana T Fisch
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Mariah LeBeau
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Melissa Hinds
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Jun Liu
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Prudence W Fisher
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Thomas E Smith
- Columbia University Vagelos College of Physicians & Surgeons, New York, and New York State Office of Mental Health, NY, USA
| | - Sidney Hankerson
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Roberto Lewis-Fernández
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Yuval Neria
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, and Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa B Dixon
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
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