Measuring Beliefs and Norms About Persons With Mental Illness

Measuring Beliefs and Norms About Persons With Mental Illness in Rural Uganda: A Randomized Survey Experiment

Survey experiment to estimate drivers of mental illness stigma

Study Overview

• Status: Completed
• Conditions: Depression; Schizophrenia; Bipolar Disorder; Mental Illness
• Intervention / Treatment: Other: Survey questionnaire

Detailed Description

Despite significant advances in scientific understanding of brain and substance use disorders accompanied by significant advances in treatment and improvements in prognosis, mental illness remains highly stigmatized throughout the world. Previous studies suggest that portraying mental illness as treatable can reduce negative attitudes toward persons with mental illness. This randomized controlled trial compares the effects of exposing study participants to vignettes portraying persons with untreated and symptomatic mental illness vs. treated mental illness with complete response vs. treated mental illness with relapse. It is hypothesized, based on prior work, that study participants exposed to vignettes depicting treated mental illness with completed response would have the greatest effect on reducing negative attitudes toward persons with mental illness, followed by treated mental illness with relapse and untreated and symptomatic mental illness.

• Study Type: Interventional
• Enrollment (Actual): 1782
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Uganda
  • Mbarara, Uganda
    • Mbarara University of Science and Technology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• all persons who considered Nyakabare Parish their primary place of residence and who were capable of providing consent

Exclusion Criteria:

• minors younger than 18 years of age, with the exception of emancipated minors
• persons who did not consider Nyakabare their primary place of residence, e.g., persons who happened to be visiting Nyakabare at the time of the survey or who owned a home in Nyakabare but spent most of their time outside the parish
• persons with whom research staff could not communicate, e.g., due to deafness, mutism, or aphasia
• persons with psychosis, neurological damage, acute intoxication, or other cognitive impairment (all of which were determined informally in the field by non-clinical research staff in consultation with a supervisor)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

10

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: V1: Control; This version of the survey questionnaire depicts a young woman with no symptoms of mental illness.
Experimental: V2: Schizophrenia; As this is a survey experiment, the "intervention" involves random assignment to a survey questionnaire with specific wording. This version of the survey questionnaire depicts a young woman with untreated and symptomatic schizophrenia.	Other: Survey questionnaire; Each version of the questionnaire portrays a young Ugandan woman with different profiles of illness severity, treatment, and treatment response.
Experimental: V3: Schizophrenia + Tx with Response; As this is a survey experiment, the "intervention" involves random assignment to a survey questionnaire with specific wording. This version of the survey questionnaire depicts a young woman with schizophrenia, successfully treated with complete response.	Other: Survey questionnaire; Each version of the questionnaire portrays a young Ugandan woman with different profiles of illness severity, treatment, and treatment response.
Experimental: V4: Schizophrenia + Tx with Relapse; As this is a survey experiment, the "intervention" involves random assignment to a survey questionnaire with specific wording. This version of the survey questionnaire depicts a young woman with schizophrenia, successfully treated with partial relapse.	Other: Survey questionnaire; Each version of the questionnaire portrays a young Ugandan woman with different profiles of illness severity, treatment, and treatment response.
Experimental: Version 5: Bipolar; As this is a survey experiment, the "intervention" involves random assignment to a survey questionnaire with specific wording. This version of the survey questionnaire depicts a young woman with untreated and symptomatic bipolar disorder.	Other: Survey questionnaire; Each version of the questionnaire portrays a young Ugandan woman with different profiles of illness severity, treatment, and treatment response.
Experimental: V6: Bipolar + Tx with Response; As this is a survey experiment, the "intervention" involves random assignment to a survey questionnaire with specific wording. This version of the survey questionnaire depicts a young woman with bipolar disorder, successfully treated with complete response.	Other: Survey questionnaire; Each version of the questionnaire portrays a young Ugandan woman with different profiles of illness severity, treatment, and treatment response.
Experimental: V7: Bipolar + Tx with Relapse; As this is a survey experiment, the "intervention" involves random assignment to a survey questionnaire with specific wording. This version of the survey questionnaire depicts a young woman with bipolar disorder, successfully treated with partial relapse.	Other: Survey questionnaire; Each version of the questionnaire portrays a young Ugandan woman with different profiles of illness severity, treatment, and treatment response.
Experimental: V8: Depression; As this is a survey experiment, the "intervention" involves random assignment to a survey questionnaire with specific wording. This version of the survey questionnaire depicts a young woman with untreated and symptomatic major depressive disorder.	Other: Survey questionnaire; Each version of the questionnaire portrays a young Ugandan woman with different profiles of illness severity, treatment, and treatment response.
Experimental: V9: Depression + Tx with Response; As this is a survey experiment, the "intervention" involves random assignment to a survey questionnaire with specific wording. This version of the survey questionnaire depicts a young woman with major depressive disorder, successfully treated with complete response.	Other: Survey questionnaire; Each version of the questionnaire portrays a young Ugandan woman with different profiles of illness severity, treatment, and treatment response.
Experimental: V10: Depression + Tx with Relapse; As this is a survey experiment, the "intervention" involves random assignment to a survey questionnaire with specific wording. This version of the survey questionnaire depicts a young woman with major depressive disorder, successfully treated with partial relapse.	Other: Survey questionnaire; Each version of the questionnaire portrays a young Ugandan woman with different profiles of illness severity, treatment, and treatment response.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Social Distance	Willingness to have the woman portrayed in the vignette to marry into the study participant's family (single item culturally adapted instrument developed specifically for this study)	Immediate (assessed with respect to the study participant's beliefs at a single time point, which is the time at which the survey is administered)
Perceived Norms about Social Distance	Study participant's perception of the extent to which other people would be willing to have the woman portrayed in the vignette to marry into their families (single item culturally adapted instrument developed specifically for this study)	Immediate (assessed with respect to the study participant's beliefs at a single time point, which is the time at which the survey is administered)
Negative Attitudes (Attribution)	Personal belief that the symptoms of the woman portrayed in the vignette represent divine punishment (single item culturally adapted instrument developed specifically for this study)	Immediate (assessed with respect to the study participant's beliefs at a single time point, which is the time at which the survey is administered)
Perceived Norms about Negative Attitudes (Attribution)	Study participant's perception of the extent to which other people believe that the symptoms of the woman portrayed in the vignette represent divine punishment (single item culturally adapted instrument developed specifically for this study)	Immediate (assessed with respect to the study participant's beliefs at a single time point, which is the time at which the survey is administered)
Negative Attitudes (Shame)	Personal belief that the symptoms of the woman portrayed in the vignette bring shame upon her family	Immediate (assessed with respect to the study participant's beliefs at a single time point, which is the time at which the survey is administered)
Perceived Norms about Negative Attitudes (Shame)	Study participant's perception of the extent to which other people believe that the symptoms of the woman portrayed in the vignette bring shame upon her family (single item culturally adapted instrument developed specifically for this study)	Immediate (assessed with respect to the study participant's beliefs at a single time point, which is the time at which the survey is administered)

Collaborators and Investigators

• Sponsor: Massachusetts General Hospital

Publications and helpful links

General Publications

• Rasmussen JD, Kakuhikire B, Baguma C, Ashaba S, Cooper-Vince CE, Perkins JM, Bangsberg DR, Tsai AC. Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda. PLoS Med. 2019 Sep 20;16(9):e1002908. doi: 10.1371/journal.pmed.1002908. eCollection 2019 Sep.

Study record dates

Study Major Dates

• Study Start (Actual): December 13, 2016
• Primary Completion (Actual): June 8, 2018
• Study Completion (Actual): June 8, 2018

Study Registration Dates

• First Submitted: August 29, 2018
• First Submitted That Met QC Criteria: August 30, 2018
• First Posted (Actual): September 4, 2018

Study Record Updates

• Last Update Posted (Actual): August 12, 2019
• Last Update Submitted That Met QC Criteria: August 8, 2019
• Last Verified: August 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Schizophrenia Spectrum and Other Psychotic Disorders; Bipolar and Related Disorders; Schizophrenia; Mental Disorders; Bipolar Disorder
• Other Study ID Numbers: 2013P000395

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No