Reducing Depression-related Stigma and Increasing-treatment Seeking Among Black Adolescents

The purposes of this study are to:

1. test among adolescent the utility of brief video-based interventions to reduce stigma-related attitudes and increase help-seeking intentions toward depression;
2. examine the role of race (Black vs other) as an independent factor in the primary outcome.

Study Overview

• Status: Completed
• Conditions: Depression; Racism
• Intervention / Treatment: Behavioral: Short videos

Detailed Description

Intervention videos will each be of ~120-second duration and feature an underage female professional (age 16) acting as a simulated patient. All three videos will focus on her as an empowered presenter with depression sharing her personal story regarding depression and describe how social supports from family, friends, and community, as well as professional help assisted her in overcoming symptoms of the illness.

Assessments will occur at baseline and post-intervention, and will include:

1. Demographics (baseline only);
2. Primary outcome: Depression-related stigma(Depression Stigma Scale [DSS]) summary score.
3. Secondary outcomes: a. DSS individual items; b. Help-seeking (General Help-Seeking Questionnaire [GHSQ]) summary score and individual items; and bc Racial attitudes: feelings thermometers.

The investigators intend to randomly assign ~1,000 individuals aged 14-18 as follows:

Subjects oversampled for Black participants (50% Black; 50% other);

Randomized, in equal proportions, and stratified by race, to view one of three ~120-second videos of a girl with:

1. No depression control (Black; BC);
2. Depression (Black, following same script as in our earlier study (Amsalem and Martin, 2021), DB); and
3. Depression adjusted (Black, with script adjusted based on input from focus group of Black girls and women; DBa).

• Study Type: Interventional
• Enrollment (Actual): 1291
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Connecticut
    • New Haven, Connecticut, United States, 06510
      • Yale Child Study Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 18 years (Child, Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• English-speaking
• Living in the US
• Ages 14 - 18

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Black girl, control (BC); ~120-second video of a Black adolescent girl, without depression	Behavioral: Short videos; Intervention videos will each be of 90-second duration and feature two underage professionals (ages 16) acting as a simulated patient. All videos will focus on an empowered presenter with depression sharing her personal story regarding depression and describe how social supports from family, friends, and community, as well as professional help assisted her in overcoming symptoms of the illness. The actors will include a Black girl and a white girl.
Active Comparator: Black girl, depressed (BD); ~120-second video of a Black adolescent girl, depressed	Behavioral: Short videos; Intervention videos will each be of 90-second duration and feature two underage professionals (ages 16) acting as a simulated patient. All videos will focus on an empowered presenter with depression sharing her personal story regarding depression and describe how social supports from family, friends, and community, as well as professional help assisted her in overcoming symptoms of the illness. The actors will include a Black girl and a white girl.
Active Comparator: Black girl, depressed, adjusted (BDa); ~120-second video of a Black adolescent girl, depressed - adjusted for the specifics of being a Black girl (as informed by a focus group of Black girls and women)	Behavioral: Short videos; Intervention videos will each be of 90-second duration and feature two underage professionals (ages 16) acting as a simulated patient. All videos will focus on an empowered presenter with depression sharing her personal story regarding depression and describe how social supports from family, friends, and community, as well as professional help assisted her in overcoming symptoms of the illness. The actors will include a Black girl and a white girl.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Depression-related stigma (Depression Stigma Scale [DSS]; Personal component only): TOTAL SCORE	The DSS (Christensen, Jorm, Evans, & Groves, 2004) is a self-report instrument composed of two 9-item subscales. The first subscale measures the participants' own/ personal attitudes, and the second measures participants' beliefs about the attitudes of others ('Depression is sign of weakness' vs. 'Most people believe that depression is a sign of weakness'). We will use the Personal subscale (DSS-Personal) in this study. The DSS has a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). The total score comprises the sum of its item scores, and a higher score indicates more stigma (worse outcome). The DSS-Personal subscale has shown adequate psychometric properties: 0.71 test-retest reliability, 0.76 internal consistency (Griffiths et al., 2004). In our earlier study (Amsalem and Martin, 2021), Cronbach's a was .83.	Before / after viewing videos (within 10 minutes)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in GHSQ Suicide Item 4	Other relative/family member Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in Help-seeking (General Help-Seeking Questionnaire [GHSQ]; Emotional and Suicide components): MEAN SCORE	The General Help-Seeking Questionnaire (GHSQ) (Wilson, Deane, Marshall, & Dalley, 2008) was developed to measure help-seeking intentions from different sources (friend, parent, mental health professional, and others) and is divided into personal-emotional problems and suicidal thoughts (Ibrahim et al., 2019). The instrument consists of 10 items for each part, measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). One question is stated as 'I would not seek help from anyone' and is reverse-scored. Higher scores on this scale indicate more help seeking (better outcome). The GHSQ has shown good psychometric properties: Cronbach's alpha = .70 and test-retest of .86 for personal-emotional problems, and Cronbach's alpha = .83 and test-retest of .88 for suicidal thoughts.	Before / after viewing videos (within 10 minutes)
Change in Racial attitudes: feelings thermometer	We will use a feelings thermometer, modeled after Norton and Herek, 2013: "Using a scale from zero to 100, please tell us your personal feelings toward each of the following groups of friends, teachers, or colleagues. As you do this task, think of an imaginary thermometer. The warmer or more favorable you feel toward the group, the higher the number you should give it. The colder or less favorable you feel, the lower the number. If you feel neither warm nor cold toward the group, rate it 50." To familiarize respondents with the response format, they will be first presented with thermometers for "Men in general" and "Women in general," with each respondent rating her or his own sex first. Next, they rate racially different groups (white women, white men, Black women, Black men) with the order of presentation randomized. Higher ratings (maximum 100) indicate warmer, more favorable feelings toward the target whereas lower ratings (minimum 0) indicate colder, more negative feelings.	Before / after viewing videos (within 10 minutes)
Change in DSS Item 1	People with depression could snap out of it if they wanted Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).	Before / after viewing videos (within 10 minutes)
Change in DSS Item 2	Depression is a sign of personal weakness Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).	Before / after viewing videos (within 10 minutes)
Change in DSS Item 3	Depression is not a real medical illness Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).	Before / after viewing videos (within 10 minutes)
Change in DSS Item 4	People with depression are dangerous Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).	Before / after viewing videos (within 10 minutes)
Change in DSS Item 5	It is best to avoid people with depression, so you don't become depressed yourself Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).	Before / after viewing videos (within 10 minutes)
Change in DSS Item 6	People with depression are unpredictable Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).	Before / after viewing videos (within 10 minutes)
Change in DSS Item 7	If I had depression, I would not tell anyone Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).	Before / after viewing videos (within 10 minutes)
Change in DSS Item 8	I would not employ someone if I knew they had been depressed Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).	Before / after viewing videos (within 10 minutes)
Change in DSS Item 9	I would not vote for a politician if I knew they had been depressed Scored on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). A higher score indicates more stigma (worse outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Emotional Item 1	Intimate partner (e.g., girlfriend, boyfriend) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Emotional Item 2	Friend (not related to you) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Emotional Item 3	Parent Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Emotional Item 4	Other relative/family member Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Emotional Item 5	Mental health professional (e.g., psychologist, social worker, counselor) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Emotional Item 6	Phone helpline (e.g., lifeline) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Emotional Item 7	Doctor/GP Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Emotional Item 8	Minister or religious leader (e.g., Priest, Rabbi, Chaplain) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Emotional Item 9	I would not seek help from anyone **REVERSE SCORED ITEM** Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). LOWER scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Emotional Item 10	I would seek help from another not listed above Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Suicide Item 1	Intimate partner (e.g., girlfriend, boyfriend) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Suicide Item 2	Friend (not related to you) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Suicide Item 3	Parent Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Suicide Item 5	Mental health professional (e.g., psychologist, social worker, counselor) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Suicide Item 6	Phone helpline (e.g., lifeline) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Suicide Item 7	Doctor/GP Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Suicide Item 8	Minister or religious leader (e.g., Priest, Rabbi, Chaplain) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Suicide Item 9	I would not seek help from anyone **REVERSE SCORED ITEM** Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). LOWER scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)
Change in GHSQ Suicide Item 10	I would seek help from another not listed above Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome).	Before / after viewing videos (within 10 minutes)

Collaborators and Investigators

• Sponsor: Yale University

Publications and helpful links

General Publications

• Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. Br J Psychiatry. 2004 Oct;185:342-9. doi: 10.1192/bjp.185.4.342.
• Wilson CJ, Deane FP, Marshall KL, Dalley A. Adolescents' suicidal thinking and reluctance to consult general medical practitioners. J Youth Adolesc. 2010 Apr;39(4):343-56. doi: 10.1007/s10964-009-9436-6. Epub 2009 Jul 15.
• Norton AT, Herek GM. Heterosexuals' attitudes toward transgender people: findings from a national probability sample of US Adults. Sex Roles. 2013;68(11-12):738-753. doi:10.1007/s11199-011-0110-6
• Martin A, Calhoun A, Paez J, Amsalem D. Destigmatizing perceptions about Black adolescent depression: randomized controlled trial of brief social contact-based video interventions. J Child Psychol Psychiatry. 2022 Nov;63(11):1270-1278. doi: 10.1111/jcpp.13570. Epub 2022 Jan 23.

Study record dates

Study Major Dates

• Study Start (Actual): July 15, 2021
• Primary Completion (Actual): August 7, 2021
• Study Completion (Actual): August 7, 2021

Study Registration Dates

• First Submitted: May 12, 2021
• First Submitted That Met QC Criteria: May 12, 2021
• First Posted (Actual): May 18, 2021

Study Record Updates

• Last Update Posted (Actual): August 25, 2021
• Last Update Submitted That Met QC Criteria: August 19, 2021
• Last Verified: August 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Mood Disorders; Depression; Depressive Disorder
• Other Study ID Numbers: 2000028980

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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