Reducing Depression Self-stigma and Increasing Treatment Seeking Intentions Among Youth

Reducing Self-stigma and Increasing Treatment Seeking Intentions Among Youth With Depressive Symptoms: A Mixed-methods Study

Young people with depression, especially those of underserved minority groups, avoid treatment due to stigma and discrimination. Social contact is a form of interpersonal contact with members of the stigmatized group and the most effective type of intervention for improvement in stigma-related knowledge and attitudes.

In a prior study, the investigators developed short video interventions to reduce stigma and increase treatment seeking among people with depression. The videos vary by protagonist race/ethnicity (Latinx, non-Latinx Black, non-Latinx White) who share their experiences with depression, challenges, and recovery process. The investigators would like to test the efficacy of these videos using Prolific (a crowdsourcing platform). Specifically, the investigators are interested in conducting a randomized controlled trial (RCT) to test the efficacy of these videos as compared to a vignette control condition on reducing self-stigma and increasing help-seeking intentions and behavior at baseline, post, and 30 day follow-up among youth with depressive symptom scores on the PHQ-9≥ 5.

Study Overview

• Status: Not yet recruiting
• Conditions: Depression; Mental Health Disorder; Stigma, Social
• Intervention / Treatment: Behavioral: Brief video intervention (Black Woman); Behavioral: Brief video intervention (Latinx Woman); Behavioral: Brief video intervention (White Woman); Behavioral: Vignette Control

Detailed Description

In a randomized control trial (RCT) with pre-, post-intervention, and 30-day follow-up assessments, we aim to 1) test the efficacy of brief social video interventions, varying protagonist race/ethnicity, as compared to vignette control in reducing self-stigma and increasing treatment-seeking intentions and behavior among 1600 Prolific users ages 18-25 with depressive symptoms (PHQ-9≥ 5), and 2) explore whether matching to protagonist race/ethnicity increases intervention efficacy. We hypothesize that 1) Brief social contact-based video interventions will reduce self-stigma towards depression and increase treatment-seeking intentions and behavior compared to vignette control, and 2) The participants whose race/ethnicity match the protagonist will have greater changes in self-stigma and treatment-seeking than participants with unmatched protagonists, i.e., matching moderates the intervention's effects.

• Study Type: Interventional
• Enrollment (Estimated): 1600
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Doron Amsalem, MD; Phone Number: (646) 774-8049; Email: Doron.Amsalem@nyspi.columbia.edu

Study Locations

• United States
  • New York
    • New York, New York, United States, 10032
      • New York State Psychiatric Institute
      • Contact: Doron Amsalem, MD; Email: Doron.Amsalem@nyspi.columbia.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Endorsing mild to severe depressive symptoms (Patient Health Questionnaire (PHQ-9) score of 5 or greater)
• Ages 18-25
• US Residents
• English speaking

Exclusion Criteria:

• Not endorsing mild to severe depressive symptoms
• Age less than 18 or greater than 25

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Brief video intervention (Black Woman); A brief social contact-based video with a Black woman protagonist	Behavioral: Brief video intervention (Black Woman); A brief social contact-based video. The video presented a young Black woman in her early twenties, a professional actor, sharing her scripted personal story of struggles as a Black woman with depression and raising themes of recovery and hope.
Experimental: Brief video intervention (Latinx Woman); A brief social contact-based video with a Latinx woman protagonist	Behavioral: Brief video intervention (Latinx Woman); A brief social contact-based video. The video presented a young Latinx woman in her early twenties, a professional actor, sharing her scripted personal story of struggles as a Latinx woman with depression and raising themes of recovery and hope.
Experimental: Brief video intervention (White Woman); A brief social contact-based video with a White woman protagonist	Behavioral: Brief video intervention (White Woman); A brief social contact-based video. The video presented a young White woman in her early twenties, a professional actor, sharing her scripted personal story of struggles as a White woman with depression and raising themes of recovery and hope.
Other: Vignette Control; A brief vignette control condition	Behavioral: Vignette Control; A brief vignette control condition with a script about a young woman who describes her struggles with depression and raises themes of recovery and hope.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Depression Stigma	The Depression Stigma Scale (DSS) is a self-report scale comprised of two 9-item subscales measuring participants' personal beliefs about depression and participants' beliefs about others' attitudes (Griffiths et al., 2004). The current study will only utilize the personal beliefs subscale. Each item is rated on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). Scores range from 9 to 45. Higher scores indicate more stigma.	Baseline
Depression Stigma	The Depression Stigma Scale (DSS) is a self-report scale comprised of two 9-item subscales measuring participants' personal beliefs about depression and participants' beliefs about others' attitudes (Griffiths et al., 2004). The current study will only utilize the personal beliefs subscale. Each item is rated on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). Scores range from 9 to 45. Higher scores indicate more stigma.	Post (immediately after the video or vignette control is shown)
Depression Stigma	The Depression Stigma Scale (DSS) is a self-report scale comprised of two 9-item subscales measuring participants' personal beliefs about depression and participants' beliefs about others' attitudes (Griffiths et al., 2004). The current study will only utilize the personal beliefs subscale. Each item is rated on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). Scores range from 9 to 45. Higher scores indicate more stigma.	30 day follow-up
Attitude Towards Seeking Professional Psychological Help	Treatment seeking intentions will be measured using three items from the Attitudes Towards Seeking Professional Psychological Help Scale (ATSPPHS) Scale (Elhai et al., 2008). Items include: 'I might want to have psychological counselling in the future', 'I would want to get psychological help if I were worried or upset for a long period of time' and 'A person with an emotional problem is not likely to solve it alone; he or she is more likely to solve it with professional help'. Responses range from 1 (disagree) to 4 (agree). Total scores range from 3 to 12 with higher scores indicating higher treatment seeking intentions.	Baseline
Attitude Towards Seeking Professional Psychological Help	Treatment seeking intentions will be measured using three items from the Attitudes Towards Seeking Professional Psychological Help Scale (ATSPPHS) Scale (Elhai et al., 2008). Items include: 'I might want to have psychological counselling in the future', 'I would want to get psychological help if I were worried or upset for a long period of time' and 'A person with an emotional problem is not likely to solve it alone; he or she is more likely to solve it with professional help'. Responses range from 1 (disagree) to 4 (agree). Total scores range from 3 to 12 with higher scores indicating higher treatment seeking intentions.	Post (immediately after the video or vignette control is shown)
Attitude Towards Seeking Professional Psychological Help	Treatment seeking intentions will be measured using three items from the Attitudes Towards Seeking Professional Psychological Help Scale (ATSPPHS) Scale (Elhai et al., 2008). Items include: 'I might want to have psychological counselling in the future', 'I would want to get psychological help if I were worried or upset for a long period of time' and 'A person with an emotional problem is not likely to solve it alone; he or she is more likely to solve it with professional help'. Responses range from 1 (disagree) to 4 (agree). Total scores range from 3 to 12 with higher scores indicating higher treatment seeking intentions.	30 day follow-up
Treatment related stigma	Treatment-related stigma will be measured with the Self-Stigma of Seeking Help scale (SSOSH-3) (Brenner et al., 2021). Items include "I would feel inadequate if I went to a therapist for psychological help," "It would make me feel inferior to ask a therapist for help," and "If I went to a therapist, I would be less satisfied with myself." Response range from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 3 to 15, with higher scores indicating greater stigma.	Baseline
Treatment related stigma	Treatment-related stigma will be measured with the Self-Stigma of Seeking Help scale (SSOSH-3) (Brenner et al., 2021). Items include "I would feel inadequate if I went to a therapist for psychological help," "It would make me feel inferior to ask a therapist for help," and "If I went to a therapist, I would be less satisfied with myself." Response range from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 3 to 15, with higher scores indicating greater stigma.	Post (immediately after the video or vignette control is shown)
Treatment related stigma	Treatment-related stigma will be measured with the Self-Stigma of Seeking Help scale (SSOSH-3) (Brenner et al., 2021). Items include "I would feel inadequate if I went to a therapist for psychological help," "It would make me feel inferior to ask a therapist for help," and "If I went to a therapist, I would be less satisfied with myself." Response range from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 3 to 15, with higher scores indicating greater stigma.	30 day follow-up
Actual help-seeking	One item will be utilized to measure actual help-seeking: Over the past 30 days, did you contact the mental health referrals we have provided or have sought out mental health treatment elsewhere?	30 day follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Emotional engagement	Emotional engagement will be measured using the Emotional Engagement Scale (de Vreede et al., 2019). The scale includes three items asking about emotional engagement (e.g., "I care about the contents of this video"), and response choices range from 1 (strongly disagree) to 4 (strongly agree). Total scores range from 3 to 12, with higher scores indicating greater emotional engagement.	Post (immediately after the video or vignette control is shown)

Collaborators and Investigators

• Sponsor: New York State Psychiatric Institute

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.
• Elhai JD, Schweinle W, Anderson SM. Reliability and validity of the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form. Psychiatry Res. 2008 Jun 30;159(3):320-9. doi: 10.1016/j.psychres.2007.04.020. Epub 2008 Apr 22.
• Brenner RE, Colvin KF, Hammer JH, Vogel DL. Using Item Response Theory to Develop Revised (SSOSH-7) and Ultra-Brief (SSOSH-3) Self-Stigma of Seeking Help Scales. Assessment. 2021 Jul;28(5):1488-1499. doi: 10.1177/1073191120958496. Epub 2020 Sep 25.
• de Vreede T, Andel SA, de Vreede GJ, Spector P, Singh V, Padmanabhan B. What is engagement and how do we measure it? Toward a domain independent definition and scale. Proceedings of the 52nd Hawaii International Conference on System Sciences. 2019, Hawaii. p. 749-758.

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2024
• Primary Completion (Estimated): May 1, 2024
• Study Completion (Estimated): May 1, 2024

Study Registration Dates

• First Submitted: November 18, 2023
• First Submitted That Met QC Criteria: December 6, 2023
• First Posted (Actual): December 15, 2023

Study Record Updates

• Last Update Posted (Actual): April 12, 2024
• Last Update Submitted That Met QC Criteria: April 10, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Mood Disorders; Depression; Depressive Disorder; Mental Disorders
• Other Study ID Numbers: 8366

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