Reducing Stigma and Increasing Treatment Seeking Intentions Among Adolescents

Brief Personalized Videos to Reduce Stigma and Increase Treatment-seeking Behavior Among Adolescents With Depression

Depression is a leading cause of illness and disability in teenagers. Longer duration of untreated depression (DUD) is associated with greater severity, poorer outcome, and cognitive impairment. Stigma toward people with depression has been identified as a barrier to seeking help; therefore, reducing stigma toward young people at depressive risk could enhance their receptivity to seeking treatment. 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 adolescents with depression. The videos feature adolescent protagonists varied by race/ethncitiy and gender (Black girl, Black boy, White girl, White boy, Hispanic girl, Hispanic boy, nonbinary or transgender adolescent) who will share their experiences with depression, challenges, and recovery process. The investigators would like to conduct a randomized controlled trial (RCT) to test the efficacy of these tailored videos as compared to a video control condition (which provides information about depression and how to seek help but does not include a personal story) on reducing self-stigma and increasing help-seeking intentions and behavior at baseline, post, 2 week follow-up, and 4 week follow-up among adolescents ages 14-18 recruited via Cloudresearch. The videos will be shown again at 2 week follow-up.

Study Overview

• Status: Completed
• Conditions: Depression; Mental Health Disorder; Adolescent Behavior; Stigma, Social
• Intervention / Treatment: Behavioral: Brief video intervention (Black Girl); Behavioral: Brief video intervention (Black Boy); Behavioral: Brief video intervention (Latinx Girl); Behavioral: Brief video intervention (Latinx Boy); Behavioral: Brief video intervention (White Girl); Behavioral: Brief video intervention (White Boy); Behavioral: Brief video intervention (Nonbinary or transgender); Behavioral: Control Condition

Detailed Description

In a randomized control trial (RCT) with pre-, post-intervention, and 2 and 4 week follow-up assessments, the investigators aim to test the efficacy of brief social contact video interventions, varying protagonist race/ethnicity, as compared to video control in reducing depression related stigma and increasing treatment-seeking intentions and behavior among adolescents ages 14-18 recruited via Cloudresearch, a crowdsourcing platform. The control condition will include a video that will provide information about depression and how to seek help but does not include a personal story. The tailored video interventions will be assigned based on participant demographics and will include adolescent protagonists varied by race/ethnicity and gender (Black girl, Black boy, White girl, White boy, Hispanic girl, Hispanic boy, nonbinary or transgender adolescent). Videos will be shown at baseline and 2 week follow-up. The investigators hypothesize that 1) Brief social contact-based video interventions will reduce stigma towards depression and increase treatment-seeking intentions and behavior compared to video control which provides information about depression and help seeking but does not include a personal story.

• Study Type: Interventional
• Enrollment (Actual): 1200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • New York, New York, United States, 10032
      • New York State Psychiatric Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Ages 14-18
• English speaking
• US Residents

Exclusion Criteria:

• Age less than 14 or greater than 18
• Non-English speaking
• Non-US Resident

Study Plan

How is the study designed?

Design Details

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

Number of Arms

8

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Brief video intervention (Black Girl); A brief social contact-based video with a Black girl protagonist	Behavioral: Brief video intervention (Black Girl); A brief social contact-based video. The video presented a young Black girl, a professional actor, sharing her scripted personal story of struggles with depression and raising themes of recovery and hope.
Experimental: Brief video intervention (Black Boy); A brief social contact-based video with a Black boy protagonist	Behavioral: Brief video intervention (Black Boy); A brief social contact-based video. The video presented a young Black boy, a professional actor, sharing his scripted personal story of struggles with depression and raising themes of recovery and hope.
Experimental: Brief video intervention (Latinx Girl); A brief social contact-based video with a Latinx girl protagonist	Behavioral: Brief video intervention (Latinx Girl); A brief social contact-based video. The video presented a young Latinx girl, a professional actor, sharing her scripted personal story of struggles with depression and raising themes of recovery and hope.
Experimental: Brief video intervention (Latinx Boy); A brief social contact-based video with a Latinx boy protagonist	Behavioral: Brief video intervention (Latinx Boy); A brief social contact-based video. The video presented a young Latinx boy, a professional actor, sharing his scripted personal story of struggles with depression and raising themes of recovery and hope.
Experimental: Brief video intervention (White Girl); A brief social contact-based video with a White girl protagonist	Behavioral: Brief video intervention (White Girl); A brief social contact-based video. The video presented a young White girl, a professional actor, sharing her scripted personal story of struggles with depression and raising themes of recovery and hope.
Experimental: Brief video intervention (White Boy); A brief social contact-based video with a White boy protagonist	Behavioral: Brief video intervention (White Boy); A brief social contact-based video. The video presented a young White boy, a professional actor, sharing his scripted personal story of struggles with depression and raising themes of recovery and hope.
Experimental: Brief video intervention (Nonbinary or transgender); A brief social contact-based video with a nonbinary or transgender protagonist	Behavioral: Brief video intervention (Nonbinary or transgender); A brief social contact-based video. The video presented a young nonbinary or transgender adolescent, a professional actor, sharing their scripted personal story of struggles with depression and raising themes of recovery and hope.
Active Comparator: Control; A brief video control condition with psychoeducation on depression and help seeking	Behavioral: Control Condition; A video that will provide information about depression and how to seek help but does not include a personal story.

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
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
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 videos are 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.	2 week follow-up
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.	4 week 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.	Post (immediately after the videos are 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.	2 week 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.	4 week follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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 videos are 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.	2 week 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.	4 week follow-up
Barriers to Access to Care Evaluation (BACE V3)	Barriers to care will be measured with items selected from the Barriers to Access to Care Evaluation (BACE v3) (Clement et al., 2012). Response range from 0 (not at all) to 3 (a lot). Total scores range from 0 to 24, with higher scores indicating greater barriers.	Baseline
Barriers to Access to Care Evaluation (BACE V3)	Barriers to care will be measured with items selected from the Barriers to Access to Care Evaluation (BACE v3) (Clement et al., 2012). Response range from 0 (not at all) to 3 (a lot). Total scores range from 0 to 24, with higher scores indicating greater barriers.	Post (immediately after the videos are shown)
Barriers to Access to Care Evaluation (BACE V3)	Barriers to care will be measured with items selected from the Barriers to Access to Care Evaluation (BACE v3) (Clement et al., 2012). Response range from 0 (not at all) to 3 (a lot). Total scores range from 0 to 24, with higher scores indicating greater barriers.	2 week follow-up
Barriers to Access to Care Evaluation (BACE V3)	Barriers to care will be measured with items selected from the Barriers to Access to Care Evaluation (BACE v3) (Clement et al., 2012). Response range from 0 (not at all) to 3 (a lot). Total scores range from 0 to 24, with higher scores indicating greater barriers.	4 week follow-up
Mental Health Treatment	One item will be utilized to measure prior mental health treatment: Have you ever received mental health treatment?	Baseline
Actual help seeking	Two items will be utilized to measure help seeking: Over the past 2 weeks, have you sought out mental health treatment? and Over the past 2 weeks, did you feel more able/willing to open up to others about how you are feeling?	2 week follow-up
Actual help seeking	Two items will be utilized to measure help seeking: Over the past 4 weeks, have you sought out mental health treatment? and Over the past 4 weeks, did you feel more able/willing to open up to others about how you are feeling?	4 week follow-up
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 videos are shown
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.	2 week follow-up

Collaborators and Investigators

• Sponsor: New York State Psychiatric Institute

Publications and helpful links

General Publications

• Clement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G. Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry. 2012 Jun 20;12:36. doi: 10.1186/1471-244X-12-36.
• 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 (Actual): June 3, 2024
• Primary Completion (Actual): August 17, 2024
• Study Completion (Actual): August 17, 2024

Study Registration Dates

• First Submitted: January 16, 2024
• First Submitted That Met QC Criteria: January 16, 2024
• First Posted (Actual): January 24, 2024

Study Record Updates

• Last Update Posted (Actual): September 4, 2024
• Last Update Submitted That Met QC Criteria: September 3, 2024
• Last Verified: September 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Depression; Mental Disorders
• Other Study ID Numbers: 8317 (CTEP)

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