Destigmatising mental health treatment and increasing openness to seeking treatment: randomised controlled trial of brief video interventions

Doron Amsalem, Melanie Wall, Amit Lazarov, John C Markowitz, Chana T Fisch, Mariah LeBeau, Melissa Hinds, Jun Liu, Prudence W Fisher, Thomas E Smith, Sidney Hankerson, Roberto Lewis-Fernández, Yuval Neria, Lisa B Dixon, Doron Amsalem, Melanie Wall, Amit Lazarov, John C Markowitz, Chana T Fisch, Mariah LeBeau, Melissa Hinds, Jun Liu, Prudence W Fisher, Thomas E Smith, Sidney Hankerson, Roberto Lewis-Fernández, Yuval Neria, Lisa B Dixon

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.

Keywords: COVID-19; Essential workers; intervention; openness to seeking treatment; stigma.

Figures

Fig. 1
Fig. 1
Study profile (August–September 2021).
Fig. 2
Fig. 2
Essential workers’ geographic distribution (August–September 2021).
Fig. 3
Fig. 3
Immediate, repeated and longer-term effects on Self-Stigma of Seeking Help scale. Total scores ranged from 3 to 15, with higher scores indicating greater stigma (3 = disagree; 6 = partly disagree; 9 = neutral; 12 = partly agree; 15 = agree); F/U, follow-up.
Fig. 4
Fig. 4
(a) Immediate, repeated and longer-term effects on Attitudes Towards Seeking Professional Psychological Help (ATSPPH) scale. (b) Immediate, repeated and longer-term effects on ATSPPH divided by the response to ‘have you sought psychological counseling?’. Total scores ranged from 3 to 12, with higher scores indicating greater openness to seeking treatment (3 = disagree; 6 = partly disagree; 7.5 = neutral; 9 = partly agree; 12 = agree); F/U, follow-up.

References

    1. De Boni RB, Balanzá-Martínez V, Mota JC, Cardoso TA, Ballester P, Atienza-Carbonell B, et al. Depression, anxiety, and lifestyle among essential workers: a web survey from Brazil and Spain during the COVID-19 pandemic. J Med Internet Res 2020; 22(10): e22835.
    1. Bell C, Williman J, Beaglehole B, Stanley J, Jenkins M, Gendall P, et al. Challenges facing essential workers: a cross-sectional survey of the subjective mental health and well-being of New Zealand healthcare and other essential workers during the COVID-19 lockdown. BMJ Open 2021; 11(7): e048107.
    1. Fang X, Zhang J, Teng C, et al. Depressive symptoms in the front-line non-medical workers during the COVID-19 outbreak in Wuhan. J Affect Disord 2020; 276: 441–5.
    1. Mazza M, Attanasio M, Pino MC, et al. Moral decision-making, stress, and social cognition in frontline workers vs. population groups during the COVID-19 pandemic: an explorative study. Front Psychol 2020; 11: 588159.
    1. Youman K, Drapalski A, Stuewig J, Bagley K, Tangney J. Race differences in psychopathology and disparities in treatment seeking: community and jail-based treatment-seeking patterns. Psychol Serv 2010; 7(1): 11.
    1. Gawthrop E. The Color of Coronavirus: COVID-19 Deaths by Race and Ethnicity in the U.S. APM Research Lab: American Public Media Group, 2022. ( [cited 5 Sep 2022]).
    1. Lancet T. The plight of essential workers during the COVID-19 pandemic. Lancet 2020; 395(10237): 1587.
    1. Tai DBG, Shah A, Doubeni CA, Sia IG, Wieland ML. The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clin Infect Dis 2021; 72(4): 703–6.
    1. Stringer SM. New York City’s Frontline Workers. Bureau of Policy & Research: City of New York – Office of the Comptroller, 2020. ( [cited 5 Sep 2022]).
    1. Misra S, Jackson VW, Chong J, Choe K, Tay C, Wong J, et al. Systematic review of cultural aspects of stigma and mental illness among racial and ethnic minority groups in the United States: implications for interventions. Am J Community Psychol 2021; 68(3–4): 486–512.
    1. Clement S, Schauman O, Graham T, et al. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med 2015; 45(1): 11–27.
    1. Smith JR, Workneh A, Yaya S. Barriers and facilitators to help-seeking for individuals with posttraumatic stress disorder: a systematic review. J Trauma Stress 2020; 33(2): 137–50.
    1. Center C, Davis M, Detre T, et al. Confronting depression and suicide in physicians: a consensus statement. J Am Med Assoc 2003; 289(23): 3161–6.
    1. Rüsch N, Angermeyer MC, Corrigan PW. Mental illness stigma: concepts, consequences and initiatives to reduce stigma. Eur Psychiatry 2005; 20(8): 529–39.
    1. Thornicroft G, Mehta N, Clement S, et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet 2016; 387(10023): 1123–32.
    1. Corrigan PW, Michaels PJ, Vega E, Gause M, Larson J, Krzyzanowski R, et al. Key ingredients to contact-based stigma change: a cross-validation. Psychiatr Rehabil J 2014; 37(1): 62–4.
    1. Janoušková M, Tušková E, Weissová A, et al. Can video interventions be used to effectively destigmatize mental illness among young people? A systematic review. Eur Psychiatry 2017; 41: 1–9.
    1. Koike S, Yamaguchi S, Ojio Y, et al. A randomised controlled trial of repeated filmed social contact on reducing mental illness-related stigma in young adults. Epidemiol Psychiatr Sci 2018; 27(2): 199–208.
    1. Amsalem D, Dixon LB, Neria Y. The coronavirus disease 2019 (COVID-19) outbreak and mental health: current risks and recommended actions. JAMA Psychiatry 2021; 78(1): 9–10.
    1. Amsalem D, Lazarov A, Markowitz JC, Smith TE, Dixon LB, Neria Y. Video intervention to increase treatment-seeking by healthcare workers during the COVID-19 pandemic: randomised controlled trial. Br J Psychiatry 2022; 220(1): 14–20.
    1. Amsalem D, Lazarov A, Markowitz JC, Gorman D, Dixon LB, Neria Y. Increasing treatment-seeking intentions of US veterans in the Covid-19 era: a randomized controlled trial. Depress Anxiety 2021; 38(6): 639–47.
    1. Amsalem D, Yang LH, Jankowski S, Lieff SA, Markowitz JC, Dixon LB. Reducing stigma toward individuals with schizophrenia using a brief video: a randomized controlled trial of young adults. Schizophr Bull 2021; 47(1): 7–14.
    1. Peer E, Brandimarte L, Samat S, Acquisti A. Beyond the Turk: alternative platforms for crowdsourcing behavioral research. J Exp Soc Psychol 2017; 70: 153–63.
    1. 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; 28(5): 1488–99.
    1. Elhai JD, Schweinle W, Anderson SM. Reliability and validity of the attitudes toward seeking professional psychological help scale-short form. Psychiatry Res 2008; 159(3): 320–9.
    1. Zeger SL, Liang K-Y, Albert PS. Models for longitudinal data: a generalized estimating equation approach. Biometrics 1988; 44: 1049–60.
    1. Vens M, Ziegler A. Generalized estimating equations and regression diagnostics for longitudinal controlled clinical trials: a case study. Comput Stat Data Anal 2012; 56: 1231–42.
    1. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med 2003; 139(11): 907–15.
    1. Breslau J, Cefalu M, Wong EC, Burnam MA, Hunter GP, Florez KR, et al. Racial/ethnic differences in perception of need for mental health treatment in a US national sample. Soc Psychiatry Psychiatr Epidemiol 2017; 52(8): 929–37.
    1. Smith K, Bhui K, Cipriani A. COVID-19, mental health and ethnic minorities. Evid Based Ment Health 2020; 23(3): 89–90.
    1. Maunder RG, Lancee WJ, Mae R, et al. Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training. BMC Health Serv Res 2010; 10: 72.
    1. Xiao Y, Wang L, Wang P. Research on the influence of content features of short video marketing on consumer purchase intentions. In International Conference on Modern Management, Education Technology and Social Science (MMETSS 2019): 415–22. Atlantis Press, 2019.
    1. Becot F, Inwood S, Bendixsen C, Henning-Smith C. Health care and health insurance access for farm families in the United States during COVID-19: essential workers without essential resources? J Agromedicine 2020; 25(4): 374–7.
    1. Torous J, Andersson G, Bertagnoli A, Christensen H, Cuijpers P, Firth J, et al. Towards a consensus around standards for smartphone apps and digital mental health. World Psychiatry 2019; 18(1): 97.
    1. Mata-Greve F, Johnson M, Pullmann MD, Friedman EC, Fillipo IG, Comtois KA, et al. Mental health and the perceived usability of digital mental health tools among essential workers and people unemployed due to COVID-19: cross-sectional survey study. JMIR Ment Health 2021; 8(8): e28360.
    1. Benhamou K, Piedra A. CBT-informed interventions for essential workers during the COVID-19 pandemic. J Contemp Psychother 2020; 50(4): 275–83.
    1. Rathbone AL, Prescott J. The use of mobile apps and SMS messaging as physical and mental health interventions: systematic review. J Med Internet Res 2017; 19(8): e295.
    1. Markowitz JC, Milrod BL. Postpandemic psychotherapy: still under siege. Psychiatr Ser 2022; 73(6): 690–2.
    1. Perinelli E, Gremigni P. Use of social desirability scales in clinical psychology: a systematic review. J Clin Psychol 2016; 72: 534–51.

Source: PubMed

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