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Lasting change: Researchers study long-term effectiveness of school-based intervention to reduce mental illness stigma

Curriculum interventions in youth can be effective and beneficial

Stigma associated with mental illness hurts social lives, lowers self-esteem and can even prevent people from seeking the care they need. Stigma is especially harmful to adolescents and young adults with mental illness, many of whom are not receiving treatment. Research has found that attitudes towards mental illness and stigmatizing behavior typically develop at a young age. Thus, efforts to fight stigma in schools by improving knowledge, attitudes and behaviors about mental illness are vital. Many studies have addressed different strategies to address stigma including curriculums, printed materials and presentations by people living with a mental illness.

In a new study published in the journal Pediatrics, Melissa J. DuPont-Reyes, PhD, MPH, assistant professor in the Department of Epidemiology and Biostatistics at the Texas A&M School of Public Health, joined colleagues in analyzing long-term changes in mental illness knowledge, attitudes and behaviors over a two-year period after delivering an anti-stigma intervention to students in the sixth grade. The study tested three approaches to increasing knowledge and positive attitudes about mental illness and treatment options, and reducing social exclusion of peers with mental illness. The researchers note that few studies have investigated such early interventions and previous work in this effort left unanswered questions about how sustainable and generalizable changes from the interventions are.

The study tested three intervention approaches in more than a dozen schools in an urban Texas public school district. The schools were randomized to receive singly or a combination of three strategies over a two-week period—a teacher-led three-module curriculum on mental illness stigma, presentations by young people with mental illness followed by group discussion, and printed materials with anti-stigma messaging—as well as a no-intervention control group. The analysis measured mental illness knowledge and positive attitudes and the willingness of students to interact with a peer known to have a mental illness about people in general and also in response to two adolescent vignette characters described as having mental illness. The researchers also measured treatment-seeking by asking if students had spoken to a therapist or counselor or were taking medication for a mental health issue, as well as self-reported mental health symptoms to determine which students were likely to need mental health treatment. Lastly, the researchers collected data on variables such as gender, race/ethnic identity and household income in the ethnically and socioeconomically diverse sample.

The researchers found that the curriculum intervention was associated with a significant increase in knowledge and positive attitudes toward people with mental illness, a notable decrease in exclusion behaviors and an increased likelihood of seeking treatment for mental health issues if needed. These effects sustained even after two years and operated similarly across all sociodemographic groups analyzed. The other interventions using presentations and printed materials were not associated with significant changes in outcomes. The researchers note that although presentations by people with mental illness has been found to be effective among adult audiences, it is not as effective in younger groups.

The first module in the curriculum discusses the concept of stigma, its consequences and how to end it. The second and third modules introduce specific mental illnesses, including attention-deficit hyperactivity disorder, anxiety disorders, depression, schizophrenia and bipolar disorder, as well as a discussion of treatments.

“The intervention met state mental health education requirements and was designed for ease of use by teachers in school settings. Importantly, it is freely available to the public. Therefore, it has high potential for dissemination,” DuPont-Reyes said. “Not only did the curriculum increase mental health literacy about different mental illnesses and treatments, but it also fostered a necessary component of empathy for people who are different in any way, including those who are coping with a mental health issue.”

DuPont-Reyes was second author on the publication, which was led by Bruce G. Link, a distinguished professor of sociology and public policy at the University of California, Riverside. The study was co-authored by Kay Barkin of Mental Health Connection of Tarrant County, based in Fort Worth, Texas; Alice P. Villatoro of The University of Texas at Austin; Jo C. Phelan of Columbia University; and Kris Painter of The University of Texas at Arlington.

This study suggests that de-stigmatizing mental illness in schools can be effective and beneficial for increasing treatment-seeking for youth experiencing a mental health issue. Future research should investigate how such interventions can be widely implemented to achieve broad impact on population mental health. The findings of this study point to the benefits of early anti-stigma intervention in schools when young people tend to first experience mental health symptoms and help-seeking opportunities.

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