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Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: Systematic review

  • N. Mehta (a1), S. Clement (a1), E. Marcus (a1), A.-C. Stona (a1), N. Bezborodovs (a1), S. Evans-Lacko (a1), J. Palacios (a1), M. Docherty (a1), E. Barley (a1), D. Rose (a1), M. Koschorke (a1), R. Shidhaye (a2), C. Henderson (a1) and G. Thornicroft (a1)...

Abstract

Background

Most research on interventions to counter stigma and discrimination has focused on short-term outcomes and has been conducted in high-income settings.

Aims

To synthesise what is known globally about effective interventions to reduce mental illness-based stigma and discrimination, in relation first to effectiveness in the medium and long term (minimum 4 weeks), and second to interventions in low- and middle-income countries (LMICs).

Method

We searched six databases from 1980 to 2013 and conducted a multi-language Google search for quantitative studies addressing the research questions. Effect sizes were calculated from eligible studies where possible, and narrative syntheses conducted. Subgroup analysis compared interventions with and without social contact.

Results

Eighty studies (n = 422 653) were included in the review. For studies with medium or long-term follow-up (72, of which 21 had calculable effect sizes) median standardised mean differences were 0.54 for knowledge and −0.26 for stigmatising attitudes. Those containing social contact (direct or indirect) were not more effective than those without. The 11 LMIC studies were all from middle-income countries. Effect sizes were rarely calculable for behavioural outcomes or in LMIC studies.

Conclusions

There is modest evidence for the effectiveness of anti-stigma interventions beyond 4 weeks follow-up in terms of increasing knowledge and reducing stigmatising attitudes. Evidence does not support the view that social contact is the more effective type of intervention for improving attitudes in the medium to long term. Methodologically strong research is needed on which to base decisions on investment in stigma-reducing interventions.

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Copyright

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.

Corresponding author

Professor Graham Thornicroft, Health Service and Population Research Department, Box PO29, Institute of Psychiatry, Pschology and Neuroscience, De Crespigny Park, London SE5 8AF, UK. Email: graham.thornicroft@kcl.ac.uk

Footnotes

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Joint first authors.

Declaration of interest

None.

Footnotes

References

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1 Goffmann, E. Stigma: Notes on the Management of Spoiled Identity. Prentice Hall, 1963.
2 Weiss, MG, Ramakrishna, J, Somma, D. Health-related stigma: rethinking concepts and interventions. Psychol Health Med 2006; 11: 277–87.
3 Sartorius, N, Schulze, H. Reducing the Stigma of Mental Illness. Cambridge University Press, 2005.
4 Rabkin, J. Public attitudes toward mental illness: a review of the literature. Schizophr Bull 1974; 10: 933.
5 Link, BG, Phelan, JC, Bresnahan, M, Stueve, A, Pescosolido, BA. Public conceptions of mental illness: labels, causes, dangerousness, and social distance. Am J Public Health 1999; 89: 1328–33.
6 Thornicroft, G. Shunned: Discrimination Against People with Mental Illness. Oxford University Press, 2006.
7 Yang, LH, Cho, SH, Kleinman, A. Stigma of mental illness. In Mental and Neurological Public Health: A Global Perspective (ed. Patel, V): 484–95. Elsevier, 2010.
8 Yang, LH, Kleinman, A, Link, BG, Phelan, JC, Lee, S, Good, B. Culture and stigma: adding moral experience to stigma theory. Soc Sci Med 2007; 64: 1524–35.
9 Raguram, R, Raghu, TM, Vounatsou, P, Weiss, MG. Schizophrenia and the cultural epidemiology of stigma in Bangalore, India. J NervMent Dis 2004; 192: 734–44.
10 Weiss, MG, Jadhav, S, Raguram, R, Vounatsou, P, Littlewood, R. Psychiatric stigma across cultures: local validation in Bangalore and London. Anthropol Med 2001; 8: 7187.
11 Corrigan, PW, Morris, SB, Michaels, PJ, Rafacz, JD, Rusch, N. Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatr Serv 2012; 63: 963–73.
12 Mansouri, N, Gharaee, B, Shariat, SV, Bolhari, J, Nooraie, RY, Rahimi-Movaghar, A, et al. The change in attitude and knowledge of health care personnel and general population following trainings provided during integration of mental health in primary health care in Iran: a systematic review. Int J Ment Health Syst 2009; 3: 15.
13 Clement, S, Lassman, F, Barley, E, Evans-Lacko, S, Williams, P, Yamaguchi, S, et al. Mass media interventions for reducing mental health-related stigma. Cochrane Database Syst Rev 2013; 7: CD009453.
14 Mittal, D, Sullivan, G, Chekuri, L, Allee, E, Corrigan, PW. Empirical studies of self-stigma reduction strategies: a critical review of the literature. Psychiatr Serv 2012; 63: 974–81.
15 Holzinger, A, Dietrich, S, Heitmann, S, Angermeyer, M. Evaluation of target-group oriented interventions aimed at reducing the stigma surrounding mental illness. Psychiatr Prax 2008; 35: 376–86.
16 Yamaguchi, S, Wu, SI, Biswas, M, Yate, M, Aoki, Y, Barley, EA, et al. Effects of short-term interventions to reduce mental health-related stigma in university or college students: a systematic review. J Nerv Ment Dis 2013; 201: 490503.
17 Ando, S, Clement, S, Barley, E, Thornicroft, G. The simulation of hallucinations to reduce the stigma of schizophrenia: a systematic review. Schizophr Res 2011; 133: 816.
18 Schachter, HM, Girardi, A, Ly, M, Lacroix, D, Lumb, AB, van Berkom, J, et al. Effects of school-based interventions on mental health stigmatization: a systematic review. Child Adolesc Psychiatr Ment Health 2008; 2: 18.
19 Cohen, J. Statistical Power Analysis for the Behavioral Sciences. Erlbaum, 1988.
20 Wilson, DB. Practical Meta-Analysis Effect Size Calculator. Campbell Collaboration, 2001 (http://www.campbellcollaboration.org/resources/effect_size_input.php).
21 Grimshaw, J, McAuley, LM, Bero, LA, Grilli, R, Oxman, AD, Ramsay, C, et al. Systematic reviews of the effectiveness of quality improvement strategies and programmes. Qual Saf Health Care 2003; 12: 298303.
22 Higgins, JPT, Green, S (eds). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2, ch 16.5. Cochrane Collaboration, 2009.
23 Higgins, JP, Altman, DG, Gotzsche, PC, Juni, P, Moher, D, Oxman, AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: 5928.
24 Gulliver, A, Griffiths, KM, Christensen, H, Mackinnon, A, Calear, AL, Parsons, A, et al. Internet-based interventions to promote mental health help-seeking in elite athletes: an exploratory randomized controlled trial. J Med Internet Res 2012; 14: 120–37.
25 Gutierrez-Maldonado, J, Caqueo-Urizar, A, Ferrer-Garcia, M. Effects of a psychoeducational intervention program on the attitudes and health perceptions of relatives of patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2009; 44: 343–8.
26 Jorm, AF, Kitchener, BA, Fischer, JA, Cvetkovski, S. Mental health first aid training by e-learning: a randomized controlled trial. Aust NZ J Psychiatry 2010; 44: 1072–81.
27 Kitchener, BA, Jorm, AF. Mental health first aid training in a workplace setting: a randomized controlled trial. BMC Psychiatry 2004; 4: 23.
28 Corker, E, Hamilton, S, Henderson, C, Weeks, C, Pinfold, V, Rose, D, et al. Experiences of discrimination among people using mental health services in England 2008–11. Br J Psychiatry 2013; 202 (suppl 55): s5863.
29 Henderson, C, Corker, E, Lewis-Holmes, E, Hamilton, S, Flach, C, Rose, D, et al. England's time to change antistigma campaign: one-year outcomes of service user-rated experiences of discrimination. Psychiatr Serv 2012; 63: 451–7.
30 Evans-Lacko, S, Henderson, C, Thornicroft, G. Public knowledge, attitudes and behaviour regarding people with mental illness in England 2009–2012. Br J Psychiatry 2013; 202 (suppl 55): s517.
31 Griffiths, KM, Carron-Arthur, B, Parsons, A, Reid, R. Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry 2014; 13: 161–75.
32 Clement, S, van Nieuwenhuizen, A, Kassam, A, Flach, C, Lazarus, A, de Castro, M, et al. Filmed v. live social contact interventions to reduce stigma: randomised controlled trial. Br J Psychiatry 2012; 201: 5764.
33 Shi, ZY, Liu, SY, Nie, LY The impact of group psychological interventions on the stigma perceived of patients with depression. J Nurs Training 2012; 27: 12131216.
34 Cohen, J, Struening, EL. Opinions about mental illness in the personnel of two large mental hospitals. J Abnorm Soc Psychol 1962; 64: 349–60.
35 Taylor, SM, Dear, MJ, Hall, GB. Attitudes toward the mentally ill and reactions to mental health facilities. Soc Sci Med 1979; 13: 281–90.
36 Link, BG, Yang, LH, Phelan, JC, Collins, PY. Measuring mental illness stigma. Schizophr Bull 2004; 30: 511–41.
37 Sharac, J, McCrone, P, Clement, S, Thornicroft, G. The economic impact of mental health stigma and discrimination: a systematic review. Epidemiol Psichiatr Soc 2010; 19: 223–32.
38 Henderson, C, Williams, P, Little, K, Thornicroft, G. Mental health problems in the workplace: changes in employers' knowledge, attitudes and practices in England 2006–2010. Br J Psychiatry 2013; 202 (suppl 55): s706.
39 Thornicroft, G, Brohan, E, Rose, D, Sartorius, N, Leese, M. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 2009; 373: 408–15.
40 Lasalvia, A, Van Weeghel, J, Reneses, B, Bacle, SV, Thornicroft, G, Bonetto, C. Discrimination reported by people with major depressive disorder: authors' reply. Lancet 2013; 381: 1181–2.
41 Henderson, C, Thornicroft, G. Evaluation of the Time to Change programme in England 2008–2011. Br J Psychiatry 2013; 202 (suppl 55): s458.
42 Jones, S, Howard, L, Thornicroft, G. ‘Diagnostic overshadowing’: worse physical health care for people with mental illness. Acta Psychiatr Scand 2008; 118: 169–71.
43 United Nations. Convention on the Rights of Persons with Disabilities. UN, 2006.
44 World Health Organization. Global Mental Health Action Plan 2013–2020. WHO, 2013.
45 Seal, KH, Abadjian, L, McCamish, N, Shi, Y, Tarasovsky, G, Weingardt, K. A randomized controlled trial of telephone motivational interviewing to enhance mental health treatment engagement in Iraq and Afghanistan veterans. Gen Hosp Psychiatry 2012; 34: 450–9.
46 Gould, M, Greenberg, N, Hetherton, J. Stigma and the military: evaluation of a PTSD psychoeducational program. J Trauma Stress 2007; 20: 505–15.
47 Campbell, M, Shryane, N, Byrne, R, Morrison, AP. A mental health promotion approach to reducing discrimination about psychosis in teenagers. Psychosis 2011; 3: 4151.
48 Pinto-Foltz, MD, Logsdon, MC, Myers, JA. Feasibility, acceptability, and initial efficacy of a knowledge-contact program to reduce mental illness stigma and improve mental health literacy in adolescents. Soc Sci Med 2011; 72: 2011–9.
49 Esters, IG, Cooker, PG, Ittenbach, RF. Effects of a unit of instruction in mental health on rural adolescents' conceptions of mental illness and attitudes about seeking help. Adolescence 1998; 33: 469–76.
50 O'Kearney, R, Gibson, M, Christensen, H, Griffiths, KM. Effects of a cognitive-behavioural internet program on depression, vulnerability to depression and stigma in adolescent males: a school-based controlled trial. Cogn Behav Ther 2006; 35: 4354.
51 O'Kearney, R, Kang, K, Christensen, H, Griffiths, K. A controlled trial of a school-based Internet program for reducing depressive symptoms in adolescent girls. Depress Anxiety 2009; 26: 6572.
52 Ventieri, D, Clarke, DM, Hay, M. The effects of a school-based educational intervention on pre-adolescents' knowledge of and attitudes towards mental illness. Adv Sch Ment Health Promot 2011; 4: 517.
53 Gonzales, JM, Tinsley, HEA, Krauder, KR. Effects of psychoeducational interventions on opinions of mental illness, attitudes towards help seeking, and expectations about psychotherapy in college students. J Coll Stud Dev 2002; 43: 5163.
54 Sharp, W, Hargrove, DS, Johnson, L, Deal, WP. Mental health education: an evaluation of a classroom based strategy to modify help seeking for mental health problems. J Coll Stud Dev 2006; 47: 419–38.
55 Faigin, DA, Stein, CH. Comparing the effects of live and video-taped theatrical performance in decreasing stigmatization of people with serious mental illness. J Ment Health 2008; 17: 594606.
56 O'Reilly, CL, Bell, JS, Kelly, PJ, Chen, TF. Impact of mental health first aid training on pharmacy students' knowledge, attitudes and self-reported behaviours: a controlled trial. Aust NZ J Psychiatry 2011; 45: 549–57.
57 Blair Irvine, A, Billow, MB, Eberhage, MG, Seeley, JR, McMahon, E, Bourgeois, M. Mental illness training for licensed staff in long-term care. Issues Ment Health Nurs 2012; 33: 181–94.
58 Patterson, P, Whittington, R, Bogg, J. Testing the effectiveness of an educational intervention aimed at changing attitudes to self-harm. J Psychiatr Ment Health Nurs 2007; 14: 100–5.
59 Treloar, AJ. Effectiveness of education programs in changing clinicians' attitudes toward treating borderline personality disorder. Psychiatr Serv 2009; 60: 1128–31.
60 Jorm, AF, Kitchener, BA, O'Kearney, R, Dear, KB. Mental health first aid training of the public in a rural area: a cluster randomized trial. BMC Psychiatry 2004; 4:33.
61 Fung, KMT, Tsang, HWH, Cheung, WM. Randomized controlled trial of the self-stigma reduction program among individuals with schizophrenia. Psychiatr Res 2011; 189: 208–14.
62 Gumley, A, Karatzias, A, Power, K, Reilly, J, McNay, L, O'Grady, M. Early intervention for relapse in schizophrenia: impact of cognitive behavioural therapy on negative beliefs about psychosis and self-esteem. Br J Clin Psychol 2006; 45: 247–60.
63 Jorm, AF, Kitchener, BA, Sawyer, MG, Scales, H, Cvetkovski, S. Mental health first aid training for high school teachers: a cluster randomized trial. BMC Psychiatry 2010; 10: 51.
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Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: Systematic review

  • N. Mehta (a1), S. Clement (a1), E. Marcus (a1), A.-C. Stona (a1), N. Bezborodovs (a1), S. Evans-Lacko (a1), J. Palacios (a1), M. Docherty (a1), E. Barley (a1), D. Rose (a1), M. Koschorke (a1), R. Shidhaye (a2), C. Henderson (a1) and G. Thornicroft (a1)...
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eLetters

NHS intervention?

tony frais, researcher, none
23 December 2015

The NHS ran a TV advertising campaign to encourage those who were having a continuous cough for 2 weeks to see a doctor.

As one in four of the population will experience some form of mental illness, is this statistic significant enough to have the NHS mount a similar campaign designed to encourage people to seek treatment as soon as possible. Such a campaign could also encourage the view that suffering mental illness is more common than the individual sufferer realises. This type of campaign campaign is also likely to be effective in further reducing stigma. ... More

Conflict of interest: None Declared

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