JMIR Publications

ABSTRACT

Background:

Public stigma in mental health often brings various adverse effects on people with mental illness. Researchers have been examining different interventions in combating public stigma.

Objective:

This study investigated the effects of reducing public stigma in mental health through immersive virtual reality (IVR) with a single-blinded randomized control trial (RCT).

Methods:

A pre-post experimental design with a one-week follow-up was conducted. Participants (N=205) were recruited through the mass mail system of The Chinese University of Hong Kong and randomized into 3 conditions: immersive animation, text, and space control. In the immersive animation condition (n=72), participants experienced the simulation of daily life and stigma experienced as an animated story protagonist with mixed anxiety and depressive disorder (MADD) with IVR. In the text condition (n=65), participants experienced the identical story to the immersive animation condition with first-person audio narration using the same virtual reality headset. In the space control condition (n=68), participants watched a video about planets with IVR. All participants received interventions with a researcher-assisted Oculus Go virtual reality headset. Participants’ public stigma was measured through self-administered online questionnaires and compared across conditions and at different time points using repeated measures ANOVA. Simple and sequential mediation analyses on the relationship of condition (immersive animation vs. text) and follow-up public stigma with possible mediators, including the sense of embodiment and story transportation were also conducted using PROCESS.

Results:

In immersive animation (mean 2.45, SD 0.63) and text (mean 2.47, SD 0.62) conditions, public stigma was significantly reduced immediately at post-experiment, P<.001, and at one-week follow-up. Both groups also had lower public stigma than the space control group (mean 2.79, SD 0.62), P=.004 for immersive animation, and P=.011 for text. However, immersive animation did not outperform text, P=.51. In simple mediation models, both the sense of embodiment (95% CI -0.22 to 0.46) and story transportation (95% CI -0.18 to 0.00) were not significant mediators. In the sequential mediation model, both the sense of embodiment and story transportation were significant sequential mediators, with the sense of embodiment being positively associated with story transportation, =.34, t134=6.68, P<.001, and story transportation negatively associated with public stigma, =-.42, t134=-4.40, P<.001. The indirect effect of the sequential mediation model was significant (95% CI -0.38 to -0.11).

Conclusions:

This study provided novel findings and a rigorous comparison in understanding the effects of IVR on public stigma. Findings showed that IVR and text with audio narration both performed similarly and significantly reduced public stigma. Story transportation was found to be an important preceding variable of stigma change. The sense of embodiment was sequentially and positively associated with story transportation, but with a more secondary and indirect role in reducing public stigma. Clinical Trial: CUHK_CCRB00638