Accepted for/Published in: JMIR Mental Health
Date Submitted: Jan 18, 2021
Date Accepted: Jul 28, 2021
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effectiveness of a Game-Based School Program for Mental Health Literacy and Stigma on Depression in Adolescents (Moving Stories): A Cluster Randomized Controlled Trial
ABSTRACT
Background:
Depressive symptoms are highly prevalent among adolescents in Western countries. However, even though treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers for help-seeking among adolescents include low mental health literacy and high stigma. We have developed the game-based school program Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience, both in the digital and non-digital world.
Objective:
The goal of the present study was to conduct a first test on the effectiveness of the newly developed game-based program Moving Stories, by means of a cluster randomized controlled trial.
Methods:
A total of 185 adolescents participated, divided over 10 classes from four schools. Half of the classes were randomly selected to follow the Moving Stories program, while the other half were in the control group, where no intervention was provided. Adolescents filled out digital questionnaires at four time points with questions on mental health literacy, stigma, depressive symptoms and the program itself (pre-test, post-test, three-months follow-up, six-months follow-up). Using R, we ran linear mixed effects models for all continuous outcome variables, and generalized linear mixed effects models for all binary outcome variables.
Results:
Compared to the control group, participants in the Moving Stories group improved at post-test in symptom recognition (OR = 1.59, 95% CI = [0.95 – 2.73], z = 1.73, P = .08 ), personal stigma (b = -0.53, 95% CI = [-1.02 – -0.03], t(179.16) = -2.08, P = .04) and perceived stigma (b = -0.61, 95% CI = [-1.31 – 0.09], t(179.75) = -1.70, P = .09). Effects on personal stigma lasted over time (three-months follow-up: b = -0.57, 95% CI = [-1.11 – -0.03] , (174.39) = -2.07, P = .04, and six-months follow-up (trend), b = -0.49, 95% CI = [-1.01 – 0.03], t(169.35) = -1.83, P = .07). Most adolescents in the Moving Stories group participated in the introduction (98%) and discussion session (94%), played the game for four or five days (83%), and indicated they would recommend the game to peers (92%).
Conclusions:
The results of the current study show the potential of the Moving Stories program as a mental health literacy and stigma program. With changes in the program to improve long-term effects and effects on behavior, Moving Stories could be implemented in schools to improve help seeking in adolescents and reduce the negative consequences and burden of depressive symptoms. Clinical Trial: Dutch Trial Register NTR7033; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=7033
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