JMIR Publications

ABSTRACT

Background:

Major depressive and anxiety disorders affect 57.3 million adults in the U.S.. People living with mental illness, including depression and anxiety experience stigma associated with the illness and receiving treatment for their illness. Stigma -- which refers to negative attitudes or beliefs about mental illness, or negative behaviors directed toward persons with mental illness (PWMI) -- is a leading and fundamental cause of health inequities. Contact interventions, which are premised on the idea that positive and voluntary contact with PWMI can effectively reduce mental illness stigma, are aimed at reducing stigma and improving health outcomes. Video-based interventions improve knowledge, attitudes and behavior in the short term, there is a need for randomized controlled trials of indirect contact or video based contact interventions to address stigma and engagement in mental health services.

Objective:

The main study objective is to assess the feasibility and acceptability, and test the preliminary efficacy, of a self-administered, video-based mobile app in reducing mental illness stigma among Black adults with moderate to severe depression or anxiety.

Methods:

The intervention will involve short videos (6-12 minutes in length) of patients describing personal narratives of mental illness, treatment and recovery; and will be delivered over 4 weeks, with two booster sessions in week 6 and 12. Study participants will be randomly assigned to one of 3 treatment arms: a standard video-based app (n=30), a video-based app modified with a concordant patient video (n=30), and a waitlist control (n=30).

Results:

We hypothesize the concordant and standard intervention group will have greater mental health service utilization, lower stigma and lower mistrust compared to the waitlist arm. As a feasibility study, we will pilot the outcome analyses (to detect a signal and estimate direction of analysis. Based on the sample size of 90 (n=30 in each treated group and control group) and power at 72%, we will be able to detect a medium effect size of Cohen’s d=0.49 at alpha=0.05 using a paired Fisher-exact test for comparing the intervention vs. control proportions for any engagement in mental health care services.

Conclusions:

Given the low uptake of mental health services for people experiencing early signs and emerging symptoms of mental illness, efforts to increase early access to mental health services will be met with ongoing significant barriers to mental health care utilization if stigma and medical mistrust are left unaddressed. Data from this pilot and feasibility randomized trial will provide critical information about the feasibility and acceptability of this intervention, and preliminary efficacy estimates. This study will fill a critical public health gap created by the stigma that leads to delayed diagnosis, delayed entry into mental health treatment, and increased morbidity and mortality related to mental illness. Clinical Trial: NCT06316804