A School-Based Intervention to Reduce Stigma & Promote Mental-Health Service Use

描述（由申请人提供）：我们提出了一项以学校为基础的实地实验，以评估旨在改变青少年早期关键时期对精神疾病的态度和行为的综合多方面干预。研究表明，耻辱和歧视痛苦地存在于精神疾病患者及其家人的生活中，阻碍了他们的机会，损害了他们的自尊，使他们无法获得有益的治疗。旨在解决这些关键问题的努力只取得了有限的成功，这表明需要采取新的办法，以综合的方式解决这些问题，这种方式应以研究为依据，并适合实施干预的生态环境。为了响应这一关键需求，拟议的项目寻求一项严格的测试，并进行长期随访，对六年级学生进行全面干预，旨在1)提高对精神疾病的知识，态度和信念，2)改变对精神疾病患者的行为，3)促进寻求精神健康问题的适当帮助。具体来说，我们评估了多成分干预的三个方面的单独和综合效果，包括：1)积极吸引青少年了解精神疾病的课程，改变消极态度和处理消极情绪（如恐惧），2)与患有精神疾病的人在学校接触的机会，以及3)积极信息和线索的背景饱和。评估分为两个阶段，第一阶段评估了干预前后对精神疾病的知识、态度和信念的变化，该评估采用全交叉设计，对800名青少年进行了8单元（2x2x2）设计。第二阶段包括在6个月、12个月和24个月的时间里，对同一青年（N=xxx）进行分层随机抽样，对有精神健康问题的青年进行抽样调查。第2阶段将1)评估干预对知识、态度和信念的长期影响，2)评估研究参与者对精神疾病患者的经历、传递或观察的行为，以及3)检查当经历精神健康问题时是否会寻求帮助。干预措施有效性的证据将为公共精神卫生提供一种工具，它迫切需要解决精神疾病患者所经历的耻辱和歧视的关键问题。

DESCRIPTION (provided by applicant): We propose a school-based field experiment to evaluate a comprehensive multifaceted intervention designed to change attitudes and behaviors regarding mental illnesses during the critical period of early adolescence. Research has documented that stigma and discrimination are painfully present in the lives of people with mental illnesses and their families, blocking opportunities, compromising self-esteem and keeping people from accessing helpful treatments. Efforts designed to address these critical issues have produced only limited success, suggesting the need for new approaches that address these problems in a comprehensive fashion that is informed by research and suited to the ecological circumstances in which the intervention will be implemented. Responding to this critical need, the proposed project seeks a rigorous test, with long term follow-up, of a comprehensive intervention in sixth grade that is designed to 1) improve knowledge attitudes and beliefs about mental illnesses, 2) change behaviors toward people with mental illnesses and 3) facilitate appropriate help seeking for mental health problems. Specifically, we evaluate the individual and combined effects of three arms of a multi-component intervention that includes: 1) a curriculum that actively engages youth to learn about mental illnesses, alter negative attitudes and address negative emotions (e.g. fear), 2) an opportunity for school-based contact with a person who has had a mental illness, and 3) a saturation of the context with positive messages and cues about mental illnesses. Achieved in two phases, Phase 1 of the evaluation assesses changes in knowledge, attitudes and beliefs about mental illnesses before and after the intervention in a fully crossed design of 800 youths arrayed in an 8-cell (2x2x2) design. Phase 2 involves a long-term follow-up at 6, 12 and 24 months of a stratified random sample of the same youth (N=xxx) that oversamples youth with mental health problems. Phase 2 will 1) evaluate the long term effects of the intervention on knowledge, attitudes and beliefs, 2) assess behaviors toward people with mental illnesses that are experienced, delivered or observed by study participants, and 3) examine whether help seeking occurs when mental health problems are experienced. Evidence of effectiveness for intervention components will provide public mental health with a tool it sorely needs to address the critical problems of stigma and discrimination experienced by people with mental illnesses.