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

描述(申请人提供)：我们提出了一项基于学校的现场实验，以评估旨在改变青春期早期关键时期对精神疾病的态度和行为的综合、多方面的干预措施。研究证明，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，阻碍了机会，损害了自尊，使人们无法获得有用的治疗。旨在解决这些关键问题的努力只取得了有限的成功，这表明有必要采取新的办法，以全面的方式解决这些问题，并从研究中了解情况，并适应将实施干预措施的生态环境。针对这一迫切需求，该项目寻求对六年级的综合干预进行严格的测试，并进行长期跟踪，旨在1)改善有关精神疾病的知识、态度和信念，2)改变对精神疾病患者的行为，3)促进对精神健康问题的适当帮助。具体地说，我们评估多成分干预的三个方面的单独和综合效果，其中包括：1)积极让年轻人学习精神疾病、改变负面态度和解决负面情绪(例如恐惧)的课程，2)有机会与患有精神疾病的人进行基于学校的接触，以及3)背景饱和，提供关于精神疾病的积极信息和提示。评估分两个阶段完成，第一阶段评估干预前后对精神疾病的知识、态度和信念的变化，采用完全交叉设计，800名年轻人按8细胞(2x2x2)设计排列。第二阶段包括对同一青年(N=xxx)进行分层随机抽样，在6个月、12个月和24个月进行长期随访，对有心理健康问题的青年进行过抽样。第二阶段将1)评估干预对知识、态度和信念的长期影响，2)评估研究参与者经历、传递或观察到的对精神疾病患者的行为，3)检查当经历心理健康问题时是否发生求助。干预部分有效性的证据将为公共精神卫生提供其迫切需要的工具，以解决精神疾病患者所经历的污名和歧视等严重问题。

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.