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

描述（由申请人提供）：我们提出了一个以学校为基础的实地实验，以评估一个全面的多方面的干预，旨在改变态度和行为的精神疾病在青春期早期的关键时期。研究表明，耻辱和歧视在精神疾病患者及其家人的生活中令人痛苦，阻碍了机会，损害了自尊，使人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，以全面的方式解决这些问题，这种方式要以研究为依据，并适合于实施干预措施的生态环境。针对这一关键需求，拟议的项目寻求对六年级的综合干预进行严格的测试，并进行长期随访，该干预旨在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）促进寻求心理健康问题的适当帮助。具体而言，我们评估了多组分干预的三个臂的单独和组合效应，包括：1）积极吸引青年人了解精神疾病、改变消极态度和解决消极情绪的课程（例如恐惧），2）有机会在学校与精神病患者接触，以及3）关于精神疾病的积极信息和线索的上下文饱和。评估分两个阶段进行，第一阶段评估了800名青少年在8单元（2x2x2）设计中排列的完全交叉设计中干预前后对精神疾病的知识、态度和信念的变化。第2阶段涉及在6个月、12个月和24个月时对同一青年（N=xxx）分层随机样本进行长期随访，该样本对有心理健康问题的青年进行过采样。第二阶段将1）评估干预对知识，态度和信仰的长期影响，2）评估研究参与者经历，交付或观察到的对精神疾病患者的行为，以及3）检查当经历心理健康问题时是否会寻求帮助。干预部分有效性的证据将为公共心理健康提供急需的工具，以解决精神疾病患者所经历的耻辱和歧视等关键问题。 公共卫生相关性：研究表明，耻辱和歧视在精神疾病患者及其家人的生活中令人痛苦，阻碍了机会，损害了自尊，使人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，全面解决这些问题。我们提出了一个以学校为基础的实地实验，以评估一个全面的多方面的干预，旨在改变对精神疾病的态度和行为在青春期早期的关键时期。

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. PUBLIC HEALTH RELEVANCE: Research shows 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. 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.