Honest, Open, Proud for Soldiers With Mental Illness

Study Overview
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Brief Summary
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The purpose of the study is to evaluate the feasibility and efficacy of the group-based intervention Honest, Open, Proud among soldiers with mental illness.

Detailed Description
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Soldiers with mental illness typically face a two-fold problem. On the one hand, they have to cope with the symptoms of their mental illness; on the other hand, they often have to deal with stigma and discrimination. Both due to fear of public stigma and due to self-stigma or shame, soldiers with mental illness may decide to keep their condition a secret or even to withdraw from other people altogether in order to minimize the risk of being labeled. Secrecy can help on the short term to protect individuals from public stigma, but usually it has negative long-term consequences such as social isolation, distress and avoidance of help-seeking. Disclosure, on the other hand, carries the risk to be discriminated by others, but can reduce the burden of secrecy, lead to support by others and reduce public stigma. In this study investigators aim to test the efficacy (see our outcomes above) of Honest, Open, Proud run by soldiers with lived experience of mental illness.

Official Title
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Adaptation and Evaluation of the Honest, Open, Proud Program for Soldiers With Mental Illness

Conditions
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Mental Illness

Intervention / Treatment
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* Behavioral: Honest, Open, Proud (HOP)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: At least one self-reported current axis I or axis II disorder according to DSM-5, which is not restricted to only substance-related disorder(s) Age 18 or above Ability to provide written informed consent Fluent in German (needed for self-report measures) At least a moderate level of self-reported disclosure-related distress/difficulty (score 4 or higher on the screening item 'In general, how distressed or worried are you in terms of secrecy or disclosure of your mental illness to others?', rated from 1, not at all, to 7, very much) Current inpatient, day-clinic or outpatient treatment at the Center for Military Mental Health, Berlin, Germany from April 2018 onwards we decided to also include non-military first responders (fire fighters or police officers) who are treated in the Center for Military Mental Health, Berlin, Germany Exclusion Criteria: Self-reported diagnosis of only a substance- or alcohol-related disorder, without non-substance related current psychiatric comorbidity. We will exclude people who only have a substance-/alcohol-related disorder because the disclosure of these disorders is not the topic of the HOP intervention Intellectual disability Organic disorders

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Honest, Open, Proud<br>The group program is about disclosure versus secrecy of one's mental illness. The groups are facilitated by two peers (soldiers with lived experience of mental illness). Each group runs for three weeks, one meeting per week, and two hours per meeting. There is one 2-hour booster session in week 6. Fidelity to manual: rated by a research assistant who is present during the group session | Behavioral: Honest, Open, Proud (HOP)<br>* Three lessons, one for each two-hour session plus one booster session Considering the pros and cons of disclosure: Discussion of one's idea of identity and mental illness, weighing the costs and benefits of (non-) disclosure Different ways to disclose: Discussion of different levels of (non-) disclosure, considering costs and benefits of each level, selecting persons to disclose to and how to test them out, anticipating responses of others to one's disclosure Telling one's story: Practice how to tell one's story, identifying peers who might be helpful with the coming out process Booster session Reviewing previous intentions to disclose one's mental illness, discussion whether one disclosed and evaluating this experience<br>* Other names: Coming Out Proud (COP);|
| No Intervention: Control group<br>Treatment as usual (TAU) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Stigma Stress Scale, 8 items | (Rüsch et al. 2009a; Rüsch et al. 2009b) | 3 weeks (T1) | 
| WHOQoL BREF; Domain psychological quality of life, 6 items | (WHOQoL Group 1998) | 6 weeks (T2) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Empowerment Scale, Subscale 'Self-esteem', 9 items | (Rogers et al. 1997) | baseline, 3, 6 and 12 weeks (T3) | 
| Psychological Well-Being Scale, 18 items | (Ryff 1989) | baseline, 3, 6 and 12 weeks | 
| Internalized Stigma of Mental Illness Inventory, Brief Version, 10 items | (Boyd et al. 2014) | baseline, 3, 6 and 12 weeks | 
| Self-Stigma of Mental Illness Scale, Short Version, subscale Self-Concurrence, 5 items | (Corrigan et al. 2012) | baseline, 3, 6 and 12 weeks | 
| Secrecy and Social Withdrawal subscales of the Stigma Coping Orientation Scales, 12 items | (Link et al. 1991) | baseline, 3, 6 and 12 weeks | 
| Disclosure related distress (In general, how distressed or worried are you in terms of secrecy or disclosure of your mental illness to others?', from 1, not at all, to 7, very much) | (Rüsch et al. 2014a) | baseline, 3, 6 and 12 weeks | 
| WHOQoL-BREF, 26 items | (WHOQOL Group 1998) | 3, 6 and 12 weeks | 
| Patient Health Questionnaire (PHQ-9), 9 items | (Kroenke et al. 2001) | baseline, 3, 6 and 12 weeks | 
| Shame about having a mental illness, 1 item | (Rüsch et al. 2014b) | baseline, 3, 6 and 12 weeks | 
| Attitudes to help-seeking, 2 items | (Rüsch et al. 2013) | baseline, 3, 6 and 12 weeks | 
| Attitudes to disclosure, 2 items | (Rüsch et al. 2011) | baseline, 3, 6 and 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Mental illness, Disclosure, stigma, soldiers, secrecy