Intervention to Reduce Serious Mental Illness and Suicide Stigma Among Medical Students

Study Overview
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Brief Summary
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The team aims to develop and test the efficacy of a serious mental illness (SMI) and suicide ideation and attempt (SIA) stigma reduction intervention for medical students. The team expects that after intervention exposure, relative to control group, participants in the experimental condition will manifest more favorable change in knowledge, attitudes, and behaviors.

Detailed Description
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People with serious mental illness (PSMI; i.e. Schizophrenia and bipolar disorder) die, on average, 25 years earlier than the general population. Suicide is a key factor for this disparity as it is the leading cause of unnatural deaths among this population. Research identifies Latinos as a particularly vulnerable group, accounting for one of the highest rates (over 30%) of serious mental illness (SMI) among ethnic minorities in the United States (US). Latinos also hold one of the highest prevalence of suicide ideation and attempts (SIA) with rates of 10.1% and 4.4% respectively. This scenario worsens for one Latino subgroup, Puerto Ricans, who have the highest prevalence of SMI (36%) and SIA among Latinos in the US (7.9% and 3.5% respectively). Taken together, these facts present a concerning scenario for Latinos, especially Puerto Ricans with SMI/SIA. Health professionals play a key role in identifying SMI/SIA among patients; unfortunately, SMI/SIA stigma hinders this process. The proposed study aims to: 1) develop the content of an intervention to reduce SMI/SIA stigma among medical students, 2) determine the acceptability and feasibility of implementing the intervention among medical students by examining recruitment/screening procedures, participation/refusal/retention rates, and participant satisfaction, and; 3) pilot test the preliminary efficacy of the intervention in reducing SMI/SIA stigma among medical students by increasing knowledge of SMI and SIA, reducing negative attitudes towards SMI/SIA and increasing behavioral skills for providing healthcare to PSMI.

Official Title
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Reducing Serious Mental Illness and Suicide Stigma Among Medical Students

Conditions
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Stigmatization, Clinical Competence

Intervention / Treatment
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* Behavioral: SMI/SIA Stigma Reduction Intervention
* Other: Disaster Preparedness Course


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Medical student currently in third year of medical school training Exclusion Criteria: Do not speak English

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Stigma Reduction Intervention<br>Participants randomized to the experimental condition will receive the SMI/SIA Stigma Reduction Intervention. | Behavioral: SMI/SIA Stigma Reduction Intervention<br>* Online course designed to reduce stigma behaviors towards serious mental illness and suicide ideation and attempt among medical students. It aims to improve medical students' healthcare delivery skills.<br>|
| Other: Disaster Preparedness Course<br>Participants randomized to the control condition will receive a Disaster Preparedness Course, addressing the basics of natural disaster preparedness. | Other: Disaster Preparedness Course<br>* Online course designed to improve professionals' skills and competencies for engaging in disaster preparedness.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Increase from baseline in scores on the Behavioral Health Skills Inventory (BHSI) | This 29-item inventory assesses standardized patient simulation interactions including three behavioral components addressing general healthcare related behaviors, SMI related behaviors and SIA related behaviors. Scores range from 0 to 58, with higher numbers reflecting higher skills in healthcare service delivery for PSMI/SIA. | Baseline, immediately after intervention, 2 week follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Increase from baseline in scores on the Serious Mental Illness Literacy Scale | This adapted and pilot tested version of the Mental Health Literacy Scale, measures participants' knowledge regarding SMI. The Scale addresses the ability to recognize SMI including: Bipolar Disorder and Schizophrenia. The Scale is composed of two sections measuring SMI knowledge. The first is composed of 15 items (4-point Likert Scale) ranging from (1) very unlikely to (4) very likely. The second section is composed of 20 items using a 5-point Likert Scale ranging from (1) strongly disagree to (5) strongly agree. | Baseline, immediately after intervention, 2 week follow-up | 
| Increase from baseline in scores on the Literacy of Suicide Scale (LOSS) | This SIA knowledge measure is answered in a correct/incorrect/don't know format. The 27 items are rated on a 3-point scale (true, false, or I don't know), with correct responses allocated a score of 1 and incorrect or I don't know responses assigned a score of 0. Higher LOSS scores indicate higher suicide literacy. | Baseline, immediately after intervention, 2 week follow-up | 
| Decrease from baseline in scores on The Mental Health Stigma Scale for Health Professionals | Used to evaluate mental illness stigma among health professionals, including medical students. This 12-item measure uses a 5-point Likert from (1) strongly agree to (5) strongly disagree. It has three dimensions (social distance, negative character attributions, and self-sufficiency problems). | Baseline, immediately after intervention, 2 week follow-up | 
| Decrease from Stigma of Suicide Scale (Short Version) | This three-factor scale measures stigma towards people who die by suicide. This short version consists of 16-items. Each item consists of a one-word descriptor of a person who dies by suicide, rated on a 5-point Likert scale from (1) strongly disagree to (5) strongly agree. | Baseline, immediately after intervention, 2 week follow-up | 
| Decrease from baseline in scores on The Emotional Reactions Scale | This scale was adapted from the original Emotional Reactions to the Mentally Ill Scale to include a suicide ideation case. This 9-item scale includes two vignettes of a person with SIA to assess emotional reaction to the scenario. Each item is rated in a 5-point Likert scale. | Baseline, immediately after intervention, 2 week follow-up | 
| Increase from baseline in scores on the Cross-Cultural Care Scale (CCCS) | This adaptation of the Cross- Cultural Care Scale which assesses preparedness to treat diverse patient populations. This 19-item scale is rated in a 5-point Likert format. | Baseline, immediately after intervention, 2 week follow-up |