Honest Open Proud for Adolescents With Mental Illness

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

Detailed Description
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Both due to fear of public stigma and due to self-stigma or shame, people with mental illness may decide to keep their condition a secret or even to withdraw from other people altogether in order to minimise the risk of being labelled. Secrecy can help on the short term to protect individuals from public stigma, but often it has negative long-term consequences such as social isolation, distress and unemployment. 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 evaluate whether a group program run both by people with mental illness (peers) and professionals helps to reduce self-stigma and makes it easier for adolescents to handle the necessary choices related to secrecy versus disclosure.

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

Conditions
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Secrecy Versus Disclosure Among Adolescents With 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 (American Psychiatric Association, 2013), which is not restricted to only substance-related disorder(s) Age 13 to 18 Ability to provide written informed consent Fluid 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) 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: 13 Years
Maximum 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: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Honest Open Proud<br>The group program is about disclosure ('coming out') versus secrecy of one's mental illness. The groups are facilitated by peers (young adults with mental illness) and mental health professionals. Each group runs for three weeks, one meeting per week, and two hours per meeting. Fidelity to manual: rated by PhD student in each session as proportion of key topics covered | Behavioral: Honest Open Proud (HOP)<br>* five lessons in three modules, two for each two-hour session Considering pros and cons of disclosing: hurtful and helpful attitudes about mental illness identify beliefs participants hold about themselves explore five-step process to challenge their personally hurtful beliefs weigh pros and cons of coming out in order to facilitate a decision on whether to disclose Different ways to disclose: different levels of (non-) disclosure and how to weigh the cons and pros disclosure via social media versus disclosing face to face how to find people that are better to disclose to than others and how to 'test them out' participants will discuss how others might respond to their disclosure and how that will affect them Telling your story: how to tell one's story in a personally meaningful way, how to identify peers who might help with the coming out process, to review how telling one's story felt<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, Corrigan, Wassel et al., 2009; Rüsch, Corrigan, Powell et al., 2009) |  | 3 weeks (T1) | 
| Health-Related Quality of Life Questionnaire KIDSCREEN-10 Index, 10 items (Deighton et al., 2014; Ravens-Sieberer et al., 2010) |  | 6 weeks (T2) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Satisfaction with intervention questionnaire (according to Keller, Konopka, Fegert, & Naumann, 2003; own development) |  | 3 weeks | 
| Empowerment Scale, Subscales 'self-esteem' and 'control over the future', 13 items (Rogers, Chamberlin, Ellison, & Crean, 1997) |  | baseline, 3 and 6 weeks | 
| Attitudes to disclosure, 2 items (Rüsch, Evans-Lacko, Henderson, Flach, & Thornicroft, 2011) | 2 items on attitudes to disclosure, adapted from a UK Dept of Health survey (see above Rüsch et al 2011 reference for further details) with seven-point Likert scale | baseline, 3 and 6 weeks | 
| Disclosure Distress, 1 item (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 and 6 weeks | 
| Shame about having a mental illness, 1 item (Do you feel ashamed about having a mental illness?; from 1, not at all, to 7, very much) (Rüsch et al., 2014b) |  | baseline, 3 and 6 weeks | 
| General Help-Seeking Questionnaire, 1 item (Wilson et al., 2005) |  | baseline, 3 and 6 weeks | 
| Beck Hopelessness Scale (BHS), 4-item short version (Yip, Paul S F & Cheung, 2006) |  | baseline, 3 and 6 weeks | 
| Self-Stigma of Mental Illness Scale (SSMIS), Subscale 'self-concurrence', 5 items (Corrigan et al., 2012; Rüsch et al., 2006) |  | baseline, 3 and 6 weeks | 
| Self-Identified Stage of Recovery (SISR), 5 items (Andresen, Caputi, & Oades, 2010) | brief self-rated assessment of stage of recovery; consists of two parts (A & B): Part A reflects five statements about stages of recovery, participants have to choose one that best reflects their current experience. Part B consists of four statements reflecting recovery processes, rated on a six-point Likert scale | baseline, 3 and 6 weeks | 
| Internalised Stigma of Mental Illness Inventory (ISMI), 10-item short version (Boyd, Otilingam, & Deforge, 2014) |  | baseline, 3 and 6 weeks | 
| Social withdrawal and secrecy, 12 item-short version (Link et al., 2009) |  | baseline, 3 and 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stigma, Mental illness, adolescents, intervention, disclosure, secrecy