Reducing Depression Self-stigma and Increasing Treatment Seeking Intentions Among Youth

Study Overview
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Brief Summary
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Young people with depression, especially those of underserved minority groups, avoid treatment due to stigma and discrimination. Social contact is a form of interpersonal contact with members of the stigmatized group and the most effective type of intervention for improvement in stigma-related knowledge and attitudes. In a prior study, the investigators developed short video interventions to reduce stigma and increase treatment seeking among people with depression. The videos vary by protagonist race/ethnicity (Latinx, non-Latinx Black, non-Latinx White) who share their experiences with depression, challenges, and recovery process. The investigators would like to test the efficacy of these videos using Prolific (a crowdsourcing platform). Specifically, the investigators are interested in conducting a randomized controlled trial (RCT) to test the efficacy of these videos as compared to a vignette control condition on reducing self-stigma and increasing help-seeking intentions and behavior at baseline, post, and 30 day follow-up among youth with depressive symptom scores on the PHQ-9≥ 5.

Detailed Description
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In a randomized control trial (RCT) with pre-, post-intervention, and 30-day follow-up assessments, we aim to 1) test the efficacy of brief social video interventions, varying protagonist race/ethnicity, as compared to vignette control in reducing self-stigma and increasing treatment-seeking intentions and behavior among 1600 Prolific users ages 18-25 with depressive symptoms (PHQ-9≥ 5), and 2) explore whether matching to protagonist race/ethnicity increases intervention efficacy. We hypothesize that 1) Brief social contact-based video interventions will reduce self-stigma towards depression and increase treatment-seeking intentions and behavior compared to vignette control, and 2) The participants whose race/ethnicity match the protagonist will have greater changes in self-stigma and treatment-seeking than participants with unmatched protagonists, i.e., matching moderates the intervention's effects.

Official Title
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Reducing Self-stigma and Increasing Treatment Seeking Intentions Among Youth With Depressive Symptoms: A Mixed-methods Study

Conditions
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Stigma, Social, Mental Health Disorder, Depression

Intervention / Treatment
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* Behavioral: Brief video intervention (Black Woman)
* Behavioral: Brief video intervention (Latinx Woman)
* Behavioral: Brief video intervention (White Woman)
* Behavioral: Vignette Control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Endorsing mild to severe depressive symptoms (Patient Health Questionnaire (PHQ-9) score of 5 or greater) Ages 18-25 US Residents English speaking Exclusion Criteria: Not endorsing mild to severe depressive symptoms Age less than 18 or greater than 25

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 25 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: Brief video intervention (Black Woman)<br>A brief social contact-based video with a Black woman protagonist | Behavioral: Brief video intervention (Black Woman)<br>* A brief social contact-based video. The video presented a young Black woman in her early twenties, a professional actor, sharing her scripted personal story of struggles as a Black woman with depression and raising themes of recovery and hope.<br>|
| Experimental: Brief video intervention (Latinx Woman)<br>A brief social contact-based video with a Latinx woman protagonist | Behavioral: Brief video intervention (Latinx Woman)<br>* A brief social contact-based video. The video presented a young Latinx woman in her early twenties, a professional actor, sharing her scripted personal story of struggles as a Latinx woman with depression and raising themes of recovery and hope.<br>|
| Experimental: Brief video intervention (White Woman)<br>A brief social contact-based video with a White woman protagonist | Behavioral: Brief video intervention (White Woman)<br>* A brief social contact-based video. The video presented a young White woman in her early twenties, a professional actor, sharing her scripted personal story of struggles as a White woman with depression and raising themes of recovery and hope.<br>|
| Other: Vignette Control<br>A brief vignette control condition | Behavioral: Vignette Control<br>* A brief vignette control condition with a script about a young woman who describes her struggles with depression and raises themes of recovery and hope.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Depression Stigma | The Depression Stigma Scale (DSS) is a self-report scale comprised of two 9-item subscales measuring participants' personal beliefs about depression and participants' beliefs about others' attitudes (Griffiths et al., 2004). The current study will only utilize the personal beliefs subscale. Each item is rated on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). Scores range from 9 to 45. Higher scores indicate more stigma. | Baseline | 
| Depression Stigma | The Depression Stigma Scale (DSS) is a self-report scale comprised of two 9-item subscales measuring participants' personal beliefs about depression and participants' beliefs about others' attitudes (Griffiths et al., 2004). The current study will only utilize the personal beliefs subscale. Each item is rated on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). Scores range from 9 to 45. Higher scores indicate more stigma. | Post (immediately after the video or vignette control is shown) | 
| Depression Stigma | The Depression Stigma Scale (DSS) is a self-report scale comprised of two 9-item subscales measuring participants' personal beliefs about depression and participants' beliefs about others' attitudes (Griffiths et al., 2004). The current study will only utilize the personal beliefs subscale. Each item is rated on a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). Scores range from 9 to 45. Higher scores indicate more stigma. | 30 day follow-up | 
| Attitude Towards Seeking Professional Psychological Help | Treatment seeking intentions will be measured using three items from the Attitudes Towards Seeking Professional Psychological Help Scale (ATSPPHS) Scale (Elhai et al., 2008). Items include: 'I might want to have psychological counselling in the future', 'I would want to get psychological help if I were worried or upset for a long period of time' and 'A person with an emotional problem is not likely to solve it alone; he or she is more likely to solve it with professional help'. Responses range from 1 (disagree) to 4 (agree). Total scores range from 3 to 12 with higher scores indicating higher treatment seeking intentions. | Baseline | 
| Attitude Towards Seeking Professional Psychological Help | Treatment seeking intentions will be measured using three items from the Attitudes Towards Seeking Professional Psychological Help Scale (ATSPPHS) Scale (Elhai et al., 2008). Items include: 'I might want to have psychological counselling in the future', 'I would want to get psychological help if I were worried or upset for a long period of time' and 'A person with an emotional problem is not likely to solve it alone; he or she is more likely to solve it with professional help'. Responses range from 1 (disagree) to 4 (agree). Total scores range from 3 to 12 with higher scores indicating higher treatment seeking intentions. | Post (immediately after the video or vignette control is shown) | 
| Attitude Towards Seeking Professional Psychological Help | Treatment seeking intentions will be measured using three items from the Attitudes Towards Seeking Professional Psychological Help Scale (ATSPPHS) Scale (Elhai et al., 2008). Items include: 'I might want to have psychological counselling in the future', 'I would want to get psychological help if I were worried or upset for a long period of time' and 'A person with an emotional problem is not likely to solve it alone; he or she is more likely to solve it with professional help'. Responses range from 1 (disagree) to 4 (agree). Total scores range from 3 to 12 with higher scores indicating higher treatment seeking intentions. | 30 day follow-up | 
| Treatment related stigma | Treatment-related stigma will be measured with the Self-Stigma of Seeking Help scale (SSOSH-3) (Brenner et al., 2021). Items include I would feel inadequate if I went to a therapist for psychological help, It would make me feel inferior to ask a therapist for help, and If I went to a therapist, I would be less satisfied with myself. Response range from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 3 to 15, with higher scores indicating greater stigma. | Baseline | 
| Treatment related stigma | Treatment-related stigma will be measured with the Self-Stigma of Seeking Help scale (SSOSH-3) (Brenner et al., 2021). Items include I would feel inadequate if I went to a therapist for psychological help, It would make me feel inferior to ask a therapist for help, and If I went to a therapist, I would be less satisfied with myself. Response range from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 3 to 15, with higher scores indicating greater stigma. | Post (immediately after the video or vignette control is shown) | 
| Treatment related stigma | Treatment-related stigma will be measured with the Self-Stigma of Seeking Help scale (SSOSH-3) (Brenner et al., 2021). Items include I would feel inadequate if I went to a therapist for psychological help, It would make me feel inferior to ask a therapist for help, and If I went to a therapist, I would be less satisfied with myself. Response range from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 3 to 15, with higher scores indicating greater stigma. | 30 day follow-up | 
| Actual help-seeking | One item will be utilized to measure actual help-seeking: Over the past 30 days, did you contact the mental health referrals we have provided or have sought out mental health treatment elsewhere? | 30 day follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Emotional engagement | Emotional engagement will be measured using the Emotional Engagement Scale (de Vreede et al., 2019). The scale includes three items asking about emotional engagement (e.g., I care about the contents of this video), and response choices range from 1 (strongly disagree) to 4 (strongly agree). Total scores range from 3 to 12, with higher scores indicating greater emotional engagement. | Post (immediately after the video or vignette control is shown) |