1. In a cluster randomized trial, exposure to Eliminating the Stigma of Differences (ESD), a school-based mental illness curriculum intervention, was associated with increased positive knowledge and attitudes about mental illness and reduced social distance from peers with mental illness among middle school students over 2-year follow-up compared to comparator interventions and control.
2. Youth with high levels of mental health symptoms were significantly more likely to seek mental health treatment if exposed to ESD.
Evidence Rating Level: 2 (Good)
Study Rundown: Previous studies have demonstrated the harmful effects of stigma on youth with mental health problems, and schools are an important context in which stigma is enacted. Few studies have assessed the effectiveness of school-based curriculum interventions on stigma and treatment seeking with long follow-up. In this cluster randomized trial, researchers examined the effectiveness of ESD, a school-based mental illness curriculum, on stigma and treatment-seeking behavior compared to other interventions and no intervention among middle school students. Youth exposed to ESD reported significantly increase positive knowledge and attitudes about mental illness and reduced social distance from peers with mental illness throughout 2-year follow-up. Exposure to ESD was associated with increased odds for seeking mental health treatment among youth with high levels of mental health symptoms.
This study was limited by its use of self-reported data for attitudes about mental illness and treatment-seeking behaviors, and pre-intervention differences existed between groups despite cluster randomization. Furthermore, the study was limited to 1 school district in Texas. Nonetheless, the study is strengthened by its randomized design and comparison of ESD against other interventions in addition to comparison against control. For physicians, these findings highlight the importance of further design and study of school-based interventions to reduce stigma and increase treatment rates among youth with mental illness.
In-Depth [randomized controlled trial]: Researchers compared the effects of the curriculum intervention, Eliminating the Stigma of Differences, against a contact intervention, antistigma printed materials, and a no-intervention control on knowledge and positive attitudes about mental illness, social distance from peers with mental illness, and mental health treatment seeking among youth at 14 urban high schools in Texas. All interventions were administered by physical education teachers to sixth-grade students, who were followed at 6-month intervals through 24 months in 2011-2015. Schools were matched based on standardized test scores, and interventions were clustered randomized to classrooms in a fully crossed 2 x 2 x 2 factorial design.
Youth exposed to the ESD curriculum showed a significant increase in positive knowledge and attitudes about mental illness (P < .001) and a significant decrease in social distance from peers with mental illness (P < .05) compared to youth in the other groups. Assignment to the ESD curriculum was associated with increased odds of seeking mental health treatment (odds ratio [OR] = 3.90; 95% confidence interval [CI] = 1.09-13.87), after adjustment for demographic factors.
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