Reducing Depression-related Stigma and Increasing Treatment-seeking Among Adolescents: Randomized Controlled Trial of a Brief Video Intervention

Young people present with the higher prevalence of mental health disorders compared to individuals at any other age, with up to 20% of adolescents likely to experience mental health disorders. Around 50% of mental health conditions start before the age of 14 and the onset of 75% of cases is before the age of 18. Depression is the most common diagnosis and epidemiological studies suggest that at any one time 8% to 10% of adolescents have severe depression. This means that the major burden of assessing and managing adolescent depression falls on primary care practitioners. Depression is a principal cause of illness and disability in teenagers, and suicide is the third most common cause of death among older adolescents. Mental health problems can significantly affect the development of children and young people having an enduring impact on their health and social functioning in adulthood. However, 75% of adolescents with mental health problems are not in contact with mental health services,8 and the primary reason for the reluctance to seek help is stigma.

Stigma refers to negative beliefs and stereotypes held toward a specific group of people and adversely affects people with mental illness. Public stigma refers to negative attitudes and beliefs that motivate individuals to fear, reject, avoid, and discriminate against people with mental illness. Individuals with mental illness expect to face prejudice and discrimination (anticipated stigma) and internalize public stereotypes of people with mental illness (self-stigma). Adolescents are particularly aware of how others perceive them and care greatly about what their peers think of them. Public stigma toward youngsters with mental illness has been identified as a barrier to seeking help; therefore, reducing public stigma among young people at risk for or even experiencing depression could enhance their receptivity to seeking help or treatment.

Applying strategies to reduce stigma towards mental health care among adolescents with high levels of depression may prevent worsening of symptoms, ameliorate impaired functioning, and reduce risks for long-term psychiatric illness. Among possible strategies, studies19 have shown that social contact is the most effective type of intervention to reduce stigmatizing attitudes. Social contact involves interpersonal contact with members of the stigmatized group: members of the general public who meet and interact with individuals who suffer from depression are likely to lessen their stigma. Corrigan identified the most important ingredients of contact-based programs: an empowered presenter with lived experience who attains his/her goals (e.g., "I was able to fight the depression and go back to school"). Although direct, in-person social contact, as well as indirect, video-based social contact have effectively improved attitudes toward mental issues and care, the latter can be implemented on a larger scale, use minimal resources and be easily disseminated.

The purpose of this study is to: (1) examine adolescents' stigma-related attitudes towards depression; and (2) test the utility of a brief video-based intervention in reducing stigma towards depression and increasing help-seeking intentions.

The investigators propose to randomly assign 1,000 individuals aged 14-18 in to either: (a) brief video-based intervention 1 ('Video 1'); (b) brief video-based intervention 2 ('Video 2'); or (c) no intervention video control arm ('Control'). The intervention videos will focus on empowered presenters with depression. The presenters will be 16-year-old adolescent professional actors, one of them is a boy (Video 1), one is a girl (Video 2). They each will share his/her personal story regarding depression and describe how social support from family, friends, and professionals have helped them overcome their symptoms and recover. The third group will watch a same length video with unrelated contents. Assessments will occur at baseline and at post-intervention and will tap into demographic identifiers and attitudes around stigma and help-seeking questionnaires.