Honest, Open, Proud for adolescents with mental illness: pilot randomized controlled trial

Nadine Mulfinger; Sabine Müller; Isabel Böge; Vehbi Sakar; Patrick W Corrigan; Sara Evans-Lacko; Luise Nehf; Julia Djamali; Anna Samarelli; Michael Kempter; Christian Ruckes; Gerhard Libal; Nathalie Oexle; Michele Noterdaeme; Nicolas Rüsch

doi:10.1111/jcpp.12853

Honest, Open, Proud for adolescents with mental illness: pilot randomized controlled trial

J Child Psychol Psychiatry. 2018 Jun;59(6):684-691. doi: 10.1111/jcpp.12853. Epub 2017 Dec 5.

Authors

Affiliations

¹ Department of Psychiatry II, Ulm University and BKH Günzburg, Germany.
² Department of Child and Adolescent Psychiatry, University Hospital Ulm, Ulm, Germany.
³ Department of Child and Adolescent Psychiatry, Centre for Psychiatry Ravensburg-Weissenau, Ravensburg, Germany.
⁴ Department of Child and Adolescent Psychiatry, Josefinum, Augsburg, Germany.
⁵ Illinois Institute of Technology, Chicago, IL, USA.
⁶ London School of Economics and Political Science, London, UK.
⁷ Interdisciplinary Centre for Clinical Trials (IZKS), Mainz, Germany.
⁸ Independent Child and Adolescent Psychiatry Outpatient Practice, Ulm, Germany.

PMID: 29205343
DOI: 10.1111/jcpp.12853

Abstract

Background: Due to public stigma or self-stigma and shame, many adolescents with mental illness (MI) struggle with the decision whether to disclose their MI to others. Both disclosure and nondisclosure are associated with risks and benefits. Honest, Open, Proud (HOP) is a peer-led group program that supports participants with disclosure decisions in order to reduce stigma's impact. Previously, HOP had only been evaluated among adults with MI.

Methods: This two-arm pilot randomized controlled trial included 98 adolescents with MI. Participants were randomly assigned to HOP and treatment as usual (TAU) or to TAU alone. Outcomes were assessed pre (T0/baseline), post (T1/after the HOP program), and at 3-week follow-up (T2/6 weeks after T0). Primary endpoints were stigma stress at T1 and quality of life at T2. Secondary outcomes included self-stigma, disclosure-related distress, empowerment, help-seeking intentions, recovery, and depressive symptoms. The trial is registered on ClinicalTrials (NCT02751229; http://www.clinicaltrials.gov).

Results: Compared to TAU, adolescents in the HOP program showed significantly reduced stigma stress at T1 (d = .92, p < .001) and increased quality of life at T2 (d = .60, p = .004). In a longitudinal mediation model, the latter effect was fully mediated by stigma stress reduction at T1. HOP further showed significant positive effects on self-stigma, disclosure-related distress, secrecy, help-seeking intentions, attitudes to disclosure, recovery, and depressive symptoms. Effects at T1 remained stable or improved further at follow-up. In a limited economic evaluation HOP was cost-efficient in relation to gains in quality of life.

Conclusions: As HOP is a compact three-session program and showed positive effects on stigma and disclosure variables as well as on symptoms and quality of life, it could help to reduce stigma's negative impact among adolescents with MI.

Keywords: Coming Out Proud; Honest, Open, Proud; Randomized controlled trial; adolescents; disclosure; mental illness; secrecy.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Depression / psychology*
Disclosure*
Female
Follow-Up Studies
Germany
Humans
Male
Mental Disorders / psychology*
Patient Acceptance of Health Care / psychology*
Pilot Projects
Psychotherapy / methods*
Quality of Life / psychology*
Social Stigma*
Stress, Psychological / therapy*
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT02751229