“It Is Hard to Be a Woman With Schizophrenia”: Randomized Controlled Trial of a Brief Video Intervention to Reduce Public Stigma in Young Adults

Doron Amsalem, MD; Samantha E. Jankowski, MA; Shannon Pagdon, BA; Linda Valeri, PhD; Stephen Smith, PhD; Lawrence H. Yang, PhD; John C. Markowitz, MD, PhD; Roberto Lewis-Fernández, MD; Lisa B. Dixon, MD, MPH

J Clin Psychiatry 2023;84(1):22m14534

ABSTRACT

Objective: Women with schizophrenia encounter specific gender-related stressors that may affect their recovery process. They are more susceptible to victimization and tend to experience more shame and stigma about their illness. Confronting stigma early in the illness could enhance treatment seeking. No studies have examined the efficacy of stigma-reducing interventions focused on public stigma toward women living with schizophrenia or have tested the effect of gender-specific content therein.

Methods: We compared the efficacy at post-intervention and 30-day follow-up of 2 brief (~80-second) videos, with and without gender-related content, and a non-intervention control, in 1,181 young adults, between September and November 2021. The videos feature an empowered young woman living with schizophrenia who describes struggling with her psychotic illness to attain recovery and hope.

Results: A 3 × 3 group-by-time analysis of variance showed decreased mean stigma scores over time in the two intervention arms relative to controls across all 5 public stigma domains: social distance (F = 17.1, P < .001), stereotyping (F = 25.0, P < .001), separateness (F = 8.3, P < .001), social restriction (F = 16.6, P < .001), and perceived recovery (F = 7.8, P < .001). Linear mixed modeling showed a greater intervention effect for women in the gender-related video group in social distance, stereotyping, and separateness.

Conclusions: Greater stigma reduction among women in the gender-related video group underscores the importance of tailoring the narrative to specific experiences related to socio-demographic characteristics, especially among members of marginalized groups. This attenuation may result in greater identification and solidarity with the presenter. Future studies should explore other socially oppressed groups, including Black, Latinx, Asian, and LGBTQ+ communities.

Continue Reading...

Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Purchase PDF for $40

Members enjoy free PDF downloads on all articles. Join today

References (39)

James SL, Abate D, Abate KH, et al; GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–1858. PubMed CrossRef
McGrath J, Saha S, Chant D, et al. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev. 2008;30(1):67–76. PubMed CrossRef
Ochoa S, Usall J, Cobo J, et al. Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. Schizophr Res Treatment. 2012;2012:916198. PubMed CrossRef
Seeman MV. Women and schizophrenia: new findings. Neuropsychiatry (London). 2013;3(4):423–431. CrossRef
Jeffery D, Clement S, Corker E, et al. Discrimination in relation to parenthood reported by community psychiatric service users in the UK: a framework analysis. BMC Psychiatry. 2013;13(1):120. PubMed CrossRef
Chernomas WM, Clarke DE, Chisholm FA. Perspectives of women living with schizophrenia. Psychiatr Serv. 2000;51(12):1517–1521. PubMed CrossRef
Manuel JI, Hinterland K, Conover S, et al. “I hope I can make it out there”: perceptions of women with severe mental illness on the transition from hospital to community. Community Ment Health J. 2012;48(3):302–308. PubMed CrossRef
Goffman E. Stigma: Notes on the Management of Spoiled Identity. Simon and Schuster; 2009.
Parcesepe AM, Cabassa LJ. Public stigma of mental illness in the United States: a systematic literature review. Adm Policy Ment Health. 2013;40(5):384–399. PubMed CrossRef
Thornicroft G, Brohan E, Rose D, et al; INDIGO Study Group. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet. 2009;373(9661):408–415. PubMed CrossRef
Corrigan PW, Watson AC. The paradox of self-stigma and mental illness. Clin Psychol Sci Pract. 2002;9(1):35–53. CrossRef
Fox AB, Earnshaw VA, Taverna EC, et al. Conceptualizing and measuring mental illness stigma: The mental illness stigma framework and critical review of measures. Stigma Health. 2018;3(4):348–376. PubMed CrossRef
Henderson C, Evans-Lacko S, Thornicroft G. Mental illness stigma, help seeking, and public health programs. Am J Public Health. 2013;103(5):777–780. PubMed CrossRef
Angermeyer MC, van der Auwera S, Carta MG, et al. Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta-analysis of population surveys. World Psychiatry. 2017;16(1):50–61. PubMed CrossRef
Borba CPC, Depadilla L, Druss BG, et al. A day in the life of women with a serious mental illness: a qualitative investigation. Womens Health Issues. 2011;21(4):286–292. PubMed CrossRef
Rice E. The invisibility of violence against women diagnosed with schizophrenia: a synthesis of perspectives. ANS Adv Nurs Sci. 2008;31(2):E9–E21. PubMed CrossRef
Firmin RL, Zalzala AB, Hamm JA, et al. How psychosis interrupts the lives of women and men differently: a qualitative comparison. Psychol Psychother. 2021;94(3):704–720. PubMed CrossRef
Oexle N, Corrigan PW. Understanding mental illness stigma toward persons with multiple stigmatized conditions: implications of intersectionality theory. Psychiatr Serv. 2018;69(5):587–589. PubMed CrossRef
Corrigan PW, Michaels PJ, Vega E, et al. Key ingredients to contact-based stigma change: a cross-validation. Psychiatr Rehabil J. 2014;37(1):62–64. PubMed CrossRef
Thornicroft G, Mehta N, Clement S, et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet. 2016;387(10023):1123–1132. PubMed CrossRef
Mehta N, Clement S, Marcus E, et al. Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review. Br J Psychiatry. 2015;207(5):377–384. PubMed CrossRef
Reinke RR, Corrigan PW, Leonhard C, et al. Examining two aspects of contact on the stigma of mental illness. J Soc Clin Psychol. 2004;23(3):377–389. CrossRef
Corrigan P, Michaels PJ, Morris S. Do the effects of antistigma programs persist over time? findings from a meta-analysis. Psychiatr Serv. 2015;66(5):543–546. PubMed CrossRef
Janoušková M, Tušková E, Weissová A, et al. Can video interventions be used to effectively destigmatize mental illness among young people? a systematic review. Eur Psychiatry. 2017;41(1):1–9. PubMed CrossRef
Amsalem D, Markowitz JC, Jankowski SE, et al. Sustained effect of a brief video in reducing public stigma toward individuals with psychosis: a randomized controlled trial of young adults. Am J Psychiatry. 2021;178(7):635–642. PubMed CrossRef
Amsalem D, Yang LH, Jankowski S, et al. Reducing stigma toward individuals with schizophrenia using a brief video: a randomized controlled trial of young adults. Schizophr Bull. 2021;47(1):7–14. PubMed CrossRef
Amsalem D, Valeri L, Jankowski SE, et al. Reducing public stigma toward individuals with psychosis across race and gender: A randomized controlled trial of young adults. Schizophr Res. 2022;243:195–202. PubMed CrossRef
Hopmeyer A, Medovoy T. Emerging adults’ self-identified peer crowd affiliations, risk behavior, and social–emotional adjustment in college. Emerg Adulthood. 2017;5(2):143–148. CrossRef
Moses T. Self-labeling and its effects among adolescents diagnosed with mental disorders. Soc Sci Med. 2009;68(3):570–578. PubMed CrossRef
Peer E, Brandimarte L, Samat S, et al. Beyond the Turk: alternative platforms for crowdsourcing behavioral research. J Exp Soc Psychol. 2017;70:153–163. CrossRef
Palan S, Schitter C. Prolific.ac—a subject pool for online experiments. J Behav Exp Finance. 2018;17:22–27. CrossRef
Boyd JE, Katz EP, Link BG, et al. The relationship of multiple aspects of stigma and personal contact with someone hospitalized for mental illness, in a nationally representative sample. Soc Psychiatry Psychiatr Epidemiol. 2010;45(11):1063–1070. PubMed CrossRef
Phelan JC. Geneticization of deviant behavior and consequences for stigma: the case of mental illness. J Health Soc Behav. 2005;46(4):307–322. PubMed CrossRef
Pescosolido BA, Monahan J, Link BG, et al. The public’s view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. Am J Public Health. 1999;89(9):1339–1345. PubMed CrossRef
Corrigan PW, Salzer M, Ralph RO, et al. Examining the factor structure of the Recovery Assessment Scale. Schizophr Bull. 2004;30(4):1035–1041. PubMed CrossRef
Covarrubias I, Han M. Mental health stigma about serious mental illness among MSW students: social contact and attitude. Soc Work. 2011;56(4):317–325. PubMed CrossRef
Chan SKW, Lee KW, Hui CLM, et al. Gender effect on public stigma changes towards psychosis in the Hong Kong Chinese population: a comparison between population surveys of 2009 and 2014. Soc Psychiatry Psychiatr Epidemiol. 2017;52(3):259–267. PubMed CrossRef
Wong EC, Collins RL, Cerully JL, et al. Effects of contact-based mental illness stigma reduction programs: age, gender, and Asian, Latino, and White American differences. Soc Psychiatry Psychiatr Epidemiol. 2018;53(3):299–308. PubMed CrossRef
Perinelli E, Gremigni P. Use of social desirability scales in clinical psychology: a systematic review. J Clin Psychol. 2016;72(6):534–551. PubMed CrossRef