Mental Disorders
Conditions
Keywords
Stigma, Community Integration
Brief summary
We are conducting a randomized clinical trial (RCT) comparing the 10-week peer-led Photovoice program to services as usual (SAU) at a large publicly funded community mental health agency in Massachusetts. The control SAU condition will be enhanced with a 60-minute peer-led group educational session about understanding and coping with prejudice and discrimination. The 10-session, peer-led Photovoice program, designed to empower individuals with serious mental illness (SMI) to confront public prejudice and discrimination and reduce personal stigma (self-stigma and perceived stigma), was developed and pilot tested at our Center, with primary contributions from staff with a lived experience of mental illness. Development of the Photovoice program was guided by an adaptation of the stress-coping model, informed by recent research and conceptualizations of the effects of stigma on people with SMI. The stress-coping model explicates the mechanisms by which public stigma about mental illness can lead to personal stigma, which in turn has a negative impact on the person's mental health and psychosocial functioning. This model also identifies critical factors that contribute to personal stigma or protect against it, as well as more vs. less adaptive coping responses, that are the primary focus of the Photovoice program.
Detailed description
We are conducting a RCT comparing the 10-week peer-led Photovoice program to services as usual (SAU) enhanced with a 60-minute peer-led group discussion session. The RCT will be at a large publicly funded community mental health agency in Massachusetts. A total of 192 participants or 96 participants per group will be recruited over a period of 36 months across the three clubhouses of the agency where the intervention will take place. We plan to have randomization cohorts of 16 individuals per delivery of the Photovoice program at each of the three clubhouses. Given the projected sample size of 192 participants, we will have 12 randomization cohorts - 4 at each clubhouse implemented at 6-month intervals. Participants will be randomized to either the Photovoice program (plus usual services) or the enhanced SAU. Participants will be assessed by a blinded rater at baseline, post-treatment, 3-month and 6-month follow-ups on a range of primary and secondary outcomes related to personal stigma, coping, and functioning. Primary analyses will test the hypotheses that the Photovoice program will lead to significantly greater reductions in self-stigma and perceived stigma, greater improvements in proactive coping with psychiatric prejudice and discrimination, and greater improvements in community functioning and integration than the enhanced SAU. Secondary analyses will evaluate whether the Photovoice program leads to greater gains than SAU in psychological adjustment, including wellbeing, personal growth and recovery. Individuals randomized to the enhanced SAU will be able to join the 10-week Photovoice program once they complete their 6-month follow up for the study.
Interventions
BEHAVIORALPhotovoice
The 10-session, peer-led Photovoice program, designed to empower individuals with SMI to confront public prejudice and discrimination and reduce personal stigma (self-stigma and perceived stigma), was developed and pilot tested at our Center, with primary contributions from staff with a lived experience of mental illness. In the Photovoice sessions, participants will be given a workbook titled Combating Prejudice and Discrimination through Photovoice Empowerment. Peer leaders will facilitate discussions based on topics in the workbook. Participants will be given cameras and guidance on taking pictures and writing narratives descriptions about the pictures, specifically the ways in which the pictures relate to experiences of prejudice and discrimination.
BEHAVIORALEnhanced Control
The control SAU condition will be enhanced with a 60-minute peer-led manualized educational group session (Leaders' Guidelines and Handout for Participants are attached). It will provide participants with information about the nature of stigma and the laws in the U.S. that protect people with disabilities from discrimination. Participants will be engaged in a discussion about their use of different strategies for proactive coping with psychiatric stigma. This session will be co-led by the same peers who will be delivering the Photovoice program to the experimental group at relevant wave and study sites. Participants randomized to the enhanced Services as Usual control condition will be invited to join a Photovoice group once they complete the final 6-month follow-up assessment.
Sponsors
Boston University Charles River Campus
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18years and older * Diagnosis of serious mental illness * Receiving services at agency where study is taking place * Willing and able to give written consent * Conversant in English
Exclusion criteria
* Prior exposure to Photovoice * Cognitive disability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Temple University Community Participation Scale, Change in Community Participation | Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment | is a 26 item instrument measuring frequency of participation and importance of various community activities (e.g., movies, library). Test-retest reliability is .7 and internal consistency is .9. Higher scores are better. We provide below the results for cumulative days of participation in the last 30 days across the 26 activities included in the measure (tcpm\_days\_participated). The possible range for this measure is 0-780. |
| Internalized Stigma of Mental Illness Scale, Change in Internalized Stigma | Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment | a 29-item, 4-point scale (strongly disagree to strongly agree) assesses behaviors, thoughts and feelings that are self-stigmatizing and includes alienation, stereotype endorsement, discriminatory experiences, social withdrawal, and stigma resistance subscales. Internal consistency is .9 and test-retest reliability is .92. Lower scores are better. The scale score is the average score on the 29 items, which are scored from 1-4. Lower scores signify less internalized stigma. |
| Approaches to Coping With Stigma, Change in Coping With Stigma | Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment | is a 27-item, 4-point scale ranging from 1-4 (strongly disagree to strongly agree) measuring strategies to cope with stigma: secrecy, withdrawal, distancing, educating others, and challenging others. The average score of the items in the first three subscales will represent the index for Avoidant Coping and the average score of the items in the last two subscales - the index for Proactive Coping with Stigma. Internal consistency for subscales range: .63-.84. Lower scores are better on Avoidant Coping and higher scores are better on Proactive Coping. |
| The Stigma Scale, Change in Perceptions of Stigma | Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment | is a 28 item, 5 point scale ranging from 0-4 (strongly disagree to strongly agree) measuring experienced and anticipated stigma. Internal consistency ranges from .85-.87 and test-retest reliability from .4 to .7. The scale score is the average score on all items. Lower scores are better. |
| Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment | This is a 21 item, semi-structured interview-based, rating of an individual's psycho-social functioning and satisfaction with various life domains. The score on each item ranges from 0-6 with higher scores indicating better functioning. The subscale scores are computed based on the average score of items included. We report below on the interpersonal functioning and intrapsychic foundations subscales. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Scales of Psychological Well-Being, Change in Well-being | Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment | This is a 54-item, 6-point (1 to 6) measure rating wellbeing (from strongly disagree to strongly agree) including subscales of mastery, personal growth, purpose in life, self-acceptance, autonomy and positive relations with others. Internal consistency is .94. It has been successfully used with individuals with SMI. Higher scores indicate greater well-being. Each subscale score is the average of the scores on included items. We present below the scores on the self-acceptance subscale. |
| Maryland Assessment of Recovery, Change in Perceptions of Recovery | Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment | is a 25-item, 5-point (1 to 5) scale that assesses a person's sense of recovery from mental illness across a variety of dimensions. Internal consistency is.95 and test-retest reliability is .89). The scale score is the average score on each item with higher scores indicating higher levels of recovery. |
| Personal Growth and Recovery Scale, Change in Perceptions of Growth and Recovery | Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment | This is a 16-item, 4 point scale (1 to 4) developed for a previous Photovoice study. Items tap aspects of a person's psychosocial functioning and recovery. Internal consistency is 0.94 and retest reliability is .79. The scale score is the average of scores on each item with higher scores indicating higher levels of recovery. |
| Brief Psychiatric Rating Scale, Change in Psychiatric Symptoms | Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment | This is a 24-item scale that rates the severity of a variety of psychiatric psychotic symptoms, positive and negative symptoms on a 7-point scale of 1 (absent) to 7 (severe). The scale score is the mean of the score on all items, ranging from 1 to 7. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Photovoice Participants in this arm will attend a 10-week peer-led Photovoice program conducted in group format.
Photovoice: The 10-session, peer-led Photovoice program, designed to empower individuals with SMI to confront public prejudice and discrimination and reduce personal stigma (self-stigma and perceived stigma), was developed and pilot tested at our Center, with primary contributions from staff with a lived experience of mental illness.
In the Photovoice sessions, participants will be given a workbook titled Combating Prejudice and Discrimination through Photovoice Empowerment. Peer leaders will facilitate discussions based on topics in the workbook. Participants will be given cameras and guidance on taking pictures and writing narratives descriptions about the pictures, specifically the ways in which the pictures relate to experiences of prejudice and discrimination. | 95 |
| Enhanced Control Participants in this arm will attend a 60-minute peer-led group discussion on stigma and discrimination, and be eligible to participate in the 10-week Photovoice program after completing all study assessments.
Enhanced Control: The control SAU condition will be enhanced with a 60-minute peer-led manualized educational group session. It will provide participants with information about the nature of stigma and the laws in the U.S. that protect people with disabilities from discrimination. Participants will be engaged in a discussion about their use of different strategies for proactive coping with psychiatric stigma. This session will be co-led by the same peers who will be delivering the Photovoice program to the experimental group at relevant wave and study sites. Participants randomized to the enhanced Services as Usual control condition will be invited to join a Photovoice group once they complete the final 6-month fo | 97 |
| Total | 192 |
Baseline characteristics
| Characteristic | Photovoice | Enhanced Control | Total |
|---|---|---|---|
| Age, Continuous | 46.36 Years STANDARD_DEVIATION 13.37 | 47.48 Years STANDARD_DEVIATION 13.86 | 46.93 Years STANDARD_DEVIATION 13.6 |
| Race/Ethnicity, Customized Asian | 1 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Black | 3 Participants | 7 Participants | 10 Participants |
| Race/Ethnicity, Customized Multi-racial/ Other | 5 Participants | 6 Participants | 11 Participants |
| Race/Ethnicity, Customized White, hispanic | 2 Participants | 2 Participants | 4 Participants |
| Race/Ethnicity, Customized White, non-Hispanic | 84 Participants | 82 Participants | 166 Participants |
| Region of Enrollment United States | 95 participants | 97 participants | 192 participants |
| Sex/Gender, Customized Female | 40 Participants | 46 Participants | 86 Participants |
| Sex/Gender, Customized Male | 54 Participants | 50 Participants | 104 Participants |
| Sex/Gender, Customized Other | 1 Participants | 1 Participants | 2 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 1 / 95 | 2 / 97 |
| other Total, other adverse events | 0 / 95 | 0 / 97 |
| serious Total, serious adverse events | 1 / 95 | 2 / 97 |
Outcome results
Primary
Approaches to Coping With Stigma, Change in Coping With Stigma
is a 27-item, 4-point scale ranging from 1-4 (strongly disagree to strongly agree) measuring strategies to cope with stigma: secrecy, withdrawal, distancing, educating others, and challenging others. The average score of the items in the first three subscales will represent the index for Avoidant Coping and the average score of the items in the last two subscales - the index for Proactive Coping with Stigma. Internal consistency for subscales range: .63-.84. Lower scores are better on Avoidant Coping and higher scores are better on Proactive Coping.
Time frame: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
Population: Participants included in analysis at each time point are those who completed the scale at that time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Photovoice | Approaches to Coping With Stigma, Change in Coping With Stigma | Proactive Coping- Baseline | 2.90 score on a scale | Standard Deviation 0.42 |
| Photovoice | Approaches to Coping With Stigma, Change in Coping With Stigma | Proactive Coping- Post-Intervention | 2.87 score on a scale | Standard Deviation 0.39 |
| Photovoice | Approaches to Coping With Stigma, Change in Coping With Stigma | Proactive Coping- 3-Month follow-up | 2.06 score on a scale | Standard Deviation 0.49 |
| Photovoice | Approaches to Coping With Stigma, Change in Coping With Stigma | Proactive Coping- 6-Month follow-up | 2.86 score on a scale | Standard Deviation 0.48 |
| Photovoice | Approaches to Coping With Stigma, Change in Coping With Stigma | Avoidant Coping- Baseline | 2.53 score on a scale | Standard Deviation 0.33 |
| Photovoice | Approaches to Coping With Stigma, Change in Coping With Stigma | Avoidant Coping- Post-Intervention | 2.52 score on a scale | Standard Deviation 0.32 |
| Photovoice | Approaches to Coping With Stigma, Change in Coping With Stigma | Avoidant Coping- 3-Month Follow-Up | 2.41 score on a scale | Standard Deviation 0.44 |
| Photovoice | Approaches to Coping With Stigma, Change in Coping With Stigma | Avoidant Coping- 6-Month Follow-Up | 2.52 score on a scale | Standard Deviation 0.36 |
| Enhanced Control | Approaches to Coping With Stigma, Change in Coping With Stigma | Avoidant Coping- 6-Month Follow-Up | 2.45 score on a scale | Standard Deviation 0.35 |
| Enhanced Control | Approaches to Coping With Stigma, Change in Coping With Stigma | Proactive Coping- Baseline | 2.93 score on a scale | Standard Deviation 0.47 |
| Enhanced Control | Approaches to Coping With Stigma, Change in Coping With Stigma | Avoidant Coping- Baseline | 2.51 score on a scale | Standard Deviation 0.3 |
| Enhanced Control | Approaches to Coping With Stigma, Change in Coping With Stigma | Proactive Coping- Post-Intervention | 2.97 score on a scale | Standard Deviation 0.47 |
| Enhanced Control | Approaches to Coping With Stigma, Change in Coping With Stigma | Avoidant Coping- 3-Month Follow-Up | 2.31 score on a scale | Standard Deviation 0.56 |
| Enhanced Control | Approaches to Coping With Stigma, Change in Coping With Stigma | Proactive Coping- 3-Month follow-up | 1.87 score on a scale | Standard Deviation 0.43 |
| Enhanced Control | Approaches to Coping With Stigma, Change in Coping With Stigma | Avoidant Coping- Post-Intervention | 2.46 score on a scale | Standard Deviation 0.38 |
| Enhanced Control | Approaches to Coping With Stigma, Change in Coping With Stigma | Proactive Coping- 6-Month follow-up | 2.96 score on a scale | Standard Deviation 0.56 |
Comparison: The two study arms were compared using mixed models analysis controlling for baseline scores. Variables included in the model were- baseline score, group, time, and group by time interaction.~The p-value reported below is for group effect for Proactive Coping.p-value: 0.884Mixed Models Analysis
Comparison: The two study arms were compared using mixed models analysis controlling for baseline scores. Variables included in the model were- baseline score, group, time, and group by time interaction.~The p-value reported below is for group effect for Avoidant Coping.p-value: 0.543Mixed Models Analysis
Primary
Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life
This is a 21 item, semi-structured interview-based, rating of an individual's psycho-social functioning and satisfaction with various life domains. The score on each item ranges from 0-6 with higher scores indicating better functioning. The subscale scores are computed based on the average score of items included. We report below on the interpersonal functioning and intrapsychic foundations subscales.
Time frame: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
Population: Participants included in the analysis at each time point are participants who completed the measure at that time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Photovoice | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | Baseline-Interpersonal | 2.79 Score on a scale. | Standard Deviation 1.06 |
| Photovoice | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | Post-Intervention-Interpersonal | 2.82 Score on a scale. | Standard Deviation 1.03 |
| Photovoice | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | 3-Month follow-up-Interpersonal | 2.86 Score on a scale. | Standard Deviation 1.09 |
| Photovoice | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | 6-Month follow-up-Interpersonal | 2.98 Score on a scale. | Standard Deviation 0.99 |
| Photovoice | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | Baseline- Intrapsychic | 3.35 Score on a scale. | Standard Deviation 0.96 |
| Photovoice | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | Post-intervention- Intrapsychic | 3.43 Score on a scale. | Standard Deviation 0.97 |
| Photovoice | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | 3-Month follow-up- Intrapsychic | 3.34 Score on a scale. | Standard Deviation 1.04 |
| Photovoice | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | 6-Month follow-up- Intrapsychic | 3.37 Score on a scale. | Standard Deviation 0.95 |
| Enhanced Control | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | 6-Month follow-up- Intrapsychic | 3.39 Score on a scale. | Standard Deviation 0.87 |
| Enhanced Control | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | Baseline-Interpersonal | 2.94 Score on a scale. | Standard Deviation 1.08 |
| Enhanced Control | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | Baseline- Intrapsychic | 3.61 Score on a scale. | Standard Deviation 0.97 |
| Enhanced Control | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | Post-Intervention-Interpersonal | 3.10 Score on a scale. | Standard Deviation 1.13 |
| Enhanced Control | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | 3-Month follow-up- Intrapsychic | 3.34 Score on a scale. | Standard Deviation 0.91 |
| Enhanced Control | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | 3-Month follow-up-Interpersonal | 2.98 Score on a scale. | Standard Deviation 1.09 |
| Enhanced Control | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | Post-intervention- Intrapsychic | 3.42 Score on a scale. | Standard Deviation 0.91 |
| Enhanced Control | Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life | 6-Month follow-up-Interpersonal | 3.11 Score on a scale. | Standard Deviation 1.03 |
Comparison: The two study arms were compared on the interpersonal function subscale using mixed models analysis controlling for baseline scores. Variables included in the model were- baseline score, group, time, and group by time interaction.p-value: 0.25Mixed Models Analysis
Comparison: The two study arms were compared on the intrapsychic foundations subscale using mixed models analysis controlling for baseline scores. Variables included in the model were- baseline score, group, time, and group by time interaction.p-value: 0.118Mixed Models Analysis
Primary
Internalized Stigma of Mental Illness Scale, Change in Internalized Stigma
a 29-item, 4-point scale (strongly disagree to strongly agree) assesses behaviors, thoughts and feelings that are self-stigmatizing and includes alienation, stereotype endorsement, discriminatory experiences, social withdrawal, and stigma resistance subscales. Internal consistency is .9 and test-retest reliability is .92. Lower scores are better. The scale score is the average score on the 29 items, which are scored from 1-4. Lower scores signify less internalized stigma.
Time frame: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
Population: Participants included in analysis at each time point are those who completed the scale at that time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Photovoice | Internalized Stigma of Mental Illness Scale, Change in Internalized Stigma | Baseline | 2.18 Score on a scale. | Standard Deviation 0.4 |
| Photovoice | Internalized Stigma of Mental Illness Scale, Change in Internalized Stigma | Post-Intervention | 2.11 Score on a scale. | Standard Deviation 0.4 |
| Photovoice | Internalized Stigma of Mental Illness Scale, Change in Internalized Stigma | 3-Month follow-up | 2.64 Score on a scale. | Standard Deviation 0.37 |
| Photovoice | Internalized Stigma of Mental Illness Scale, Change in Internalized Stigma | 6-Month follow-up | 2.08 Score on a scale. | Standard Deviation 0.41 |
| Enhanced Control | Internalized Stigma of Mental Illness Scale, Change in Internalized Stigma | 6-Month follow-up | 2.01 Score on a scale. | Standard Deviation 0.43 |
| Enhanced Control | Internalized Stigma of Mental Illness Scale, Change in Internalized Stigma | Baseline | 2.09 Score on a scale. | Standard Deviation 0.42 |
| Enhanced Control | Internalized Stigma of Mental Illness Scale, Change in Internalized Stigma | 3-Month follow-up | 2.71 Score on a scale. | Standard Deviation 0.31 |
| Enhanced Control | Internalized Stigma of Mental Illness Scale, Change in Internalized Stigma | Post-Intervention | 2.05 Score on a scale. | Standard Deviation 0.45 |
Comparison: The two study arms were compared using mixed models analysis controlling for baseline scores. Variables included in the model were- baseline score, group, time, and group by time interaction. The p-value reported below is for group effect.p-value: 0.66Mixed Models Analysis
Primary
Temple University Community Participation Scale, Change in Community Participation
is a 26 item instrument measuring frequency of participation and importance of various community activities (e.g., movies, library). Test-retest reliability is .7 and internal consistency is .9. Higher scores are better. We provide below the results for cumulative days of participation in the last 30 days across the 26 activities included in the measure (tcpm\_days\_participated). The possible range for this measure is 0-780.
Time frame: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
Population: Participants included in the analysis at each time point are those who completed the questionnaire at that time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Photovoice | Temple University Community Participation Scale, Change in Community Participation | tcpm_days_participated- Baseline | 51.25 Days of participation | Standard Deviation 31.74 |
| Photovoice | Temple University Community Participation Scale, Change in Community Participation | tcpm_days_participated-Post-Intervention | 47.40 Days of participation | Standard Deviation 26.81 |
| Photovoice | Temple University Community Participation Scale, Change in Community Participation | tcpm_days_participated-3-Month follow-up | 45.75 Days of participation | Standard Deviation 29.56 |
| Photovoice | Temple University Community Participation Scale, Change in Community Participation | tcpm_days_participated-6-Month follow-up | 45.10 Days of participation | Standard Deviation 26.93 |
| Enhanced Control | Temple University Community Participation Scale, Change in Community Participation | tcpm_days_participated-6-Month follow-up | 44.17 Days of participation | Standard Deviation 29.11 |
| Enhanced Control | Temple University Community Participation Scale, Change in Community Participation | tcpm_days_participated- Baseline | 54.80 Days of participation | Standard Deviation 34.74 |
| Enhanced Control | Temple University Community Participation Scale, Change in Community Participation | tcpm_days_participated-3-Month follow-up | 47.76 Days of participation | Standard Deviation 30.9 |
| Enhanced Control | Temple University Community Participation Scale, Change in Community Participation | tcpm_days_participated-Post-Intervention | 48.99 Days of participation | Standard Deviation 33.96 |
Comparison: The two study arms were compared using mixed models analysis controlling for baseline scores. Variables included in the model were- baseline score, group, time, and group by time interaction. The p-value reported below is for group effect for tcpm\_days\_participated.p-value: 0.917Mixed Models Analysis
Primary
The Stigma Scale, Change in Perceptions of Stigma
is a 28 item, 5 point scale ranging from 0-4 (strongly disagree to strongly agree) measuring experienced and anticipated stigma. Internal consistency ranges from .85-.87 and test-retest reliability from .4 to .7. The scale score is the average score on all items. Lower scores are better.
Time frame: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
Population: Participants included in the analysis at each time point are those who completed the scale at that time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Photovoice | The Stigma Scale, Change in Perceptions of Stigma | Baseline | 1.92 score on a scale | Standard Deviation 0.59 |
| Photovoice | The Stigma Scale, Change in Perceptions of Stigma | Post-Intervention | 1.87 score on a scale | Standard Deviation 0.59 |
| Photovoice | The Stigma Scale, Change in Perceptions of Stigma | 3-Month follow-up | 1.87 score on a scale | Standard Deviation 0.56 |
| Photovoice | The Stigma Scale, Change in Perceptions of Stigma | 6-Month follow-up | 1.78 score on a scale | Standard Deviation 0.6 |
| Enhanced Control | The Stigma Scale, Change in Perceptions of Stigma | 6-Month follow-up | 1.76 score on a scale | Standard Deviation 0.63 |
| Enhanced Control | The Stigma Scale, Change in Perceptions of Stigma | Baseline | 1.81 score on a scale | Standard Deviation 0.61 |
| Enhanced Control | The Stigma Scale, Change in Perceptions of Stigma | 3-Month follow-up | 1.82 score on a scale | Standard Deviation 0.64 |
| Enhanced Control | The Stigma Scale, Change in Perceptions of Stigma | Post-Intervention | 1.75 score on a scale | Standard Deviation 0.66 |
Comparison: The two study arms were compared using mixed models analysis controlling for baseline scores. Variables included in the model were- baseline score, group, time, and group by time interaction.p-value: 0.135Mixed Models Analysis
Secondary
Brief Psychiatric Rating Scale, Change in Psychiatric Symptoms
This is a 24-item scale that rates the severity of a variety of psychiatric psychotic symptoms, positive and negative symptoms on a 7-point scale of 1 (absent) to 7 (severe). The scale score is the mean of the score on all items, ranging from 1 to 7.
Time frame: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
Population: The number analyzed at each time point represent the number who completed the assessment at that time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Photovoice | Brief Psychiatric Rating Scale, Change in Psychiatric Symptoms | Baseline | 1.79 Score on a scale. | Standard Deviation 0.47 |
| Photovoice | Brief Psychiatric Rating Scale, Change in Psychiatric Symptoms | Post-Intervention | 1.71 Score on a scale. | Standard Deviation 0.43 |
| Photovoice | Brief Psychiatric Rating Scale, Change in Psychiatric Symptoms | 6-Month follow-up | 1.78 Score on a scale. | Standard Deviation 0.45 |
| Photovoice | Brief Psychiatric Rating Scale, Change in Psychiatric Symptoms | 3-Month follow-up | 1.77 Score on a scale. | Standard Deviation 0.42 |
| Enhanced Control | Brief Psychiatric Rating Scale, Change in Psychiatric Symptoms | 6-Month follow-up | 1.72 Score on a scale. | Standard Deviation 0.39 |
| Enhanced Control | Brief Psychiatric Rating Scale, Change in Psychiatric Symptoms | Baseline | 1.78 Score on a scale. | Standard Deviation 0.41 |
| Enhanced Control | Brief Psychiatric Rating Scale, Change in Psychiatric Symptoms | Post-Intervention | 1.80 Score on a scale. | Standard Deviation 0.43 |
| Enhanced Control | Brief Psychiatric Rating Scale, Change in Psychiatric Symptoms | 3-Month follow-up | 1.85 Score on a scale. | Standard Deviation 0.43 |
Comparison: The two study arms were compared using mixed models analysis controlling for baseline scores. Variables included in the model were- baseline score, group, time, and group by time interaction.p-value: 0.017Mixed Models Analysis
Secondary
Maryland Assessment of Recovery, Change in Perceptions of Recovery
is a 25-item, 5-point (1 to 5) scale that assesses a person's sense of recovery from mental illness across a variety of dimensions. Internal consistency is.95 and test-retest reliability is .89). The scale score is the average score on each item with higher scores indicating higher levels of recovery.
Time frame: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
Population: Participants included in the analysis at each time point are those who completed the measure at that timepoint.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Photovoice | Maryland Assessment of Recovery, Change in Perceptions of Recovery | Baseline | 3.95 Score on a scale. | Standard Deviation 0.43 |
| Photovoice | Maryland Assessment of Recovery, Change in Perceptions of Recovery | Post-Intervention | 3.94 Score on a scale. | Standard Deviation 0.54 |
| Photovoice | Maryland Assessment of Recovery, Change in Perceptions of Recovery | 3-Month follow-up | 3.92 Score on a scale. | Standard Deviation 0.53 |
| Photovoice | Maryland Assessment of Recovery, Change in Perceptions of Recovery | 6-Month follow-up | 4.02 Score on a scale. | Standard Deviation 0.55 |
| Enhanced Control | Maryland Assessment of Recovery, Change in Perceptions of Recovery | 6-Month follow-up | 4.02 Score on a scale. | Standard Deviation 0.52 |
| Enhanced Control | Maryland Assessment of Recovery, Change in Perceptions of Recovery | Baseline | 4.07 Score on a scale. | Standard Deviation 0.51 |
| Enhanced Control | Maryland Assessment of Recovery, Change in Perceptions of Recovery | 3-Month follow-up | 4.05 Score on a scale. | Standard Deviation 0.48 |
| Enhanced Control | Maryland Assessment of Recovery, Change in Perceptions of Recovery | Post-Intervention | 4.07 Score on a scale. | Standard Deviation 0.54 |
Comparison: The two study arms were compared using mixed models analysis controlling for baseline scores. Variables included in the model were- baseline score, group, time, and group by time interaction.p-value: 0.076Mixed Models Analysis
Secondary
Personal Growth and Recovery Scale, Change in Perceptions of Growth and Recovery
This is a 16-item, 4 point scale (1 to 4) developed for a previous Photovoice study. Items tap aspects of a person's psychosocial functioning and recovery. Internal consistency is 0.94 and retest reliability is .79. The scale score is the average of scores on each item with higher scores indicating higher levels of recovery.
Time frame: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
Population: The participants included in analysis at each time point are those who completed the measure at that time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Photovoice | Personal Growth and Recovery Scale, Change in Perceptions of Growth and Recovery | Baseline | 3.31 Score on a scale. | Standard Deviation 0.58 |
| Photovoice | Personal Growth and Recovery Scale, Change in Perceptions of Growth and Recovery | Post-Intervention | 3.31 Score on a scale. | Standard Deviation 0.61 |
| Photovoice | Personal Growth and Recovery Scale, Change in Perceptions of Growth and Recovery | 3-Month follow-up | 3.32 Score on a scale. | Standard Deviation 0.6 |
| Photovoice | Personal Growth and Recovery Scale, Change in Perceptions of Growth and Recovery | 6-Month follow-up | 3.38 Score on a scale. | Standard Deviation 0.57 |
| Enhanced Control | Personal Growth and Recovery Scale, Change in Perceptions of Growth and Recovery | 6-Month follow-up | 3.43 Score on a scale. | Standard Deviation 0.55 |
| Enhanced Control | Personal Growth and Recovery Scale, Change in Perceptions of Growth and Recovery | Baseline | 3.38 Score on a scale. | Standard Deviation 0.57 |
| Enhanced Control | Personal Growth and Recovery Scale, Change in Perceptions of Growth and Recovery | 3-Month follow-up | 3.36 Score on a scale. | Standard Deviation 0.58 |
| Enhanced Control | Personal Growth and Recovery Scale, Change in Perceptions of Growth and Recovery | Post-Intervention | 3.36 Score on a scale. | Standard Deviation 0.56 |
Comparison: The two study arms were compared using mixed models analysis controlling for baseline scores. Variables included in the model were- baseline score, group, time, and group by time interaction.p-value: 0.978Mixed Models Analysis
Secondary
Scales of Psychological Well-Being, Change in Well-being
This is a 54-item, 6-point (1 to 6) measure rating wellbeing (from strongly disagree to strongly agree) including subscales of mastery, personal growth, purpose in life, self-acceptance, autonomy and positive relations with others. Internal consistency is .94. It has been successfully used with individuals with SMI. Higher scores indicate greater well-being. Each subscale score is the average of the scores on included items. We present below the scores on the self-acceptance subscale.
Time frame: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
Population: The participants included in analysis at each time point are those who completed the measure at that time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Photovoice | Scales of Psychological Well-Being, Change in Well-being | Baseline | 3.75 Score on a scale. | Standard Deviation 1.02 |
| Photovoice | Scales of Psychological Well-Being, Change in Well-being | Post-Intervention | 3.83 Score on a scale. | Standard Deviation 1.06 |
| Photovoice | Scales of Psychological Well-Being, Change in Well-being | 3-Month follow-up | 3.86 Score on a scale. | Standard Deviation 0.95 |
| Photovoice | Scales of Psychological Well-Being, Change in Well-being | 6-Month follow-up | 3.96 Score on a scale. | Standard Deviation 1.07 |
| Enhanced Control | Scales of Psychological Well-Being, Change in Well-being | 6-Month follow-up | 3.89 Score on a scale. | Standard Deviation 0.96 |
| Enhanced Control | Scales of Psychological Well-Being, Change in Well-being | Baseline | 3.92 Score on a scale. | Standard Deviation 1.07 |
| Enhanced Control | Scales of Psychological Well-Being, Change in Well-being | 3-Month follow-up | 3.81 Score on a scale. | Standard Deviation 1.04 |
| Enhanced Control | Scales of Psychological Well-Being, Change in Well-being | Post-Intervention | 3.90 Score on a scale. | Standard Deviation 0.95 |
Comparison: The two study arms were compared using mixed models analysis controlling for baseline scores. Variables included in the model were- baseline score, group, time, and group by time interaction.p-value: 0.597Mixed Models Analysis