Mental Illness
Conditions
Keywords
Mental illness, Disclosure, stigma, soldiers, secrecy
Brief summary
The purpose of the study is to evaluate the feasibility and efficacy of the group-based intervention Honest, Open, Proud among soldiers with mental illness.
Detailed description
Soldiers with mental illness typically face a two-fold problem. On the one hand, they have to cope with the symptoms of their mental illness; on the other hand, they often have to deal with stigma and discrimination. Both due to fear of public stigma and due to self-stigma or shame, soldiers with mental illness may decide to keep their condition a secret or even to withdraw from other people altogether in order to minimize the risk of being labeled. Secrecy can help on the short term to protect individuals from public stigma, but usually it has negative long-term consequences such as social isolation, distress and avoidance of help-seeking. Disclosure, on the other hand, carries the risk to be discriminated by others, but can reduce the burden of secrecy, lead to support by others and reduce public stigma. In this study investigators aim to test the efficacy (see our outcomes above) of Honest, Open, Proud run by soldiers with lived experience of mental illness.
Interventions
BEHAVIORALHonest, Open, Proud (HOP)
Three lessons, one for each two-hour session plus one booster session 1. Considering the pros and cons of disclosure: Discussion of one's idea of identity and mental illness, weighing the costs and benefits of (non-) disclosure 2. Different ways to disclose: Discussion of different levels of (non-) disclosure, considering costs and benefits of each level, selecting persons to disclose to and how to test them out, anticipating responses of others to one's disclosure 3. Telling one's story: Practice how to tell one's story, identifying peers who might be helpful with the coming out process 4. Booster session Reviewing previous intentions to disclose one's mental illness, discussion whether one disclosed and evaluating this experience
Sponsors
Center for Military Mental Health, Berlin, Germany
Illinois Institute of Technology, Chicago, USA
University of Ulm
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* At least one self-reported current axis I or axis II disorder according to DSM-5, which is not restricted to only substance-related disorder(s) * Age 18 or above * Ability to provide written informed consent * Fluent in German (needed for self-report measures) * At least a moderate level of self-reported disclosure-related distress/difficulty (score 4 or higher on the screening item 'In general, how distressed or worried are you in terms of secrecy or disclosure of your mental illness to others?', rated from 1, not at all, to 7, very much) * Current inpatient, day-clinic or outpatient treatment at the Center for Military Mental Health, Berlin, Germany * from April 2018 onwards we decided to also include non-military first responders (fire fighters or police officers) who are treated in the Center for Military Mental Health, Berlin, Germany
Exclusion criteria
* Self-reported diagnosis of only a substance- or alcohol-related disorder, without non-substance related current psychiatric comorbidity. We will exclude people who only have a substance-/alcohol-related disorder because the disclosure of these disorders is not the topic of the HOP intervention * Intellectual disability * Organic disorders
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Stigma Stress Scale, 8 items | 3 weeks (T1) | (Rüsch et al. 2009a; Rüsch et al. 2009b) |
| WHOQoL BREF; Domain psychological quality of life, 6 items | 6 weeks (T2) | (WHOQoL Group 1998) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Internalized Stigma of Mental Illness Inventory, Brief Version, 10 items | baseline, 3, 6 and 12 weeks | (Boyd et al. 2014) |
| Self-Stigma of Mental Illness Scale, Short Version, subscale Self-Concurrence, 5 items | baseline, 3, 6 and 12 weeks | (Corrigan et al. 2012) |
| Secrecy and Social Withdrawal subscales of the Stigma Coping Orientation Scales, 12 items | baseline, 3, 6 and 12 weeks | (Link et al. 1991) |
| Disclosure related distress (In general, how distressed or worried are you in terms of secrecy or disclosure of your mental illness to others?', from 1, not at all, to 7, very much) | baseline, 3, 6 and 12 weeks | (Rüsch et al. 2014a) |
| Empowerment Scale, Subscale 'Self-esteem', 9 items | baseline, 3, 6 and 12 weeks (T3) | (Rogers et al. 1997) |
| Patient Health Questionnaire (PHQ-9), 9 items | baseline, 3, 6 and 12 weeks | (Kroenke et al. 2001) |
| Shame about having a mental illness, 1 item | baseline, 3, 6 and 12 weeks | (Rüsch et al. 2014b) |
| Attitudes to help-seeking, 2 items | baseline, 3, 6 and 12 weeks | (Rüsch et al. 2013) |
| Attitudes to disclosure, 2 items | baseline, 3, 6 and 12 weeks | (Rüsch et al. 2011) |
| WHOQoL-BREF, 26 items | 3, 6 and 12 weeks | (WHOQOL Group 1998) |
| Psychological Well-Being Scale, 18 items | baseline, 3, 6 and 12 weeks | (Ryff 1989) |
Countries
Germany, United States
Outcome results
None listed