Abstract
People with mental illness are challenged by self-stigma, leading to a sense of behavioral futility and reduced goal seeking. Honest, Open, Proud (HOP) program is a peer service program that utilizes strategic disclosure to combat self-stigma. HOP was developed and predominantly examined in western culture, leaving unknown its effectiveness in East Asian countries. The current study reports adaptation and evaluation of HOP for Chinese people living with serious mental illness. Adaption underwent a community-based participatory research approach to assure cultural responsiveness. A pilot randomized controlled trial with 135 participants revealed that HOP diminished self-stigma in participants. Satisfaction and feasibility assessments indicated HOP was well received within the focal community. Results suggested HOP had benefits on disclosure self-efficacy and self-stigma for those participating in the program. Future research should further examine cultural mediators of peer support and disclosure on stigma and empowerment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
All data for this study can be downloaded for no charge from www.ncse1.org.
Change history
02 November 2022
A Correction to this paper has been published: https://doi.org/10.1007/s11469-022-00946-3
References
Banfield, M., Morse, A. R., & Gulliver, A. (2020). Contextual influences on the impact of a peer worker-led self-stigma program for people with mental health issues: Protocol for an interventional implementation science study. Implementation Science Communications, 1(1), 26. https://doi.org/10.1186/s43058-020-00002-y
Castro, F. G., Barrera, M., & Holleran Steiker, L. K. (2010). Issues and challenges in the design of culturally adapted evidence-based interventions. Annual Review of Clinical Psychology, 6, 213–239. https://doi.org/10.1146/annurev-clinpsy-033109-132032
Chen, F.-P., Lai, G.Y.-C., & Yang, L. (2013). Mental illness disclosure in Chinese immigrant communities. Journal of Counseling Psychology, 60(3), 379–391. https://doi.org/10.1037/a0032620
Conley, C. S., Hundert, C. G., Charles, J. L. K., Huguenel, B. M., Al-khouja, M., Qin, S., Paniagua, D., & Corrigan, P. W. (2020). Honest, open, proud–college: Effectiveness of a peer-led small-group intervention for reducing the stigma of mental illness. Stigma and Health, 5(2), 168–178. https://doi.org/10.1037/sah0000185
Corrigan, P. W., Larson, J. E., Michaels, P. J., Buchholz, B. A., Rossi, R. D., Fontecchio, M. J., Castro, D., Gause, M., Krzyżanowski, R., & Rüsch, N. (2015). Diminishing the self-stigma of mental illness by coming out proud. Psychiatry Research, 229(1–2), 148–154. https://doi.org/10.1016/j.psychres.2015.07.053
Corrigan, P. W., Larson, J. E., & Rüsch, N. (2009). Self-stigma and the “why try” effect: Impact on life goals and evidence-based practices. World Psychiatry, 8(2), 75–81.
Corrigan, P. W., Michaels, P. J., Vega, E., Gause, M., Watson, A. C., & Rüsch, N. (2012). Self-stigma of mental illness scale–short form: Reliability and validity. Psychiatry Research, 199(1), 65–69. https://doi.org/10.1016/j.psychres.2012.04.009
Corrigan, P. W., Rafacz, J., & Rüsch, N. (2011). Examining a progressive model of self-stigma and its impact on people with serious mental illness. Psychiatry Research, 189(3), 339–343. https://doi.org/10.1016/j.psychres.2011.05.024
Corrigan, P. W., & Rao, D. (2012). On the Self-stigma of mental illness: Stages, disclosure, and strategies for change. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 57(8), 464–469.
Corrigan, P. W., Rüsch, N., & Scior, K. (2018). Adapting disclosure programs to reduce the stigma of mental illness. Psychiatric Services (Washington, D.C.), 69(7), 826–828. https://doi.org/10.1176/appi.ps.201700478
Cunningham, K. C., & Lucksted, A. (2017). Social cognition, internalized stigma, and recovery orientation among adults with serious mental illness. Psychiatric Rehabilitation Journal, 40(4), 409–411. https://doi.org/10.1037/prj0000248
Fan, R. (1997). Self-determination vs. family-determination: Two incommensurable principles of autonomy: a report from East Asia. Bioethics, 11(3–4), 309–322. https://doi.org/10.1111/1467-8519.00070
Hasson-Ohayon, I., Ehrlich-Ben Or, S., Vahab, K., Amiaz, R., Weiser, M., & Roe, D. (2012). Insight into mental illness and self-stigma: The mediating role of shame proneness. Psychiatry Research, 200(2), 802–806. https://doi.org/10.1016/j.psychres.2012.07.038
Link, B. (1982). Mental Patient status, work, and income: An examination of the effects of a psychiatric label. American Sociological Review, 47(2), 202–215. https://doi.org/10.2307/2094963
Link, B. G., Struening, E. L., Neese-Todd, S., Asmussen, S., & Phelan, J. C. (2001). Stigma as a barrier to recovery: The consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services (Washington, D.C.), 52(12), 1621–1626. https://doi.org/10.1176/appi.ps.52.12.1621
Minkler, M., & Wallerstein, N. (2011). Community-based participatory research for health: From process to outcomes. John Wiley & Sons.
Mulfinger, N., Müller, S., Böge, I., Sakar, V., Corrigan, P. W., Evans-Lacko, S., Nehf, L., Djamali, J., Samarelli, A., Kempter, M., Ruckes, C., Libal, G., Oexle, N., Noterdaeme, M., & Rüsch, N. (2018). Honest, Open, Proud for adolescents with mental illness: Pilot randomized controlled trial. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 59(6), 684–691. https://doi.org/10.1111/jcpp.12853
Owens, T. J. (1994). Two Dimensions of self-esteem: Reciprocal effects of positive self-worth and self-deprecation on adolescent problems. American Sociological Review, 59(3), 391–407. https://doi.org/10.2307/2095940
Pasmatzi, E., Koulierakis, G., & Giaglis, G. (2016). Self-stigma, self-esteem and self-efficacy of mentally ill. Psychiatriki, 27(4), 243–252. https://doi.org/10.22365/jpsych.2016.274.243
Pattyn, E., Verhaeghe, M., Sercu, C., & Bracke, P. (2014). Public Stigma and self-stigma: Differential association with attitudes toward formal and informal help seeking. Psychiatric Services, 65(2), 232–238. https://doi.org/10.1176/appi.ps.201200561
Perlick, D. A., Rosenheck, R. A., Clarkin, J. F., Sirey, J. A., Salahi, J., Struening, E. L., & Link, B. G. (2001). Stigma as a barrier to recovery: Adverse effects of perceived stigma on social adaptation of persons diagnosed with bipolar affective disorder. Psychiatric Services (Washington, D.C.), 52(12), 1627–1632. https://doi.org/10.1176/appi.ps.52.12.1627
Rosenfield, S., & Neese-Todd, S. (1993). Elements of a psychosocial clubhouse program associated with a satisfying quality of life. Hospital & Community Psychiatry, 44(1), 76–78.
Rüsch, N., Abbruzzese, E., Hagedorn, E., Hartenhauer, D., Kaufmann, I., Curschellas, J., Ventling, S., Zuaboni, G., Bridler, R., Olschewski, M., Kawohl, W., Rössler, W., Kleim, B., & Corrigan, P. W. (2014). Efficacy of Coming out proud to reduce stigma’s impact among people with mental illness: Pilot randomised controlled trial. The British Journal of Psychiatry, 204(5), 391–397. https://doi.org/10.1192/bjp.bp.113.135772
Rüsch, N., & Kösters, M. (2021). Honest, Open, Proud to support disclosure decisions and to decrease stigma’s impact among people with mental illness: Conceptual review and meta-analysis of program efficacy. Social Psychiatry and Psychiatric Epidemiology, 56(9), 1513–1526. https://doi.org/10.1007/s00127-021-02076-y
Scior, K., Rüsch, N., White, C., & Corrigan, P. W. (2020). Supporting mental health disclosure decisions: The Honest, Open, Proud programme. The British Journal of Psychiatry, 216(5), 243–245. https://doi.org/10.1192/bjp.2019.256
Sheehan, L., Ballentine, S., Agnew, L., Ali, Y., Canser, M., Connor, J., Jones, R., Laster, E., Muhammad, K., Noble, S., Walley, G., & Corrigan, P. (2015). Inspiring change manual: a community-based participatory research workbook for involving African Americans with serious mental illness in research. Illinois Institute of Technology.
Shi, W., Shen, Z., Wang, S., & Hall, B. J. (2020). Barriers to Professional mental health help-seeking among chinese adults: A systematic review. Frontiers in Psychiatry, 11. https://www.frontiersin.org/article/https://doi.org/10.3389/fpsyt.2020.00442
Talluri, S., & Corrigan, P. (2022). The Benefits of Disclosure. In G. Schomerus & P. W. Corrigan (Eds.), The Stigma of substance use disorders (pp. 180–192). Cambridge University Press.
Taniguchi, E. (2021). College students’ mental illness disclosure and self-esteem: A moderating role of self-image goals. Journal of American College Health: J of ACH, 1–7.https://doi.org/10.1080/07448481.2020.1865973
Teh, J. L., King, D., Watson, B., & Liu, S. (2014). Self-stigma, anticipated stigma, and help-seeking communication in people with mental illness. Portal : Journal of Multidisciplinary International Studies, 11(1), 1–18. https://doi.org/10.3316/informit.915566752474109
Thornhill, R., & Fincher, C. L. (2014). Collectivism–Individualism, family ties, and philopatry. In R. Thornhill & C. L. Fincher (Eds.), The Parasite-Stress Theory of Values and Sociality: Infectious Disease, History and Human Values Worldwide (pp. 113–170). Springer International Publishing. https://doi.org/10.1007/978-3-319-08040-6_5
Vauth, R., Kleim, B., Wirtz, M., & Corrigan, P. W. (2007). Self-efficacy and empowerment as outcomes of self-stigmatizing and coping in schizophrenia. Psychiatry Research, 150(1), 71–80. https://doi.org/10.1016/j.psychres.2006.07.005
Yanos, P. T., Lucksted, A., Drapalski, A. L., Roe, D., & Lysaker, P. (2015). Interventions targeting mental health self-stigma: A review and comparison. Psychiatric Rehabilitation Journal, 38(2), 171–178. https://doi.org/10.1037/prj0000100
Yokoyama, K., Morimoto, T., Ichihara-Takeda, S., Yoshino, J., Matsuyama, K., & Ikeda, N. (2019). Relationship between self-disclosure to first acquaintances and subjective well-being in people with schizophrenia spectrum disorders living in the community. PLoS ONE, 14(10), e0223819. https://doi.org/10.1371/journal.pone.0223819
Acknowledgements
CBPR Team includes Sanshan Gan, Haiying Mao, Xiaohong Mo, Liu Yang, and Furong Zhang.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Informed Consent
All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all people before being included in the study.
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Manuscript submitted to the International Journal of Mental Health and Addiction as Regular article
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Qin, S., Sheehan, L., Yau, E. et al. Adapting and Evaluating a Strategic Disclosure Program to Address Mental Health Stigma Among Chinese. Int J Ment Health Addiction (2022). https://doi.org/10.1007/s11469-022-00911-0
Accepted:
Published:
DOI: https://doi.org/10.1007/s11469-022-00911-0