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Addressing Mental Health Stigma in Early Adolescence: Middle School Antistigma Interventions

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Abstract

Early adolescence is a crucial period in the development of mental health disorders. Although a significant number of adolescents experience mental health needs, only a third of adolescents with mental health disorders receive treatment; many adolescents cite the stigmatization of mental health disorders as a deterrent to seeking help. Cognitive and social developments in early adolescence make middle school an ideal period to combat stigma. School-based antistigma interventions, however, have historically targeted high school and college students, thus missing a valuable window for intervention. This article reviews existing empirical studies on middle school antistigma interventions, along with examining relevant developmental research and theory. Taken together, the literature points to the significant potential such interventions may hold for shifting middle school students’ knowledge and attitudes around mental health disorders. In particular, interventions drawing on active learning approaches that incorporate youth’s voices, perspectives, and leadership may be more effective in influencing various aspects of mental health stigma among middle school students. At the same time, there are significant limitations to the current literature. Recommendations for future research are discussed.

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References

  • Aseltine, R. H., & DeMartino, R. (2004). An outcome evaluation of the SOS suicide prevention program. American Journal of Public health, 94, 446–451.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bearman, K. J., & La Greca, A. M. (2002). Assessing friend support of adolescents’ diabetes care: The Diabetes Social Support Questionnaire—friends version. Journal of Pediatric Psychology, 27, 417–428.

    Article  PubMed  Google Scholar 

  • Brown, B. B. (2004). Adolescents’ relationships with peers. In R. M. Lerner & L. Steinberg (Eds.), Handbook of adolescent psychology (2nd ed., pp. 363–394). Indianapolis: Wiley Publishing.

    Google Scholar 

  • Brown, B. B., & Klute, C. (2006). Friendships, cliques, and crowds. In G. R. Adams & M. D. Berzonsky (Eds.), Blackwell handbook of adolescence (pp. 330–348). Malden: Blackwell Publishing.

    Chapter  Google Scholar 

  • Bulanda, J. J., Bruhn, C., Byro-Johnson, T., & Zentmyer, M. (2014). Addressing mental health stigma among young adolescents: Evaluation of a youth-led approach. Health & Social Work, 39, 72–80.

    Article  Google Scholar 

  • Calvo, R. (2016). Health literacy and quality of care among latino immigrants in the United States. Health & Social Work, 41, e44–e51.

    Article  Google Scholar 

  • Chandra, A., & Minkovitz, C. S. (2006). Stigma starts early: Gender differences in teen willingness to use mental health services. Journal of Adolescent Health, 38, 754.

    Article  Google Scholar 

  • Chandra, A., & Minkovitz, C. S. (2007). Factors that influence mental health stigma among 8th grade adolescents. Journal of Youth and Adolescence, 36, 763–774.

    Article  Google Scholar 

  • Chen, S.-P., Koller, M., Krupa, T., & Stuart, H. (2016). Contact in the classroom: Developing a program model for youth mental health contact-based anti-stigma education. Community Mental Health Journal, 52, 281–293.

    Article  PubMed  Google Scholar 

  • Cheng, H.-L., Wang, C., McDermott, R., Kridel, M., & Rislin, J. L. (2018). Self-stigma, mental health literacy, and attitudes toward seeking psychological help. Journal of Counseling & Development, 96, 64–74.

    Article  Google Scholar 

  • Chisholm, K., Patterson, P., Torgerson, C., Turner, E., Jenkinson, D., & Birchwood, M. (2016). Impact of contact on adolescents’ mental health literacy and stigma: The SchoolSpace cluster randomized controlled trial. BMJ Open. https://doi.org/10.1136/bmjopen-2015-009435.

    Article  PubMed  PubMed Central  Google Scholar 

  • Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45, 11–27.

    Article  PubMed  Google Scholar 

  • Coles, M. E., Ravid, A., Gibb, B., George-Denn, D., Bronstein, L., & McLeod, S. (2016). Adolescent mental health literacy: Young people’s knowledge of depression and social anxiety disorder. Journal of Adolescent Health, 58, 57–62.

    Article  Google Scholar 

  • Condliffe, B. (2017). Project-based learning: A literature review. Working paper. MDRC.

  • Costello, E. J., Copeland, W., & Angold, A. (2011). Trends in psychopathology across the adolescent years: What changes when children become adolescents, and when adolescents become adults? The Journal of Child Psychology and Psychiatry, 52, 1015–1025.

    Article  PubMed  Google Scholar 

  • Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837–844.

    Article  PubMed  Google Scholar 

  • Coughlan, H., Tiedt, L., Clarke, M., Kelleher, I., Tabish, J., Molloy, C., Cannon, M. (2014). Prevalence of DSM-IV mental disorders, deliberate self-harm and suicidal ideation in early adolescence: An Irish population-based study. Journal of Adolescence, 37, 1–9.

    Article  PubMed  Google Scholar 

  • Davies, D. (2004). Child development: A practitioner’s guide (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • Del Casale, A., Manfredi, G., Kotzalidis, G. D., Serata, D., Rapinesi, C., Caccia, F., Girardi, P. (2013). Awareness and education on mental disorder in teenagers reduce stigma for mental illness: A preliminary study. Journal of Psychopathology, 19, 208–212.

    Google Scholar 

  • Desocio, J., Stember, L., & Schrinsky, J. (2006). Teaching children about mental health and illness: A school nurse health education program. The Journal of School Nursing, 22, 81–86.

    Article  PubMed  Google Scholar 

  • Elkind, D. (1967). Egocentrism in adolescence. Child Development, 38, 1025–1034.

    Article  PubMed  Google Scholar 

  • Elkind, D. (1985). Egocentrism redux. Developmental Review, 5, 218–226.

    Article  Google Scholar 

  • Essler, V., Arthur, A., & Stickley, T. (2006). Using a school-based intervention to challenge stigmatizing attitudes and promote mental health in teenagers. Journal of Mental Health, 15, 243–250.

    Article  Google Scholar 

  • Giannakopoulos, G., Assimopoulos, H., Petanidou, D., Tzavara, C., Kolaitis, G., & Tsiantis, J. (2012). Effectiveness of a school-based intervention for enhancing adolescents' positive attitudes towards people with mental illness. Mental Illness, 4(2), e16.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hammer, J. H., Parent, M. C., & Spiker, D. A. (2018). Mental Help Seeking Attitudes Scale (MHSAS): Development, reliability, validity, and comparison with the ATSSPH-SF and IASMHS-PO. Journal of Counseling Psychology, 65, 74–85.

    Article  PubMed  Google Scholar 

  • Han, M., Cha, R., Lee, H. A., & Lee, S. E. (2017). Mental-illness stigma among Korean immigrants: Role of culture and destigmatization strategies. Asian American Journal of Psychology, 8, 134–141.

    Article  Google Scholar 

  • Hart, L. M., Mason, R. J., Kelly, C. M., Cvetkovski, S., & Jorm, A. F. (2016). ‘teen Mental Health First Aid’: A description of the program and an initial evaluation. International Journal of Mental Health Systems. https://doi.org/10.1186/s13033-016-0034-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Harter, S. (1999). The construction of self: A developmental perspective. New York: Guilford Press.

    Google Scholar 

  • Ke, S., Lai, J., Sun, T., Yang, M. M. H., Wang, J. C. C., & Austin, J. (2015). Healthy young minds: The effects of a 1-hour classroom workshop on mental illness stigma in high school students. Community Mental Health Journal, 51, 329–337.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K., & Walters, E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593–602.

    Article  PubMed  Google Scholar 

  • Lam, L. T. (2014). Mental health literacy and mental health status in adolescents: A population-based survey. Child and Adolescent Psychiatry and Mental Health, 8, 26.

    Article  Google Scholar 

  • Lauria-Horner, B. A., Kutcher, S., & Brooks, S. J. (2004). The feasibility of a mental health curriculum in elementary school. Canadian Journal of Psychiatry, 49, 208–211.

    Article  PubMed  Google Scholar 

  • Lindsey, M. A., Chambers, K., Pohle, C., Beall, P., & Lucksted, A. (2013). Understanding the behavioral determinants of mental health service use by urban, under-resourced black youth: Adolescent and caregiver perspectives. Journal of Child & Family Studies, 22, 107–121.

    Article  Google Scholar 

  • MacArthur, G. J., Harrison, S., Caldwell, D. M., Hickman, M., & Campbell R. (2016). Peer-led interventions to prevent tobacco, alcohol and/or drug use among young people aged 11–21 years: A systematic review and meta-analysis. Addiction, 111, 391–407.

    Article  Google Scholar 

  • Masuda, A., Anderson, P. L., & Edmonds, J. (2012). Help-seeking attitudes, mental health stigma, and self-concealment among African American College Students. Journal of Black Studies, 43, 773–786.

    Article  Google Scholar 

  • Masuda, A., Anderson, P. L., Twohig, M. P., Feinstein, A. B., Chou, Y., Wendell, J. W., Stormo, A. R. (2009). Help-seeking experiences and attitudes among African American, Asian American, and European American College Students. International Journal for the Advancement of Counselling, 31, 168–180.

    Article  Google Scholar 

  • Merikangas, K. R., He, J., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., … Olfson, M. (2011). Service utilization for lifetime mental disorders in U.S. adolescents: Results of the National Comorbidity Survey—Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 50, 32–45.

    Article  Google Scholar 

  • Merikangas, K. R., He, J.-P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010a). Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics, 125, 75–81.

    Article  PubMed  Google Scholar 

  • Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Shelli, A., Cui, L., Swendsen, J. (2010b). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication-Adolescents Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49, 980–989.

    Article  Google Scholar 

  • Milin, R., Kutcher, S., Lewis, S. P., Walker, S., Wei, Y., Ferril, N., Armstrong, M. A. (2016). Impact of a mental health curriculum on knowledge and stigma among high school students: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 55, 383–391.

    Article  PubMed  Google Scholar 

  • Moses, T. (2010). Being treated differently: Stigma experiences with family, peers, and school staff among adolescents with mental health disorders. Social Science & Medicine, 70, 985–993.

    Article  Google Scholar 

  • Nash, S., Sixbey, M., An, S., & Puig, A. (2017). University students’ perceived need for mental health services: A study of variables related to not seeking help. Psychological Services, 14, 502–512.

    Article  PubMed  Google Scholar 

  • Newcomb-Anjo, S. E. (2018). Applying what is known about adolescent development to improve school-based mental health literacy of depression interventions: Bridging research to practice. Adolescent Research Review. https://doi.org/10.1007/s40894-018-0083-6.

    Article  Google Scholar 

  • Oldfield, J., Humphrey, N., & Hebron, J. (2016). The role of parental and peer attachment relationships and school connectedness in predicting adolescent mental health outcomes. Child and Adolescent Mental Health, 21, 21–29.

    Article  PubMed  Google Scholar 

  • Olsson, D. P., & Kennedy, M. G. (2010). Mental health literacy among young people in a small US town: Recognition of disorders and hypothetical helping responses. Early Intervention in Psychiatry, 4, 291–298.

    Article  PubMed  Google Scholar 

  • Painter, K., Phelan, J. C., DuPont-Reyes, M. J., Barkin, K. F., Villatoro, A. P., & Link, B. G. (2017). Evaluation of antistigma interventions with sixth-grade students: A school-based field experiment. Psychiatric Services, 68, 345–352.

    Article  PubMed  Google Scholar 

  • Piaget, J., & Inhelder, B. (1962). The psychology of the child. New York: Basic Books.

    Google Scholar 

  • Pinto, M. D., Hickman, R., Logsdon, M. C., & Burant, C. (2012). Psychometric Evaluation of the Revised Attribution Questionnaire (r-AQ) to measure mental illness stigma in adolescents. Journal of Nursing Measurement, 20, 47–58.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pitre, N., Stewart, S., Adams, S., Bedard, T., & Landry, S. (2007). The use of puppets with elementary school children in reducing stigmatizing attitudes towards mental illness. Journal of Mental Health, 16, 415–429.

    Article  Google Scholar 

  • Prinstein, M. J., & Dodge, K. A. (2008). Understanding peer influence in children and adolescents. New York: The Guilford Press.

    Google Scholar 

  • Rickwood, D., Cavanagh, S., Curtis, L., & Sakrouge, R. (2004). Educating young people about mental health and mental illness: Evaluating a school-based programme. International Journal of Mental Health Promotion, 6(4), 23–34.

    Article  Google Scholar 

  • Salerno, J. P. (2016). Effectiveness of universal school-based mental health awareness programs among youth in the United States: A systematic review. Journal of School Health, 86, 922–931.

    Article  PubMed  Google Scholar 

  • Schachter, H. M., Girardi, A., Ly, M., Lacroix, D., Lumb, A. B., van Berkom, J., Gill, R. (2008). Effects of school-based interventions on mental health stigmatization: A systematic review. Child and Adolescent Psychiatry and Mental Health, 2, 18.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schulze, B., Richter-Werling, M., Matschinger, H., & Angermeyer, M. C. (2003). Crazy? So what! Effects of a school project on students’ attitudes towards people with schizophrenia. Acta Psychiatrica Scandinavica, 107, 142–150.

    Article  PubMed  Google Scholar 

  • Steinberg, L., & Monahan, K. C. (2007). Age differences in resistance to peer influence. Developmental Psychology, 43, 1531–1543.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stinson, J., Kohut, S. A., Forgeron, P., Amaria, K., Bell, M., Kaufman, M., Spiegel, L. (2016). The iPeer2Peer program: A pilot randomized controlled trial in adolescents with juvenile idiopathic arthritis. Pediatric Rheumatology. https://doi.org/10.1186/s12969-016-0108-2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Strunk, C. M., King, K. A., Vidourek, R. A., & Sorter, M. T. (2014). Effectiveness of the surviving the Teens® suicide prevention and depression awareness program: An impact evaluation utilizing a comparison group. Health Education & Behavior, 41, 605–613.

    Article  Google Scholar 

  • Swartz, K. L., Kastelic, E. A., Hess, S. G., Cox, T. S., Gonzales, L. C., & Mink, S. P. & DePaulo, J. R. Jr (2010). The effectiveness of a school-based adolescent depression education program. Health Education & Behavior, 37, 11–22.

    Article  Google Scholar 

  • Swartz, K. L., Musci, R. J., Beaudry, M. B., Heley, K., Miller, L., Alges, C., Wilcox, H. C. (2017). School-based curriculum to improve depression literacy among US secondary school students: A randomized effectiveness trial. American Journal of Public Health, 107, 1970–1976.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vargas, S. M., Cabassa, L. J., Nicasio, A., De La Cruz, A. A., Jackson, E., Rosario, M., Lewis-Fernández, R. (2015). Toward a cultural adaptation of pharmacotherapy: Latino views of depression and antidepressant therapy. Transcultural Psychiatry, 52, 244–273.

    Article  PubMed  Google Scholar 

  • Ventieri, D., Clarke, D. M., & Hay, M. (2011). The effects of a school-based educational intervention on preadolescents’ knowledge of and attitudes towards mental illness. Advances in School Mental Health Promotion, 4(3), 5–17.

    Article  Google Scholar 

  • Wahl, O. (1999). Mental health consumers’ experience of stigma. Schizophrenia Bulletin, 25, 467–478.

    Article  PubMed  Google Scholar 

  • Wahl, O., Susin, J., Kaplan, L., Lax, A., & Zatina, D. (2011). Changing knowledge and attitudes with a middle school mental health education curriculum. Stigma Research and Action, 1, 44–53.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wahl, O., Susin, J., Lax, A., Kaplan, L., & Zatina, D. (2012). Knowledge and attitudes about mental illness: A survey of middle school students. Psychiatric Services, 63, 649–654.

    Article  PubMed  Google Scholar 

  • Watson, A. C., Otey, E., Westbrook, A. L., Gardner, A. L., Lamb, T. A., Corrigan, P. W., … Fenton, W. S. (2004). Changing middle schoolers’ attitudes about mental illness through education. Schizophrenia Bulletin, 30, 563–572.

    Article  PubMed  Google Scholar 

  • Wei, Y., Hayden, J. A., Kutcher, S., Zygmunt, A., & McGarth, P. (2013). The effectiveness of school mental health literacy programs to address knowledge, attitudes and help seeking among youth. Early Intervention in Psychiatry, 7, 109–121.

    Article  PubMed  Google Scholar 

  • Weisman, H. L., Kia-Keating, M., Lippincott, A., Taylor, Z., & Zheng, J. (2016). Mental health stigma prevention: Pilot testing a novel, language arts curriculum-based approach for youth. Journal of School Health, 86, 709–716.

    Article  PubMed  Google Scholar 

  • Weiss, M. F. (1985). Children’s attitudes toward mental illness as assessed by the opinions about mental illness scale. Psychological Reports, 57, 251–258.

    Article  PubMed  Google Scholar 

  • Whitbeck, L. B., Hartshorn, K.J.S., Crawford, D. M., Walls, M. L., Gentzler, K. C., & Hoyt, D. R. (2014). Mental and substance use disorders from early adolescence to young adulthood among indigenous young people: Final diagnostic results form an 8-year panel study. Social Psychiatry and Psychiatric Epidemiology, 49, 961–973.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wong, E. C., Cerully, J. L., Collin, R. L., & Roth, E. (2014). Findings from the school-based theatrical performance walk in our shoes. RAND Health Quarterly, 4(2), 1–9.

    Google Scholar 

  • Wright, A., Harris, M. G., Jorm, A. F., Cotton, S. M., Harrigan, S. M., McGorry, P. D., Hurworth, R. E. (2005). Recognition of depression and psychosis by young Australians and their beliefs about treatment. Medical Journal of Australia, 183, 18–23.

    Article  PubMed  Google Scholar 

  • Yamaguchi, S., Mino, Y., & Uddin, S. (2011). Strategies and future attempts to reduce stigmatization and increase awareness of mental health problems among young people: A narrative review of educational interventions. Psychiatry and Clinical Neurosciences, 56, 405–415.

    Article  Google Scholar 

  • Yang, J., Lopez Cervera, R., Tye, S. J., Ekker, S. C., & Pierret, C. (2018). Adolescent mental health education InSciEd out: A case study of an alternative middle school population. Journal of Translational medicine, 16, 84.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yang, L. H., Thornifcroft, G., Alvarado, R., Vega, E., & Link, B. G. (2014). Recent advances in cross-cultural measurement in psychiatric epidemiology: Utilizing ‘what matters most’ to identify culture-specific aspects of stigma. International Journal of Epidemiology, 43, 494–510.

    Article  PubMed  Google Scholar 

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LA and SS conceived of the review together. LA drafted the manuscript, and SS contributed to writing and editing. Both LA and SS read and approved the final manuscript.

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Correspondence to Sarah E. O. Schwartz.

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Austin, L.J., Schwartz, S.E.O. Addressing Mental Health Stigma in Early Adolescence: Middle School Antistigma Interventions. Adolescent Res Rev 4, 223–233 (2019). https://doi.org/10.1007/s40894-018-0101-8

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