School-based program reverses bias against mental illness in Black and Latinx teens

A school-based educational program successfully lowered mental health stigma among Black and Latinx adolescents. Bias mental illness is common among teenagers, and the consequence is worsened mental health and avoidance of treatment for those who need it.

The study led by Melissa Dupont-Reyes, PhD, assistant professor of sociomedical sciences and epidemiology at Columbia University Mailman School of Public Health, appears in the journal Stigma and Health.

Earlier research found the intervention effective in reducing stigma among teenagers broadly, but it was unknown whether it could reduce high rates of stigma among Black and Latinx adolescents, particularly boys.

“Marginalized groups have been left out of anti-stigma prevention efforts. Evidence also suggests these groups may seek to avoid the additional stigmatized label of mental illness to avoid even more marginalization,” says Dupont-Reyes.

Study participants comprised 751 sixth graders across 14 Texas schools. Classes were randomized to receive none, one, or a combination of three interventions: a three-hour anti-stigma teacher-led curriculum; contact with a young adult who described their experience with bipolar disorder; or/or materials with anti-stigma messaging. A subset of 302, students completed questionnaires at baseline and a two-year follow-up.

The researchers assessed stigma by asking participants to agree or disagree with questions like: “People with mental illnesses tend to be violent and dangerous,” “It would be embarrassing to have a mental illness,” “I heard people use slang terms about mental illness like ‘psycho’, ‘crazy’, or ‘looney’ to put people down.” They also assessed the degree to which adolescents are willing to interact with a peer with mental illness in different contexts.

While non-Latino Black boys and Latino boys and girls reported greater disparities in stigma at baseline compared to non-Latina white girls, these disparities were mostly eliminated in the follow-up following receipt of the curriculum and contact components. The interventions were particularly effective in eliminating race/ethnic disparities in stigma among girls.

Overall, the anti-stigma curriculum was more effective than the contact intervention. However, improvement in knowledge/attitudes for non-Latino Black boys was driven by the contact intervention, not the curriculum intervention. According to the researchers, tailored, targeted approaches may be needed for non-Latino Black and Latino boys.

The researchers say that if students received efficacious anti-stigma educational programming in school settings regularly, such as earlier in elementary school or “boosters” in high school, perhaps any residual disparities in stigma among boys of color would dissipate.

“We now have strong evidence that anti-stigma interventions reduce mental illness stigma and how they reduce disparities in these biases. This knowledge will help us shape future anti-stigma interventions for diverse populations,” says Dupont-Reyes.

Study co-authors include Jo C. Phelan, Columbia Mailman; Alice P. Villatoro, Santa Clara University; Jared Datzman, Texas A&M University; Kris Painter, University of Texas, Arlington; Kris Painter, Barkin Communications; and Bruce G. Link, University of California, Riverside.

Funding was provided by the National Institute of Mental Health (MH095254, 5-T32-MH 13043).