Beyond education and contact program components, existing research on how to design a successful adolescent stigma reduction intervention has been inconclusive. This study evaluated the effectiveness of a school-based mental health (MH) stigma reduction and health promotion program, Ending the Silence (ETS), developed by the National Alliance on Mental Illness (NAMI). A diverse sample of 206 high school students in New York City participated in the current study. Using a cluster randomized controlled trial design, 14 ninth-12th grade classes (Grade 9 -12) were randomly assigned to the ETS program or an active control presentation on careers in psychology. Students completed 4 surveys throughout the study (pre, immediate post-presentation, 4 weeks post, 8 weeks post). Prospective results (over 2 months) and qualitative feedback were analyzed. Prospectively, mixed effects modeling indicated significant effects in favor of the ETS group for reduced negative stereotypes, improved mental health knowledge, and less anticipated risk for disclosing to a counselor. There were also trends in favor of the ETS group for reductions in intended social distancing and negative affect, and improvements in help-seeking intentions. Other predictors of stigma included mental health knowledge, gender, race/ethnicity, prior contact with mental illness, and grade level. Qualitative feedback indicated positive impressions of ETS overall, but suggestions for more interactive activities and discussion. Relatively brief programs such as ETS appear to be a practical vehicle for stigma reduction. Future research is warranted on longer-term programs and adolescent development variables.

Although research consistently shows that persons with direct experience and other forms of contact with mental illness endorse less mental health stigma than others, it is unclear how stigma is expressed by persons experiencing mental health symptoms who have not formally been labeled. One possibility is that unlabeled persons may engage in “defensive projection” and thereby endorse more stigma. Research with young adults with untreated mental health problems suggests that “self-identification” is associated with less stigma and may moderate this effect. The present study investigated whether having a subclinical mental disorder is related to greater stigma and whether self-identification moderates this relationship. Four hundred ninety-four college students and general community members were administered scales assessing psychiatric symptoms, self-identification of mental illness, and 2 dimensions of stigma (agreement with negative stereotypes and microaggression behavior). Findings supported the defensive projection hypothesis, in that persons with subclinical mental disorders demonstrated more stigma than others. Findings also supported that the defensive projection was moderated by self-identification; however, findings indicated that self-identification did not completely override the effect of having a subclinical mental disorder on stigma, as participants with high self-identification and subclinical mental disorder still demonstrated higher scores in both aspects of stigma than participants with no subclinical mental disorder. Findings suggest that antistigma interventions need to place more emphasis on the normalization of mental health conditions to reduce instances in which persons reject others partly because they struggle to accept aspects of themselves.

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