Disclosure to Reduce the Self-Stigma of Mental Illness in College Students: A Small Feasibility Pilot of a Manualized Intervention - Honest, Open, Proud – College

Background/Purpose:

Individuals with mental illness (MI) face both societal and self-stigmatization which can be a barrier to treatment seeking; for college students this impact can be significant and even lethal (ACHA, 2008).  Given that MI stigmatization may result in unequal access to needed care, it is an important target for social work in its pursuit of the Grand Challenges (AASWSW, 2016).

The harmful effects of self-stigma may be alleviated through purposeful disclosure - sharing one’s lived experience with a MI – in contrast to secrecy which can be a damaging coping strategy (Corrigan et al., 2010).  To that end, Honest, Open, Proud – College (HOPC) is a manualized, peer-led group intervention created incorporating feedback from students with lived experience (Al-Khouja et al., 2015).  HOPC guides participants through a disclosure decision-making process as a destigmatizing act.  This presentation describes HOPC, feasibility findings, and small-sample comparisons serving as pilot data for a larger study.

Methods:

Participants were randomly assigned to either HOPC condition or waitlist control.  Longitudinal data were collected electronically at two time points coinciding with the program’s first two sessions.

The sample consisted of 16 students (HOPC n=7; Waitlist n=9) ages ranging from 18 to 43 years (M=22.0; s.d.=6.6).  Most participants were white (n=15, 93.8%) and undergraduate students (n=12, 75.0%).  Most were currently engaged in mental health counseling (n=10, 62.5%).

Outcome variables include a self-stigma scale (SSMIS-SF); a cognitive appraisal of stigma stress (CASS); Secrecy; and disclosure related self-efficacy [DRSE].  For all, higher scores indicate higher levels of the construct.  Univariate and bivariate analyses included descriptive statistics and paired and independent sample t-tests.  Using t-tests to compare between/within small groups has received empirical support (e.g. Winter, 2013).

Results:

Average scores on the SSMIS-SF, CASS, and Secrecy Scale decreased for the HOPC group between pre and posttest, but not significantly so, and when compared to waitlist scores, were not significantly different.  However, HOPC participants did show a significant increase in DRSE between pre and posttest t(6)= -4.04, p<0.01 whereas the waitlist’s average DRSE scores remained stable. An independent samples t-test comparing DRSE at posttest indicates that while the HOPC scores are lower than the waitlist, the difference is not significant t(14)=1.87, p=0.08.

Conclusions & Implications:

Feasibility findings suggest that HOPC can be implemented at a private, faith-based university.  While the sample for this pilot is small, the interest of students and staff is promising.  The intervention did not have a significant effect on many of the outcome measures.  DRSE, however, did increase among participants, indicating that HOPC may be effective in helping participants increase perceptions of ability and readiness to more openly share their MI lived experience. 

Future investigations should utilize measurement time points further out from the intervention’s implementation and include more participants, addressing key limitations in this pilot study’s method (short time frame and low statistical power).  However, despite limitations, this study provides initial support for HOPC’s feasibility and usefulness in supporting students who live with MIs to increase DRSE, which may have implications for the experience of self-stigma.