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Empowering the Next Generation to End Stigma By Starting the Conversation: Bring Change to Mind and the College Toolbox Project

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Objective To examine outcomes in a 4-year college pilot program built on stigma change research. U Bring Change to Mind (UBC2M) was developed and launched at Indiana University (IU) in 2014 as an institutionally supported, student-led organization to make campuses “safe and stigma-free zones.” The accompanying College Toolbox Project (CTP) assessed change in student prejudice and discriminatory predispositions as well as perceptions and behaviors at follow-up. Method All entering Class of 2019 students were invited to complete a Web-based survey (N = 3,287; response rate = 44.6%). In their third year, students were sent a follow-up survey. Stigma indicators for 1,132 students completing both waves were analyzed using descriptive statistics and multivariate regressions. Models controlled for social desirability, prior contact, socio-demographics, and self-reported mental illness. Participation was examined for potential biases. Results Statistically significant positive changes in attitudes and behavioral predispositions emerged. Although fewer students with prior contact endorsed stigma items initially, they reported significant reduction at follow-up. UBC2M active engagement was associated with lowering prejudice. Both passive and active engagement predicted change in discriminatory predispositions as well as current inclusive behaviors and positive perceptions of campus mental health culture. Conclusion A long-term, community-based, student empowerment approach with institutional supports is a promising avenue to reduce stigma on college campuses, to develop the next generation of mental health leaders, and to potentially reduce societal levels of stigma in the long run. CTP provides evidence that both contact and contextual visibility matter, and that UBC2M offers a nationally networked organizational strategy to reduce stigma.
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NEW RESEARCH
Empowering the Next Generation to End Stigma by
Starting the Conversation: Bring Change to Mind and
the College Toolbox Project
Bernice A. Pescosolido, PhD, Brea L. Perry, PhD, Anne C. Krendl, PhD
Objective: To examine outcomes in a 4-year college pilot program built on stigma change research. U Bring Change to Mind (UBC2M) was
developed and launched at Indiana University (IU) in 2014 as an institutionally supported, student-led organization to make campuses safe and stigma-
free zones.The accompanying College Toolbox Project (CTP) assessed change in student prejudice and discriminatory predispositions as well as
perceptions and behaviors at follow-up.
Method: All entering Class of 2019 students were invited to complete a Web-based survey (N ¼3,287; response rate ¼44.6%). In their third year,
students were sent a follow-up survey. Stigma indicators for 1,132 students completing both waves were analyzed using descriptive statistics and
multivariate regressions. Models controlled for social desirability, prior contact, socio-demographics, and self-reported mental illness. Participation was
examined for potential biases.
Results: Statistically signicant positive changes in attitudes and behavioral predispositions emerged. Although fewer students with prior contact
endorsed stigma items initially, they reported signicant reduction at follow-up. UBC2M active engagement was associated with lowering prejudice.
Both passive and active engagement predicted change in discriminatory predispositions as well as current inclusive behaviors and positive perceptions of
campus mental health culture.
Conclusion: A long-term, community-based, student empowerment approach with institutional supports is a promising avenue to reduce stigma on
college campuses, to develop the next generation of mental health leaders, and to potentially reduce societal levels of stigma in the long run. CTP
provides evidence that both contact and contextual visibility matter, and that UBC2M offers a nationally networked organizational strategy to reduce
stigma.
Key words: stigma, mental health, intervention, college, emerging adults
J Am Acad Child Adolesc Psychiatry 2019;-(-):--.
research resurgence over the past two decades
has provided a solid scientic foundation for
understanding possibilities and limits for stigma
reduction.
1
Recent reviews, including the National Acad-
emy of Sciences (NAS) report, Ending Discrimination
Against People with Mental Illness and Substance Use Disor-
ders: The Evidence for Stigma Change,
2
provide both
encouraging and discouraging conclusions.
3-8
On the pos-
itive side, concepts have been claried, facilitating an un-
derstanding of the multilevel, complex nature of stigma
surrounding mental illness (MI), dened as the prejudice
and discrimination surrounding MI.
1,5,9
Efforts to reduce
the consequences of negative social labeling of MI have
clearer targets and goals. Furthermore, in Western nations,
most of the public tacitly endorses underlying neurobio-
logical causes of MI while rejecting older, morally based
etiologies (ie, weak character).
3,10
Intervention studies
demonstrate the ability to move the needle,reducing
damaging beliefs, perceptions, and behaviors.
11-13
Finally,
perhaps the biggest change since the 1950s, is the growing
willingness of individuals to talk to friends and relatives
about mental health problems.
14
Personied by high-prole
individuals disclosing mental health struggles across sports,
entertainment, literary, and even political spheres, testi-
monies of service usersas active ingredients of stigma
reduction is promising.
15
Contrary evidence shades optimism. In the United
States, stigma has not dissipated as predicted after deinsti-
tutionalization.
3,16
As the foremost obstacle to recovery,
17
stigma continues to amplify the devastating effects of MI
on individuals, families, professions, and commu-
nities.
4,18,19
From years of life lost to continued high
A
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unemployment rates, stigma diminishes personal and soci-
etal productivity.
20
Despite becoming more sophisticated in
understanding MI, a near public majority expresses ani-
mosity and endorses exclusion.
6
The battle over parity in
insurance, research funding, and services continues.
21
Some
messages, once considered key (eg, a disease like any
other), have been shown to be ineffective at this point.
22
Many anti-stigma efforts, based on mythsabout stigma
reduction, are never tested for effectiveness.
5
Those tested
have been characterized as having weak study designs,
inadequate sample sizes, and effects that extinguish over
time. Interventions focus primarily on attitude, less critical
from consumersviewpoints, rather than behaviors or
behavioral predispositions.
5,12,13
Even the utility of the
contact hypothesisas a change agent is up for debate.
11,23
Seasoned stigma researchers and providers recommend
abandoning familiar but ineffective approaches
5
(p. xx).
In response, Glenn Close, actor and activist, began
speaking about MI in the context of her familys history,
building an advocacy organization centered on conversa-
tionas a mechanism to decrease stigma. In August 2009,
Bring Change to Mind (BC2M) aired its rst public service
announcement (Grand Central Terminal) and formulated
its two organizational pillars: a scientic foundation, and
inclusion of family and friends in all efforts (https://
bringchange2mind.org). This article reports data on one
of BC2Ms three major programs: U(niversity) Bring
Change to Mind (UBC2M), a student-led, anti-stigma
effort designed to create stigma-free zoneson college
campuses. As Sontag-Padilla et al.
24
recently documented,
peer-to-peer programming has now been recognized as a
potential solution in higher education.
College administrators have taken note of mental health
(MH) issues, given recent research that has documented
high levels of MH problems among college students and a
similar rate of untreated problems as seen in the general
population.
25-28
Students generally enter during the mean
age of MI onset (1524 years of age) and face critical life
course transitions, including an elevation of academic re-
sponsibilities, movement out of the family home, shake-up
in friendship and support networks, and multiple cross-
pressures from social, living, and academic arrange-
ments.
29
With pressure on college health centers to increase
MH services, parents, students, administrators have
changed the dialogue. New advocacy organizations formed:
in 2000, the JED Foundation (https://www.jedfoundation.
org); Active Minds in 2003 (https://www.activeminds.org/
about-us./our-story); the National Alliance on Mental Ill-
nesss revamped college efforts in 2013 (https://www.nami.
org/About-NAMI/NAMI-News/2013/New-Semester-New-
NAMI-on-Campus-Clubs); and Mental Health Americas
Life on Campus Program (http://www.mentalhealthamerica.
net/whats-your-plan-college-mental-health-disorder). Many
colleges and universities assembled task forces to confront
these pressures and to discuss novel programing (eg,
McLean Hospitals ICARE
25
Internet-based treatment for
depression in college students, now in clinical trials).
Until recently, there were no rigorous evaluations of
stigma reduction efforts in higher education.
24
Here, we
assess BC2Ms college program, UBC2M. We examine
change over time on multiple stigma dimensions. On the
individual level, we hypothesized that active engagement
with UBC2M (eg, attending events, seeking out informa-
tion through social media or coursework) will have short-
term (favorable normative beliefs, more openness in
discussing MH) and long-term (stigma reduction) benets.
At the campus level, we hypothesized that passive exposure
to UBC2M (eg, the UBC2M logo, bus, or yers around
campus) will have similar short-term and long-term bene-
ts. The fundamental rationale for the individual-level hy-
pothesis stems from classical theory of prejudice reduction
based on active contact among those of equal status in the
pursuit of common goals.
30
The contextual-level hypothesis
draws from two sources: rst, the synthetic, dual-process
theory of culture that suggests that cultural worldviews
shape local network inclusion
31
; second, the theory that the
larger culture, dened as normative beliefs and shared
behavioral expectations in a particular place, affects in-
dividualsattitudes and beliefs, especially among the newer
members.
32,33
By evaluating within-person change in atti-
tudes and behavioral predispositions alongside current be-
haviors and perceptions, the results offer promising
directions for stigma interventions.
METHOD
Study Design
The CTP Outcomes Assessment (IU-IRB Protocol
1407536121) is based on online surveys administered in 2
waves during Years 2 and 4. Year 1 involved human subject
approvals, specic Indiana University (IU) permissions,
pilot events and instrument testing. All Class of 2019 stu-
dents (N ¼7,376) were eligible to participate at baseline
(Time 1; T1). IU Research Technologiesdata manager, not
the research team, provided access to the IU(Bloomington)
Data Vault by the IU Council of Data Stewards, allowing
conrmation of rst year status. Students were invited to
the survey at Orientation. Later, the Strategic Planning and
Research group, Ofce of Enrollment Management, sent
survey invitation e-mails, queued condential reminders to
nonrespondents, and provided limited socio-demographic
data for consented subjects. Students completing the
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survey (N ¼3,287; response rate ¼44.6%) received a
student-designed swag bag(eg, IU/BC2M tank top, fanny
pack, light backpack). Two years later, current Class of
2019 students were sent invitations to the follow-up survey
(Time 2; T2 N ¼1,832; response rate ¼27.6%). We focus
on 1,193 students who completed both waves. Missing data
on individual variables slightly reduce sample sizes. Intra-
individual comparison lessens response bias inherent in
comparing responses of all panel respondents. As part of a
separate research question investigating whether and how
language matters, the survey at both time points used four
forms, randomly assigned to students. The different forms
each used person-rst language, but described the person as
having mental illness,”“mental health problems,”“a his-
tory of mental illness,or a history of mental health
problems.Analyses of covariance controlling for prior
contact with individuals with MI found no effects of lan-
guage, so data are collapsed across forms.
The IU undergraduate demographics were 51% female
respondents, 70.8% white, and 62.5% in-state students. In
addition, 58.1% of the students were between 18 and 21 years
old (mean age, 18.37 years; https://www.collegefactual.com/
colleges/indiana-university-bloomington/student-life/diversity/).
Women accounted for 70.7% of respondents, 82.2% were
white, 69.5% were in-state students, 17.3% reported a
current/past MI, and 24.3% had low socioeconomic status
(see Tables S1 and S2, available online).
The Program: UBC2M
The impetus for a college program came from three sources.
First, given small-to-modest changes documented in large-
scale public efforts and extinguishing effects in individual-
level interventions, BC2M searched for alternative theories
of change. Sociological research suggested that cultural
change does not happen so much as a result of changing
hearts and mindsbut because individuals with new atti-
tudes, values, and beliefs come to the fore in organizations
and society.
34-37
Variously referred to as cohort replacement
theory or the acquired disposition models of cultural
change, this approach posits that individualscharacter and
beliefs stabilize in formative periods, remaining fairly stable
afterward. This pointed to younger cohorts as a longer-run
strategy, with the advantage of potentially creating a new
generation of medical, political, and social leadership in
mental illness, including stigma. At the same time, pio-
neering research on college student mental health, reports
from college counseling center directors, and Center for
Disease Control and Prevention (CDC) suicide reports
document a growing MH crisis among youth.
26,38-40
UBC2M marked the goal of making colleges and uni-
versities safe and stigma-free zones,focusing on public
stigma, that is, the campus cultural climate. It followed the
review by Yamaguchi et al.
12
of educational- based efforts
calling for longer-term follow-up of stigma efforts. The
Program Advisor for Cognitive Disorders (Banbury Center),
held a planning meeting April 1417, 2014, at Cold Spring
Harbor Laboratory. Eighteen IU undergraduate and grad-
uate students, national and international stigma researchers,
and founder and members of BC2M and youth MH pro-
grams spent 2 days developing the bonesof a novel college
program. The result was a two-part effort to develop and to
assess a campus-based effort at IU, the academic home of
BC2Ms Chair of the Scientic Advisory Board (rst
author). First, the College Toolbox Project (CTP) provided
institutional support, and an assessment carried out by an
interdisciplinary science, staff, and student team working
pro bono. The CTP synced with what would later become
the primary NAS report
2
recommendation: long-lasting
stigma change requires continuous efforts that attack all
levels of stigma and use all tools available. Faculty designed
and implemented the assessment, provided mentorship, and
worked with institutional ofcials to clear administrative
hurdles. Second, UBC2M, the University arm of BC2M,
would be a student-led club planning and carrying out anti-
stigma activities, advocating for change in college policies,
and creating safe and stigma-free zones.
UBC2Ms foundation was based on ve general prin-
ciples from stigma research (Table 1). UBC2M targets
college as community,but where specic events may
focus on different groups (eg, freshman, students of color,
faculty, the larger Bloomington community). Leadership,
based on a peer-to-peer model, is charged with designing
programs and policies that speak to stigma, including the
possibility of intersectional or multiple stigmas, and are
provided the resources to do so. The basis for UBC2M
efforts is scientic research, avoiding approaches known to
be ineffective, condescending, or narrowly pedantic. Leaders
leverage community resources for greater impact and to
integrate anti-stigma efforts into the life of the community,
not just those with or with an interest in MH. UBC2M
aims for an approach with exibility to change, continually
drawing from community energy, and moving with socio-
demographic and cultural trends.
2,5
These ve general principles translate into ve working
principles. First, start early and often. Second, use primarily
aby students, for studentsapproach with activities,
including formative research, designed and carried out by
students with staff/faculty mentoring. Third, use a bait and
ipmodel. Research suggests that previous contact is a
fairly robust correlate of lower stigma, a potentially powerful
change lever, and a characteristic of typical participants
(those inside the choir).
41
Yet, those who report not
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knowing persons with mental health issues (those outside
the choir) are less likely to participate, and more typically
endorse stigma. Engaging wide participation calls for
innovative events and participation incentives (class credits,
swag, fun, support for other clubs). Fourth, leverage existing
student organizations, relevant classes, and university re-
sources to weave MH into the campus fabric. Finally, view
UBC2M, from the outset, as a living libraryof experi-
ences, creating resources (eg, event blueprints,whether
successful or not) with the expectation that each student
cohort, and each UBC2M campus, would build ownership
by developing unique events and blueprints.
College students showed remarkable leadership and
enthusiasm, facing the logistic and institutional challenges
successfully. Over time, student leadership developed
normative standards or expectations for their semester ac-
tivities. These include: biweekly club meetings; activity at
New Student Orientation Late Nite(eg, IU belonging art
project, a mosaic of individually drawn cardboard tiles);
participation in the Sex, Drugs, and RocknRoll Welcome
Weekevent (eg Stigma can suck my popsicleactivity
with temporary tattoo and lime green popsicle give away),
Student Involvement Fair (table for recruitment), First
ThursdaysFestival (eg, hands-on stigma activity with
TABLE 1 Summary of Selected Principles From Stigma Reduction Research (Panel A) Tailored for College/University Programs
(Panel B)
Panel A
Selected Underlying General Principles for
Anti-Stigma Programs Implication for Current Program
Target a Population, Clarify
Relevant Message
Do not target general, national population as a
whole, but groups likely to be open to change
and that are potential leaders
College students stand at a key transition
point; goal is inclusion and tolerance
Choose Leaders of the
Communityand Provide
Resources
Institutional programs, especially if forced, are
less likely to be effective
Faculty and staff are less likely than students
to develop successful student programs
that target culture
Avoid Known, Ineffective
Approaches
Base the program in the research on effective
anti-stigma approaches
Mentoring for student club includes science;
go beyond classroom
Leverage existing resources Avoid common unwillingness among MH
organizations to work together and typical
tradition to ownprograms
Partner with existing student groups,
institutional events
Build in Change Flexibility is essential to continue efcacy as
communities undergo social change.
Detailed manualized programs inappropriate
for anti-stigma programs
Panel B
Tailored Principles for Anti-Stigma University
Programs Implication for Current Program
Start Young Within the college population, special focus on
entering students
Include all students in events, but target rst-
year students for special emphasis
By Students, for Students Organic focus on the campus climate, not
institutional requirements or needs; awareness
remains in-scope
Education most effective with younger
groups; leave to faculty, administration
Employ Bait and FlipModel Consider rst what will draw students in to
receive the messages and start conversations
Get outside the choirto be most effective
Inltrate, Share, and Build
Resources
Events require resources often outside student
organization budget; get outside the choir
facilitated by co-branding and volunteering in
related events
Seek places, other student groups or college
ofces with similar goals to pool resources
and introduce similarity of larger goals
Create Shareable Resources
That Build Larger Effort
Provide guides to failed and successful events;
this includes what it takes to do the event, how
to do it, where tailoring should be considered,
and engage students to do simple, summative
assessments included in materials
Create living libraryof each event that
includes blueprint and assessment, and
allows for other campuses to have
ownership and program to move with
higher education culture
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UBC2M giveaways); one major UBC2M event (eg, Bring
in the Bootyscavenger hunt with MH activity stations);
one co-branded event (eg, Union BoardsLove the Skin
Youre InFashion Show promoting body-type diversity
and inclusivity); annual campus anti-stigma campaign
competition; one academic event (eg dinner and panel on
13 Reasons WhyTV series); De-Stressevent (eg, nals
study-break activities such as massages, coloring, kinetic
sand, word searches, and snacks); campus bus wrap design
(eg, lime green skin with branding and stigma storyline);
student speakers during annual BC2M gala and major
events; and other efforts, both small (eg, tabling events) and
large (eg, Kelley School of Business hosting Late Show
actor/comedy writer/alumnus Brian Stack to speak about
anxiety and depression).
Measures
Dependent Variables. With stigma research on college
experiences being relatively recent, items were chosen from
standard scales, college-specic measures were developed,
and standard social distance items were adapted.
10
A prin-
cipal components analysis (PCA) determined whether items
loaded together with acceptable eigenvalues (>1) and suf-
ciently high Cronbachs
a
for internal consistency. As
required, individual scale items were reverse scored so that
higher raw scores indicate more stigma. In each case, results
suggested a one-factor solution. Retained items had a factor
loading of 0.30 or above.
42
We adapted two sets of prejudice items with responses
ranging from 1 (strongly agree) to 4 (strongly disagree). First,
12 items tapping General Prejudice (eg, I am frightened to
be around persons with a history of mental illness) were
analyzed. PCA identied eight items with acceptable inter-
item reliability (Cronbachs
a
>0.77) that loaded on the
rst factor (loadings: 0.390.70). Remaining items were
discarded. Second, College-Specic Prejudice drew from 12
items (eg, Students who have a history of mental illness
should not be admitted to IU). Nine items loaded on one
factor (loadings: 0.500.76), with good inter-item reliability
(Cronbachs
a
>0.85). Three items were discarded.
Discriminatory predispositions were measured using
adapted College-Specic Social Distance, comprising 11 items
on unwillingness to engage across different interactions (eg,
have a student with mental illness in one of your classes,”“as
a roommate). Responses were 1 (denitely willing) to 4
(denitely unwilling). All 11 items loaded on one factor
(loadings: 0.440.83), with high inter-item reliability
(Cronbachs
a
>.91).
General and College-Specic Prejudice as well as
College-Specic Social Distance were measured at both
times. Current perceptions and behaviors were assessed only
at T2. Perceptions of Campus Mental Health (MH) Cul-
ture included six items (eg, I feel more free to talk about
mental health problems and stigma issues) with responses
from 1 (strongly agree) to 4 (strongly disagree). All six items
loaded on one factor (factor loadings: 0.680.85) with high
inter-item reliability (Cronbachs
a
¼0.86). Behavior,
Number of MH Conversation Partners, was assessed
through a list asking the number of person types (ie, stu-
dents, faculty) with whom they had talked about mental
health or stigma in the past year, serving as an indicator of
discussion or disclosure disinhibition (Table 2).
Independent Variables. Contact occurred in two ways:
through UBC2M Active Engagement or UBC2M Passive
Engagement. Active was assessed in two ways: asking re-
spondents to check UBC2M-sponsored events that they
attended (Number of Events Attended), and identifying all
possible ways they were in contact with or became aware of
UBC2Mfrom a list of eight possibilities: UBC2M website,
UBC2M Facebook page, UBC2M Twitter follower, ban-
ners, UBC2M events, UBC2M courses, UBC2M bus, or
no interaction (Number of Contact Types). Of the possible
contact types, 4 had endorsements from >10% of the total
respondents: banners (30.5%), UBC2M events (19.9%),
UBC2M bus (31.9%), and no interaction (30.1%). Bivar-
iate correlations were used to determine the association
between contact types and stigma change for any variables.
No signicant effects emerged (all pvalues >.10). Active
contact types reected different ways in which respondents
could have actively sought out UBC2M-related information
or activities. Overall Active Engagement combined the two.
UBC2M Passive Engagement was measured by asking re-
spondents to identify the correct UBC2M logo (Recognized
Logo) from four options, assessing exposure free from social
desirability or recall bias. Passive engagement was also was
measured by asking respondents How did you hear about
UBC2M?(yers, social media, class, friends, students,
branded items, Number of Ways Student Heard about
UBC2M) with a noneoption. Passive UBC2M engage-
ment is distinguished from active contact because they
capture exposure without having sought out the informa-
tion. From these, Overall UBC2M Passive Engagement was
created.Support for active participation is widespread in
stigma research.
1
However, research also suggests that cul-
tural symbols affect individualsevaluations. They assign
meaning, in this case positive, that individuals interpret.
43
Swidler
44
has argued that during unsettled times in in-
dividualslives (such as entering college), symbols, doctrine,
and ritual shape attitudes and behaviors. With professors,
friends and material symbols touting acceptance of differ-
ence in MH, even passive engagement holds potential.
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Although national stigma studies have documented
only inconsistent ndings for socio-demographic variables,
college studies have found that younger, male, and poorer
respondents endorse stigma.
28
We control for those here.
Finally, studies have assessed the importance of prior con-
tact with individuals with MI and respondentsdesires to
provide answers that they believe others would expect.
1,30,45
Although effects were found in face-to-face interviews only
(versus computer-assisted, like CTP), we control for social
desirability.
46
At the end of the survey, respondents pro-
vided demographic information: Sex (male or female), Age
(in years), Race (white or nonwhite), Ethnicity (Latinx/not),
Self-reported Mental Illness (yes or no), Childhood Socio-
economic Status (high or low), and In-state Status (yes or
no). For Prior Contact, respondents reported number of
individuals with MI that they knew at baseline. At T2 only,
respondents also completed seven true/false items from a
standard scale to assess Social Desirability (eg, I have never
deliberately said something that hurt someones
feelings).
47,48
Analytic Strategy
Paired ttests for T1/T2 measures assessed within-person
change over time. Dependent measures were converted to
difference scores between T1 and T2. Negative difference
scores indicate greater stigma reduction and fewer discrim-
inatory predispositions, since higher raw scores on each
measure indicate more stigma. The difference model ad-
dresses time-invariant omitted variables, including prior
experiences or static traits that might inuence individuals
engagement level. Replicated analyses using an alternative
specication for two repeated measures, the lagged depen-
dent variable model, produced identical patterns of signi-
cance for engagement (on request). Separate models
determined whether active (Number of Events Attended,
Overall Active Engagement) or passive (Recognized Logo,
Overall Passive Engagement) engagement had long-term
benets associated with stigma change (General Prejudice,
College-Specic Prejudice), discriminatory predisposition
(College-Specic Social Distance), and/or short-term ben-
ets associated with favorable, current campus culture per-
ceptions (Campus MH Culture), and current behavior
(Number of MH Conversation Partners). Each model
assessed whether a specic type of engagement predicted a
specic dependent variable, using ordinary least-squares
regressions (with OLS, linear, and/or nonlinear poly-
nomial terms) or Poisson regression analyses, as appropriate.
All regression models adjusted for Sex, Age, Race, Self-
reported MI, Childhood Socioeconomic Status, and In-
state Status. Additional sensitivity analyses examining
Ethnicity, Social Desirability, and Prior Contact revealed no
difference in substantive conclusions. These later variables
were dropped for parsimony. Models were successfully
replicated in the subsample self-reporting MI and in using
all available cases in T1 and T2.
OLS regression was used to determine whether re-
spondentsUBC2M active and passive engagement was
associated with changes in prejudice and discriminatory
predispositions. Because variables measuring active, but not
passive, engagement were skewed, we entered them as both
linear and nonlinear (polynomial) terms (simultaneously) in
their respective regression equations. The expectation with
such skewed data is that the effect of participating in no
events, as compared to one event, may be different from
between 4, 5, or 6 events, which mark the upper range of
the distribution. Polynomial terms are reported only when
signicant. To examine whether UBC2M engagement was
associated with more favorable perceptions of Campus MH
TABLE 2 Descriptive Statistics (n, Means, SD) for Prejudice and Discriminatory Predispositions, Campus Mental Health (MH)
Culture, and U Bring Change to Mind (UBC2M) Engagement (Active, Passive), College Toolbox Project, Indiana University (IU),
20152018 (N ¼1,132)
Stigma Types Time Point n Mean (SD)
Attitudes and Beliefs about
Mental Illness
General Prejudice T1 975 15.69 (4.10)
T2 975 13.97 (3.57)
College-Specic Prejudice T1 933 14.81 (4.54)
T2 933 12.78 (3.78)
Discriminatory
Predispositions
College-Specic
Social Distance
T1 913 19.98 (6.28)
T2 913 17.27 (5.85)
Perceptions of Campus Culture Campus MH Culture T2 1,132 15.95 (7.36)
Behavior No. of MH Conversation Partners T2 1,132 2.55 (1.95)
Active UBC2M
Engagement
No. of Events Attended T2 1,132 0.88 (1.57)
No. of Contact Types T2 1,132 0.97 (1.09)
Passive UBC2M Engagement Recognized Logo T2 1,132 0.50 (.50)
No. of How Heard T2 1,132 15.95 (7.36)
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Culture and Number of Conversation MH Partners, a
simple count, not zero-inated, was used with Poisson
regression analyses in Stata 15. Statistical signicance was
set at
a
0.05, two-tailed test (for full results, see
Tables S3S6, available online).
RESULTS
Prejudice and Discriminatory Predispositions
Paired ttests for the stigma measures at T1/T2 revealed that
stigma was lower at T2 across all measures. Specically,
General Prejudice decreased over time (mean
T1
¼15.67,
SD ¼4.10; mean
T2
¼13.97, SD ¼3.57; t(974) ¼13.05,
p<.001, 95% CI ¼1.46, 1.98), as did College-Specic
Prejudice (mean
T1
¼14.81, SD ¼4.54; mean
T2
¼
12.78, SD ¼3.74; t(932) ¼13.30, p<.001, 95% CI ¼
1.73, 2.32). College-Specic Social Distance (mean
T1
¼
19.98, SD ¼6.28; mean
T2
¼17.27, SD ¼5.85) also
decreased over time (t(912) ¼13.21, p<.001, 95% CI ¼
2.30, 3.11). This magnitude of change ranges from a 10.9%
to 13.8% decrease. Among controls, only older entering
students, women, and out-of-state students fairly consis-
tently reported passive changes.
Active Exposure
UBC2M Active Engagement had differential effects on
stigma. Specically, Number of Events Attended was asso-
ciated with reductions in both General and College-Specic
Prejudice (respectively,
b
¼0.06, SE ¼0.01, p<.001,
95% CI ¼0.09, 0.03;
b
¼0.05, SE ¼0.02, p¼.005,
95% CI ¼0.08, 0.01) as well as College-Specic Social
Distance (
b
¼0.05, SE ¼0.02, p¼.02, 95% CI ¼
0.09, 0.01). However, all effects were nonlinear
(Figure 1). Stigma reduction was relatively small if re-
spondents attended only a few (one to three) events, but was
pronounced when respondents attended multiple (four or
more) events (Figure 1A). This does not support our initial
assumptions about non-inear effects. It does support a
tipping point,nonlinear effect. The Number of Events
Attended was linearly associated with increased favorable
perceptions about Campus MH Culture (
b
¼1.29, SE ¼
0.13, p<.001, 95% CI ¼1.03, 1.55), and Number of
MH Conversation Partners (ie, incidence rate ratio [IRR] ¼
1.08, 95% CI ¼1.06, 1.10) (Table 3).
Similarly, Number of Contact Types was associated
with stigma reduction, but only for General Prejudice (
b
¼
0.15, SE ¼0.07, p¼.02, 95% CI ¼0.28, 0.02) and
College-Specic Prejudice (
b
¼0.22, SE ¼0.08, p¼
.004, 95% CI ¼0.37, 0.07) (Table 3). In both cases,
relatively little contact was associated with minimal stigma
reduction, but multiple forms (three to four) of contact
were consequential, again suggesting a tipping point
(Figure 1B). Overall Number of Contact Types did not
affect College-Specic Social Distance, but was linearly
associated with increased favorable perceptions of Campus
MH Culture (
b
¼2.68, SE ¼0.18, p<.001, 95% CI ¼
2.32, 3.04]), and Number of MH Conversation Partners
(IRR ¼1.20, 95% CI ¼1.16, 1.23) (Table 3). Table S7,
available online, lists the number of respondents by number
of events attended and by number of contact types.
Passive Exposure
Passive UBC2M Exposure (Number of How Heard) was
not associated with either General or College-Specic
Prejudice (all
b
values <0.26, SEs >.12, pvalues >
.15). However, Number of How Heard was associated with
more favorable perceptions of Campus MH Culture (
b
¼
2.94, SE ¼0.17, p<.001, 95% CI ¼2.62, 3.27),and
Number of MH Conversation Partners (IRR ¼1.23, 95%
CI ¼1.19, 1.26) (Figures 2A and B, respectively; Table 3).
Table S8, available online, reports the number of re-
spondents by given number of exposures. Similarly,
Recognized Logo was not associated with any change (ie, all
b
values <0.24, SEs >0.27, pvalues >.44). However,
Recognized Logo was associated with more favorable
Campus MH Culture perceptions (
b
¼5.56, SE ¼0.40,
p<.001, 95% CI ¼4.78, 6.34),and Number of MH
Conversation Partners (IRR ¼1.43, 95% CI ¼1.32, 1.54)
(Table 3).
Replication in Self-Reported MI Subsample
UBC2M engagement, whether active or passive, was not
associated with stigma change among students self-
reporting MI (Table S8, available online). There is one
exception: Recognized Logo was associated with a signi-
cant increase in College-Specic Social Distance (
b
¼
1.71, SE ¼0.83, p<.05). This may be an anomaly, may
reect this subgroups lower stigma at outset, or may
suggest an unwillingness to be segregated only with others
identied as a person with.However, all UBC2M
engagement measures, whether active or passive, were
signicantly positively related (p<.001) to more favorable
perceptions of Campus MH Culture and to Number of
MH Conversation Partners. Furthermore, self-reporting
MI was signicantly associated with positive change on
all outcome measures.
DISCUSSION
Based on recent research and policy reports, we designed
and assessed a college-based program, UBC2M, to reduce
stigma. The assessment design included both formative
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assessments (conducted by students for each activity, not
reported here) and summative assessments (conducted by
faculty in a two-wave Internet survey).
Our data analyses indicated that the program had
long-term benets, reduction in stigmaprejudice,
discriminatory predispositionsas well as short-term
benets, positive changes in perceptions of a favorable
campus MH culture, and inclusive behaviors. Signicant
changes occurred, on average, for about 11% to 14% of
the population. Although this may not be as dramatic as
some small-scale interventions have documented, several
key points are in order. First, given lower endorsements of
stigma by entering college students than the general pop-
ulation, we were pleased to see any change. Second, these
rates of change are nearly 5 times greater than national
efforts recorded over a 10-year period.
47
Third, this de-
scribes change among more than those who participated
heavily (ie, about 5% reported attending 4þevents), and
demonstrates the power of contact. Finally, our nding
that active and passive engagement predict more favorable
normative beliefs about MH (eg, perceptions of campus
MH culture, Number of MH conversation partners)
suggests that the program may also shift the larger campus
culture of MI. Because normative beliefs have a powerful
effect on individualsattitudes and beliefs,
32,33
this shift
may lead to more widespread and potentially longer-lasting
stigma reduction.
We do not claim that IU is, at present, a safe and
stigma-free zone,but these results do suggest a positive
impact of UBC2M on the college context. This is not to say
that the CTP is without limitations. For an Internet-based
survey administered to an entire college cohort, the response
rate was high
48
; however, we cannot assess effects among
students who declined to participate. Indeed, participation
may have been nonrandom, as those who completed both
surveys had lower baseline stigma than did those not
completing the follow-up. This does suggest attrition bias in
our sample. Moreover, the overrepresentation of women
and white students, although commonly reported in
contemporary survey research, suggests that more tailored
research and anti-stigma activity are in order. Furthermore,
we did not have a control group. Although considered at
great length (eg, other Big Ten Universities), the research
team decided that scientic, logistic, and nancial costs
FIGURE 1 Effect of Active U Bring Change to Mind (UBC2M) Engagement on General Prejudice, College-Specic Prejudice, and
College-Specic Social Distance
web 3C=FPO
Note: (A) Number of Events Attended, College Toolbox Project, 20152018 (N ¼1,132); (B) Number of Contact Types, College Toolbox Project, 20152018 (N ¼1,132).
Please note color gures are available online.
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TABLE 3 Results of Separate Multivariate Regressions of Student U Bring Change to Mind (UBC2M) Engagement (Active, Passive) on Prejudice, Discriminatory
Predisposition, Campus Mental Health Cultural Perceptions, and Behaviors,
a,b
College Toolbox Project, Indiana University (IU), 20152018 (N ¼1,132)
Attitudes
Behavioral
Predisposition
Perceptions of
Culture Behavior
Change in
General
Prejudice
c
Change in
College-Specic
Prejudice
c
Change in College-
Specic Social
Distance
c
Favorable
Campus MH
Culture
c
No. of MH
Conversation
Partners
d
b
SE
b
SE
b
SE
b
SE IRR 95% CI
Type of Engagement
With UBC2M
Active No. of events
attended
0.30* 0.14 0.27 0.16 0.27 0.22 1.29*** 0.13 1.08 1.06e1.10
No. of events
attended squared
e0.06*** 0.01 e0.05** 0.02 e0.05* 0.02 NS NS NS NS
Amount of contact 0.50* 0.26 e0.22** 0.08 e0.25 0.19 2.68*** 0.18 1.20 1.16e1.23
Amount of
contact squared
e0.15* 0.07 e0.22** 0.08 NS NS NS NS NS NS
Passive Correctly
recognized logo
0.05 0.27 e0.24 0.31 0.21 0.42 5.56 0.40 1.43 1.32e1.54
Types of exposure e0.05 0.12 0.03 0.13 e0.26 0.18 2.94*** 0.17 1.23 1.19e1.26
Note: IRR ¼incidence rate ratio; MH ¼Mental Health; NS ¼not signicant; SE ¼standard error.
a
Separate regressions were conducted to assess whether each type of engagement (eg, number of events attended) predicted each specic dependent variable (eg, change in general
prejudice). Linear and polynomial terms for each engagement type were entered together in the same model. Polynomial terms are included where signicant.
b
All models adjusted for sex (male or female), age (in years), race (white or nonwhite), self-reported mental illness (yes or no), childhood socioeconomic status (high or low), and in-state status
(yes or no).
c
Ordinary least-square regressions.
d
Poisson regressions.
*
p<.05; **p<.01; ***p<.001.
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were prohibitive. In lieu of this, we focused on intra-
individual change, which addresses time-invariant unob-
served heterogeneity to reduce concerns about confounding
effects. Although we cannot say with certainty that changes
were due only to the UBC2M program, the nonlinear
relationship between studentsreports of awareness or
attendance at UBC2M events and change were reassuring.
It is also possible that passive exposure to UBC2M did not
directly inuence respondentsperceptions of IUs campus
culture; rather, respondents who correctly remembered
passive exposure to UBC2M might have been biased toward
identifying the logo because they were more aware of MH
issues. In contrast to that possibility, respondents who
correctly identied the UBC2M logo at T2 did not differ in
their baseline T1 prejudice. Again, this is reassuring but by
no means conclusive. Finally, even if UBC2M diffuses
stigma, it leaves out a critical groupthose emerging adults
who do not or cannot attend higher education. That group
may be at even greater risk.
Social science theory and research offered a different
pathway to stigma reductioncohort replacement focusing
on individuals in critical years of attitude and normative
formation. Stigma has proved to be a formidable, stubborn
aspect of contemporary US culture. Science has documented
only temporary and minor change in response to traditional
anti-stigma efforts. Colleges and universities, to a large
extent, enroll emerging adults at peak age-risk for the onset of
serious mental illnesses, where academic challenges and life
transitions are stressful, and where the outcomes of failing to
complete college has profound effects on the life course.
40,49
Yet, higher education not only holds the potential to disrupt
stigma and to produce future leaders to build a culture of
MH, but offers an immediate impetus for change as a by-
product of changing demand from parents and students.
On one hand, UBC2M may be seen as unique among
interventions because it is not manualized.That is pre-
cisely the point. The Toolbox created by UBC2M provides
ideas, protocols, scientic justication, and models of as-
sessments that can be performed by students. To be truly
effective, each college or university must tailor these pro-
totypes to their cultural context, providing more guides to
the living library. On the other hand, UBC2M may not be
seen as unique from other college club programs. UBC2M
is a deep touchprogram requiring participation, even if
tacit, from a range of faculty, staff, administrators, and a
national organization. This contact is critical to sustain-
ability and continuity.
UBC2M is only in the beginning stages, and it ad-
dresses only part of the problem. However, any anti-
stigma effort must rst establish a reasonable target. For
UBC2M, issues of the nature, accessibility, or quality of
campus services were ruled out of scope. UBC2M was
designed to address the campus cultural climate in the
short run, and perhaps to serve as a pathway to larger
cultural change in the long run. Yet the NAS report
2
describes countries with successful stigma reduction ef-
forts as having built a nationally networked program (eg,
Australian Rotary Health engaged all local chapters; the
Time To Change Program was backed by government
funds). It is unlikely that this kind of public
FIGURE 2 Effect of Number of Ways in Which Respondents Heard About U Bring Change to Mind (UBC2M) on Students
Assessment of Campus Culture of Mental Health and the Number of Types of People With Whom Respondent Talked About
Mental Illness and/or Stigma
web 3C=FPO
Note: (A) Campus Mental Health Culture, Number of How Heard, College Toolbox Project, 20152018 (N ¼1,132); (B) Number of Conversation Partners, Number of How
Heard, College Toolbox Project, 20152018 (N ¼1,132). Please note color gures are available online.
10 www.jaacap.org Journal of the American Academy of Child & Adolescent Psychiatry
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PESCOSOLIDO et al.
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governmental or private, nonprot effort will take hold in
the United States. It has not, to date. However, as one of
its great treasures, Americas system of higher education,
despite its problems and patchwork of institutional types,
stands as a likely source for building such a national
change network. There can be no better time than now
with the Millennial generations outspoken views, greater
tolerance of difference, and energy directed toward
making the world a better place.
50
Accepted July 26, 2019.
Drs. Pescosolido, Perry, and Krendl are with Indiana University, Bloomington.
Dr. Pescosolido is also with Indiana Consortium for Mental Health Services
Research, Bloomington.
Funding for the student program and survey costs were provided by Bring
Change to Mind. All investigators provided research services pro bono, with
the exception of travel for the rst author to BC2M meetings as required.
Dr. Perry served as the statistical expert for this research.
The authors thank Alex Capshew, MA, Academic Specialist, Indiana Con-
sortium for Mental Health Services Research, Indiana University, for her assis-
tance during the entire span of program development and assessment. They
also thank Susan Barnett Purrington, PhD, and Hannah Chiarella, BFA, who
ably lled the important role of UBC2M Project Manager at Indiana University
during the pilot period, and Markie Pasternak, MA, who served as graduate
advisor to the UBC2M student organization. Finally, they thank the Indiana
University student leaders of UBC2M, especially founders Rachel Green, BS,
Alexis Parrell, BA, and Rachel Martinez, BA, and more recent leaders, Geor-
gePatrick Hutchins, BS, Christine Ake, BS, Korie Rice, BA, and Margaret Ben-
son, BA for their dedication to mental illness issues.
Disclosure: Drs. Pescosolido, Perry, and Krendl have reported no biomedical
nancial interests or potential conicts of interest.
Correspondence to Bernice A. Pescosolido, 1022 East Third Street, Schuessler
Institute for Social Research, Bloomington, IN 47401; e-mail: pescosol@indiana.
edu
0890-8567/$36.00/ª2019 American Academy of Child and Adolescent
Psychiatry. Published by Elsevier Inc. This is an open access article under the
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
https://doi.org/10.1016/j.jaac.2019.06.016
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PESCOSOLIDO et al.
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... It has been shown the two levels are interrelated, with social stigma directly influencing the development of self-stigma, but not the other way [4]. Strategies to reduce social stigma of MHCs have been studied at the college level, including exploring the effectiveness of targeted interventions [5]. Initiatives to reduce stigma of MHCs on college campuses are usually based on interpersonal or intergroup contact, which has been extensively documented to be an effective approach [6]. ...
... Here we describe only those related to the analyses presented in this work-in-progress. Stigma was gauged through the items proposed by the College Toolbox Project (CTP) [5], which has three sub-constructs: general prejudice (8 items), college-specific prejudice (9 items), and college-specific social distance (11 items). A subsection of the last subscale (5 items) was adapted to make it more specific to the engineering context, and to adjust for the possibility of in-person and online spaces for engineering students' interactions. ...
... The College Toolbox Project (CTP) [49] was used to measure stigma constructs. The three constructs considered by CTP are: general prejudice (8 items), college-specific prejudice (9 items), and collegespecific social distance (11 items). ...
... Therefore, it is important to account for stigma when trying to increase help-seeking attitudes within engineering. Given that large-scale interventions have been proved effective for reducing stigma in higher education [49], engineering-specific interventions to tackle such stigmas could have potential to reduce stigma among engineering students and may increase their help-seeking attitudes as a result. ...
... As the newer generations become increasingly affected by MHC [22] it is critical that institutions are prepared to acknowledge these challenges through targeted efforts to create less stigmatized environments about MHC and secure the resources that can support students who need them. Strategies to reduce social stigma of MHCs have been studied at the college level [23], including exploring the effectiveness of targeted interventions [24]- [26]. The largest of such studies to date is a longitudinal study conducted at Indiana University, which found that an institutionally supported community-based intervention was effective in reducing prejudice and discriminatory predisposition among the complete cohort of undergraduate students exposed to it (i.e. ...
... The largest of such studies to date is a longitudinal study conducted at Indiana University, which found that an institutionally supported community-based intervention was effective in reducing prejudice and discriminatory predisposition among the complete cohort of undergraduate students exposed to it (i.e. Class of 2019) [26]. Initiatives to reduce stigma of MHCs on college campuses are usually based on interpersonal or intergroup contact, which has been extensively documented to be an effective approach [27]. ...
... the Etiology and Effects of Stigma model served as a conceptual framework to identify the various factors influencing mental health stigma (see Figure 1) [7]. Questionnaire items were adapted from existing Dutch and non-Dutch stigma surveys, including the cross-national SGc-MHS [2,23], the national Stigma Studychildren [24] and the college toolbox Project -Baseline Survey [25]. the coordinating team held several meetings to discuss the progress of the survey and the adequacy of the items. ...
Article
Aims The Red Noses Culturally-Sensitive Stigma Survey (RN-CSS) contributes to the underexplored research domain of adolescents’ stigmatising attitudes and behaviours towards peers with mental health difficulties and mental healthcare services. It also addresses the need for comprehensive and culturally-sensitive tools to assess stigma in this context. Methods Drawing on insights from focus groups and building upon the existing Stigma in Global Context-Mental Health Study, we have successfully developed and implemented the first culturally-sensitive stigma survey tailored for school-aged adolescents of different migration/cultural backgrounds. The questionnaire includes an unlabelled case vignette depicting a peer with symptoms of depression and gathers data on various domains, including (1) sociodemographic variables; (2) education-related information; (3) COVID-19; (4) perceptions of mental health difficulties and mental healthcare services (i.e. severity assessment, causal attributions, care recommendations, personal stigma, perceived stigma, and service stigma); (5) subjective wellbeing and familiarity with mental health difficulties; (6) social support; (7) school context; (8) bullying; and (9) knowledge of anti-stigma campaigns. Results Our final sample comprises 5075 pupils from 38 secondary schools in Flanders, Belgium. Conclusions In this article, we present the study’s background and rationale, the development of the questionnaire, and the sampling and recruitment methods employed. Furthermore, we provide a summary of the sample characteristics and preliminary descriptive results of the RN-CSS. Subsequent empirical studies will address the research objectives outlined in this protocol paper. The research opportunities provided by the developed materials and dataset are being discussed.
... In broader college and university settings, there have been effective campaigns to educate students about mental illness. Encouraging students to speak out about their experiences with mental illness and mental health treatment serves the dual purpose of increasing contact with mental illness and reducing mental health stigma [13,32,33]. Our novel findings provide a strong rationale for conducting larger research studies to inform the development of programs targeted specifically to reduce mental health stigma among international students, focused on bringing personal experiences with mental illness out of the shadows and into the campus discourse. ...
Article
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International students in the United States (U.S.) are at increased risk for mental health challenges, but less likely than their U.S.-born peers to seek professional mental health support. We administered an online survey to 132 international students enrolled at 14 U.S. colleges and universities to explore whether demographics, time in the U.S., religiosity, prior contact with people experiencing mental illness, individualism, and collectivism were associated with stigmatizing attitudes and mental health help-seeking. Only increased contact with mental illness was significantly associated with lower mental health stigma in this sample. Identifying as a woman, having more prior contact with mental illness, and collectivism were associated with positive attitudes toward help-seeking, while individualism was associated with negative attitudes toward help-seeking. Interventions that normalize and destigmatize mental health challenges should be adapted to reflect the unique experiences of international students, and new interventions may seek to highlight the value of increased contact and collectivistic attitudes in facilitating mental health help-seeking.
... Although research on their anti-convulsant properties is limited, evidence suggests that these nanoparticles may have neuroprotective properties that could indirectly reduce seizures [70,71]. it has been reported that a silver ion solution in water [72] has a significantly higher minimum inhibitory concentration (Mic) for anti-bacterial effects compared to the silver colloid solution. However, in terms of anti-viral effects, the silver colloid solution is 10 times stronger than the silver ion solution [73]. ...
Article
Nanoparticles (NPs) have played a pivotal role in various biomedical applications, spanning from sensing to drug delivery, imaging and anti-viral therapy. The therapeutic utilisation of NPs in clinical trials was established in the early 1990s. Silver nanoparticles (AgNPs) possess anti-microbial, anti-cancer and anti-viral properties, which make them a possible anti-viral drug to combat the COVID-19 virus. Free radicals and reactive oxygen species are produced by AgNPs, which causes apoptosis induction and prevents viral contamination. The shape and size of AgNPs can influence their interactions and biological activities. Therefore, it is recommended that silver nanoparticles (AgNPs) be used as a valuable tool in the management of COVID-19 pandemic. These nanoparticles possess strong anti-microbial properties, allowing them to penetrate and destroy microbial cells. Additionally, the toxicity level of nanoparticles depends on the administered dose, and surface modifications are necessary to reduce toxicity, preventing direct interaction between metal surfaces and cells. By utilising silver nanoparticles, drugs can be targeted to specific areas in the body. For example, in the case of COVID-19, anti-viral drugs can be stimulated as nanoparticles in the lungs to accelerate disease recovery. Nanoparticle-based systems have the capability to transport drugs and treat specific body parts. This review offers an examination of silver nanoparticle-based drug delivery systems for combatting COVID-19, with the objective of boosting the bioavailability of existing medications, decreasing their toxicity and raising their efficiency.
... Different data types (modalities) have been used to predict AD such as magnetic resonance imaging (MRI) [24], positron emission tomography (PET) [25], cerebrospinal fluid (CSF) biomarkers [26], and fusion of different neuroimages [27]. Saleem et al. [28] and Weiner et al. [29] deeply surveyed AD different modalities that are used in the literature of ML. The majority of the literature depends mainly on the MRI modality which produced limited results [30,31]. ...
Article
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Alzheimer’s disease (AD) is an irreversible neurodegenerative disease characterized by progressive neuronal deterioration. Early detection of AD is critical for mitigating disease progression and improving patient life. While deep learning (DL) techniques have shown promise in analyzing neuroimaging data for AD diagnosis, their interpretability has been a significant impediment toward explainable medical diagnosis. The typical practices of diagnosing AD, which involve clinical biomarkers and neuroimaging tests, have been limited in producing trustworthy and explainable progression detection models at an early stage. Another method based on finding the patient’s cognitive score through analyzing time series data has been adopted as an acceptable and cost-effective alternative in providing a deeper insight into patients’ conditions. In this study, we propose a hybrid CNN-LSTM-based model for predicting AD progression based on the fusion of four longitudinal cognitive sub-scores modalities. Our hybrid model employs the Bayesian optimizer as a computational technique to help optimize the selection of the adequate DL model’s architecture. A genetic algorithm-based feature selection has been incorporated as an optimization step to determine the best feature set from the extracted deep representations of the CNN-LSTM, and we replaced the traditional SoftMax classifier with a robust and optimized random forest classifier. An extensive set of experiments utilizing the ADNI dataset examined the operational role of each optimization step while demonstrating the effectiveness of the proposed hybrid model. The model achieved the best results compared to other DL and classical machine learning methods. To ensure diagnostic interpretability, we used the SHAP and LIME techniques to provide explainability features for the proposed model’s decisions. This work attempts to present the best possible, trustworthy decision-making AD diagnostics, potentially in deployable real-world settings.
... This model induces anemia, including erythrocytopenia (~50%), Hb drop (~60%), and HCT drop within 4 days after phenylhydrazine injection [18]. Based on its antioxidant ability, it was hypothesized in the ongoing investigation that curcumin would prevent the onset of anemia brought on by medications that generate oxidations and hemolysis [19]. Treatment with curcumin may partially reverse the biochemical, hematological, and histopathological alterations brought on by lead acetate. ...
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We investigate the physiological efficacy of encapsulated curcumin in the treatment of adult Albino Wistar rats with phenylhydrazine (PHZ)-induced hemolytic anemia. Thirty adult male rats were employed in this investigation, and randomly parted into five groups. One was used as a negative control group (NCG) and fed on chow and water. Animals in the T1 group received an i.p PHZ (40mg/kg B.W) for two days; those in the T2 group received PHZ (40 mg/kg) and oral curcumin at 50 mg/kg daily for four weeks; and those in the T3 and T4 groups received PHZ (40 mg/kg) and phytosome-loaded curcumin at 25 & 50 mg/Kg daily for four weeks, respectively. All of the animals were sacrificed as the experimentation done. Haematological parameters were done for additional biochemical analyses. Analyses of cytogenic activity and hematological parameters were assessed. The current study shows that loaded curcumin on phytosomes with a sufficient polydisperssin index maintains the stability of phytosomes and exhibits a strong ability to attenuate the anemic effects caused by phenyl hydrazine. This might hold out the possibility of developing a fresh approach to treating various pathological and physiological anemia forms. Ultimately, we discovered that phytosom was easily loaded and enclosed within an appropriate size and shape. By enhancing hematological parameters in addition to its physiological role in reducing the genotoxic effect of phenylhyrazine, curcumin and its liposome are regarded as an effective treatment for anemia in rats.
Article
Identity Development Evolution and Sharing (IDEAS) reduces provider stigma, but few have been trained to implement IDEAS, highlighting a need for implementation strategies that facilitate uptake. We evaluated whether external facilitation successfully supported IDEAS implementation and whether IDEAS reduced provider stigma within and across sites irrespective of implementation barriers and facilitators. Key informants from 10 sites completed interviews and surveys of appropriateness, acceptability, and feasibility. Interviews were analyzed using the Consolidated Framework for Implementation Research guidelines. Intervention effectiveness was measured via paired t tests of pre-/post-quantitative data on provider stigma completed by practitioners who attended the training. Ten sites successfully implemented IDEAS via external facilitation; 58 practitioners from nine sites completed pre- and post-surveys. Data showed significant decreases in stigma after the intervention. IDEAS, supported by external facilitation, is a feasible, acceptable, and appropriate means of reducing stigma among occupational therapy practitioners.
Article
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The 1957 and 1976 Americans View Their Mental Health surveys from the Institute of Social Research were partially replicated in the 1996 General Social Survey (GSS) to examine the policy implications of people’s responses to feeling an impending nervous breakdown. Questions about problems in modern living were added to the GSS to provide a profile of the public’s view of mental health problems. Results were compared for 1957, 1976, and 1996. In 1957, 19% of respondents had experienced an impending nervous breakdown; in 1996, 26% had had this experience. Between 1957 and 1996, participants increased their use of informal social supports, decreased their use of physicians, and increased their use of nonmedical mental health professionals. These findings support policies that strengthen informal support seeking and access to effective psychosocial treatments rather than current mental health reimbursement practices, which emphasize the role of primary care physicians.
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The authors argue that cultural fragmentation models predict that cultural change is driven primarily by period effects, whereas acquired dispositions models predict that cultural change is driven by cohort effects. To ascertain which model is on the right track, the authors develop a novel method to measure “cultural durability,” namely, the share of over-time variance that is due to either period or cohort effects for 164 variables from the 1972–2014 General Social Surveys. The authors find fairly strong levels of cultural durability across most items, especially those connected to values and morality, but less so for attitudes toward legal and political institutions.
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Background: Most research on interventions to counter stigma and discrimination has focused on short-term outcomes and has been conducted in high-income settings. Aims: To synthesise what is known globally about effective interventions to reduce mental illness-based stigma and discrimination, in relation first to effectiveness in the medium and long term (minimum 4 weeks), and second to interventions in low- and middle-income countries (LMICs). Method: We searched six databases from 1980 to 2013 and conducted a multi-language Google search for quantitative studies addressing the research questions. Effect sizes were calculated from eligible studies where possible, and narrative syntheses conducted. Subgroup analysis compared interventions with and without social contact. Results: Eighty studies (n = 422 653) were included in the review. For studies with medium or long-term follow-up (72, of which 21 had calculable effect sizes) median standardised mean differences were 0.54 for knowledge and -0.26 for stigmatising attitudes. Those containing social contact (direct or indirect) were not more effective than those without. The 11 LMIC studies were all from middle-income countries. Effect sizes were rarely calculable for behavioural outcomes or in LMIC studies. Conclusions: There is modest evidence for the effectiveness of anti-stigma interventions beyond 4 weeks follow-up in terms of increasing knowledge and reducing stigmatising attitudes. Evidence does not support the view that social contact is the more effective type of intervention for improving attitudes in the medium to long term. Methodologically strong research is needed on which to base decisions on investment in stigma-reducing interventions.
Book
This resource challenges key paradigms currently held about the prevention or reduction of stigma attached to mental illness using evidence and the experience the authors gathered during the many years of their work in this field. Each chapter examines one currently held paradigm and presents reasons why it should be replaced with a new perspective. It argues for enlightened opportunism (using every opportunity to fight stigma), rather than more time-consuming planning, and emphasizes that the best way to approach anti-stigma work is to select targets jointly with those who are most concerned.
Chapter
Physical conditions, such as body size, physical deformity, and deafness, elicit stigma, which has emotional, social, and health consequences. Researchers have consistently found that contact with a stigmatized individual can be one of the most powerful tools for dismantling this stigma. Specifically, the contact hypothesis argues that a lack of knowledge about stigmatized others makes it easier to stereotype and discriminate against them. Although the contact hypothesis has been supported in research, this chapter argues that network science offers relevant theory and research that may be instructive for further understanding and contextualizing the contact hypothesis. This chapter suggests that the structure and content of social networks affect stigmatizing attitudes and provide a theoretical basis to examine how individuals who are routinely in "contact" with stigmatized persons (e.g., family members, co-workers, and health professionals) may influence stigma. Finally, the chapter discusses the importance of these insights for anti-stigma campaigns.
Article
Objective: To examine the relationship between college students' familiarity with and involvement in Active Minds, a student peer organization focused on increasing mental health awareness, decreasing stigma, and affecting mental health knowledge, attitudes, and behaviors. Method: Students (N = 1,129) across 12 California colleges completed three waves of a web-based survey during the 2016-2017 academic year to assess familiarity with and involvement in Active Minds and mental health attitudes, behaviors, and perceived knowledge. Fixed-effects models assessed relations between changes in organization familiarity and involvement and changes in mental health-related outcomes over time overall and stratified by students' baseline engagement (ie, familiarity/involvement) with Active Minds. Results: Overall, increased familiarity with Active Minds was associated with increases in perceived knowledge (0.40; p < .001) and decreases in stigma over time (-0.33; p < .001). Increased involvement was associated with increases in perceived knowledge (0.40; p < .001) and a range of helping behaviors. Associations differed by students' baseline engagement with Active Minds. For students with low engagement, increased familiarity with Active Minds was associated with decreased stigma and improved perceived knowledge. For students with moderate baseline engagement, increasing involvement with Active Minds was associated with increases in helping behaviors (eg, providing emotional support, connecting others to services) over time. Conclusion: Student peer organizations' activities can improve college student mental health attitudes and perceived knowledge and significantly increase helping behaviors. Such organizations can complement more traditional programs and play an important role in improving the campus climate with respect to mental health.
Article
Objective To evaluate the impact on the general public of England's Time to Change program to reduce mental health-related stigma and discrimination using newly developed measures of knowledge and intended behaviour regarding people with mental health problems, and an established attitudes scale, and to investigate whether social desirability affects responses to the new measures and test whether this varies according to data collection method. Method The Mental Health Knowledge Schedule (MAKS) and Reported and Intended Behaviour Scale (RIBS) were administered together with the 13-item version of the Marlowe-Crowne Social Desirability Scale to 2 samples (each n = 196) drawn from the Time to Change mass media campaign target group; one group was interviewed face to face, while the other completed the measures as an online survey. Results After controlling for other covariates, interaction terms between collection method and social desirability were positive for each instrument. The social desirability score was associated with the RIBS score in the face-to-face group only (β = 0.35, 95% CI 0.14 to 0.57), but not with the MAKS score in either group; however, MAKS scores were more likely to be positive when data were collected face to face (β = 1.53, 95% CI 0.74 to 2.32). Conclusions Behavioural intentions toward people with mental health problems may be better assessed using online self-complete methods than in-person interviews. The effect of face-to-face interviewing on knowledge requires further investigation.
Article
Stigma and discrimination in relation to mental illnesses have been described as having worse consequences than the conditions themselves. Most medical literature in this area of research has been descriptive and has focused on attitudes towards people with mental illness rather than on interventions to reduce stigma. In this narrative Review, we summarise what is known globally from published systematic reviews and primary data on effective interventions intended to reduce mental-illness-related stigma or discrimination. The main findings emerging from this narrative overview are that: (1) at the population level there is a fairly consistent pattern of short-term benefits for positive attitude change, and some lesser evidence for knowledge improvement; (2) for people with mental illness, some group-level anti-stigma inventions show promise and merit further assessment; (3) for specific target groups, such as students, social-contact-based interventions usually achieve short-term (but less clearly long-term) attitudinal improvements, and less often produce knowledge gains; (4) this is a heterogeneous field of study with few strong study designs with large sample sizes; (5) research from low-income and middle-income countries is conspicuous by its relative absence; (6) caution needs to be exercised in not overgeneralising lessons from one target group to another; (7) there is a clear need for studies with longer-term follow-up to assess whether initial gains are sustained or attenuated, and whether booster doses of the intervention are needed to maintain progress; (8) few studies in any part of the world have focused on either the service user's perspective of stigma and discrimination or on the behaviour domain of behavioural change, either by people with or without mental illness in the complex processes of stigmatisation. We found that social contact is the most effective type of intervention to improve stigma-related knowledge and attitudes in the short term. However, the evidence for longer-term benefit of such social contact to reduce stigma is weak. In view of the magnitude of challenges that result from mental health stigma and discrimination, a concerted effort is needed to fund methodologically strong research that will provide robust evidence to support decisions on investment in interventions to reduce stigma.
Article
Social science research on stigma has grown dramatically over the past two decades, particularly in social psychology, where researchers have elucidated the ways in which people construct cognitive categories and link those categories to stereotyped beliefs. In the midst of this growth, the stigma concept has been criticized as being too vaguely defined and individually focused. In response to these criticisms, we define stigma as the co-occurrence of its components-labeling, stereotyping, separation, status loss, and discrimination-and further indicate that for stigmatization to occur, power must be exercised. The stigma concept we construct has implications for understanding several core issues in stigma research, ranging from the definition of the concept to the reasons stigma sometimes represents a very persistent predicament in the lives of persons affected by it. Finally, because there are so many stigmatized circumstances and because stigmatizing processes can affect multiple domains of people's lives, stigmatization probably has a dramatic bearing on the distribution of life chances in such areas as earnings, housing, criminal involvement, health, and life itself. It follows that social scientists who are interested in understanding the distribution of such life chances should also be interested in stigma.