Table 19GRADE Summary of Findings for Self-Stigma — Clinical Review

Outcome, follow-up, no. participants (trials) Findings Certainty of the evidence (GRADE) What happens?
Self-stigma

Post-intervention: 191 (2 RCTs 39 , 50 )

Post-booster: 97 (1 RCT 39 )

Longest follow-up: 117 (2 RCTs 40 , 50 )

Two trials, with high risk of bias (predicted direction unclear), reported on the impact of peer support interventions on self-stigma among youth with mental health concerns. Participants had a mean age of 1550 to 2139,40 years, most of them female individuals (69.3% in 1 trial50 and 82.2% in the other39,40). The peer support interventions were HOP50 and HOP-C39,40 programs Outcomes were measured at post-intervention, post-booster and at follow-up (6 weeks50 to 2 months40 after core sessions), using the 4 subscales of the SSMIS-SF(range 5 to 45)53 or the ISMI54 (10-item version, range 1 to 4). In both measures, higher scores indicate more self-stigma.

At post-treatment, the results were heterogenous (2 RCTs,39,50 n = 191). Conley et al.39 found that in the harm subdomain of the SSMIS-SF scale, HOP-C was favoured compared to waitlist control at follow-up ( p = 0.019).39 Results for change from baseline for the other domains were not reported. In the Mulfinger et al.50 study, at post-intervention, change from baseline of the overall score of SSMIS showed that HOP was associated with a significant reduction in self-stigma compared to TAU (Mean between-group difference for change from baseline –2.93 [95% CI = –5.35 to –0.52]).There were no significant difference between groups in the change from baseline of ISMI scores.50

At post-booster (1 RCT,39 n=97) evidence from Conley et al. showed little to no difference in the effect of HOP-C compared to waitlist reducing self-stigma, as found by the between-group t-tests for the agreement, application, and harm subdomains of the SSMIS-SF.

At the longest follow-up (2 RCTs; 6 weeks50 or 2 months40) the evidence was heterogenous. HOP-C was not associated with any significant reduction in any of the subdomain scores of SSMIS compared to waitlist control.39,40 Results from Mulfinger et al.50 found that participants who received HOP reported significantly lower self-stigma scores at 2 months follow-up compared to those who received TAU. Mean between-group difference for change from baseline in ISMI scores –0.35 [95% CI = –0.54 to –0.05]) Mean between-group difference for change from baseline in SSMIS scores –5.14 [95% CI = –8.22 to –2.05])

 Very low

due to serious concerns for risk of bias, inconsistency, indirectness, and imprecision.a,b,c

The findings for effect of HOP vs. control (waitlist/ TAU) on self-stigma at post-intervention are heterogeneous, and the evidence is very uncertain.a

There may be little to no difference in the effect of HOP vs. control (waitlist/ treatment as usual) on self-stigma at post-booster, but the evidence is very uncertain.b

The findings for effect of HOP vs. control (waitlist/ treatment as usual) on self-stigma at the longest follow-up are heterogeneous, and the evidence is very uncertain.c

HOP= Honest, Open, Proud; HOP-C = Honest, Open, Proud–College; ISMI-SF = Internalized Stigma of Mental Illness-Short Form; RCT = randomized controlled trial; SSMIS-SF = Self-Stigma of Mental Illness Scale–Short Form; TAU = treatment as usual

a

At post-intervention: rated down once for risk of bias due to serious concerns about the potential for bias arising from missing outcome data and bias in measurement of the outcomes (participant reported subjective outcomes); rated down once due to serious concerns for inconsistency because of inconsistent results between the trials, rated down once due to serious concerns for indirectness because only 1 program (HOP/HOP-C) was identified and the population seemed relatively homogenous, thereby lowering the generalizability of findings to peer support programs in general; rated down once due to serious concerns about imprecision because of the relatively lower sample size in each comparison; publication bias was not detected.

b

At post-booster: rated down once for risk of bias due to serious concerns about the potential for bias arising from missing outcome data and bias in measurement of the outcomes (participant reported subjective outcomes); rated down once due to serious concerns for inconsistency because of limited of evidence of consistency as only 1 trial was available that reported on the outcome at this time point; rated down once due to serious concerns for indirectness because only 1 program (HOP/HOP-C) was identified and the population seemed relatively homogenous, thereby lowering the generalizability of findings to peer support programs in general; rated down once due to serious concerns about imprecision because of the relatively lower sample size in each comparison; publication bias was not detected.

c

At longest follow-up: rated down once for risk of bias due to serious concerns about the potential for bias arising from missing outcome data and bias in measurement of the outcomes (participant reported subjective outcomes); rated down once due to serious concerns for inconsistency because of inconsistent results between the trials at longest follow-up; rated down once due to serious concerns for indirectness because only 1 program (HOP/HOP-C) was identified and the population seemed relatively homogenous, thereby lowering the generalizability of findings to peer support programs in general; rated down once due to serious concerns about imprecision because of the relatively lower sample size in each comparison; publication bias was not detected.

From: Peer Support Programs for Youth Mental Health

Cover of Peer Support Programs for Youth Mental Health
Peer Support Programs for Youth Mental Health: Health Technology Assessment [Internet].
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