Table 20GRADE Summary of Findings for Stigma Stress

Outcome, Follow-up, no. participants (trials) Findings Certainty of the evidence (GRADE) What happens?
Stigma stress

Post-intervention: 84 (1 RCT 50 )

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

Two RCTs,39,40,50 all with high risk of bias (unclear direction) reported on stigma stress. Participants had a mean age of 1550 to 2139,40 years, most of them female individuals (69.3%50 to 82.2%39,40). The reported mental health concerns across the trials were depression (59.1%50 to 85.5%39) and anxiety (17.3%50 to 69.2%39). The peer support interventions were HOP50 and HOP-C39,40 programs, comparing to treatment as usual50 or waitlist controls.39,40 Outcomes were measured at post-intervention, and at follow-up (6 weeks50 or 2 months40 after core sessions), using the outcome calculated as perceived harm minus perceived resources form the Stigma Stress Scale. Higher scores (range –6 to 6) indicate increased stigma-related stress. At the post-intervention and post-booster follow-ups of the HOP-C trial,39 stigma stress was not calculated, rather the results of the subscale scores were reported separately.

At post-intervention, results from 1 RCT (Mulfinger et al.50) suggested that peer support may be favoured compared to TAU.in lowering the stress related to self-stigma. Mean between-group difference for change from baseline to post-intervention was –2.06 (95% CI –2.70 to –1.42)50

At the longest follow-up, the evidence was heterogenous (2 RCTs40,50;6 weeks50 or 2 months40). The Conley et al. trial (reported in Hundert et al.)40 found little to no difference in the effect of peer support intervention (HOP-C) in reducing stigma-related stress, whereas the results from the Mulfinger et al. trial50 favoured peer support. At 6 weeks follow-up, the mean differences for change from baseline in the HOP group was 2.19 units lower than the TAU group (95% CI –2.89 to –1.43).

 Very low

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

Formal peer support may be favoured vs. TAU with respect to stigma stress at post-intervention, but the evidence is very uncertain.

The findings for effect of formal peer support vs. control (waitlist or TAU) on stigma stress at the longest follow-up are inconsistent, and the evidence is very uncertain.

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 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].
Copyright © 2022 Canadian Agency for Drugs and Technologies in Health.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.