Abstract: Ending the Stigma: An Umbrella Review of Meta-Analyses on Mental Illness Stigma Reduction Studies
Addressing mental illness stigma is an international health priority. According to the World Health Organization (2001), 1 in 4 people will develop a mental illness and recent estimates indicate that the U.S. spent more than $200 billion on mental health treatment (Roehrig, 2016). Research has shown that perceptions of stigma reduces likelihood to seek treatment (Corrigan, 2004; Thornicroft, 2008), endangers patients (Knaak, Mantler, & Szeto, 2017), and diminishes quality of life (Cerully, Acosta, Sloan, 2018). For these reasons, the present study conducted the first umbrella review of meta-analyses of mental illness stigma reduction interventions. Studies were eligible if they were available in English, conducted a meta-analysis, and examined the efficacy of interventions seeking to reduce stigma toward mental illness. A systematic literature review was conducted, which revealed a total of ten studies that were eligible for inclusion. After extracting data, a narrative synthesis (Ioannidis, 2009) was conducted. All but one study had either moderate or high quality. Results revealed that six studies examined the efficacy of interventions seeking to reduce public stigmatizing attitudes and behaviors toward people with mental illness, three studies considered interventions that worked to reduce perceptions of internalized stigma related to mental illness, and one study reviewed both public and internal stigma reduction interventions. For public stigmatizing attitudes, the most effective interventions involved contact and educational approaches. However, neither approach significantly reduced stigma at a follow-up assessment. Mental health training programs (d = .14, 95% CI = .05 to .23, I2 = 48) and multicomponent psychoeducation interventions (d = .13, 95% CI = .59 to .23, I2 = 31) significantly influenced stigmatizing attitudes at follow-up. Results for public stigmatizing behaviors were less clear. Two meta-analyses reported the effects of interventions on reducing stigmatizing behaviors. One meta-analysis reported that contact strategies were most effective (d = .59, 95% CI = .37 to .8, I2 = 64) and that education interventions had the smallest impact (d = .27, 95% CI = .08 to .46, I2 = 72). Meanwhile, the other meta-analysis reported that education interventions (d = .25) were more effective compared to contact strategies (d = .19). At follow-up, only education interventions (k = 6, d = .27, 95% CI = .05 to .49, I2 = 67) significantly influenced behavior. All four meta-analyses looking at internalized stigma interventions reviewed multicomponent psychoeducation interventions. These studies found that effects were small-to-moderate in scope and that they did not persist longitudinally. Our results suggest that both education and contact interventions are effective in the short term, but more programming efforts are needed in order to understand how to improve long term effectiveness. Education interventions were more effective at influencing behaviors, however. There was considerable heterogeneity within internalized stigma intervention studies, suggesting that future research should explore moderators that influence the efficacy of these approaches.