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Impact of a Mental Health Curriculum on Knowledge and Stigma Among High School Students: A Randomized Controlled Trial

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Objective

This study evaluated the effectiveness of a school-based mental health literacy intervention for adolescents on knowledge and stigma.

Method

A total of 24 high schools and 534 students in the regional area of Ottawa, Ontario, Canada participated in this randomized controlled trial. Schools were randomly assigned to either the curriculum or control condition. The curriculum was integrated into the province's grade 11 and 12 “Healthy Living” courses and was delivered by teachers. Changes in mental health knowledge and stigma were measured using pre- and posttest questionnaires. Descriptive analyses were conducted to provide sample characteristics, and multilevel modeling was used to examine study outcomes.

Results

For the curriculum condition, there was a significant change in stigma scores over time (p = .001), with positive attitudes toward mental illness increasing from pre to post. There was also a significant change in knowledge scores over time (p < .001), with knowledge scores increasing from pre to post. No significant changes in knowledge or stigma were found for participants in the control condition. A meaningful relationship was found whereby increases in knowledge significantly predicted increases in positive attitudes toward mental health (p < .001).

Conclusion

This is the first large randomized controlled trial to demonstrate the effectiveness in mental health literacy of an integrated, manualized mental health educational resource for high school students on knowledge and stigma. Findings also support the applicability by teachers and suggest the potential for broad-based implementation of the educational curriculum in high schools. Replication and further studies are warranted.

Clinical trial registration information—Impact of a Mental Health Curriculum for High School Students on Knowledge and Stigma; http://clinicaltrials.gov/; NCT02561780

Section snippets

Participants and Procedure

All high schools in the regional area of Ottawa, Ontario, Canada were offered the opportunity to participate in the study. A total of 30 schools that agreed to participate were randomized, by a research assistant using a random number generator, to 1 of 3 arms: teaching as usual (TAU, or control), curriculum, and curriculum + follow-up eLearning modules. The Mental Health and High School Curriculum Guide (The Curriculum Guide) was required to be integrated within the grade 11 or 12 Ontario

Participants

After agreeing to participate, 5 schools were unable to meet study requirements and withdrew postrandomization, before initiation of the study. One school with a classroom of 25 students (4% of the overall sample) was excluded because of students’ low reading levels. This resulted in a total of 24 participating schools.

All teachers who received training delivered the curriculum in full. After completing the study, 23 teachers returned satisfaction and evaluation surveys providing feedback on

Discussion

This study is the first RCT to examine the effectiveness of a mental health literacy curriculum developed for high school students and delivered in the classroom. Students who received The Curriculum Guide showed significant improvements in mental health knowledge and a reduction in stigma compared to those receiving TAU, with the magnitude of these findings being substantial. In addition, we found that improvement in mental health knowledge predicted a corresponding improvement in attitudes

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    This article is discussed in an editorial by Dr. Bernice A. Pescosolido on page 353.

    Clinical guidance is available at the end of this article.

    This study was funded by The Royal Ottawa Foundation and supported by the University of Ottawa Institute of Mental Health Research, with grants from Telus, The Ottawa Senators Foundation, and the Do It For Daron (DIFD) fund. The sponsors played no role in the conduct of the study; collection, management, analysis, and interpretation of the data; preparation or approval of the manuscript.

    The authors thank the Ottawa-Carleton District School Board, the Ottawa Catholic School Board, and the Renfrew County District School Board for their assistance in this study, as well as the teachers and students who volunteered to be part of it. The authors also thank Darcy Santor, PhD, University of Ottawa, for his contribution to the items on attitudes toward mental illness.

    Disclosure: Dr. Milin has served on the Pediatric Advisory Board of US WorldMeds and has received speakers’ honoraria for CME activity from the American Academy of Addiction Psychiatry. Dr. Kutcher serves as the Sun Life Financial Chair in Adolescent Mental Health. Dr. Lewis, Mss. Walker, Wei, and Ferrill, and Mr. Armstrong report no biomedical financial interests or potential conflicts of interest.

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