Interventions to reduce stigma towards people with severe mental illness: Systematic review and meta-analysis
Abstract
This review evaluates the evidence on what interventions are effective in reducing public stigma towards people with severe mental illness, defined as schizophrenia, psychosis or bipolar disorder. We included 62 randomised controlled trials of contact interventions, educational interventions, mixed contact and education, family psychoeducation programs, and hallucination simulations. Contact interventions led to small-to-medium reductions in stigmatising attitudes (d = 0.39, 95% CI: 0.22 to 0.55) and desire for social distance (d = 0.59, 95% CI: 0.37 to 0.80) post-intervention, but these were reduced after adjusting for publication bias (d = 0.24 and d = 0.40, respectively). Effects did not vary by type or length of contact. Effects at follow-up were smaller and not significant. Education interventions led to small-to-medium reductions in stigmatising attitudes (d = 0.30, 95% CI: 0.14 to 0.47) and desire for social distance (d = 0.27, 95% CI: 0.08 to 0.46) post-intervention. Small improvements in social distance persisted up to 6 months later (d = 0.27, 95% CI: 0.05 to 0.49), but not attitudes (d = 0.03, 95% CI: -0.12 to 0.18). The combination of contact and education showed similar effects to those that presented either intervention alone, and head-to-head comparisons did not show a clear advantage for either kind of intervention. Family psychoeducation programs showed reductions in stigma post-intervention (d = 0.41, 95% CI: 0.11 to 0.70). The effectiveness of hallucination simulations was mixed. In conclusion, contact interventions and educational interventions have small-to-medium immediate effects upon stigma, but further research is required to investigate how to sustain benefits in the longer-term, and to understand the active ingredients of interventions to maximise their effectiveness.
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Social contact had a consistently positive effect on reducing stigmatising attitudes, perceived stigma in help seeking, and social distance.
“Social contact had a consistently positive effect on reducing stigmatising attitudes, perceived stigma in help seeking, and social distance.186,195,198,[203][204][205][206][207][208]”
From The Lancet Commission on ending stigma and discrimination in mental health (2022) · cites this paper as [198]
Video-based contact combined with education was effective in reducing stigma among students and health professionals, and led to a more balanced portrayal of people with mental health problems by media professionals.
“Video-based contact combined with education was effective in reducing stigma among students in general and among health professionals, 198,199,[209][210][211] and led to a more balanced portrayal of people with mental health problems by media professionals.212”
From The Lancet Commission on ending stigma and discrimination in mental health (2022) · cites this paper as [198]
Combined interventions, particularly those including educational and social contact components, significantly reduced stigmatising attitudes and social distance.
“Combined interventions, particularly those including educational and social contact components, significantly reduced stigmatising attitudes and social distance.178,196,198,199”
From The Lancet Commission on ending stigma and discrimination in mental health (2022) · cites this paper as [198]
Although simulated hallucinations increased empathy for people with schizophrenia, evidence for their effectiveness in causing attitude change is inconsistent, with some studies indicating they may worsen rather than improve attitudes and desire for social distance.
“Although simulated hallucinations increased empathy for people with schizophrenia, the evidence for their effectiveness in causing attitude change is inconsistent, with some studies indicating that they may worsen rather than improve attitudes and desire for social distance.198”
From The Lancet Commission on ending stigma and discrimination in mental health (2022) · cites this paper as [198]
Only two interventions to reduce stigma towards people with severe mental illness had been evaluated in Australia, one of which was only available as part of a university experiment.
“Furthermore, only two interventions had been evaluated in Australia, one of which was only available as part of a university experiment.”
From Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works? (2021) · cites this paper as [9]
There was little guidance on what components of interventions are needed for effective stigma reduction.
“There was also little guidance on what components of interventions are needed for effective stigma reduction.”
From Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works? (2021) · cites this paper as [9]
The meta-analysis found limited evidence on longer-term effects of interventions to reduce stigma.
“This found that both contact- and education-based interventions showed small-to-medium immediate reductions in stigma, but there was limited evidence on longer-term effects.”
From Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works? (2021) · cites this paper as [9]
A recent meta-analysis of randomised controlled trials found that both contact- and education-based interventions showed small-to-medium immediate reductions in stigma towards people with severe mental illness.
“This found that both contact- and education-based interventions showed small-to-medium immediate reductions in stigma, but there was limited evidence on longer-term effects.”
From Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works? (2021) · cites this paper as [9]
A meta-analysis of randomised trials showed both education and contact interventions were effective in reducing stigma.
“This reflects the findings of a meta-analysis of randomised trials which showed both education and contact interventions were effective in reducing stigma [9].”
From Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works? (2021) · cites this paper as [9]
Most of the international studies did not evaluate 'named' programs that could be easily implemented elsewhere.
“Although international programs have not been adopted into the Australian context, it is worth highlighting that most of the international studies did not evaluate ‘named’ programs that could be easily implemented elsewhere.”
From Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works? (2021) · cites this paper as [9]
There was little overlap of the programs identified in this review with those found in a meta-analysis of randomised controlled trials of international anti-stigma programs.
“There was little overlap of the programs identified in this review with those found in a meta-analysis of randomised controlled trials of international anti-stigma programs [9].”
From Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works? (2021) · cites this paper as [9]
The finding that hallucination simulation increased stigma is concordant with a previous meta-analysis [42] showing it can increase social distance and negative attitudes.
“which is concordant with a previous meta-analysis that demonstrated that it can increase social distance and negative attitudes [42].”
From Innovative Technology–Based Interventions to Reduce Stigma Toward People With Mental Illness: Systematic Review and Meta-analysis (2022) · cites this paper as [42]
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The Lancet Commission on ending stigma and discrimination in mental health
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Intergroup contact and mental health stigma: a comparative effectiveness meta-analysis
Maunder, R. D., & White, F. A. (2019) · Clinical Psychology Review · doi:10.1016/j.cpr.2019.101749 · Cited by 152 · see citing works
Prolonged grief disorder in ICD-11 and <i>DSM</i> -5-TR: Challenges and controversies
Eisma, M. C. (2023) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674231154206 · Cited by 130 · see citing works
Salazar de Pablo, G., De Micheli, A., Nieman, D. H., Correll, C. U., Kessing, L. V., Pfennig, A., Bechdolf, A., Borgwardt, S., Arango, C., van Amelsvoort, T., et al. (2020) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2020.10.007 · Cited by 104 · see citing works
Clay, J., Eaton, J., Gronholm, P. C., Semrau, M., & Votruba, N. (2020) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796020000797 · Cited by 103 · see citing works
Changes in mental illness stigma over 30 years–improvement, persistence, or deterioration
Schomerus, G., Schindler, S., Sander, C., Baumann, E., & Angermeyer, M. C. (2022) · European Psychiatry · doi:10.1192/j.eurpsy.2022.2337 · Cited by 98 · see citing works
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Unpacking stigma: meta-analyses of correlates and moderators of personal stigma in psychosis
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Pain management in people with severe mental illness: an agenda for progress
Onwumere, J., Stubbs, B., Stirling, M., Shiers, D., Gaughran, F., Rice, A. S. C., C de C Williams, A., & Scott, W. (2022) · Pain · doi:10.1097/j.pain.0000000000002633 · Cited by 35 · see citing works
- Authors
- Morgan, A. J., Reavley, N. J., Ross, A., Too, L. S., & Jorm, A. F.
- Affiliations
- The University of Melbourne (AU)
- Corresponding author
- Morgan, Amy J.
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 103
- Pages
- 120-133
- ISSN
- 0022-3956 (ISSN-L)
- OpenAlex
- W2804498743
- Cited by
- 372
- References
- 86
- Citations by year
- 2026: 39 · 2025: 46 · 2024: 57 · 2023: 71 · 2022: 76 · 2021: 39 · 2020: 26 · 2019: 16 · 2018: 2
- FWCI
- 3.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Funders
- Commonwealth Department of Health, Australia
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Sociology and Political Science › Social and Intergroup Psychology
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- public stigma, severe mental illness, schizophrenia, psychosis, bipolar disorder, contact interventions, educational intervention, family psychoeducation, stigmatizing attitudes, social distance, intervention effectiveness
- MeSH terms
- Mental Disorders, Humans, Psychological Distance, Randomized Controlled Trials as Topic, Early Intervention, Educational, Social Stigma
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