Innovative Technology–Based Interventions to Reduce Stigma Toward People With Mental Illness: Systematic Review and Meta-analysis

Rodríguez-Rivas, Matías E; Cangas, Adolfo J; Cariola, Laura A; Varela, Jorge J; Valdebenito, Sara

doi:10.2196/35099

Cited by 68Mental Health Treatment and AccessDigital Mental Health InterventionsSocial and Intergroup Psychology

Innovative Technology–Based Interventions to Reduce Stigma Toward People With Mental Illness: Systematic Review and Meta-analysis

Open access

Rodríguez-Rivas, Matías E, Cangas, Adolfo J, Cariola, Laura A, Varela, Jorge J, Valdebenito, Sara·2022·JMIR Serious Games

DOI 10.2196/35099PMC PMC9153904

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Abstract

Background: Stigma toward people with mental illness presents serious consequences for the impacted individuals, such as social exclusion and increased difficulties in the recovery process. Recently, several interventions have been developed to mitigate public stigma, based on the use of innovative technologies, such as virtual reality and video games. Objective: This review aims to systematically review, synthesize, measure, and critically discuss experimental studies that measure the effect of technological interventions on stigmatization levels. Methods: This systematic review and meta-analysis was based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and included studies in English and Spanish published between 2016 and 2021. Searches were run in 5 different databases (ie, PubMed, PsycInfo, Scopus, Cochrane Library, and ScienceDirect). Only randomized controlled trials were included. Two independent reviewers determined the eligibility, extracted data, and rated methodological quality of the studies. Meta-analyses were performed using the Comprehensive Meta-Analysis software. Results: Based on the 1158 articles screened, 72 articles were evaluated as full text, of which 9 were included in the qualitative and quantitative syntheses. A diversity of interventions was observed, including video games, audiovisual simulation of hallucinations, virtual reality, and electronic contact with mental health services users. The meta-analysis (n=1832 participants) demonstrated that these interventions had a consistent medium effect on reducing the level of public stigma (d=–0.64; 95% CI 0.31-0.96; P<.001). Conclusions: Innovative interventions involving the use of technologies are an effective tool in stigma reduction, therefore new challenges are proposed and discussed for the demonstration of their adaptability to different contexts and countries, thus leading to their massification. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021261935; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021261935

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TL;DR

This systematic review and meta-analysis found that innovative technology–based interventions (video games, virtual reality, audiovisual hallucination simulation, and e-contact) had a medium effect on reducing public stigma toward people with mental illness. Across 9 randomized controlled trials and 1832 participants, the pooled effect was d=–0.64 (95% CI 0.31-0.96; P<.001), with high heterogeneity.

Key findings

The meta-analysis of 9 RCTs (n=1832) showed a medium effect of technology-based interventions on reducing public stigma: d=–0.64 (95% CI 0.31-0.96; P<.001).
Interventions included video games (n=4), audiovisual simulation of hallucinations (n=1), virtual reality (n=2), and e-contact with mental health service users (n=2); most studies were with undergraduate students (8/9, 89%).
One audiovisual hallucination simulation study showed an increase in stigma (P=.036; d=0.32), and one videogame-with-avatars study showed no statistical effect on stigma (P=.14; d=–0.18).
Heterogeneity was high (P<.001; I2=87.6%; Q=64.96). Publication bias analyses suggested no differences attributable to bias; Rosenthal’s fail-safe N was 180.

Methods

Systematic review and meta-analysis following PRISMA, registered in PROSPERO (CRD42021261935), searching PubMed, PsycInfo, Scopus, Cochrane Library, and ScienceDirect for English and Spanish articles published March 5, 2016, to March 5, 2021.
Included only randomized controlled trials using innovative technologies (smartphone apps, videogames, e-contact, or virtual reality) aimed at reducing public stigma toward people with mental illness; 1158 articles were screened, 72 full texts evaluated, and 9 included.
Two independent reviewers selected studies and extracted data (Cohen κ=0.75); risk of bias was assessed with Cochrane ROB-2; meta-analysis used Comprehensive Meta-Analysis software with random effects models, standardized mean difference, I2 and Q-statistic, trim-and-fill, and fail-safe N.

Limitations

The paper states: gray literature was not included, which can increase publication bias risk; the small number of studies and high heterogeneity prevented estimating which technology-based intervention was most effective; all included studies focused on high-school and university students, limiting generalizability to the general population; and most studies lacked follow-up, preventing analysis of long-term stigma reduction.
Evident from the text: only 9 RCTs were pooled, and the funnel plot was not used because fewer than 10 studies were included, so publication bias assessment relied on trim-and-fill and fail-safe N rather than visual funnel-plot inspection.

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Integrity signals

Registry

Crossref · 10.2196/35099

Cites

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Statistics

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Claims the paper makes

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Findingown data
In a meta-analysis of 9 randomized controlled trials with 1832 participants, technology-based interventions had a consistent medium effect on reducing public stigma (d=-0.64; 95% CI 0.31-0.96; P<.001).
“The meta-analysis (n=1832 participants) demonstrated that these interventions had a consistent medium effect on reducing the level of public stigma (d=–0.64; 95% CI 0.31-0.96; P<.001).”
Quote in the paperSubstantial claim
- Rests on an assumption: The diverse technology-based interventions and public stigma scales included in the meta-analysis measure a sufficiently common construct to be pooled into a single effect size.
- Rests on an assumption: The high risk of bias in some included studies does not materially affect the pooled effect estimate.
Findingown data
Technology-based interventions had medium effects on reducing the level of public stigma compared with the control group (d=-0.64; 95% CI 0.31-0.96; P<.001).
“the technology-based interventions had medium effects on reducing the level of public stigma (d=–0.64; 95% CI 0.31–0.96; P<.001) compared with the control group.”
Quote in the paperSubstantial claim
Findingcitation
The study using videogame with avatars [32] did not show any statistical effect in the level of stigma (P=.14; d=-0.18).
“another that used videogame with avatars [32] did not show any statistical effect in the level of stigma (P=.14; d=–0.18).”
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Findingown data
High heterogeneity was observed among the included studies (P<.001; I2=87.6%; Q=64.96).
“High heterogeneity was observed among the included studies (P<.001; I2=87.6%; Q=64.96)”
Quote in the paperSubstantial claim
Findingcitation
The study using audiovisual simulation of symptoms [31] showed an increase in the level of stigma (P=.036; d=0.32).
“Only 1 study [31] that used audiovisual simulation symptoms showed an increase in the level of stigma (P=.036; d=0.32)”
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Findingown data
Results suggest that there were no differences in effect sizes attributable to bias.
“Results suggest that there were no differences in effect sizes attributable to bias.”
Quote in the paperSubstantial claim
Findingown data
Based on the parameter of Duval and Tweedie's trim-and-fill analysis, no studies appear to be missing.
“Based on the parameter of Duval and Tweedie’s trim-and-fill analysis, it seems that no studies are missing.”
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Findingown data
Rosenthal's fail-safe N was 180, suggesting that 180 missing studies with no effects would be necessary to achieve a combined 2-tailed P value exceeding .05.
“Test was equal to 180, suggesting that it would be necessary to allocate and include 180 missing studies with no effects for every observed study to achieve the combined 2-tailed P value exceeding .05.”
Quote in the paperSubstantial claim
Findingown data
Under a random effect model, the point estimate for the combined studies did not differ when comparing the original and the adjusted estimate (in both cases, standardized mean difference 0.63; 95% CI 0.94-0.30).
“Under a random effect model, the point estimate for the combined studies did not differ when comparing the original and the adjusted estimate (in both cases, standardized mean difference 0.63; 95% CI 0.94-0.30).”
Quote in the paperSubstantial claim
Findingcitation
All experimental studies involving technology-based interventions in stigma reduction focus on the young population.
“all experimental studies involving technology-based interventions in stigma reduction focus on the young population”
Quote in the paperSubstantial claim
Study design and conductown data
One included study had high risk of bias in selective reporting.
“Finally, only 1 study [31] had a high ROB in selective reporting”
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Premisecitation
Funnel plot evaluation of publication bias is not reliable when fewer than 10 studies are pooled in direct comparison.
“The use of the funnel plot for the evaluation of publication bias was not incorporated, because it has been demonstrated that its use is not reliable when the number of studies pooled in direct comparison is less than 10 [27].”
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Study design and conductown data
Interrater reliability for screening and coding was Cohen κ=0.75 (SE 0.11), indicating medium to high agreement among coders.
“We obtained a Cohen κ of 0.75 (SE 0.11), demonstrating a medium to high degree of agreement among coders.”
Quote in the paperNot a substantial claim
Interpretationown data
Innovative interventions involving the use of technologies are an effective tool in stigma reduction.
“Innovative interventions involving the use of technologies are an effective tool in stigma reduction, therefore new challenges are proposed and discussed for the demonstration of their adaptability to different contexts and countries, thus leading to their massification.”
Quote in the paperSubstantial claim
- Rests on an assumption: The diverse technology-based interventions and public stigma scales included in the meta-analysis measure a sufficiently common construct to be pooled into a single effect size.
- Rests on an assumption: The high risk of bias in some included studies does not materially affect the pooled effect estimate.
Study design and conductown data
Most included studies were considered to have low risk of bias in methodological quality.
“As shown in Figure 2, most of the studies included in this review were considered as having low ROB in terms of their methodological quality.”
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Study design and conductown data
Two included studies showed high risk of bias related to allocation concealment.
“Besides, 2 other studies [11,32] showed a high ROB related to the allocation concealment.”
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Study design and conductcitation
Random effects models were used because of heterogeneity in the type of intervention across studies.
“Random effects models were used due to the heterogeneity in the type of intervention in the studies [30].”
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Study design and conductown data
Three included studies showed high risk of bias in blinding of participants and blinding of outcome assessment.
“However, 3 studies [31,32,37] showed a high ROB in the blinding of the participants and blinding of outcome assessment.”
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Premisecitation
Duval and Tweedie's trim-and-fill analysis offers the best estimate of the unbiased effect [30].
“the test offers the best estimate of the unbiased effect [30].”
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Premisecitation
Virtual reality has demonstrated a reduction of negative perceptions and attitudes toward people with mental illnesses.
“along with a reduction of the negative perceptions and attitudes toward people with mental illnesses [16].”
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Premisecitation
The usefulness and effectiveness of virtual reality can be explained by the degree of immersion in a strongly educational environment, which promotes change of attitudes and beliefs.
“This usefulness and effectiveness can be explained by the degree of immersion in a strongly educational environment, which promotes the change of attitudes and beliefs [17].”
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Interpretationown data
It is highly unlikely that missing studies could alter the substantive conclusion.
“Therefore, it is highly unlikely that missing studies could alter the substantive conclusion.”
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Premisecitation
Several research studies show that providing information, such as biographical aspects, is essential to reduce stigma because it allows people to empathize, understand, and change their attitudes, knowledge, and stigmatizing behaviors [44].
“several research studies show that the information provided is essential to reduce stigma, where, for example, it has been helpful to refer to biographical aspects (eg, related to difficulties, personal adversities), because it allows people to empathize, understand, and generate a change in their attitudes, knowledge, and stigmatizing behaviors [44].”
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- cites [44] Longdon, E, 2017, Isr J Psychiatry Relat Sci
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Interpretationcitation
The larger effect is probably due to increasing technological development, with greater realism, immersion, and technological interaction [40].
“This is probably due to the increasing technological development, where realism, immersion, and technological interaction are greater, becoming an increasingly natural means of communication and daily application [40].”
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Interpretationown data
The results of this meta-analysis support the use of new and innovative technology-based interventions to reduce stigma toward people with mental illness.
“The results of this meta-analysis support the use of new and innovative technology–based interventions to reduce stigma toward people with mental illness.”
- Also stated in: § Principal Findings · boosted
  “Our study demonstrated the usefulness of innovative interventions in stigma reduction”
Quote in the paperSubstantial claim
Interpretationcitation
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].”
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Interpretationreasoning
The findings of this study are better (larger effect) compared with a previous meta-analysis [39] that reported only a small effect of contact and educative interventions.
“Its findings are better compared with a previous meta-analysis [39], which reported only a small effect of contact interventions for people with mental illness, and for the educative intervention, both classical and common-type interventions.”
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Study design and conductown data
The small number of studies and high heterogeneity prevented us from estimating which technology-based intervention was the most effective.
“the small number of studies and high heterogeneity prevented us from estimating which technology-based intervention was the most effective”
Quote in the paperSubstantial claim

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Findingown data
Four included studies were conducted in Europe, 2 in North America, and 1 each in Asia, Australia, and Latin America.
“As many as 4 studies (44%) were conducted in Europe, 2 (22%) in North America, and only 1 each in Asia (11%), Australia (11%), and Latin America (11%).”
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Findingown data
The 9 included randomized controlled trials used video games (n=4), audiovisual simulation of hallucinations (n=1), virtual reality (n=2), and e-contact with mental health services users through videoconferencing and online chats (n=2).
“A total of 9 randomized control trial studies were included, which utilized a variety of technology-based interventions to reduce stigma, including interventions using video games (n=4), audiovisual simulation of hallucinations (n=1), virtual reality (n=2), and the use of e-contact with mental health services users through videoconferencing and online chats (n=2).”
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Findingown data
Of 1158 articles screened, 72 were evaluated as full text, and 9 were included in the qualitative and quantitative syntheses.
“Based on the 1158 articles screened, 72 articles were evaluated as full text, of which 9 were included in the qualitative and quantitative syntheses.”
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- Rests on an assumption: The search strategy and databases identified all relevant studies.
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Findingown data
Most participants in the included studies were female, with the proportion of female participants ranging from 50.3% to 81.1%.
“Most of the participants were female. The proportion of female participants ranged from 50.3% to 81.1%”
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Findingown data
The mean age of participants in the included studies ranged from 15.7 to 24 years.
“the mean age of the participants ranged from 15.7 to 24 years.”
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Findingown data
Most included studies were conducted with undergraduate students (8/9, 89%).
“Most of these studies were conducted with undergraduate students (8/9, 89%).”
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Findingown data
Public stigma in the included studies was measured through different scales, most commonly the Attribution Questionnaire and the Questionnaire on Student Attitudes Toward Schizophrenia.
“Public stigma in the studies was measured through different scales, with the most commonly used being the Attribution Questionnaire and the Questionnaire on Student Attitudes Toward Schizophrenia.”
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Findingown data
A total of 9 articles were included in the meta-analysis, with a total sample of 1832 participants.
“A total of 9 articles were included in the meta-analysis, with a total sample of 1832 participants.”
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Findingcitation
The included study using videogames through avatar identification [32] reported a significant effect (B=-0.21; P<.05) for the reduction of social distance, despite no significant effect on stigma.
“one of the included studies, which used videogames through avatar identification [32], despite showing no significant effect on stigma in the combined effect analysis, reported a significance effect (B=–0.21; P<.05) for the reduction of social distance”
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Study design and conductown data
The systematic review and meta-analysis protocol was registered in PROSPERO (CRD42021261935).
“The systematic review and meta-analysis protocol were registered in the Prospective Register of Systematic Reviews (PROSPERO) international database (registration ID: CRD42021261935)”
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Study design and conductcitation
The review was conducted according to PRISMA guidelines and recommendations.
“was conducted according to the guidelines and recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) [25].”
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Study design and conductown data
No included study showed high risk of other bias or random sequence generation.
“and no study showed a high risk of other bias or random sequence generation.”
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Study design and conductcitation
For 3 studies with more than 1 stigma scale, the multiple measures were combined into a single effect size following methodology for complex data structures.
“As 3 of the studies included more than 1 scale that assessed levels of stigma [11,22,31], we conducted an analysis that combined them into a single effect size. In those cases, we followed the methodology suggestion for complex data structures [30].”
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Study design and conductown data
A third investigator examined all included articles to review selection and resolve discrepancies.
“A third investigator (LAC) examined all the included articles to review this selection and resolve discrepancies.”
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Study design and conductown data
Risk of bias of each study was independently assessed using the Cochrane ROB-2 assessment tool.
“To assess the quality of the selected articles, 2 researchers (MER-R and AJC) independently assessed the risk of bias (ROB) of each study using the Cochrane ROB-2 assessment tool”
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Study design and conductnone given
Two independent reviewers determined eligibility, extracted data, and rated methodological quality of the studies.
“Two independent reviewers determined the eligibility, extracted data, and rated methodological quality of the studies.”
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Study design and conductown data
Two included studies presented incomplete data.
“Regarding data, 2 studies [22,37] presented incomplete data.”
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Premisecitation
Discrimination, prejudice, and stereotypes in society severely impact recovery, quality of life, and well-being of people with mental illnesses and their families, and represent the main gap in accessing specialized mental health services by the general population.
“Thus, discrimination, prejudice, and stereotypes present in society not only severely impact the recovery process, quality of life, and well-being of people with mental illnesses and their families, but also represent the main gap in accessing specialized mental health services by the general population [4,5].”
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Premisecitation
Research has shown high levels of discrimination, stigma, and prejudice toward people with mental health problems, especially schizophrenia and bipolar disorder.
“The aforesaid has great relevance in the global context, where research has shown the presence of high levels of discrimination, stigma, and prejudice toward those impacted by mental health problems, especially schizophrenia and bipolar disorder [6,7].”
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Study design and conductcitation
Publication bias was quantified using Duval and Tweedie's trim-and-fill analysis and Rosenthal's fail-safe N test.
“In addition, we used statistical procedures to quantify the effect of publication bias, by Duval and Tweedie’s trim-and-fill analysis and Rosenthal’s fail-safe N test [35].”
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Premisecitation
Stigma toward people with mental illness has a negative effect on their quality of life, therapeutic results, and risk of suicide and mortality.
“It has a negative effect on their quality of life, worse therapeutic results, and even an increased risk of suicide and mortality [1-3].”
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Premisecitation
Virtual reality has demonstrated utility in the treatment of mental health problems such as phobias and anxiety symptoms.
“For example, it has demonstrated its utility in the treatment of mental health problems, such as phobias and anxiety symptoms, among others [15]”
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Premisecitation
Direct contact with people with mental illnesses and educational initiatives are essential and effective interventions to reduce stigma.
“It has been demonstrated that direct contact with people with mental illnesses and educational initiatives are essential and effective interventions to reduce stigma [8,9].”
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Study design and conductcitation
For 2 studies reporting standardized regression, β coefficients were entered into the meta-analysis software as correlation coefficients according to Peterson and Brown.
“In addition, as 2 of the studies [32,33] reported their results through standardized regression, the β coefficients were entered into the comprehensive meta-analysis software (CMA) as correlation coefficient, according to the recommendations of Peterson and Brown [34].”
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Premisecitation
Video games are an effective tool to reduce anxious and depressive symptomatology in patients and are useful to reduce misconceptions and stigmatization about severe mental illnesses such as schizophrenia or bipolar disorder.
“Among this type of interventions, the use of video games has been highlighted as an effective tool to reduce anxious and depressive symptomatology in patients, and has been useful to reduce misconceptions and stigmatization about severe mental illnesses, such as schizophrenia or bipolar disorder [12,13].”
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Premisecitation
The application of virtual and immersive reality in mental health has become increasingly common.
“In addition, because of the growth of technologies, the application of virtual and immersive reality in mental health has become increasingly common [14].”
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Premisenone given
Globally, stigma toward people with mental illness is a serious public health problem and is considered the main barrier to social inclusion and participation of those impacted.
“Globally, stigma toward people with mental illness represents a serious public health problem and is considered the main barrier to social inclusion and participation of those impacted.”
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Interpretationreasoning
The high heterogeneity among included studies was expected due to the variety of interventions.
“which was expected due to the variety of interventions.”
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Premisecitation
Direct face-to-face contact with people with mental illness is a key component of successful stigma reduction programs.
“Although direct face-to-face contact with people with mental illness has been shown to be a key component of successful stigma reduction programs, their implementation in virtual learning and innovative spaces is recent [10].”
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Premisecitation
e-Contact using chat and synchronous videoconferencing can reduce anxiety, stigma, and stereotypes toward people with mental disorders and promote an inclusive attitude.
“However, e-contact implementation in the field of stigma reduction is new and innovative, and it has been demonstrated that e-contact using chat and synchronous videoconferencing can reduce anxiety, stigma, and stereotypes toward the population impacted by mental disorders, and promote an inclusive attitude [11,22].”
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Premisecitation
Electronic contact has been used as a strategy for promoting awareness and reducing prejudice among ideologically different groups.
“Finally, as an innovative intervention, electronic contact (e-contact)—defined as “computer-mediated real-time interactions where members of different groups interact online” through virtual media with mental health services users [20]—has been used as a strategy for promoting awareness and reducing prejudice among ideologically different groups [21].”
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Premisecitation
Innovative technology-based interventions have had a great impact on reducing stigma toward people with mental illness, mainly due to their adaptability to different contexts and age ranges.
“In the last years, several authors have shown that innovative technology-based interventions have had a great impact on the reduction of stigma toward people with mental illness, mainly due to its adaptability to different contexts and age ranges [11].”
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Premisecitation
Simulation platforms have shown controversial results, with some studies showing increased stigmatization when used through simulation of hallucinatory symptomatology.
“By contrast, the use of simulation platforms has showed controversial results, with some studies showing an increase of stigmatization when used through the simulation of hallucinatory symptomatology, which can promote negative beliefs and attitudes toward people with mental illness [18,19].”
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Interpretationown data
The interventions have a positive impact and are effective for stigma reduction.
“demonstrating a positive impact and effectiveness of these interventions.”
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Premisecitation
A recent meta-analysis [41] showed that antistigma interventions involving contact had an immediate small-to-medium effect, equivalent across diverse contact mediums such as videos and presentation.
“a recent meta-analysis showed that antistigma interventions involving contact had an immediate small-to-medium effect, and it was equivalent with diverse types of contact mediums, such as videos and presentation [41].”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [41] source
  Not checked in the free run.
Classified as probably not a substantial claim.
Premisecitation
Rosenthal's fail-safe N test is a technique for computing the number of missing studies that would be necessary to nullify the found effect [38].
“Rosenthal’s fail-safe N test is a technique for computing the number of missing studies that would be necessary to nullify the found effect [38].”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [38] source
  Not checked in the free run.
May combine two claims.
Interpretationreasoning
The negative results may be explained by the focus on symptoms rather than on the recovery process, which may increase stereotypes and prejudice, especially toward people with schizophrenia.
“These negative results may be explained by the focus on symptoms rather than on the recovery process, which may increase stereotypes and prejudice, especially toward people with schizophrenia.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.
Interpretationreasoning
These types of interventions have a variety of advantages and offer innovative solutions to everyday problems, due to their adaptability to different contexts and lower associated cost, along with the possibility of privacy in a protected environment.
“These types of interventions have a variety of advantages and offer innovative solutions to everyday problems, due to their adaptability to different contexts and lower associated cost, along with the possibility of privacy in a protected environment”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation
Adaptation of educative and contact components has demonstrated great utility in e-contact with people with mental illness, offering wider dissemination and reaching remote areas [11,22].
“Its adaptation had demonstrated a great utility, for example, in e-contact with people with mental illness, as they offer the possibility of wider dissemination and even the possibility of reaching remote areas [11,22].”
Quote in the paperNot a substantial claim0 of 2 sources checked
- cites [11] source
  Not checked in the free run.
- cites [22] source
  Not checked in the free run.
May combine two claims.
Study design and conductnone given
All the studies found and included focused on the population of high-school and university students, which may limit the generalizability of the results to the general population.
“all the studies found and included focused on the population of high-school and university students, which may limit the generalizability of the results to the general population.”
Quote in the paperNot a substantial claim
May combine two claims.
Study design and conductcitation
We did not include gray literature, which can increase the risk of publication bias [45].
“we did not include gray literature, which can increase the risk of publication bias [45].”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [45] source
  Not checked in the free run.
May combine two claims.
Interpretationown data
Innovative interventions involving virtual reality and communication technologies are effective tools for stigma reduction toward people with mental illness and can be an alternative and a complement for traditional methods on stigma reduction.
“Our meta-analysis showed that innovative interventions involving the use of virtual reality and communication technologies are effective tools for stigma reduction toward people with mental illness and can be an alternative and a complement for the traditional methods on stigma reduction.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisecitation
The Help Club app provides access to communities of mutual support in mental health in virtual spaces through virtual reality, demonstrating the potential of the metaverse as a space for social interaction.
“we highlight the recently developed app Help Club [48], which provides the possibility of access to communities of mutual support in mental health in virtual spaces, through the use of virtual reality, demonstrating the potential and growing impact of metaverse as a space for social interaction and an increasingly used tool.”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [48] Help Club app: Mental Health Help for the MetaverseVery Real Help2022-03-18https://veryrealhelp.com
  Not checked in the free run.
May combine two claims.
Study design and conductown data
Most of the included studies did not include follow-up studies, which prevented the analysis of long-term stigma reduction.
“most of the included studies did not include follow-up studies, which prevented the analysis of long-term stigma reduction.”
Quote in the paperNot a substantial claim

44 of 44

The paper relies on this without support.
The diverse technology-based interventions and public stigma scales included in the meta-analysis measure a sufficiently common construct to be pooled into a single effect size.
“A diversity of interventions was observed, including video games, audiovisual simulation of hallucinations, virtual reality, and electronic contact with mental health services users.”
“Public stigma in the studies was measured through different scales, with the most commonly used being the Attribution Questionnaire and the Questionnaire on Student Attitudes Toward Schizophrenia.”
“Random effects models were used due to the heterogeneity in the type of intervention in the studies [30].”
The paper relies on this without support.
The high risk of bias in some included studies does not materially affect the pooled effect estimate.
“As shown in Figure 2, most of the studies included in this review were considered as having low ROB in terms of their methodological quality. However, 3 studies [31,32,37] showed a high ROB in the blinding of the participants and blinding of outcome assessment.”
The paper relies on this without support.
The search strategy and databases identified all relevant studies.
“Searches were run in 5 different databases (ie, PubMed, PsycInfo, Scopus, Cochrane Library, and ScienceDirect).”
“In addition, a final manual trace back literature search was conducted in August 2021 to identify any recently published sources/literature.”

3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Digital solutions might be especially well-positioned to help individuals who are seeking support to overcome barriers, for example by offering more flexibility and reducing stigma.
“Excitingly, digital solutions might be especially well-positioned to help individuals who are seeking support to overcome barriers, for example by offering more flexibility and reducing stigma [Rodríguez-Rivas et al., 2022].”
From Closing the accessibility gap to mental health treatment with a personalized self-referral chatbot (2024) · cites this paper as Rodríguez-Rivas et al., 2022

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

Stated minimum female proportion conflicts with Table 1
Minor
The text states that the lowest female proportion was 50.3%, but Table 1 lists a study with 50.0% female participants.

1 of 1

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“In addition, all experimental studies involving technology-based interventions in stigma reduction focus on the young population, which represents a major challenge for future studies focused on the development, implementation, and evaluation of these types of interventions for different ages, such as adults and the e…”
Background
The trim-and-fill method for publication bias: practical guidelines and recommendations based on a large database of meta-analyses
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“The aforesaid has great relevance in the global context, where research has shown the presence of high levels of discrimination, stigma, and prejudice toward those impacted by mental health problems, especially schizophrenia and bipolar disorder [6,7].”
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Grey literature: An important resource in systematic reviews
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Background
Interventions to reduce stigma towards people with severe mental illness: Systematic review and meta-analysis
Morgan, A. J., Reavley, N. J., Ross, A., Too, L. S., & Jorm, A. F. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2018.05.017 · Cited by 372 · see citing works
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Stigma-Stop: A Serious Game against the Stigma toward Mental Health in Educational Settings
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EFECTOS DEL CONTACTO ELECTRÓNICO VÍA VIDEOCONFERENCIA EN LA REDUCCIÓN DEL ESTIGMA HACIA LAS PERSONAS CON ENFERMEDADES MENTALES
RODRÍGUEZ-RIVAS, M. E., FERRER, J. M. R., LÓPEZ, I. D. A., CAMPOY, J. M. F., ALONSO, L. M., LEÓN, A. M., AGUADO, C. M., & SOLER, R. C. (2021) · Intervención en Contextos Clínicos y de la Salud: Un enfoque práctico desde la investigación. · doi:10.2307/j.ctv2gz3w4s.7 · Cited by 2 · see citing works
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Authors: Rodríguez-Rivas, M. E., Cangas, A. J., Cariola, L. A., Varela, J. J., & Valdebenito, S.
Affiliations: University of Almería (ES)
University of Edinburgh (GB)
Universidad del Desarrollo (CL)
University of Cambridge (GB)
ORCID: Rodríguez-Rivas, Matías E
Cangas, Adolfo J
Cariola, Laura A
Varela, Jorge J
Valdebenito, Sara
Venue: JMIR Serious Games
Publisher: JMIR Publications Inc.
Published: 2022-05-30
Volume: 10
Issue: 2
Pages: e35099
ISSN: 2291-9279 (ISSN-L)
DOI: 10.2196/35099
PMC: PMC9153904
OpenAlex: W4226061081
Semantic Scholar: 3552b158705016d874ae9c3bf411c3f4e4faf4b6
Cited by: 68
References: 53
Citations by year: 2026: 12 · 2025: 19 · 2024: 24 · 2023: 11 · 2022: 2
FWCI: 2.10
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: JMIR Serious Games (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Apollo (University of Cambridge) (submittedVersion, cc-by)
Apollo (cc-by)
Funders: Agenția Națională pentru Cercetare și Dezvoltare
Agencia Nacional de Investigación y Desarrollo
CHIST-ERA
Topics: Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Social Sciences › Sociology and Political Science › Social and Intergroup Psychology
Keywords: stigma reduction, public stigma, mental illness, virtual reality, video games, serious games, technology-based interventions, social exclusion

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Innovative Technology–Based Interventions to Reduce Stigma Toward People With Mental Illness: Systematic Review and Meta-analysis

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