'Tell Your Story': a randomized controlled trial of an online intervention to reduce mental health stigma and increase help-seeking in refugee men with posttraumatic stress

• Published in: Psychological medicine 2020-04, Vol.50 (5), p.781-792
• Main Authors: Nickerson, Angela, Byrow, Yulisha, Pajak, Rosanna, McMahon, Tadgh, Bryant, Richard A, Christensen, Helen, Liddell, Belinda J
• Format: Article
• Language: English
• Subjects: Adult; Clinical trials; Displaced persons; Efficacy; Health services utilization; Help seeking behavior; Humans; Intention; Internet; Internet access; Internet-Based Intervention; Intervention; Male; Men; Mental disorders; Mental Health; Mental health care; Mental health services; Middle Aged; New South Wales; Patient Acceptance of Health Care - psychology; Persian language; Post traumatic stress disorder; Refugees; Refugees - psychology; Self esteem; Social contact; Social Stigma; Stigma; Stress Disorders, Post-Traumatic - psychology; Symptoms; Traumatic incidents; Young Adult
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291719000606

Refugees report elevated rates of posttraumatic stress disorder (PTSD), but are relatively unlikely to seek help for their symptoms. Mental health stigma is a key barrier to help-seeking amongst refugees. We evaluated the efficacy of an online intervention in reducing self-stigma and increasing help-seeking in refugee men. Participants were 103 refugee men with PTSD symptoms from Arabic, Farsi or Tamil-speaking backgrounds who were randomly assigned to either receive an 11-module online stigma reduction intervention specifically designed for refugees ('Tell Your Story', TYS) or to a wait-list control (WLC) group. Participants completed online assessments of self-stigma for PTSD and help-seeking, and help-seeking intentions and behaviors at baseline, post-intervention, and at a 1 month follow-up. Intent-to-treat analyses indicated that, compared to the WLC, TYS resulted in significantly smaller increases in self-stigma for seeking help from post-treatment to follow-up (d = 0.42, p = 0.008). Further, participants in the TYS conditions showed greater help-seeking behavior from new sources at follow-up (B = 0.69, 95% CI 0.19-1.18, p = 0.007) than those in the WLC. The WLC showed significantly greater increases in help-seeking intentions from post-intervention to follow-up (d = 0.27, p = 0.027), relative to the TYS group. This is the first investigation of a mental health stigma reduction program specifically designed for refugees. Findings suggest that evidence-based stigma reduction strategies are beneficial in targeting self-stigma related to help-seeking and increasing help-seeking amongst refugees. These results indicate that online interventions focusing on social contact may be a promising avenue for removing barriers to accessing help for mental health symptoms in traumatized refugees.