Honest, Open, Proud for Soldiers with Mental Illness

NCT ID: NCT03218748

Last Updated: 2024-12-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

99 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-11-15

Study Completion Date

2024-10-01

Brief Summary

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The purpose of the study is to evaluate the feasibility and efficacy of the group-based intervention "Honest, Open, Proud" among soldiers with mental illness.

Detailed Description

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Soldiers with mental illness typically face a two-fold problem. On the one hand, they have to cope with the symptoms of their mental illness; on the other hand, they often have to deal with stigma and discrimination. Both due to fear of public stigma and due to self-stigma or shame, soldiers with mental illness may decide to keep their condition a secret or even to withdraw from other people altogether in order to minimize the risk of being labeled. Secrecy can help on the short term to protect individuals from public stigma, but usually it has negative long-term consequences such as social isolation, distress and avoidance of help-seeking. Disclosure, on the other hand, carries the risk to be discriminated by others, but can reduce the burden of secrecy, lead to support by others and reduce public stigma.

In this study investigators aim to test the efficacy (see our outcomes above) of Honest, Open, Proud run by soldiers with lived experience of mental illness.

Conditions

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Mental Illness

Keywords

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Mental illness Disclosure stigma soldiers secrecy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Honest, Open, Proud

The group program is about disclosure versus secrecy of one's mental illness. The groups are facilitated by two peers (soldiers with lived experience of mental illness). Each group runs for three weeks, one meeting per week, and two hours per meeting. There is one 2-hour booster session in week 6.

Fidelity to manual: rated by a research assistant who is present during the group session

Group Type EXPERIMENTAL

Honest, Open, Proud (HOP)

Intervention Type BEHAVIORAL

Three lessons, one for each two-hour session plus one booster session

1. Considering the pros and cons of disclosure:

Discussion of one's idea of identity and mental illness, weighing the costs and benefits of (non-) disclosure
2. Different ways to disclose:

Discussion of different levels of (non-) disclosure, considering costs and benefits of each level, selecting persons to disclose to and how to test them out, anticipating responses of others to one's disclosure
3. Telling one's story:

Practice how to tell one's story, identifying peers who might be helpful with the coming out process
4. Booster session Reviewing previous intentions to disclose one's mental illness, discussion whether one disclosed and evaluating this experience

Control group

Treatment as usual (TAU)

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Honest, Open, Proud (HOP)

Three lessons, one for each two-hour session plus one booster session

1. Considering the pros and cons of disclosure:

Discussion of one's idea of identity and mental illness, weighing the costs and benefits of (non-) disclosure
2. Different ways to disclose:

Discussion of different levels of (non-) disclosure, considering costs and benefits of each level, selecting persons to disclose to and how to test them out, anticipating responses of others to one's disclosure
3. Telling one's story:

Practice how to tell one's story, identifying peers who might be helpful with the coming out process
4. Booster session Reviewing previous intentions to disclose one's mental illness, discussion whether one disclosed and evaluating this experience

Intervention Type BEHAVIORAL

Other Intervention Names

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Coming Out Proud (COP)

Eligibility Criteria

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Inclusion Criteria

* At least one self-reported current axis I or axis II disorder according to DSM-5, which is not restricted to only substance-related disorder(s)
* Age 18 or above
* Ability to provide written informed consent
* Fluent in German (needed for self-report measures)
* At least a moderate level of self-reported disclosure-related distress/difficulty (score 4 or higher on the screening item 'In general, how distressed or worried are you in terms of secrecy or disclosure of your mental illness to others?', rated from 1, not at all, to 7, very much)
* Current inpatient, day-clinic or outpatient treatment at the Center for Military Mental Health, Berlin, Germany
* from April 2018 onwards we decided to also include non-military first responders (fire fighters or police officers) who are treated in the Center for Military Mental Health, Berlin, Germany

Exclusion Criteria

* Self-reported diagnosis of only a substance- or alcohol-related disorder, without non-substance related current psychiatric comorbidity. We will exclude people who only have a substance-/alcohol-related disorder because the disclosure of these disorders is not the topic of the HOP intervention
* Intellectual disability
* Organic disorders
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Center for Military Mental Health, Berlin, Germany

UNKNOWN

Sponsor Role collaborator

Illinois Institute of Technology, Chicago, USA

UNKNOWN

Sponsor Role collaborator

University of Ulm

OTHER

Sponsor Role lead

Responsible Party

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Nicolas Rüsch

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nicolas Rüsch, Dr.

Role: PRINCIPAL_INVESTIGATOR

Department of Psychiatry II, Section Public Mental Health, Ulm University, Bezirkskrankenhaus Günzburg

Gerd-Dieter Willmund, Dr.

Role: PRINCIPAL_INVESTIGATOR

Center for Military Mental Health, Berlin, Germany

Peter Zimmermann, Dr.

Role: PRINCIPAL_INVESTIGATOR

Center for Military Mental Health, Berlin, Germany

Locations

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Illinois Institute of Technology

Chicago, Illinois, United States

Site Status

Center for Military Mental Health

Berlin, , Germany

Site Status

Department of Psychiatry II, Section Pubic Mental Health, Ulm University, Bezirkskrankenhaus Günzburg

Ulm, , Germany

Site Status

Countries

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United States Germany

References

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Boyd JE, Otilingam PG, Deforge BR. Brief version of the Internalized Stigma of Mental Illness (ISMI) scale: psychometric properties and relationship to depression, self esteem, recovery orientation, empowerment, and perceived devaluation and discrimination. Psychiatr Rehabil J. 2014 Mar;37(1):17-23. doi: 10.1037/prj0000035.

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Rusch N, Corrigan PW, Heekeren K, Theodoridou A, Dvorsky D, Metzler S, Muller M, Walitza S, Rossler W. Well-being among persons at risk of psychosis: the role of self-labeling, shame, and stigma stress. Psychiatr Serv. 2014 Apr 1;65(4):483-9. doi: 10.1176/appi.ps.201300169.

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Rusch N, Heekeren K, Theodoridou A, Dvorsky D, Muller M, Paust T, Corrigan PW, Walitza S, Rossler W. Attitudes towards help-seeking and stigma among young people at risk for psychosis. Psychiatry Res. 2013 Dec 30;210(3):1313-5. doi: 10.1016/j.psychres.2013.08.028. Epub 2013 Sep 4.

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Rusch N, Evans-Lacko SE, Henderson C, Flach C, Thornicroft G. Knowledge and attitudes as predictors of intentions to seek help for and disclose a mental illness. Psychiatr Serv. 2011 Jun;62(6):675-8. doi: 10.1176/ps.62.6.pss6206_0675.

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Rusch N, Corrigan PW, Powell K, Rajah A, Olschewski M, Wilkniss S, Batia K. A stress-coping model of mental illness stigma: II. Emotional stress responses, coping behavior and outcome. Schizophr Res. 2009 May;110(1-3):65-71. doi: 10.1016/j.schres.2009.01.005. Epub 2009 Feb 23.

Reference Type BACKGROUND
PMID: 19237266 (View on PubMed)

Rusch N, Corrigan PW, Wassel A, Michaels P, Olschewski M, Wilkniss S, Batia K. A stress-coping model of mental illness stigma: I. Predictors of cognitive stress appraisal. Schizophr Res. 2009 May;110(1-3):59-64. doi: 10.1016/j.schres.2009.01.006. Epub 2009 Mar 6.

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Reference Type BACKGROUND

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Reference Type BACKGROUND
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Rusch N, Helms C, Horger J, Hohle B, Bernert H, Muschner P, Rose C, Corrigan PW, Mulfinger N, Zimmermann P, Willmund GD. The peer-led Honest, Open, Proud program to decrease the impact of mental illness stigma among German military personnel: randomized controlled trial. Soc Psychiatry Psychiatr Epidemiol. 2025 Jul 22. doi: 10.1007/s00127-025-02960-x. Online ahead of print.

Reference Type DERIVED
PMID: 40696200 (View on PubMed)

Other Identifiers

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HOP Soldiers

Identifier Type: -

Identifier Source: org_study_id