Graduation Year

2024

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Mental Health Law and Policy

Major Professor

Kristin A. Kosyluk, Ph.D.

Committee Member

Amber M. Gum, Ph.D.

Committee Member

Dinora Martinez-Tyson, Ph.D., MPH, MA

Committee Member

Brent J. Small, Ph.D.

Committee Member

Shannon M. Suldo, Ph.D.

Keywords

Teen Mental Health, Parents, Affiliate Stigma, Early Onset, Suicide, Mental Health Condition

Abstract

Adolescence is a developmental period that often involves extreme physical, psychological, and emotional changes and sometimes the experience of significant personal and social challenges. In addition to these challenges, youth are trying to find their place in the world and developing their identities, which depend heavily on their relationships with others. Adolescents who struggle with their mental health and also fail to develop meaningful connections with others, tend to have poor self-esteem, self-isolate, are ostracized by others, and have a poor social self-concept, all of which are associated with poor mental health and increased risk for suicidal ideation. The impact of these outcomes intensifies when youth identify with a marginalized group such as race or sexual gender. Research indicates that most lifelong mental illnesses begin in the early years of childhood. Various forms of stigma may exacerbate a young person’s struggle with mental health and are associated with more significant problems like suicidal ideation. Seeking professional help is one of the first steps to adequately address mental health concerns for individuals, and early intervention results in better long-term outcomes. According to the gateway provider model, intervention for youths’ mental health concerns is initiated by parents/guardians, or “gateway providers,” and affiliate stigma (that felt by parents/guardians), is a significant barrier to parental help-seeking behaviors. One way to encourage help-seeking behaviors for all populations is to remove stigma. This can be accomplished in many ways, one being to develop contact-based programs (a form of interaction between groups) that debunk common stereotypes, increase one’s mental health literacy, improve help-seeking behaviors, and decrease forms of stigma. Therefore, this dissertation has three aims. Aim 1—to qualitatively explore the mental health climate of high schools, and stakeholder perspectives on a contact-based anti-stigma program for youth, Aim 2—to examine the effectiveness of listening to teen podcasts on improving various forms of stigma within teens, and Aim 3—to pilot the effectiveness of watching videos of teen stories and teen interviews with a mental health professional on various forms of stigma among parents. The primary focus of this dissertation did not involve evaluating suicidality in youth or trying to understand the phenomena, however, its purpose included efforts to improve suicide-related risk factors. Research indicates that improving or eliminating these stigma-related suicide risk factors reduces suicidality among youth. Therefore, this dissertation has an Exploratory Aim—to examine how contact-based strategies impact suicide-related risk factors in youth. This dissertation begins with a qualitative study. Through focus groups with three high school stakeholder groups (FG1, teens N = 10; FG2, teachers N = 3; FG3, parents, teachers, school professionals, and other adults N = 16), we explored stakeholder awareness and perceptions of high school mental health climate and stigma. We also explored stakeholder opinions of adapting This Is My Brave (TIMB), a contact-based stigma reduction program, for a teen audience. This qualitative study was followed by a randomized controlled trial, which was the first to evaluate whether the targeted population of 18 and 19-year-old teens (N = 70) listening to TIMB podcasts titled “Our Turn To Talk” (OTTT) would improve attitudes about help-seeking, public and internalized stigma. We also collected data through two subscales in the internalized stigma of seeking help scale (alienation, social withdrawal), which are suicide risk factors. The last study targeted parents (N = 167), and piloted the novel approach of parents viewing videos of teens narrating their lived experiences with a mental health condition followed by interviews with a mental health professional regarding a specific teen mental health issue. We examined how the approach impacted parents’ affiliate stigma, care and help-seeking for children, attitudes about mental health treatment for children, racism, transphobia, and sexual orientation stigma. And finally, we explored whether pre-/post- differences emerged between the video conditions. Results of this dissertation helped researchers understand the mental health climate of high schools local to the research university, learning that there are not many curriculum options for high school students to learn about mental health, that high schoolers struggle significantly with their mental health, they are silenced by mental illness stigma, self-harm and suicidal ideation begin before high school, and that there was support and caution about adapting a program like TIMB for a teen audience. The randomized controlled trial indicated that for 18 and 19-year-olds, listening to TIMB-OTTT podcasts is effective at improving attitudes toward seeking mental health, reducing public and internalized stigma, and improving suicide-related risk factors. The pilot study indicated that viewing videos of teens talking about their mental health journey and interviewing a mental health professional is an effective way to improve parental affiliate stigma, the self-stigma of seeking help for children, care seeking for children, attitudes about mental health treatment for children, and positive anti-racism beliefs. The TIMB-OTTT videos did not have a significant impact on transgenderism or sexual orientation stigma. Overall, results of this dissertation contribute to the literature on the use of contact-based stigma reduction approaches to improve stigma, mental health help-seeking behaviors, and suicide risk factors in youth and to improve parental affiliate stigma, their self-stigma of seeking help for children, their care seeking for children, their attitudes about mental health treatment for children, and positive anti-racism beliefs. This is the first study to target these narrowed populations of 18 and 19-year-olds and parents using the contact-based approaches of podcasts and video narratives (respectively).

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