Page 142 - GHES-3-1

Global Health Economics and
Sustainability
Reducing public stigma related to psychosis

toward PMIH, with significant small-to-medium effect dangerousness, (6) enhance willingness to help and
sizes (Corrigan et al., 2012; Morgan et al., 2018; Na et al., interact, (7) lower perceived responsibility, (8) decrease
2022). These effects span cognitive (beliefs), emotional coercive treatment, (9) improve empathy, and (10) reduce
(responses), and behavioral (intended actions) components negative emotions toward individuals with psychosis,
of stigma, with lasting improvements in beliefs and compared with a control group, and that these effects
intended actions observed during follow-ups. However, would be maintained at 1-month follow-up.
existing interventions, while successful in enhancing Ethical approval was obtained from the Departmental
knowledge and reducing discriminatory behavior, are Ethics Review Committee (DERC) at the National
less effective in addressing emotional responses (Na et al., University of Singapore (NUS) and endorsed by the
2022). The impact of educational approaches on mental NUS Institutional Review Board (IRB), reference code
health stigma has been confirmed across various cultures 2022-September-10. The study adhered to the Declaration
(Corrigan et al., 2012). Similarly, educational interventions of Helsinki.
focused on understanding psychosis have led to notable
improvements in stigmatizing attitudes and social 2. Data and methods
distancing, with long-term maintenance of changes in
social distancing but not in attitudes (Morgan et al., 2018). 2.1. Participants
Psychoeducational interventions vary widely in The sample size of 118 participants was calculated using
content, duration, and delivery methods (Morgan et al., G*Power 3.1 software, with an effect size of 0.2, alpha level
2018). Na et al. (2022) found that neither the length nor the of 0.05, and power of 0.8 for a repeated-measures, between-
medium of delivery significantly affected the effectiveness factors analysis of variance (ANOVA). Due to the absence
of psychoeducation in reducing stigma. Several experts of effect sizes from similar studies, a small-to-medium
recommend that interventions should use a balanced, effect size was anticipated. According to Cohen’s (1988)
multidimensional approach, incorporating psychosocial guidelines, a small effect size is 0.10, a medium effect size
perspectives on mental health issues (Jorm & Griffiths, is 0.25, and a large effect size is 0.40.
2008; Lincoln et al., 2008; Yamaguchi et al., 2011). There Figure 1 shows the CONSORT diagram of participant
is also consensus on the need to include evidence-based flow throughout the study. A total of 148 participants who
information to directly counteract stereotypes about were Singaporean and over 18 years old were initially
mental health issues (Corrigan et al., 2012; Corrigan et al., included. With 15 participants not completing the
2000; Lincoln et al., 2008), share personal testimonies of follow-up, list-wise deletion reduced the final sample to
those with psychological difficulties (Knaak et al., 2017), 133. Participants, recruited through online advertisements
and highlight their potential for recovery (Knaak et al., targeting university students and the general public,
2014). Despite this, current interventions still primarily ranged in age from 19 to 58 years (M = 22.07, SD = 5.38),
focus on explanatory models and factual information with 62% being females. The demographic characteristics
addressing myths (Corrigan et al., 2012; Morgan et al., of participants in the intervention and control groups are
2018), often overlooking personal testimonies and detailed in Table 1 and showed no significant differences at
examples of recovery (Knaak et al., 2014; Na et al., 2022). pre-intervention.
1.6. Current study 2.2. Standardized measures
Building on the increasing empirical evidence supporting 2.2.1. Attitudes to Mental Illness-Singapore (AMI-SG)
the effectiveness of brief psychoeducation (Corrigan et al., version
2004; Na et al., 2022), this study aimed to evaluate the The AMI-SG is a 20-item, 4-factor self-report questionnaire
effectiveness of a digital single-session cognitive behavioral developed by Yuan et al. (2016) to assess public attitudes
psychoeducation program in reducing public stigma toward mental ill-health. Confirmatory factor analysis
associated with psychosis in a randomized controlled indicated that the model fits well, with a comparative fit
trial. A 1-month follow-up was included to evaluate the index of 0.933 and a Tucker–Lewis index of 0.955 (Yuan
sustainability of the stigma reduction effects. et al., 2016). The items are rated on a 5-point Likert scale
The study hypothesized that psychoeducation from 1 (strongly disagree) to 5 (strongly agree). The four
would significantly (1) reduce social distancing, subscales are (1) social distancing, (2) tolerance and
(2) increase tolerance and support for community care, support for community care, (3) social restrictiveness, and
(3) decrease social restrictiveness, (4) lessen prejudice (4) prejudice and misconception. These subscales have
and misconceptions, (5) reduce fear and perceived good internal consistency, with Cronbach’s alpha values

Volume 3 Issue 1 (2025) 134 https://doi.org/10.36922/ghes.3363