People with serious mental illness (PSMI; i.e. Schizophrenia and bipolar disorder) die, on average, 25 years earlier than the general population. Suicide is a key factor for this disparity as it is the leading cause of unnatural deaths among this population. Latinxs are a particularly vulnerable group accounting for one of the highest rates of SMI and suicide ideation and attempt (SIA) among ethnic minorities in the United States. Health professionals play a key role in identifying SMI/SIA among patients; unfortunately, SMI/SIA stigma hinders this process. This is vital, as research has documented that half of PSMI who are suicide victims contact their physicians prior to their deaths. Furthermore, Latinxs seek SMI/SIA related services in general medical settings, rather than through mental health care. Thus, the National Action Alliance for Suicide Prevention?s Research Prioritization Task Force calls for effective SMI stigma-reduction interventions targeting health professionals in order to prevent SIA through early identification and increasing referrals for at-risk individuals. In light of this, the proposed R34 project aims to:
Aim 1 - Develop the content of an intervention to reduce SMI/SIA stigma among medical students.
Aim 2 - Determine the acceptability and feasibility of implementing the intervention among medical students by examining recruitment/screening procedures, participation/refusal/retention rates, and participant satisfaction.
Aim 3 - Pilot test, via a small randomized controlled trial (RCT), the preliminary efficacy of the intervention in reducing SMI/SIA stigma among medical students by: increasing knowledge of SMI/SIA, reducing negative attitudes towards SMI/SIA, and increasing behavioral skills for providing healthcare to PSMI. The team will develop the intervention content based on their previous studies, recommendations from the Community Advisory Board and input from medical students via iterative focus groups (Aim 1). Afterwards, 126 medical students recruited in Puerto Rico and Florida will be randomly assigned to either the SMI/SIA stigma reduction intervention (n=63) or a time and attention matched controlled condition (n=63) to determine its acceptability/feasibility and test its preliminary efficacy (Aims 2 & 3). The team will examine the intervention?s efficacy in reducing SMI/SIA stigma via direct observation of: 1) interactions with Standardized Patient Simulations (n=126), and; 2) a subsample (n=40) of interactions with real-world patients. Following, the team will then examine students? and patients? views and attitudes regarding these real-world clinical interactions via qualitative interviews. If data from this study points to an efficacious intervention, the team will implement a fully powered Hybrid-I type RCT design examining the intervention?s effectiveness and implementation strategies. If successful, medical schools will have a powerful cross-cultural tool to train students on stigma-free skills impacting SMI/SIA prevention efforts with high-risk populations.

Public Health Relevance

This project aims to develop and pilot test via a small randomized controlled trial (RCT) a serious mental illness (SMI) and suicide stigma reduction intervention among medical students. This intervention aims to: 1) increase medical students? knowledge about SMI and suicide, 2) reduce negative attitudes regarding SMI and suicide and 3) increase behavioral skills for the provision of healthcare to Latinxs with SMI and suicide ideation and attempts. If data from this study points to an efficacious intervention, the team will implement a subsequent fully powered Hybrid-I type RCT design via an R01 to examine the interventions? effectiveness and implementation strategies.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Special Emphasis Panel (ZMH1)
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Juliano-Bult, Denise M
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Ponce School of Medicine
Schools of Medicine
United States
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