key: cord-0027942-4x9amh6v authors: Amsalem, Doron; Halloran, Justin; Penque, Brent; Celentano, Jillian; Martin, Andrés title: Effect of a Brief Social Contact Video on Transphobia and Depression-Related Stigma Among Adolescents: A Randomized Clinical Trial date: 2022-02-25 journal: JAMA Netw Open DOI: 10.1001/jamanetworkopen.2022.0376 sha: 78d13d377d459322d08284ab2e45ca767317ae74 doc_id: 27942 cord_uid: 4x9amh6v IMPORTANCE: Transphobia and stigma remain barriers to seeking mental health care for gender-diverse adolescents. OBJECTIVE: To examine the utility of brief social contact–based video interventions of transgender protagonists with depression to reduce transphobia and depression-related stigma and increase treatment-seeking intentions among adolescents in the general population. DESIGN, SETTING, AND PARTICIPANTS: During August 2021, a total of 1437 participants were recruited and randomly assigned to 1 of 4 video-based conditions in a 2:2:1:1 ratio: (1) transgender adolescent girls, (2) transgender adolescent boys, (3) cisgender adolescent girls, or (4) cisgender adolescent boys. INTERVENTIONS: In each of the approximately 110-second videos, an empowered presenter shared their personal story about coping with depression and reaching out for help. MAIN OUTCOMES AND MEASURES: The primary outcome was the score on the Attitudes Toward Transgender Men and Women (ATTMW) scale. Secondary outcomes were (1) a “gender thermometer” rating for warmth in transgender perception, (2) the Depression Stigma Scale (DSS) score, and (3) the General Health-Seeking Questionnaire (GHSQ) score. RESULTS: Of the 1437 randomized participants, 1098 (76%) completed the postintervention assessment and passed all the validity tests (mean [SD] age, 16.9 [1.2] years; 481 [44%] male; 640 [58%] White). A significant change in attitudes toward transgender youth was found within the intervention group only (mean [SD] ATTMW scores: intervention group, 34.6 [23.1] at baseline to 32.8 [24.2] after intervention; P < .001; control group, 33.5 [23.4] at baseline to 32.4 [24.1] after intervention; P = .01). The mean (SD) total DSS scores decreased significantly across study groups (intervention: 1.3 [3.3]; control: 1.7 [3.3]; P < .001). A significant increase in intention to seek help from a parent was found in the intervention (mean [SD] GHSQ score, 0.2 [1.1]) and control (mean [SD] GHSQ score, 0.3 [1.2]) groups (P < .001), as was a decrease in those not wanting to seek help from anyone (mean [SD] GHSQ score: intervention, 0.2 [1.6], P = .009; control, 0.3 [1.2], P < .001) Secondary analyses revealed significant differences in baseline ATTMW scores and intervention effects between transgender and gender-diverse and cisgender participants and between lesbian, gay, bisexual, or queer (LGBQ) and straight participants (F = 36.7, P < .001) and heterosexual participants (F = 37.0, P < .001). A significant difference was also found in mean (SD) transgender warmth scores from baseline to after intervention between groups (2.6° [13.1°] in the intervention group vs 0.4° [8.3°] in the control group; P < .001). CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, brief social contact–based videos proved efficacious in reducing transphobia and depression-related stigma and in increasing treatment-seeking intentions among adolescents in the general population. By personifying, individualizing, and providing face and voice to the experience of transgender youth, other adolescents, especially those who are cisgender and/or of a heterosexual orientation, can gain empathetic insights into the lives of their often marginalized and stigmatized fellow youth. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04969003 Brief Summary: The purposes of this new study are to test among adolescent viewers the utility of brief video-based interventions to: 1. reduce transphobia; 2. reduce depression-related stigma and increase likelihood of treatmentseeking; and 3. examine the role of viewer's sex (male / female / non-binary), race (Black vs non-Black), and sexual orientation (straight vs LGBQ) as independent factors on the outcomes of interest. Detailed Description: Intervention videos will each be of ~100-second duration and feature four underage professionals (ages 16) acting as simulated patients. All videos will focus on an empowered presenter with depression sharing their personal story regarding depression. They will describe how social supports from family, friends, and community, as well as professional help assisted them in overcoming symptoms of the illness, as well as how being transgender may have had an impact on it. The four actors will include two males (one trans, one cis) and tow females (one trans, one cis). Assessments will occur at baseline and post-intervention, and will include: For each of study we intend to randomly assign ~1,000 individuals aged 14-18 as follows: Randomized, in equal proportions, and stratified by sex and race, to view one of four ~100-second videos: a. Transgender male; b. Cis-gender male); c. Transgender female; d. Cis-gender female. Assigned Interventions Active Comparator: Transgender male (TM) 90-second video of depressed transgender male Behavioral: Short videos Intervention videos will each be of 90-second duration and feature four underage professionals (ages 16) acting as simulated patients. All videos will focus on an empowered presenter with depression sharing their personal story regarding depression and describe how social supports from family, friends, and community, as well as professional help assisted them in overcoming symptoms of their illness. The actors will include a transgender male, a cis-gender male, a transgender female, and a cis-gender female. Active Comparator: Cis-gender male (CM) 90-second video of depressed cis-gender male Behavioral: Short videos Intervention videos will each be of 90-second duration and feature four underage professionals (ages 16) acting as simulated patients. All videos will focus on an empowered presenter with depression sharing their personal story regarding depression and describe how social supports from family, friends, and community, as well as professional help assisted them in overcoming symptoms of their illness. The actors will include a transgender male, a cis-gender male, a transgender female, and a cis-gender female. Active Comparator: Transgender female (TF) 90-second video of depressed transgender female Behavioral: Short videos Intervention videos will each be of 90-second duration and feature four underage professionals (ages 16) acting as simulated patients. All videos will focus on an empowered presenter with depression sharing their personal story regarding depression and describe how social supports from family, friends, and community, as well as professional help assisted them in overcoming symptoms of their illness. The actors will include a transgender male, a cis-gender male, a transgender female, and a cis-gender female. Active Comparator: Cis-gender female (CF) 90-second video of depressed cis-gender female Behavioral: Short videos Intervention videos will each be of 90-second duration and feature four underage professionals (ages 16) acting as simulated patients. All videos will focus on an empowered presenter with depression sharing their personal story regarding depression and describe how social supports from family, friends, and community, as well as professional help assisted them in overcoming symptoms of their illness. The actors will include a transgender male, a cis-gender male, a transgender female, and a cis-gender female. Primary Outcome Measure: 1. Attitudes toward Transgender Men and Women (ATTMW) scale Attitudes toward Transgender Men and Women (ATTMW; Billard, 2018) is a scale to measure transphobic attitudes. It is a 24-item scale consisting of two similar but non-identical 12-item subscales, one for transgender males (ATTM), and one for women (ATTW). In this study, the study team will assign only one of the two subscales, according to the condition that subjects as randomly assigned to: those viewing the transgender adolescent male will be assigned to the ATTM; those to the female, to the ATTW. The results of both subscales are compatible with each other and can be merged into a single ATMW score. Each of the items is a statement on which participants are asked to rate their agreement on a 7-point Likert-type scale: from 1 (strongly disagree) to 7 (strongly agree). Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice. The first 9 items are the same for the ATTM and AATW. Items 10-12 are unique for each of the two scales. These "Using a scale from zero to 100, please tell us your personal feelings toward each of the following groups of friends, teachers, or colleagues. As you do this task, think of an imaginary thermometer. The warmer or more favorable you feel toward the group, the higher the number you should give it. The colder or less favorable you feel, the lower the number. If you feel neither warm nor cold toward the group, rate it 50." To familiarize respondents with the response format, they will be first presented with thermometers for "Men in general" and "Women in general," with each respondent rating her or his own sex first. Next, they rate different gender groups (transgender males, transgender females). Higher ratings (maximum 100) indicate warmer, more favorable feelings toward the target whereas lower ratings (minimum 0) indicate colder, more negative feelings. [Time Frame: Before / after viewing videos (within 10 minutes)] The DSS (Christensen, Jorm, Evans, & Groves, 2004) is a self-report instrument composed of two 9-item subscales. The first subscale measures the participants' own/ personal attitudes, and the second measures participants' beliefs about the attitudes of others ('Depression is sign of weakness' vs. 'Most people believe that depression is a sign of weakness'). The Personal subscale (DSS-Personal) will be used in this study. The DSS has a 5-point Likert scale ranging from strongly disagree (1) to strongly agree (5). The total score comprises the sum of its item scores, and a higher score indicates more stigma (worse outcome Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome). [Time Frame: Before / after viewing videos (within 10 minutes)] If you were having a personal or emotional problem, how likely is it that you would seek help from the following people? Friend (not related to you) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome). [Time Frame: Before / after viewing videos (within 10 minutes)] 16. Change in GHSQ Emotional Item 3 If you were having a personal or emotional problem, how likely is it that you would seek help from the following people? Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome). [Time Frame: Before / after viewing videos (within 10 minutes)] If you were having a personal or emotional problem, how likely is it that you would seek help from the following people? Other relative/family member Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome). [Time Frame: Before / after viewing videos (within 10 minutes)] 18. Change in GHSQ Emotional Item 5 If you were having a personal or emotional problem, how likely is it that you would seek help from the following people? Mental health professional (e.g., psychologist, social worker, counselor) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome). [Time Frame: Before / after viewing videos (within 10 minutes)] If you were having a personal or emotional problem, how likely is it that you would seek help from the following people? Phone helpline (e.g., lifeline) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome). [Time Frame: Before / after viewing videos (within 10 minutes)] 20. Change in GHSQ Emotional Item 7 If you were having a personal or emotional problem, how likely is it that you would seek help from the following people? Doctor/GP Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome). [Time Frame: Before / after viewing videos (within 10 minutes)] 21. Change in GHSQ Emotional Item 8 If you were having a personal or emotional problem, how likely is it that you would seek help from the following people? Minister or religious leader (e.g., Priest, Rabbi, Chaplain) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome). [Time Frame: Before / after viewing videos (within 10 minutes)] If you were having a personal or emotional problem, how likely is it that you would seek help from the following people? I would not seek help from anyone **REVERSE SCORED ITEM** Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). LOWER scores on this item indicate more help seeking (better outcome). [ Minister or religious leader (e.g., Priest, Rabbi, Chaplain) Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome). [Time Frame: Before / after viewing videos (within 10 minutes)] 32. Change in GHSQ Suicide Item 9 If you were having suicidal thoughts, how likely is it that you would seek help from the following people? GHSQ Item# 9: I would not seek help from anyone **REVERSE SCORED ITEM** Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). LOWER scores on this item indicate more help seeking (better outcome). [Time Frame: Before / after viewing videos (within 10 minutes)] 33. Change in GHSQ Suicide Item 10 If you were having suicidal thoughts, how likely is it that you would seek help from the following people? GHSQ Item# 10:I would seek help from another not listed above Measured with a 7-point Likert scale ranging from 1 (extremely unlikely) to 7 (extremely likely). Higher scores on this item indicate more help seeking (better outcome). [Time Frame: Before / after viewing videos (within 10 minutes)] 34. Change in ATTMW Item 1 ATTMW Item#1: Transgender men/women will never really be men/women Score on a 7-point Likert-type scale: from 1 (strongly disagree) to 7 (strongly agree). Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice. [Time Frame: Before / after viewing videos (within 10 minutes)] 35. Change in ATTMW Item 2 ATTMW Item#2:Transgender men/women are not really men/women Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice Change in ATTMW Item 3 ATTMW Item#3:Transgender men/women are only able to look like men/women, but not be men/women Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice Change in ATTMW Item 7 ATTMW Item #8:Transgender men/women cannot just "identify" as men/women Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice Change in ATTMW Item 9 ATTMW Item #11:Transgender men/women don't really understand what it means to be a man/woman Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice Change in **ATTM** Item 11 ATTMW Item #11:Transgender men are emotionally unstable -Page 9 of 11 Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice Change in **ATTW** Item 11 Transgender women are defying their nature Transgender men seem absolutely normal to me (R) (R) = REVERSE-SCORED Scored on a 7-point Likert-type scale: from 1 (strongly disagree) to 7 (strongly agree) Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice Higher scores indicate greater anti-transgender prejudice, while lower scores indicate less prejudice NOTE : More than one Outcome Measure has the Title 'Change in **ATTM** Item 11' and the Time Frame 'Before / after viewing videos (within 10 minutes)' Eligibility Minimum Age: 14 Years Maximum Age: 18 Years Sex: All Gender Based: No Accepts Healthy Volunteers: Yes Criteria: Inclusion Criteria: • English-speaking • Living in the US • Ages Exclusion Criteria: • None Contacts/Locations Central Contact Person Central Contact Backup: Study Officials: NOTE : Study Official is required by the WHO and ICMJE. Locations: United States Effect of webbased depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial Adolescents' suicidal thinking and reluctance to consult general medical practitioners Heterosexuals' attitudes toward transgender people: findings from a national probability sample of US Adults Attitudes Toward Transgender Men and Women: Development and Validation of a New Measure Plan to Share IPD: No